4520 Oak Leaf CirCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
R¢cKrveo
FROM
AMOUNT $ I
E]CASH n CHECK
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
T ank You
C ? BY
CITY OF EAGAN
3795 Pilot Knob Road
6ogan, Mlnnesota 55122
Phona: 464-6100
Water ;:o`'e.te:,e?•
_ PERMIT
Date:
4524 0&.klea.' Cr.
Site Address :
Lot `r Block ? Sub/5ec.
? '.«n FIerrard.
Name
„
3
Add
ress 1 5_?
nqr.l eaF C.r.
Ee.{ra.n i
. , - . ,
City Phone:
hiilbert Co. CS'vi
? )
Name
.
?
!-'?@1 Marie Ave.
°? Address
?
„
0
City
_ Phone:
This Permit is issued on the express condition that all work sholl be
Minnesota Stotutes and City of Eagan Ordinances.
No.
Receipt No.:
Single
Residentiol
15823
New/Alter./Repair. Cost of Instcllation
Permlt Fee l
Surtho?fle
Total
done in accordonce wfth all applicable Stote of
Building Official
CITY OF EAGAN Remarks
Addition HES MAR TH A D ITION Lot S Blk 1 Paroel 10 17103 050 01
Owner ? K '' ? Street 4520 Oak Leaf Circle state Eagan, MIIV 55123
Improvement Date Amount Annual Years ?C Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 44
SEWER LATERAL 1980 '
r
WATERMAIN
-
WATER LATERAL `-1.? I 1980 . 267-62 15 01,141. O2- 6Y
1
WATER AREA ,a¢1
15
STORM SEW TRK
STORM SEW LAT 1980 15
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit Char e
WATER CONN.
SUILDING PER.
SAC SOO OO 11298 8-14-78
PARK
CITY CF EAGAN WATER SERVICE PERMIT
3795 Piict Knob Road PERMIT NO.:
Eagon, MN 55122 DATE:
Zoning: No. of Units:
Owner.
Address:
Site Address:
Plumber. -
Meter No.: Connection Chorge:
Size: _ -- Account Deposit: i
Reader No.: Permit Fee:
I agree to complp wifh the Citq of Eogon Surcharge:
Ordinances. t
Misc. Charges: ?
T
Toroi:
By _ Date Poid:
Dote of Insp.: __ Insp
CITY OF EAGAN SEVNER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eog•.n, MN 55122 DATE;
Zoning: No. of Units:
Owner. _. ' - -
+4ddress: _? - - - - -
Site Address: ? ` -
Plumber. . , 1 agree to compfy wifh !6e City of Eagan
Ordinances.
BY ----
Dote of Insp.:
Connection Cherge: ? ' ? n • ? 7 ' ' r
Account Deposii:
Permit Fee:
Surcharge:
Misc. Charges
Total :
Date Paid: -
cIrr oF E?r,aN
N? 493?
3795 Pilot Knob Road Eegan, MN 55722
PHONE: 454-8700
BUILDING PERMIT kPPLICATION Receipt # 4? ?
Te be oted hr SF Dwlg. 8 Gar. Est. value 50,000 pate S 11 _ _ 1978
Site Address 4520 Oak Leaf Circle Erect g7 occuconcr_ I
Lot 5 Block 1 seC/sub. Ches Mar 4 qlter ? Zoniny Rl
nir ?
Re Fire Zone 3
Porcel # p
a?e ? Type af Const. V
rc Name Mr. $ Mrs. Steve Jerrard Mo
? # Srories
w
? Address Dertwlish ? Front
0 CI Phone Gmde ? Depth 29 ft.
? Tillqes Construction twvro.rob Feea
o
o? Nome
Addre,s 20936 HOlOyke
Assessment 8
Lakeville 469-2144 wocer asew.
ci Phom
Police
?w Nome Fire
?
l
Address
Eng. ,
u
4 C Phone Planner
Councll
I hereby atknowledge that I have read this applicotion ond state that BId9• Off. $/1 7l7R
the information is correct and a9ree to comply with ail applica6le
State of Minnewta Stot tes on ot Eagon Ordinances. APC
Signature of Permitte?-???€'-i
Permit 1'W•DV _
s?rchar9e 25900
Plon check
SAC 500.00
Water Conn. 250 .00
Woter Meter 60.00
Road Unit 75.00
Total 1050,50
A Building Permit is issued ro: on the expresz condition that
oll work shall be done in cmr nce w' applicabl
Building e State Minnewta Stntutes and City of Eagan Ordirwnces.
Offfclal ? ??Le•.d+s?
