4377 Orion LaneCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
R6CEI V ED
FROM
AMOUNT $ I.
& DOLLARS
toa
[]CASH E]CHECK
FUNO CODE AMOUNT
.. ')
L.F
, / .. .
ThankYou
? BY
u
: .13950
YVhita-Payers Copy
Yellow-Posting Copy
Pink-File Copy
' • ctnr oF EAc??N
• 3795 Pilot Knob Road Eegae, MN 55122
PHONtt 454-8100
BUILDING PERMIT
Ts 6e u?d fer •_ 7' `Fr
004.
N2 5169
Receipt #
Sife /lddress ^ 77 ft"i-c v, Erect Q- Occuponcy
Lot Block - Set/Sub. ;r-Alter ? Zoning
-
Porcel
Repair
p
Fire Zone ?
Enlcrge p TYpe of Const.
W Nome Move ? # Stories
z
qddress ?
Demolish
?
Front ; ft.
Ci Phone Grode p Depth ft.
cc Name ?'- Approvob
A
?? Addrcss Assessment
Woter & Sew.
Ci ph?
r?
Police
? W Namo Fire
?? Address Eng.
<W Ci Phone Plonner
Council
1 heroby acknowledge that I hove reod this application and state that gldg. Off.
the information {s correct and agree to comply with cil opplicable
SMte of Minnesoto Stotutes and City of Eogan Ordinances. r'--
APC
Permit • '?
Surcharge
Picn check ?•" .'?t7
SAC
Water Conn.
Water Meter ^ ?n
.. _ .i ?
Total
Signature of Permittee - . I
A Building Perm+t is issued to• •?`??=' ?'"'' '`}nzt• InC• on the express condition that
all work shall be done in eccordance with oll applicable State of Minnesota Stotutes ond City of Eogan Ordinances.
Building Officiul -
t
?asit # Deh Isa*a hrsuM"
Plumbing j
Mechonical
INSPECTIONS DATE INSP. Rouflh-In Ffnal
Footings m ` Oate Inrp, pote tnsp.
Foundation Plumbing -S?
Frcme/ins. ? 7 Mechonical
Final +
!
?
Remorks:
CITY OF EAGAN , - -.r! * +?Tr. k±s+,-.nT?•-•,
3795 Pilot Knob Road
Eagan, Minnesota 55121
Phone: 454-8100
Date:
HEATrjir'? PERMIT
Kety 1• 1979
Sire Address: `-37i Or_ iOn L&ne _
Lot Block Sub/Sec. _ WPk I'
IName '"Wld PSterser, CUnSwL'12CtlOri
.
0
e
?
?
?
?
e
0
V
TI
M
IiAddress ! 101 "- 1101th S-*.
City ? "':'<MingtoA 55420 Phone: 9'84"5144
Name -:1nE-Ryut1 P;tmibiag & PPat].s1g InC.
Address = 74745 So. Rabert ''x'a!1
City ? . ?' ti •-. .,?. , . Phone:
iis Permit is issued on the express condition that oll work shall be
innesota Stotutes and City of Eogan Ordinonces.
NO. i430
Receipt No.:
$ingle I
Residentiol
Multi Res., Comm./Ind. I
New/Alter./Repair
Cost of Installation
Permit Fee
-: ?-?
Surcharge -
Tota I
done in accordance with oll opplicable Stote of
Building Offitial
. CITY OF EAGAN
' 3795 Piloe Knob Road
Eo9en, Minnesoto 55122
Phone: 454-8100
PI.LTMSIYG PERMIT
.
Date: May 1, 1979
Site Address: 4377 Oti0I1 Laise
Lot I ' Block 1 Sub/Sec. _ WPk II
.
e
3
O
Name .3v°nd Peterem Constrnct3on
Address `e 70I - 110t21 fit.
City $1CxmingtA1n 5542t? Phone: 884-5144
Nome C',?n2-Ryar; Pluzabfrig & 'tieati.ng InC.
?
.g
0
r
Address 1'174S 80. Pabext 'rrail
I
No. 1337
Receipt No.: 14033
Single
Residentiol x
Multi Res., Comm./Ind. I
New/Alter./Repoir r?elh,
Cost of Installation
Permit Fee
Surchorge
20.04
50
'JI City , ,?f. -n? •.E, ? - :-,:.£s Phone: Total ^ , .
This Permit is issued on the express condition thot oil work shail be done in accordance with all applicable Stote of
Minnewta Statutes ond City of Eagan Ordinonces.
Building Ofticial
INSPECTIaN RECORD
CITY OF EAGAN PERMIT TYPE: 1"0 1 1 !' ?NA
3830 Pilot Knob Road Permit Number: `' `O 170
Eagan, Minnesota 551 22-1 897 Date Issued: ;' 4± n
(612) 681-4675
SITE ADDRESS: I APPLICANT:
, c t ??N i rtt?? ;. . .. . ?r?•, i i N?.i ? i rt; tIF O ItRK ?Nrl ?a. 4.11. 9904+
w
rtt x '? ? ??• ! ? r`?.? ?{:. , .
