3967 Palisade WayCITY OF EAGAN Remarks wtr Cor1T1. pd. on 9-11-72
Addition Cedar Grove #8 Lot 1 Qik 9 Parcel 10 16707 010 09
Ownedj:i z;Street 3967 Pal1S3de W3y State Eagan,MN 55122
l' D?./?1 AA(1-l 1.? Ld1.7? ?f i
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK ( LS 970 125.00 5100 2 PaiCl
# SEWER LATERAL 1 971L 1 1539.10
WATERMAIN
# WATER LATERAL 1974 5
WATER AREA
STORM SEW TRK
# STORM SEW LAT 1974 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 00.00 6410 -11- 2
9UILDING PER.
s,ac 2.00 6410
-11- 2
PARK
cirr oF EAc,AN
• 3793 Pilef Kwob Rood
PHONE
4 Eayen, MII 55142
34
8100
BWLDING PERMIT s -
?tecelpt #
Te bo ww MrFA:1ILY RQOM ADD. Est. Value $15, 304 pO1e ;f av 2.3 , 14 $3
5iro Addrcu 3957 Palisade Way E
t O
11-3
rec
? ccuponcy
Lor 1 Block 9 Sec/Sub,Ced ar Grove 8 Alter p Zoning £.-1
parcel # 10 16707 010 09 Repair Q Fire Zone IvA
E T
Vt1
nlorge XX] ype of Const.
?yame Nicl: ., akubowakv Mov # St
ie
W e p or
s
9 z Addross 39G7 Palisade Wav Der„olish ? Length
Ci 'A gaa 55122 phorM 4 54-6227 Grode p Depth26-Sq. Ft.
lx Ric'?fiela bros Construction ADDrOVaI? Fee:
a Name ` •
?? Address 131?J Kendon Lane
r Ci 'lendota Iite. phor, 452-1E16
Name
?i
I hereby acknowledge thot I have reod this application ond state that
fhe informotion is torrect and ogree to tomply with oll opplicoble
State of Minnesata Statutes und City of-Togdn.-0ro_irqnces.
Assessmenr
Water & $ew.
Pol ice
Fire
E+0•
Plonner
Council
Bldy. Off.
APC
Permit 140. pU
Surcharqe 9.00
Plon check 64.25
SAC
Water Conn.
Water Meter
Rood Unit
Total $201.75
5iynoture of Permittee.
/1 Building Permit Is issued to: ?{ch?el? B?4s. C0ustr11vtinn on the ezprcss Conditlon thnt
all work sholl be done in acaordonce with 0 a plicabla Stote of Mlnnesoto 5totyjgAxW City of Ea9on Ordinonces.
Buildirg Officicl J
c_ .
Permit No. Permit Holdor Misc. Permit No. Holder
Plumbing
H.V.A.C.
Well
Water
Disp.
Stwsr
Electric {?1 Z 7(/
Inspeetion Date Insp. Other
Faotinpt G-
Foundation
Freming
Rouqh Pibp.
Rouph HVA
Inwlation
Fital Plbp.
Final HVAC
Final
Water Dewiba Location:
YVell
?
Sewsr ?
I Pr. dkp. - '
Receipt MECHANICAL PERMIT
CITY OF EAGAN
Fill in numbered spaces
Type or Print /egib/y
Permit No.
Fee
S/C
Tot.
1. Date 2. Installation Cost
?
3. Job Address L`ot j Blk. ? Tract
4. Owner < < -
5. Contractor Phone
6. Address
7. City State Zip
8. Building Type: Residential ? Commercial O Institutional O
9. Work Description: New ? Add 0
10. Describe
11.
Type
No. Equipment BTU - M. Ea.
Forced Air No. Epuipment CFM
Ai
H
dli
Mfg. an
r
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I 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 :
Rough
Inspections: Date Insp.
Alter ? Repair ?
for
Final
Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Thisreques; void ?-,7_0
18 mon[hs h am / / ? /' Ut.6uE d 3g7?(e,
?/•J i ._c. U
r3 27659 1.