CITY OP EAGAN
9793 Pilot Keeb Read Eugan, MN 55122
PHONE: 454-8700
BUILDING PERMIT APPLICATtON
To ba used for SF Dwlg. 8 Gar. Est. Value 50,000
Site qddress 4520 Oak Leaf Circle
Lot 5 Block 1 Sec/Sub.Ches MdT 4
Parcel #
W Nome ?T• $'
? Address
o Tillaes Construction
o? ?? 20936 Holoyke
?:., Lakeville pk?.p 469-2144
Nome
1 hercby ackrwwledge that I have read this application und state that
the information is wrred and agree to comply with ail oppliwble
State of Minnewta Sm?t`tes aof Eogan Ordirwnces.
Sipnaturc of Pertnitteq'
N4 4938
ReceiPt # -'s'4¢?e
I
erecr g] occuconcy _
AIMr ? Zoning R1
Repoir ? Fire Zone 3
Enlarpa ? Type of Const. V
Move p # Storiez
Demolish
?
Fmnt ?
N.
Grode ? Dev* 29 h.
Aeerevah Fees
Aaessment --94? i jT?es
woter S Sew.
Palice
Fire
Eny.
Planner
Cpun[il
Bldg. Off. /11178
APC
Pertnit 1'4U•DU _
Surcharge 25.00
Plon check
SqC 500.00
Woter Conn. 250 - 00
WaMr Meter 60.00
Boad Unit 75.00
Total 1050. 50
A Buildirg Permit is issued ro: on the express condition thot
ell work sholl ye done in Aco nee w' opplicable Stateyt Minnewta Statutes and City of Eagan Ordinancas
Buildirp Officlal
•t ,
. .. ?
?j?? _ rp p < ?y ,
? - I- 3 I- 79
/ Minnesota State Board of Electricity
VJ54 University Ave., St. Paul, Minn. 55104-Phone 645-7703
/WREQUEST FOR ELECTRICAI INSPECTION
cts6CK BELOW WORK COVERED BY THIS REQUEST
R 18830
Type of Building New Add. Rep. Check Appliances W'ved For Check Fquipment Wired For
Home ? ? ? Range a- Temporary Wicing ?
Duplex ? ? 0 Water Heater 2" Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryer 9' Electtic Heating ?
Commercial Bldg. ? ? ? Fumace Elr S0o Unloader ?
Industrial Bldg. ? ? 11 A'v Conditionei G1? Bulk Milk Tank ?
Fazm ? ? ? List List
Othei ? ? p
He
h
He%ers?
COMPUTE INSPECTION Fi2OJ&? I VtdY
101 to 200 Amps. [0 100 Amperes ? I II 31 [0 100 Amperes I I I
Above 200 Amos. -1?bove 100 Amns.? Above 100 Amus.
__"'__? I TOT? ? *?? o?
I, the Electrical Inspector, hereby certiy` ??'/?"6 q7t the o ? s?pecti has been m
(Rough-in)_ ?Date f?-37'7ff
(Final) Date '/- 3/-7 f -
This request void 18 months from
\4is rrGuest void 18 months from
/aaiq
R 18830
Date of this Request
I, as g Licensed Electrical Contractor Owner do hereby request inspection of the above electri-
cal wiring installed at: 4-,6' 4/ ?,? /
Street Address or Route No. o City
Section Township ange County a
Which is occupied byzr? ?
Is a roughin inspection required on this job? No ? Yes ? Ready Now O Will Call ?
Power Supplier &" Address
Electrical Contractoi Z!?_4 --le_- Z' :. J Contractor's License NbS_Z.&1C
(Company Name)
Mailing Address A01 ` ?' • ?5l$^ .2
(Electrical ont ctor of wne? Making Thls Installation)
Authorized Signature ? , ` Phone No.w?
( lectrical Co t ac or or Owne1 Mal g EIs Instellatlon)
(?7&IJ ?( E his inspection request wili not be accepted 6y the
?? State Board unless pmper inspection fee is enclosed.
(Iprtifirtttr nf Orrupttnry
Citp of eagan
Drpurtmcnt rrf Builhittg lnsprdimt
Tbir Certifitate iirued Purtuant to tbc +equiremrntt of Sertion 306 ot tlx Uniform Building
Code catifyin8 tbat at tJx time of iuuanre tbiJ structure wur rn comPliance witb ihe vA+ioHf
adinanrea o f nce City rrgularin8 building conn+rution or uar. For tbe (allacing:
u,.cumc?.em SF Dwlg &(''ax'age Blash,,,i, no. 4938
o-wmrra I iYrcm.w<uw V FiRzm. 3 u.,wto« R-1---
_ . . 4.71U U IiEdT C]SCl?,,.,i;?y ?Qdri, MN . . .,,.? .. _ .