PERMIT SUBTYPE: TYPE OF WORK:
v'I hAl'C+
??I •I• f i' 1 1?iN ( Ft(I(1rl11(1
)
Permit No. Permit Holder Dab Telephone I
ELECTRIC
PLUMBING '
i
HVAC
Inspeetlon Date Insp. Cammenta
FOOTINGS ?
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
QAS SVC
TEST
INSUL
GYP BOAFiD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FiG
DECK FINAL
CITY OF EAGAN Remarks
Addition WIL.DERNESS PARK 2Nil AnDTTTnN Loc sik 1 Parcei 1 f) 84251 100 01
Owneryll' Acl 1 aba%: ?"? •? 5treet 4377 Orion Lane state Eagan, MIJ. 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SUR F.
STREET RESTQR.
GRADING
SAN SEW TRUNK )
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA 4rhioc 1979 584.20 $8.42 10 S,
STORM SEW TRK 1979
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 75.00 13950 4-23-79
WATER CONN. 270.00 13950 4-23-79
SUILDING PER. #5169
SAC
PARK
oF Fr?a?N WATER SERVICE PERMIT
Pilot Keob Rood PERMIT NO.:
, MN 55122 DATE: ?
I: - No, of Units:
ite Address: - o]C1021 ra3s2p,
lumber.
heter No.: - Connection Charge:
ize: Account Deposit:
eader No.: - Permit Fee:
egree M eomply with tlie City of Eagan Surcharge:
irdlnanees. Misc. Chorges:
Total:
Y Dote Poid:
bte of Insp.: _ Insp.:
rY o;. EAoAH SEWER SERVICE PERMIT
95 Pilot Knob Road PERMIT NO.:
"n, MN 55122 DATE:
nin9: No. of Units:
ner: ?
dress: --
? Address:
mber:
}
v•
gree to eompfp witi+ the City of Eagon Connection Charge: ?,? ?
'
linanees, Account Deposit:
Permif Fee:
Surcharge: __
Misc. Chorges:
e of Irisp.; Total:
?•? Dote Poid:
cITr oF enG?w
379$ Pilot Knob Rood Eogun, MN 55122
PMONl: 454-8100
BUILDING PERMIT APPLICATION
SF DWlq & G3Ya4e Eo. Vai?e 55,000.
N" 5169
Receipt #
Sita Address 4377 OY].Ori I.c'll10 Erect [ Occupancy /R3
R -
Lot 10 glock 1 SeclSub. Wilderness P ax'k 2nKWter ? Zoning $1
10 R4991 inn ni Repalr ? Fire Zone 3
Parcel .fk
Enlar9e ? Type of Const.
c Nome S. PetPS52T1 COT1S't. 711C. Move ? #Staries
Z 4701 W. 110th St.
ndd?ss Demoush p Front 64 ft•
3
° Ci Mp1S $5437 phone 884-5144 Grade ? Depth 50 fr?
Approvah Faes
p Name
Zou Addrew AsyesSment
u? Woter & Sew.
Phone
Ci
Pollce
?Z Name Fire
Address . Eng.
<'Z" Cf Phone Planner
Council
I hereby ackrwwledge that I have read t' upplic ' te th gldg. Off.
the informotion is correct ond agre com ifh all pli e
Stute of Minnesota Sta*'t?,d an Or '. e Sazre
AP?
Permit 14Zf.1/6
Surcharge 27.50
Plan check 74.00
sAC 525. 0
Water Conn. 270•00
Water Meter 60.00
Toral 1,179.50
$ignature of Permittee I
A Building Permit is issued to: S. P2t.2Y5 bTIS . IriC _ on the express condit{on tfiot
011 work shull be done in accordaA 'itk o I' le State of Minnewta Stotutes and City of Eagan Ordinonces.
Bulidirg Offlcint ?ope 1/4bc?-4/
This requeot void 18 months from
11
R 49967
Date of this Request Ma.4 31, 1979
I, as [S Licensed Electrical Contractor O Owner, do hereby request inspection of the ahove electri-
cal wiring installed at: /_j 0 p,1 (t_)pa"\d
Street Address or Route No. 4377 OS'1on F,n. CityEagan
Section Township
Range County Dakota
Which is occupied by Svend Feterson Construction
(Name of Octupanq
Is a roughin inspection required on this job? No ? Yes D Ready Now O Will Call fZ
Power Supplier _Dakota E1ect1'ic Asen. Address $21 31'd St Farmtneton?MN
55oz4
Electrical Contractor Ken SOreilson Fil.eCtTie Contractor's License NoA103
(COmpany Name)
MailingAddress_gO7O 12$h AVB. SO.p BlpOIDirigtOri, Aua 55420
(Elect? C ntr tar ov Ownar Making Thls Installatlon)
Authorized Signature?jaws.e9-rn Phone No. 854-4470
(Electrical Contractor a O ef Making Thlz Installet n)
((`?{ /? `t?? This iaspection request will not 6e accepted by the
rJ Ll ?? ?? (?? ? State Board unless proper inspection fee is enclosed.