Faquest Date Fire No. RouPh-In Insuection '
p. ?/?p?r? Re?qy iretl? ?fleatly Now?Will Nntity, Inspec-
1 `?L `A ei I?Q?as nNo . ??r'When (ieady
0 Licensetl ElacVical Contractor 1 hereby request inapection of above
>kOwneF electrical work instellad et .
SVeet Address, 8ox or Route No.
'
? City
?
c vdff
6 lipALz F G!
emion o. Township Name or No. Range o. County
Dfi)CO71if
Occupnnt(PPINT)
z KuBoWs/5Y Phone N .
q s- 60 aa
Pawer Suppliet Addrass
DAVoTA G,EL %af ?-'-
Electrical
o
rect
om
pany Name)
C
M
or (C Contractor's License No.
?
?
?
?
!?
Q
?
{IV / tX??
Mailing Address (C'en[r8Cmrof Owner Making Instailationl
9 LsS - W?t t????? ?s?a-z
AuMorized Sienature 1 onvactor?Owner Making A tallatio 1 Phone Numb
er
/ /
/
?cS7 ?f7a.?.1
WILL NOT
MINNESOiA STAWBOARD OF EIECTflY BE TMIS ACCEPTED INSPECT BY ION THE PEQUEST STATE BOAN?
G?iggs•Midwey Bldg. - Room N-791 I_j l1NLE53 PHOPEH INSPECTION FEE IS
7821 UniversityAVa., St Peul, MN 551114 ENCLOSED.
cA....e INt91 99?9111
1I REQUEST FOR ELECTRICAL.INSPECTION
?nV 2 7 6 5 9 0 Sea instrmtion4for completing thls fonn on bnck ot yellow copy.
'"X' Below Work CoveYed by This Reqirest
EB-00001-03
3T"Zo(a
e Adtl R.P. Typa ot Building Appliances Wired Equipment Wired
Home Range Temporery Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fafm Other peci y ther (SUer,ifyl
ther ISUecify Uther Other
Canpute Inspection Fee Below N Fea ServlceEntrencoSiza # Fea FaedersISubieetlers k Fee Circuits
0 to 100 Am s - 0 to 30 qm 5 0 to 30 Am
701 to 200 qmps 31 to 100 Amps 31 to 100 q s
A
bove 200 qmps Above 700-Amps Above 700_Am s
Transformers Remote Control Cira j CrO Partia VOther Fee
- Signs Special Inspection S ? 000 "
flertarks TAt FEE
floueh-in
Final ? . ,
/ 4a 1e? 1. ncel
Inspectoq hereby
cartify that Ihe abova
inspectian has bean
meAe.
K`«
w:
This repuest vnid
18 nronths from
TO'.IQ OF EAGHId
3795 Pilot &:ob i:oad
Eagan, Ninneaota 55121
, PERMIT NO
246
The Board of Supervisors hereby granta to Cedat' t3i'ove C=etancLicn Cp,
of 7343 Caaoord Slvd. EasL, Scuth st. Pau1.55075
a Fl$p'1'IIJa Paxmit for: (Ownet) Cedar [l:ewn r.enst.=,C%l= Ca,
at_???' ?»*aa & 3967 Paliedae Wav pursuant to application dated
• .
9/t/q2
iee Paid: $40.00 Dated this l,]th day o£ 20,40 smpt , 19?,
1.00 a/C
Building Inspector
/L% /Z- 7G 7 6 iG
c;
TOWN OP EAGAN
3795 Pilot Knob Poad
Eagan, D4innesota 55121
PERMIT N0. 259 1
The Board of Supervisors hereby grants to CedaY' (k'dva ConetTUOtlon Co.
of 730 Canoord Blvd, gast. 3outh 8t. Paul 55075
a P1affia Permit for; (Owner) peder (rove OonaLivotlati Co.
at 396T;WXWbm & 3967 Pallaade Wgy ? pursuant Co application dated
9rrr2
Fee Paid: $40.00 Dated this l1th day og 58ptember ? 10 7?,
1.00 ac '
09
Bt3.lding Inspector
'- LO7
CITY OF EAGAN
Include 2 sets of plans,
? 1 site plan w/el.evations
BUILDING PERMIT APPLICATION 1 set of energy calculations,
To Be Used For ? ? V? ation Date
Site Address: P,¢6A5A? OFF'ICE USE O Y
Int ? sloclc ? sec.gErect Occupancy
Parcel #: 10 kD`"f O yl Olo oQ Alter Zoning -
Repair Fire Zone
Enlarge? Type of Const. ?_
Owner: /.rI-[?I l? R?CJ/US f?l?