_e lia? .. .
.
` .-.._ : . By: - . .. __'
Januaxy 31, 1979
-
- - -
awaw o? . wot:
• ..-'?' ---._ .-?... .... . . _.?.... . .. ._::., .. . ?_.
. .. . .. . _, ..., < _..._ .. _..
. . ..._? .._.:_ _.. . _ . W..,.oo?
._. ._. _.. . _.._... -_....:?*. - -
& 11'6? ? ?
2005 RESIDEN'I'IAL BUILDING PERMIT APPLICATION
City OfEagan
3830 Pilot Knob Road, Eagau MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
00
New Canstruction Reauiremenis RemodeUReoah Renuirements Oifice Use Dniv
3 registered site surveys showing sq. R. of lot, sq. ft. of house; and all roofed areas 2 wpies af plan Cert of Survey Recd _ Y_ N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _ N.
2 copies of plan showiig beam & window sizes; poured found design, etc. 1 site surveyfor addifions & decks Tree Pres Required _Y _N
isetofEnergyCalculations AddBion•indicete'rfonsdesep6csystem Onaite$epticSystem _Y _N
3 copies of Tree Preservation Plan'rf lot platled afler7/1l93
Rim Joist Detail OpAOns selection sheet (buildings with 3 oriess unlts)
Date
Site Address Ua k Ce,4 Coostruction Cost 000 P - ' I'
C'( 4 11<' I? UnidSte #
Descriptioo oF Work 1_?,s7 a )J' q/0 C' ?
Multi-Family Bldg _ Y? N Fireplace(s) _ 0_ 1 _ 2
Property Owner /a a Telephone # ( ) ?6' s'''0047
Contractor l A, c ? •
Address oc
State /tt 1L City Ch
Zip Telephone # (6S ( ) e
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cate?orv 1 _
• Residential Ventilation Category 1 Worksheet
(J submission lype) Submitted • Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #f
Telephone #(
N If so, 25% plan review
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
3tatutes; I understand this is not a germit, 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 re uires a review and
approval of plans. n??EMn
?
A NEW BUILDING
Minnesota Rules 7672
. New Energy Code Worksheet
Submitled
lrf?r t p ?i ?<SY?'JI
App 'nted Name
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 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 Y, 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
O 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 08 04-plex ? 12 12-plex Plbg_Y or _ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? . 38 Demolish Interior 0 44 Siding
? 32 AddiGon ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building• ? 43 Reroof O 46 Windnws/Doors
? 34 Replacement •Demolition (Entire Bidg) - G ive PCA handout to applicant
Valuation Occupancy MCES System
Census Code 2oning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs j? Length Fire Sprinklered
Type of Const y
- )' \
T
- Width
Footings (new bldg)
_?C Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulati0n
REQUIRED INSPECTIONS
_ FinaUC.O.
? Final/No C.O.
_ Plumbing
HVAC
Other
, Pool _ Ftgs _ AidGas Tests Final
_ Siding _ Stucco , Stone _ Brick
_ Windows
_ Retaining Wall
r
Approved By: Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Lrcense Search
Copies
Other
Total
f3??r(1
2004 RESIDENTIAL BUILDING PERNIIT APPLICATION
t 7,?UL7,lt City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
# :?Loo-i
Ck
6
New Comiruc6on Reauiremenis RemodeVReoair Reouirements ?ca_nt ,
3 regisfered site surveys showing sq. fl. of lot, sq. ft. of house; and j roofed areas 2 cop?es of plan
ddti
h
d G? Of Sun+euReGd
RectY
A
PIBP
T
e X; ?
t?l
Y
;
(20%maximum lot cwerage allowed)
2 copies of plan showing beam & wiridow sizes; poured fiund design, etc. ons
eate
a
1 sel of Energy Cakulations for
. 1 site survry for additions & decks [[
r
e
rea
?tne f'res i6eq4i[Ed :
_
Y: N
lsetofEnergyCakulations Addifion - indicafeifonrsifesepUcsysfem pf?it83BpiicSotenl _YN'.
3 copies of Tree PreservaGon Plan "rf lot platled afler 711/93
Rim Jdsl Detail Options selection sheet (bldgs with 3 or less units
Date}?
/ ConstructionCost ?
_
SiteAddress F ? /)Op L7/?+e L
?* ys-ZZ) L"/9? GA UniUSte #
-`
&.H?'
Description of Work IAJS7^C- I T? 5 //?S?-?T
Mulri-Family Bldg _ Y? N Fireplace(s) _ 0 z 1 _ 2
??
2 & ?1 5 Telephone #(??
Property Owuer ),
nt.