:w Minnesota State Board of Electricity
,1964 University Ave., St. Paul, Minn. 55104-Phone 645-7703
?`- REQUEST FOR ELECTRICAL INSPECTION
CHECyK BELOW WOitK COVERED BY THIS REQUEST
,/ 'e71-
;R49967
Type of Building New Add. Rep. Check Appliances Wired For Check Fquipmen[ Wired Foi
Home El ? ? Range ? Temporary Wiring ?
Duplex ? ? ? WateiHeater ? LightingFixtu[es ?
Apt. Bldg. ? ? ? Dryei ? Elec[cic Heating ?
Commercial Bldg. ? ? ? ['umace N Silo Unloader ?
lndustria] Bldg. ? ? ? A'v Conditioner 19 Bulk Milk Tank Cl
Farm ? ? ? List D x List
Other
.
?
?
? Others
Herc )
?B Others?-
Here 1
COMPUTE INSPECTION FEE BELOW • ? ,?
Sevice Entrance Size: # Fee Fced Subf Fee Cixcuits: # Fee
0 tu 100 Am s 0 to 30 A 0 to 30 Am eces dE?
101 to 200 Amps. 0. 31 ro 100 Amper 31 to 100 Am eres
Above 200 Amps. Above 100 Amp . Above 100 Amps.
Transformers RemoteControlCirc. Partialorotherfee
Signs Special lns ection Minimum Tee $5.00
Remarks
CO3IIp].0t.8 a(3U88 wiY'iIIg -- ? TOTAL FEE
?
I, the Electrical Inspeclor, hereby certify
(Final)
This request void 18 months from
has been ma ? e?,od
?ate
Date 4/? ;z-72f
?rr#ifira#P uf (Orrupttnrij
eitp of Cagan
igrpttrfmrni nf BuilDing lnsperiicm
Tbit CMificate isrued pufraant to tfx nquiyemenu of Settion 306 o( the Uniform Building
Codr eati(png that at the trme of irsuanca thir strurture wur in romplianct untb thc varioru
ordirraara of tbe City ngulating buiJdirsg ronnrartron or nse. For tin f ollowing:
SF DW1g &. Garacxe BIde.PemutNo. 51EI9
?w rTra R3 TrPC.?? V 3 z.W,o;.Na Rl
o,,,?,fB„o?, S. PeteTSexl Const. „aa. ???•mlis MP1
?quswa: t 1, 1579
,?(? ?? ? RESIDENTIAL
BUILDING PERMIT APPLICATION
cirv oF eacaN
3830 PILOT KNOB RD, EAGAN MN 55122
851-881-4875
Naw Conetructlon ReauhemeMa
• 3 registereA sHe surveys showing sq. N, of lot, sq, tt. of house; and all roofed areas
(20% meximum bt caverage albwed)
• 2 copies of plan showing beam & wtriaow s2es; pouretl found destgn, etc.)
• 1 set of Energy Calculatbns
• 3 copies o1 Tree Presenatbn Plen il bt platted atter 7/1/93
. Rim ,bist Detail Optbns selection sheet (bldgs wM 3 or less unks)
DATE 710,2?
SITE ADDRESS
TYPE OF
APPUCANT (.- ( ? c, 4' V)G , 0
STREET ADDRESS `/a / 5 e Na vc,f Z>?
TELEPHONE # (rln 3?1'36 7( CELL PHONE #
MULTI-FAMILY BLDG _Y J?N
FIREPLACE(S) _ 0 _ 1 _ 2
(SO /1 STATE 1,4111P -y?
PROPERTY OWNER jt icc, I/0. 0 h`o V-P _ TELEPHONE # 0
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RUI.ES 7670 CA1'EGORY 1 r
(J submission type) • ResideMial Ventilation Category t Worksheet Submitted •
• Energy Envelope Caiculatlons Submitted
Plumbing Conhactor: __
Plumbing system includes:
Mechanical Conhactor:
Mechanical system includes:
Sewer/Water Conhacfor.
_ Air Conditioning
_ Heat Recovery System
Phone ri
Phone tl
MAY 2 0 2002
ZZP
Fee: $70.00
-------- ------------------------------------------------------------------ ------------------------------------ -----------
I hereby acknowledge mat 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 Ordinanc,e?s.j
Signafure of Applicanf
.•_-----°------°--------_._._._....••.-°.._._....._....._.?.._ .._??.??._...__.
OFFICE USE ONLY
_ Water Softener
_ Water Heater
_ No. of Baths
Phone #
Lawn SpruMer
No. of R.I. Baths
^
/ 7 / _7S
n
• 2 copies ol pian
• 1setWEnergyCelculatlonBfOrheatedaAdttions
• tsttesurveyrorezlerbraddroons&decks
• IndkateNhomesenedbysepticsyslemPoradOAbns
VALUATION Y 4 (& 5-6
,Q
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex O 13 16-plex O 20 Paol ? 30 Accessory Bldg
O 02 SF Dwelling ? 08 06-plex O 16 Fireplace 0 21 Porch (3sea.) O 31 Ext. Alt - MuRi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorcNAddn. (4sea.) ? 33 E#. All - SF
0 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) O 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N 0 25 Miscellaneous
? 31 New O 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition O 36 Move Bldg. O 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' O 43 Reroof ? 46 WindowslDOOrs
? 34 Replacement 'Demolitfon (EnNre Bldg only) - Give PCA handout to applicaM
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) _ FinallC.O.