F ? ?- Nbve # stories
Pddress: ?1 "'j Demolish _ Front / ft.
City/Zip Code: 410,¢,{/ Grade Depth ft.
Phone #: if.°,2
Contractor:
Pddress •
City/Zip Code: p/.E&bn7d /6'S .5.5
Phone #: /V52- /G/e-
Arch./Eng.:
Address:
City/Zip Code:
Phone #:
APPROVALS FEES
%
Assessments Permit 12
Water/Sewer Surcharge
Police Plan Check
Fire SAC
Eng. Water Conn.
planner Water Meter
Council Road Unit
Bldg. Off. % -
P.PC
TarAL -t '?C? I I 9?
CITY OF EAGAN ?T p
., 3793 Pibf Knob Road Eogan, MN 55142 jr ? 8067
p(
?PHON[s 454-8100
BUILDING PERMIT Receipt # 2S73
T. 6s uead ferFAMILY ROOM ADD. Est yalue $18,000 Dote May 23 lq 83
Sife Address 3967 Palisade Way Erect ? Occupancy R-3
I.ot 1 Bi«k 9 swS?y Cedar Grove 8 qlror p Zoning R-1
pamel # 10 16707 010 09 Repoir ? Fire Zone NA
E
X Vn
nlorge
?] Type of Const.
rc
W Name NiCk .7akubowsky Move ? # Stories
; Address 3967 Palisade Way ' Demolish ? Length 16
b aPan 55122 454-6227
Ci p??e Grode ? Depth 26
S4. Ft.-
rc Richgels Bros Construction Apprmab Fees
p Name •
Addren 1310 Kendon Lane
r- P:..Mendota Hts. ?___ 452-1616
Nome _
Addmss
I hereby acknowled9a fhat I have read this
the information is torrect and ogree to
State of Minnesoro Statutes and City
Signoture of Pertnittee a/ ?
A Building Permif fs issued fo: Richg
oll work shall be done In occordance wlth Bu7ldirq Official ?
ond state thaf
all applicable
of
Assessmenf _
Water 8 Sew.
Polite -
Fire
Enp.
Plonr?er _
e
Council _
Bldg. Off. _
APC
Permit 1Gb.JV
Surchorge 9.00
Plan check 64.25
SAC
Water Conn.
Woter Meter
Road Unit
Total $201.75
_ on ths exprese conditlon thm
Ciry of Eogan Ordinances.
x
EAGAN TOWNSHIP
BUILDING PERMIT
.
ownB: . -
~ ..... ?- _ ...'?--..._..---- ...
Address (Preseni) ---...?.....
Builder ..................... ...... .._....
Addrass ........ __......_...------
DESCRIPTION
L"
N ° 2842
Eagan Township
Town Hall
Dale "9-1y _ ?'L
................ .........
.
Storias To Se Used For Fron! Depth Heigh! Esi. Cos! Permii Fee Remarks
1 7 - ?0
aO s'r ; v: ,??-z-
3"%
LOCATION /-yl 9.5-6' _ aacw?. nvau vr w acr aayiavn va a.vcaaav?a I a.oi aloCx Ap61IlOp Oi TIBC=
? v
This permii does nof aulhorise the use of siteefe, roads, alleys or sidewelks nor daes it give the owner ot hia agant
the righ2 fo oreaie enp sifuation which is a nuisance or which presenis a hazard 2o the healih, safely, convenienea end
general welfare fo anpone in the eommunifp.
TFIIS PERMIT MUST BE KEPT ON THE PAEMISE WHILE THF; WORK IS IN PROGRESS.
This is !o certify, !hal...64,4-?^.!...?...-------------------- has permisaion !o erecf a...... 9__ ?. ...?-'.?;+r,??? ........ _.__upon
the above described premise subjee! !o the provisiona of the 8nilding Ordinance for Eagan T?nship dd opied April 11,
1955.