Contractor F ??? ?x?,- zl
Address 3(6 `5V L-) l?W "T !j City
State te.? Zip y?i ? 7 Telephone #(%?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cate¢orv 1 _ ?nesota Rules 7672
Enefgy Code Category . Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
(J su6mission type) Submitted Su6mitted
• Energy Envelope Calculatlons 5ubmitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Conhactor
SewerlWater Contractor
Telephone # (
Telephone # (
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a pernut, 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 whisk-roigwsea?a.reuniew_and
a roval of lans. !=?
PP P A On
?oo ,i 'P
Applicant's Printe-d Name
s Signature
` UEL' 16 ?JJ4
OFFICE USE ONLY
Sub Types
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3sea.) ? 31 Ext. Alt- Mufti
? 03 01of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4sea.) ? 33 Ext.Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screenlgazeho) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex PIbg_Yor_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 36 Demolish Interior ? 44 Siding
? 32 Add'Rion ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Wid[h
_ Footings (new bidg)
_ Footings(deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ RI. _ AirTest _ Final
_ Insulation
REQUIItED INSPECTIONS
Fina]/C.O.
FinallNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucoo _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Suroharge
Treatment Plant
License Search
Copies
Other
Total
PERMIT# 7 V :J z O
RECEIPT DATE:
8008 BUIDENTIAL f'LU14I$IN6 f'EitMIT Af'PLICATION
CITY OF E4fi"
3630 PILOT I{NO$ i{D
EAaArr, huv 55122
651-681-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITE ADDRESS: '1 N-o Dwe" OrG16
OWNER NAME: : (Z w Uubois TELEPHONE #: ( 101)0 OS15 - D 1 p3
(AREA COOE)
INSTALLERNAME: NOY'blbWl ? ,lkWl6lvlcA TELEPHONE#: (ip 12 '927' `'f d33
STREETADDRESS: 20110$ (arAV4lGIcI Ay?,?o spw}4i (AREACODE)
CITY: fAIrJ. STATE: Mti ZiP; 5540$
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100
00
includes $40.00 County tee .
Note: Additional consuitant fees may apply ,
• MODIFICATIONIALTERA710N TO EXI5TING DWELLING UNIT, INCLUDING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit (+ 518" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener X water heater $ 15.00
State Surcharge $ 50
rTotal g 15.50
I hereby acknowledge that 1 have read this application, state that fhe information is correct, and agrae to complywith ail applicahle City of Eagan ordinances. It
is tbe applicanPs responsibility to noliTy the property owner thac the City of Eagan assumes no liability for any tlamages caused by the City dunng its normal
operational and maintenance activities to the facilities constructed under this permit within City propeAy/dght-of-wayfaasement.
51GNA U F PERMITTEE 1f02
r ?
e ?
.. ? ?
nnxE 4LO
BU2F,DIIdG PERMIT APPLICATION
Include 2 sets of platts, 1 site plan w/elevations and 1 set of enerqy ?lculations.
ssur?,do'D
To be used Eor T es? ?. Valuation ?
Site IuidresE;
Lot S Block J See. Sub, CIGo 3Jss Parcel Number
Oa.mer ?M2c; Telephone _
AddTess
Contractor Telephone 4& "- Z14-4-
Address 1?
/i,??
Arch./Eng.
Address
Telephone
Erect
Alter
Repair
Enlarge
Nbve
nemolish
Grade
QFFIC6 USE
Date of ApAroval & Initial
Assessment G61'J.
water/sewer I ?
Police
Fire
Eng.
Plantier
Council
Rldg. Off.
A.P.C.
lallIv-
y
OFFICE USE
Occupancy /
Zoning
Fire Zone ?
Type of Const. //
# of Stories
Front ?(o
Depth ?. ?
FEES •
Permit ------
Stuchar5fl
2-?
--. ?'??-?
pLin Check
SAC ,h O O
F7ater Conr,- Q??
Flater Meter
yP A? .., - 00
7S '-
TOTAI, ? C7 4 O, ti A
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--- ?----
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4520 Oak Leaf Cir
Lot: 5 Block: 1 Addition: Ches Mar 4th
PID:10- 17103 - 050 -01
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
e- Fireplace
Gas Fireplace (new)
Contractor:
Hearth and Home Technologies
2700 N. Fairview Ave
Roseville MN 55113
(651) 633 -2561
Improvements to the home may requ
concealing.
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
e smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
Carbon monoxide detectors are required by law in ALL single family homes.
Owner:
Kenneth J Dubois
4520 Oak Leaf Cir
Eagan MN 55123
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
$90.00
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
Issued By: Signature
Building
EA092350
12/17/2009
ePermit