_ Footings(deck) _ FinaVNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof °_.Ice & Water _ Final Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing Siding Smcco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retanring Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Suppy & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Buiiding Inspector
Copies
Other
Total
CI7Y C?F F_AGFlN
f:A£iH:I:ER: S TEI;MINAL Nn: 67
nArE: 06/04/37 T.T.MF_a 14:28e07
ID r
NAN+E: LEVEL FDGE CONST TNC
3210 3001 4377 URTC1N LN 99.75
21.55 9110i. 4377 OkLON I...N 2e`0
k
?
io+.a1 Receipi: Ainoun+,e 1!12.25
CROiA951.
USER ID: NANCY
? G"IAF EAGAN PERMIT
3830 Pilot Knob Road PERMIT TYPE: a u? ? o r N G
?
Eagan, Minnesota 55122-1897 Permit Number: 030170
(612) 681-4675 Date Issued: 06/ 0'? / ? 7
SITE ADDRESS:
4377 ORION LAN[
LOT: 10 BLOGK: 1
WILDERNESS PARK ,%ND
P.I.N.: 10-84251-1.00-01
DESCRIPTION:
_> (RooFrNC)
B,Ui?,dit_Permit T y p e
ui,jdiCf? k,?kAi-I< T,ype
? tiert"sus Code
n ?3
.. ...ch.4
?
.?
'. ..r . - ..=rj
T y??
n .
i??.'«"'?.^y u.. f "t..:e`?'.-J
P
1J}/
t
.. cJ ?
SF (MZSC.)
REPRIR
434 ALT. RESIDENTIAL
REMARKS
FEE SUMMARY:
VALuA7r.o'N
$Sooae
Base Fee
Surcharge
Totn1 Fee
$99,75
$2.5m
$192.25
CONTRACTOR: - Applicant - sT. LIC. OWNER:
LEVEL EDGE CONST INC 19454909 0006863 HNLLER MARY
t190 W 123-1/2 57 4372 ORION LfJ
SqVAGE MIV 55375 EAGAN MN 55123
.(612) 945-9989 (612)628-2565
1
? I
T Siei°eby ael<tlowlo d?gs that S f?6ve'rsad" thi,'s ap3fil€eatiam an? state that.the_
informakinn is ccarrect and agree to comply with ui1 appl,icublQ State af h9n.
StatLites and CiGy, ofi'Ea¢a€t aradznaTtces.
L l, R?J 1149
? APPLICANTIPERMITEE SIGNATURE -r ISD : SI ATURE k
REACTIVAT;,,-
PERMIt # -
'A fni I
CITY OF EAGAN
1993 BUILDING PERMIT APPLICATION
681-4675
SIN6LE & MULT1-FAMILY 2 sets of plans, 3 registered site surveys. 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural 6 structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not plcked up by last working day of month-
in which request is made, 2) address is changed or 3) lot change i.s requested once permit
is issued.
Date - - / / Yaluation of ?ork
Site Address: )-h •
57REET fU1TE 0
Tenant Name: (commercial only)
IAT BIACK SUSD.
W t ??
N
Descri tion of work: i ?eGY 'a
The appl icant i s: ? Owner ntractor ? Other (Deseribe) ,
+ Y\ Phone
Name
Property
O lAST ?IRS7
?3 -1
wner ? ? ?
Address
SiREEi fTE I
0"" State Z1p
City
Company LJ1> O 'rs, Phone S
Contractor Address <14zl License dW Exp.3 31
City ?G-1P?RQ State Zip ? Z
Company Phone
Architect/
Engineer Name Registration
Address
City State Zip
Sewer & water 1lcensed plumber . Processing time for
sewer 8 water permits is two days once area has been approved.
I hereby acknowledge that I have read this a plication and state that the information is
correct and agree to comply wi al appli 1 State of Minnesota Statutes and City of
Eagan Ordinances.
5ignature of Applicant: .
?? - OFFICE USE ONLY
. . fl .
;
„
BUILDING PERMIT TYPE
?'
'?R
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging O A, nish
Basement
? 02 SF Dwg. ? 07 4-Plex O 12 Multi. Misc. °.: 0,>17 Swim Pool °
? 03 SF Addition 0 OB B-Plex O 13 Garage/Accessory O 18 Comm./Ind.
E3 04 SF Porch O 09 12-Plex 0 14 Fireplace O 19 Comm./Ind. Misc.
? 05 SF Misc. ? 30 Multi. Add'1. ? 15 Deck ? 20 Publlc Facility
? 21 Miscellaneous
WORK TYPE
? 31 New ? 33 Alterations O 35 Tenant Finish ? 37 Demolish
O 32 Additlon ? 34 Repair 0.36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC bccupancy
Zoning
i of Stories
length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
O Site
O Ma7lboard
Basement sq. ft.
lst F1. sq. ft.
2nd F7. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
? Footing
? Final
MWCC System
City Mater
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
? Framing O 'Insulation
? Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
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:
v.lmcion: $
SAC %
SAC Units
Spr+ ? r? s /d.Z ? Gv i? n?'r2 rrim s s T'pn2 !-c C c) V?e T
.?