................................... I .... ....... "`--:..._.....::?............... Per ..... ............... --`F.'.'.?.':.:.:?...._!?.................... ....
Chairman of Tnwn Baard B u i
lding (aspectoz
6 16
MASTER CARD
LOCATION
-
OWNER C'???
STRUCTURE AND 1
LAND USED AS
Permit
No.
Issued Issued To
Contracfor I Owner
BUILDING _ 2By2
PLUMBING ?
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING ?
GAS INSTALLING
SANITARY SEWER
OTHER
4' L
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING 9?2 1 - - -? SEPTIC
FOUNDATION ? CESSPOOL
FRAMING p-/ TILE FIELD FT.
FINAL
ELECTRICAL
HEATWG
? DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER f Q • ?7
F
:
- 1 ?
'_
_
_?__ .
•
j 0 /3.7 `
Violations Noted
on Back
COMMENTS:
`
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOIATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
1:1 ACCEVTABIE SUBSTITUTION$ OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPIIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
IZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions oLserved to be at variance with ordinancas of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABIY COMPLETED
COMMENTS:
BUIIDING INSPECTO
44? x
j .
L°"d P1on"'"g ?lf/("ll 6075 Nighwuy No.65 N.L
land SVr.eying • ( Minnwpelis,
soa, te,t;,,9 '?/1?/1lPP%f11yr t?llG Mi--. ssuz
C;vil Engineerin9 , Td.phone 7E4-6060
Muni<ipol lnBin<e.?ng Engi neers & Surveyors •reo Cede El]
Mortgage Loan Survey Par Ceda,r Grove CiOt1St. ri0.
'4',
-?
-- , -,- --=-? ? r
' I
i l1l .
11m
o g? J, v ri ? o ?.
`
? . ? (,0
?4 4 (7:.
I +-
I ? p <
U
-.L r
I .1 . . . j _ ; C
• ? V.... i 1 '.. _ AV ? .
LOT ? BLOCK CEDAR GROVE NO. 8
COUNTY OF DAKOTA
---- Denotes Drainoge and Utility Easement
thl? Is o fror and ao.rec? .ep.eun?wtion of o survey ef eh< bevndorit> a} the load obore doni6ed and ol Me
loaatlon ef alt bulld{nq>, il on, rhe•eon? ond all vie[ble ennmehmrnt,, il ony, i.om e, on ao:d bnd. Th1s sur?ay i>
made only in aonnecNon wirh o morrgaqe loan now brlny ploaed on Me property and no liabilify b au.mad
e-iept lo the holder of w,h morfgoge or uny other inter<af aaq.i,ed 6r fhe .eosow ef wth mortgoge. It is
,onde.stood and ogreed no mon,mcMs Avre 6een Af,jtpd for tFe p.,pose o} establi>hfnp let lin.i or beundarr
aorners. Dated ?hit 4 day of Ll?? ? A. D. 19 -4
' SUBURBAN ENGINfERING,INC.
SCALE: 1 inchc 40 feet '"9'"` ' s"•"''°-•'
bY
19-9
C •
EAGFN TOWNSHIP
3795 PiloC Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERP4IT FOR WATER SERVICE CONNSCTTON
Date• Number• 972
Billin
Owner:
Plumbe
NO , 1bta1 Chg.
Building is a:
Resldenae xx
tRultiple No,
Commercial
Industrial
Other
Meter
3ite Addreas
Silling Address,
Is
?f-Ljav?
, 00 9/11/72
Meter No. lPermit Fee 10:1/72
1/72
Meter Reading Meter Dep.
Meter Sealed: Yea_ lAdd'1 Chg.
Inspected by
Date
Remarks:
By:
Chief Iaspector
In consideration of the isaue and delivery to me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules and
regulatioas of Bagan Township, Dakota Couaty Mianeso a.
By:(
,??IiYVY?lr?Nle P _ -
Please notify the above office when ready for impection and connection.
l-9-8
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55I11
Telephone 454•5242
PERAIIT FOR SEWER SERVICE CONNECTION
DATE: N0MffiER 1130
OWNE P r }? Add res s?"? G OQ
. y? ?