DATE
BL'Ii.DI1C PE3MI1' ?,P°LIC:?TIO':
Include ? se[s of plans, 1 site plan w/elevacions and 1 set of energv caicuations.
?-
To be used for ?• Valuation
Site address:.V-j77 DC: eyd:!F: S j?i?R d?C p'C N 4
Lot /0 Block ? Sec. /Sub. Yarcel \ur.,ber ?D 8./d/? //DD O/
- T
Ocane0 L?ONS? / 0'V '+'Telephone ?? ?? ??T T
Addressy70/ /z/ //U7-li S?
`yGOL s . /YN S`a" 4/ a 7
Con[ractor
Telephane
Ac'aress
Arch/Eng. Telephene
?
Address
OFFICE CSE OVI.Y
Erect
Alter _
Repair _
Enlarge
Move _
Demolish
Grade
Date of Ao roval and Initial
Assessment
Wa[er/Sewer
Police
.. Fire
Engineec
Planner
Council
I
Occupancy
Zoning
Fire Zone
Type of Const.
11 of Stories
Front At_
Depth ?,5b
Fees
Permit ?
Surcharge
Plan Check 7y gx
SAC ?'s ?
Water Connection
Wat
r
Meter
e L> ?
?
J
/ 73- ? -
--_.-- ---- - ? - ? ?? ?? ?a
_..
,-?'V.
J o ?`? , ?o??
.?9?0 ?
S?Y ? ? ? '
s?; c? ? a
Cartificate for:
' Svend.Peterson
4711 Hest 110th Street Bx: 371111
Bloomington, Mn. 55437 ?
DELMAR H. SCHWANZ
LANDSURVEVOR
Reqifbra0 Untler Lawa of Tha 5[ale ol Minnasob
7978 - 146TH STREET W. - BOX M ROSEMOUNT, MINNESOTA 68088 PHONE 812 4231789
SURVEYOR'S CERTIfICATE -
RION - -T-$ !aT
? o
?
so. oo N 0°os'sa "w
0
-------?
I
SCAI.E: 1 inch = 40 feet
- - - -}
8.0
w
n w
W)
a /
56,0 v
n
?
0 ? vaoaoseo o
A
= '? HOUSE ?
jN
/ /
36.0
o
' p? ,
iA
z ??
?
?
28.0
-
b
l ?Ig
g g o
M LOT 10 I ^?
braina6e & utillY?
ea3ement ?
?- - - - = ---?.
9Q00 N0°09'58"W
I hereby certify that this is a true and correct representation of
Lot 10, B1ock 1, WILDERNESS PARK SECOND ADDITION, accordlnG to 'che
recorded plat thereof, Dakota County, Minnesota.
Also shoNi.ng the location of a proposed house as staked therecn.'
Dated: April 4, 1979
I
/? b
r
b'? l
1 y
I
MINNESOTA REGISTRATION NO.B
^'" a 2000 BUILDING PERMIT APPLICATION (RESIDENTIAI)
ll??b cirr oF encnr?
??#1??5? 3830 PILOT KNOB RD - 33722
651-881-4875
NewCanahucHonReaulremenh Remodel/ReoalrReaulrementa
I /2B. 25
C'c,llrGl lv/laI UD
M'N
n 3 replstered Yte surveya ahowinq aq. R. of bt. eq. B. of house 2 copfes of plan
pntl go rooled areaa f70X mmdmum lot coveraae albwedl --+seVePerwrgV-6ffculalians for heafed adtlHlons
> 2 caplea of plans (ahow beqm & wlntlow sizes; poured Ind. deslfln; efc.) 1 aite wrveY for exteAOr adtlitlons d deeka
? 1 iet of energy calculallont
a 3 copies of hae preservallon plan tt bf platted aMer 7/11/93 ,
DATE: ?O o CONSIRUCTION COST:
DESCRIPTION OP WORK:
SfREET ADDRESS: `I 377 C? tr ? m? L ti
LOT: 10 BIOCK: ? SUBD./P.I.D. lf: 1?1 i(cL-1-15 Pw k 21o14841,--
Name: vQ`fl f16 V-Q- -TG-? Phone #: b S l- 68 $-1 S 6 S
PROPERTY taat ?r Flrs?
OWNER H ?1? ^ r
Sheef Address: 113 7-7 Z?
Ci}y State: M? Lp: S? l?3
- 7.
Company: Phone #:
(area code)
CONTRACTOR
Sheet Address: llcense # Exq•
CBy
State:
ARCHITECT/
ENGINEER Company: Name:
Telephone #: (
Sheei Address: Registraflon #:
Clty
State:
Sewedwater licensed plumber (N insWllina sewerlwaterl: Phone #:
Zip:
Zip:
I herebY acknowledge Ihat I have read 1hb applicafbn, ftfe ihat 1he Intortnatbn B cortect, and agree b eomply wiM all app6cable Sfate
of Minnesota Statutes and Clty of Eagan Ordinances.
Signature of ApplicanY. --
OFFICE USE ONLY
Certiflcates of Survey Received ? Yes _ No J
._1i
Tree Preservatlon Plan Recelved _ Yes - No _ Not Required
???
OFFICE U3E ONLY
BUILDING PERMIT SUBTYPES
? 01 FoundaGOn ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex ? 09 07-plex
? 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-plex
? 06 04-plex 0 12 12-plex
WORK TYPE
Pk-'31 New
? 32 Addition
? 33 Alteration
? 34 Repair
? 13 16-piex -k'21
? 17 Garage O 22
? 18 Deck ? 23
? 19 Lower Level ? 24
Plbg _Y or_ N ? 25
? 20 Pool ? 30
Poroh (3-sea.) ? 31 Ext Alt - Muiti
Poroh/Addn. (4-sea.) ? 33 Ext. Alt - SF
Porch (screened) ? 36 Mutti
Storm Damage
Miscenaneous
Accessory BWg.
? 36 Move Bidg. ? 43 Reroof
? 37 Demolish (Bldg)" ? 44 Siding
? 38 Demoiish (Interior) ? 45 Fire Repair
? 42 Demolish (Foundation) O 46 Windows/Doors
' Give PCA handout to apptlcant for demolition permit
GENERAL INFORMATION
SAC Code 0)
No. of Units o
No. of Buildings i
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
Basement sq. ft.
Main level sq. ft.
sq.ft.
3 e ?.obsq. ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building
sq.ft.
12 sq.ft.
i2 Footprint sq. ft.
Census Code
MC/ES System
City Water
14v Booster Pump
PRV
Fire Sprinklered
Engineering Variance
T vy
LI3K
Permit Fee ValuaUon: $ 6400_66
Suroharge
Plan Review
License (2 x 12 ??rN Xq0 5 ? 6 p
MC/ES SAC
Ciry SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Suroharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
.?
C.?{
r ?
rvew ?'j F?ehcti doo ?- a ;gOv
g - ?q?e ec.S8m2eL? l-t, aco
Lvv?ll?2r ? ??C LI?OOp
??n ?oJ a
, Lc?6
y, 00 6
IICh? 233(F
J7s
1 ?31 ie Fi
73? 21C ?I ?.
. •son ?.a
' .c 110th Street Bk: 3711 1?
,,u.ngton, Mn. 55437 • A . . ? l?y .
? DELMAR H. SCHWANZ
LANOfURVEYOP . qplsNntl 11n0u Nwi af TbS Siale OI Mlnnewto .. , , '.
2779 - 1467M BTqEET W. - BO% M HOSfiMOUNT, MINNESOTA 6600 PHONE 812 43b176p , SURVEYOR'S CERTIFICATE
?----?RF81V--'--- - -1-a;,:F . .
°
?
sAOO N0009'88"W SCALF. 1 innh • 40 feet
o , ? .., .. . , ,
.?---- --•
s W : W
? 4 PROP09E0 a Q .
?„ . %110USE ?p?/n
?? 38 .O ! 2 ? ? . .
Q
. ?`28.0
, $ y ,Z o
M LOT IQ M
brain$ge & ut111
eaeement
: '.eaoo No°o9 ae
I he3^eby certify that thia le a true and correct'repre4entatl.At1 flf
I,ot' 10 , B1ock 1, ,WII.DERNESS PARK SECOND ADDITION{ aacording bp`the
rec4rCed plat theraof, Aalcota County, Minneeota.
Aleo ehowing the Socation of a proposed houag as ataked thereon.' i.
Dated: April 4, 1979 ,
I
?l
cr tl
1 c1
? yl -7
1?
3Gj 2006RESIDENTIAL BUILDING rERMIT arrLicaTioN
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 9 651-675-5675 FAX # 651-675-5694
Nev+Construclion Reauirements
3 regktered site surveys showing sq. it oi tot, sq. ft of house; and all roofed areas
(20% mazimum lot coverege allowed)
2 wpies of pfan showing beam & window sizes; poured iound d=sign, etc.
1 set oi Energy Calalations
3 copies of Tree Preservation Plan'rf lo[ plattzd affer 711(93
Rim Jast Detaa Options selecfion sheet (buildings wifh 3 or less units)
Minnegasco mechanicalventllafionfonn
RemodelRieoair Reaui2menis
2 copies of plan showing footings, beams joists
t set of Energy Calcuhtions iw heated add'NOre
1 sife survey for addilions & decks
Add'rtron - indicafe if on-site sepfk sysfem
#?-7D 0d
off?.u5e o??
?C??erioPSuney?ecd y; ?'
7reePresYlan#?eoi .?'1"! ;N.
7reepresRequiied` `X!?.Fl
Qo-sdeSeA4c..S.ystem _Y-"N
Date o / 36 /
Site Address &/S7 06
2 ConstructionCost
Unit/Ste #
Description of Work 5 i Cl?
Multi-FamilyBldg _ Y ZN Fireplace(s) X 1
Property Owner Telephone # (Gs? ) 9?'r y- 11-2 Y
?-
Contractor -
Address
State City
Zip Telephone k ( )
COMPLETE THIS AREA ONLY IF CONSTRIJCTING ANEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Cafegory . Residenfial Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submiried
In the last 12 months, hos the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
SeweNWater 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 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.
l"?l/?2(? ?l?v?s?'-,
Applicant's Printed Name
"?/?---
Applicant's Signature
DO NOT WRITE BELOW THIS LI1VE
Sub Tvpes
? 01 Foundation ? 07 DS-plex
? 02 SF Dwelling ? 08 Ofi-piex
? 03 01 of _ plex ? 09 07-plex
? 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 'IU-plex
? 06 04-plex ? 12 12-plex
Work Tvaes
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 13 16-plex
0 16 Fireplace
? 17 Garage
? 18 Deck
? 19 Lower Level
? 20 Pool
? 21 Porch (3-sea.)
? 22 PorchlAddn. (4-sea.)
? 23 Porch (screenlgazebo)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt- Multi
? 33 Ext. Alt - SF
? 36 Mu16 Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
`Demoli8on (Entire Bldg) - Give PCA handout ta applicant
DesGriptlon; WaterDamage_Yes
Valuation Occupancy
Plan Review 100% or 25°k
Census Code Zoning
SAC Units Stories
# of Units Sq. Ft.
# of Bldgs Length
Type of Const Width
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
_ Foundarion
_ Drain Tile
Itoof Ice & Water Final
_ Framing -
_ F'ueplace _ RI. _ Air Tcst _ Final
Insvlation
Approved By.
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Sheetrock
FinallC.O.
FinaUNo C.O.
HVAC
Other
_ Pool Ftgs AirlGas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
_ Windows
_ Retaining Wail
Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatrnent Planf
License Search
Copies
Other
Total
Use BLUE or BLACK Ink
For Office Use I
'al
Permit j
City of Emu
I Permit Fee: ~y
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Tenant: Suite M
RESIDENT/OWNER Name: Krh 1`G 1 Sc,--~ Phone:
Address / City/ Zip: 1 J ?7 0 K1 U r~
Applicant is: Owner Contractor
TYPE OF WORK Description of work: ~✓t~ f~i~ 1~~~ ('S'e ldoC.
Construction Cost: CJ(J C) Multi-Family Building: (Yes / No 7
CONTRACTOR Name: License#: 64
Address: 1 (G S~
City: State:N Zip: Srl~l
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www:gopherstateonecall.org
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:
L ~
X X
Applica is Printed Name Applicant's Signature
Page 1 of 3
4111/
C!ty of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date:
r
Use BLUE or BLACK Ink
For Office Use �^� (���
Permit #: 1 t V oa
14-DaPermit Fee: 0299 . 't)14-
Date
te Received: q
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:
1'3) -7 ::,r, )L Lam.
Name: r,-7,1AP/ (4si
Unit #:
011:)0
Phone: (;-`l 79' 11 2V
Address/City/Zip: 73`)-7 or'o,-, Al SS -113
Applicant is: Owner ° Contractor
Description of work: a--) ss fru lro r-/aisil�f/ • /ix/s "Ale
L
Construction Cost:3 ?.,ACU 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)
PD 1°10
Civ c ✓ 1 78'
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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
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.ciopherstateonecall.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 TrRz" Pi v I Se in
Applicant's Printed Name
X -'M —.
Applicant's Signature
Page 1 of 3
L4-3-]-7 ()viol')
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
1 Single Family
Multi
01 of _ Plex
WORK TYPES
New
Addition
44. Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 1 00%
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
Interior Improvement
Move Building
Fire Repair
Repair
4/39
1
J3
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition) Ne>
Foundation
si rk
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Drain Tile
Roof: _Ice & Water Final
Framing
Fireplace: _Rough In Air Test Final
Insulation
Sheathing
Sheetrock
Reviewed By:
t) 1iii
Siding
Reroof
Windows
Egress Window
%Ic D
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
72i PRV
Fire Sprinklers
I�
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: _Footings Air/Gas Tests Final
Siding: _Stucco Lath Stone Lath Brick
Windows
Retaining Wall: Footings Backfill Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
/32 '5
-244 ys, st, @ 7/ °=
r7�
01�
Page 2 of 3
Use BLUE or BLACK Ink
r
For Office Use
4 11 100
City of ~n Permit#: 1 1/'id I
b I ® #il
I Permit Fee: Vl
3830 Pilot Knob Road i 3
Eagan MN 55122 I Date Received: r
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 L Staff:
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: C13?? d L~
Tenant: Suite
Resident/Owner Name: e ` Phone:
Address / City / Zip: Gl 's 7 7 0 o
Name: License
Contractor Address: City:
State: Zip: Phone:
Contact: Email
Type of Work New _ Replacement _ Repair - Rebuild Modify Space - Work in R.O.W.
Description of work: 6(,
RESIDENTIAL
Water Heater
Water
Lawn Irrigation RPZ PVB) Softener
Permit Type
Add Plumbing Fixtures Main Lower Level)
Septic System
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $200.00 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)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.om
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 ~/CI< ✓/5~-1 x .11,v ,
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
I
~I
1
Use BLUE or BLACK Ink
r
For Office Use
I
Permit
City of Eap 15-19
Permit Fee:
I
3830 Pilot Knob Road
Eagan MN 55122 Date Received:1 15 10 l
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: 1
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: loo l .3 Site Address: Unit
Name: I'~~2~L ~~/1.✓f~e-~ Phone: ~f-f 2 -O13,-
Resident/
Owner Address/City/Zip:
Applicant is: ,K Owner Contractor
Description of work:
Type of Work
Construction Cost: ~y Multi-Family Building: (Yes / No,---
Company: Contact:
Contractor 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:
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.
Applicant's Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA140360
Date Issued:12/13/2016
Permit Category:ePermit
Site Address: 4377 Orion Lane
Lot:010 Block: 001 Addition: Wilderness Park 2nd
PID:10-84251-01-100
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Stove
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Mark R Paulsen
4377 Orion Lane
Eagan MN 55123
(651) 329-0138
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:EA140730
Date Issued:01/17/2017
Permit Category:ePermit
Site Address: 4377 Orion Lane
Lot:010 Block: 001 Addition: Wilderness Park 2nd
PID:10-84251-01-100
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Mark R Paulsen
4377 Orion Lane
Eagan MN 55123
(651) 785-3820
Standard Heating & Air Conditioning
130 Plymouth Ave. N
Minneapolis MN 55411
(612) 824-2656
Applicant/Permitee: Signature Issued By: Signature
r Use BLUE or BLACK Ink `!
For Office Us
/.//0 cf,f,i
h7 00
40/'
City of Eaaafl ::::! °
r 1 _/1/7. 1
3830 Pilot Knob Road / 1
Eagan MN 55122RCEIVED Date Received: (O - . '7i"
Phone: (651)675-5675 c' I
Fax: (651)675-5694 JUN 2 , 2017Staff:
/�
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: g1,-7 Site Address: Li Yr? 0r L—, Unit#:
. Name: F3-r1Se,..
y►��+tr-� t� Phone: SSL 3 �7 -t,(3 gf'
.Owner .. ,:r Address/City/Zip: 7 7 O�`AL_,,4_,,,,
T'''--):::2)
Applicant is: Owner Contractor
7 1144' r Description of work: 11-t4cL^ i4----,,,,,,,L(
x
�` �`' Construction Cost: i%<' �j�(�C Multi-Family Building:(Yes /No )
Company: Contact:
"Contractor Address: City:
State: Zip: Phone: Email:
rt nSI
License#: Lead Certificate#:A n
If the project is exempt from lead certification, please explain why:
l�,Jtiy,. 0,v1 if i 1,79
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:
Fire Suppression Contractor: Phone:
a TE Plans ani su ffi . = • ation Po Ens of
�� ppoftin�rbcumen -. �# u subr,���ars :P �
the information maybe classified . , non-public rf yours • de speci!f c e m n ro rld pearl ° rt to 4
r •n �toat rade : 5 .
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.gooherstateonecall.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 fora 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 Pi AQtG 1 0,6 e.., x,AIN•1` ,,
Applicant's Printed Name Applicant's Signature
Page 1 of 3
q7 •//7-
&:Oirt DO NOT WRITE BELOW THIS LINE /4774/00O
SUB TYPES
Foundation Fireplace _ Porch (3-Season) _ Exterior Alteration(Single Family)
p Single Family Garage Porch (4-Season) Exterior Alteration (Multi)
__ Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex Lower Level Pool _ Accessory Building
WORK TYPES
New 14 Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair Windows _ Demolish Foundation
Replace Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION _
Valuation 4 ~�V. — Occupancy 1-RC. 1 MCES System
Plan Review Code Edition (/Mil 2O15 SAC Units
(25%_100010()° ) Zoning ?Z City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction \i' j Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final I C.O. Required
Footings (Addition) S Final I No C.O. Required
Foundation Foundation Before Backfill to HVAC_Gas Service Test Gas Line Air Test
Roof: Ice &Water _Final Pool: _Footings Air/Gas Tests Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test _Final Siding: _Stucco Lath Stone Lath _Brick EFIS
O Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: (O ifY1 /1r Kt Y Building Inspector
RESIDENTIAL FEES d L.l3 Sq • f1--
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit &Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
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June 20, 2017
To: Mark Paulsen
4377 Orion Lane
Eagan MN, 55123
Re: Wall removal
Dear Mark,
Thank you for requesting Complete Building Solutions, LLC("CBS")to inspect your home
at 4377 Orion Lane. You are planning renovations to this home and would like to
remove the walls between the kitchen and living room and also between the kitchen
and dining room. You have requested CBS inspect the home to verify whether or not
these walls are load bearing.
On June 20th, 2017 CBS inspected the home and took measurements and pictures to
record our findings. Our inspection found that the roof assembly is supported by roof
trusses.We have determined the trusses have 2 bearing points which are located at the
exterior walls.We have determined the walls between the kitchen and living/dining
room are non-load bearing and can be removed without any further structural support.
If you have any questions or concerns, please feel free to contact us. Thank you for the
opportunity for Complete Building Solutions, LLC to provide you with this service.
Sincerely,
, '`
Bruce Polaczyk, P.E. =.
MN License#10377 U0010830 **t;
'0 10377 Ric