PLUMBER - ?
PIdM6 }'l°? TYPE OF PIPE
./
DESCRIPTION OF BUILDING
Industriall Comnerciall Reaidentiel I Multiple Dwelling I No, of units
Location of Connectione:
Connection Charge 260.00 nd 9/11 /72
Permit Fee 10.00 pd 9/71/72
.50 pa 9/11/72
Street Repairs
Total
Inspected by:
Date
Remarka•
By.
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed worlc in accordance with the rules and
regulaCions of Eagan Toimship, Dakota CounYy, Minn sota
BY
Pleaee aotify when ready for.inspection and connection and before any portion
of the work is cwered.
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
cirv oF eacaN
3830 PILOT KNOB RD - 55122
???H cil 651-681-4875
New ConstnicXOn ReaWremenh Ramodel/Reoalr Reaulremenb
> 3 reglMereC sIte surveys ahowlnp sq. IL of lof, sq. R. ol house
and gfl rooletl areos (20X mmc!mum tot coveraae albwetl)
> 2 coples ol plana (show beam 8 wlndow alzes; poured Ind. design: etc.)
> 1 aet of energy calculallans
> 3 caplea of free preahHon pl If lol plaMed aRer 7/1/93
7DAiE: ??710 /60 /L ,
2 coptea ol plan
1 set of energy cdculaflons for heatetl adc9Hau
1 site wrvey for extedor atltliflons R decks
COST:
?0 r?A
02 '?
DESCRIPTION OF WORK: ?4.6? '--
STREET ADDRESS: ?Z6 ? Ca I e? a V 1'?
LOT: .__?__ BLOCK: ? SUBD./P.I.D. N: L edQ?'?Y?lVP ?$
Name: Phone
?-
PRAPERTY taat ? Flist
OWNER l ??
Sheet Address: G?? Pa ? C'1 w
Cfly ?' w Cnan ? Stafe: ?- 11P: S s I 2"t
v e 1 PeripYS (
Company: '? 1? r s c? ?` 6H c?l Phone ?:
(area code)
CONTRACTOR Sheet Add^ress: llcense # "'I el V NExp. \
ciy 0?-- srate: N` zip:
ARCHITECT/
ENGINEER Company: Name:
Tetephone #: ( )
Sheet Address: Registratlon #:
City State: Zip:
Sewedwater licensed plumber (H instalflnu sewerMraterl: Phone #:
A
I hereby xknowledge that I have read fhis applkaHon, sfate thaf the information
of Minnesola Stalutea and Ciy of Eagan Ordinancea
Signalure of Applicant:
OFFICE USE ONL
Certificates of Survey Received _ Yes _ No
agree fq.?6m,gy wNh al appOcable State
Tree Preservation Plan Received - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex O 09 07-plex
? 04 02-plex O 10 08-plex
? OS 03-plex ? 11 1 aPleX
? 06 04-plex ? 12 12-plex
WORK TYPE
? 31 New
0 32 Addition
? 33 Alteration
? 34 Repair
O 13 16-plex ? 21 Porch (3-sea.)
? 17 Garage ? 22 Porch/Addn.(4-sea.)
? 18 Deck ? 23 Porch(screened)
? 19 Lower Level ? 24 Storm Damage
Plbg _Y a_ N ? 25 Miscellaneous
? 20 Pool ? 30 Accessory Bldg.
0 36 Move Bldg. ? 43 Reroof
? 37 Demolish (Bidg)` ? 44 Siding
? 38 Demolish (Interior) ? 45 Fire Repair
? 42 Demolish (Foundation) ? 46 Windows/Doors
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq. ft.
MISCELLANEOUS INSPECTIONS
0 Stucco/Stone
APPROVALS
Planning _
Building
Engineering
sq.ft.
sq.ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pf.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation:
O 31 ExtAlt-Muni
? 33 Ext. Alt - SF
? 36 MuRi
SAC Units
% SAC
? _qb,do
C4 of Eagn
383p Pitot Knob Roed
Eagan MN 55122
Phone: (657) 6755675
Fex: (651) 615-M
C?sq a-&
? ---- - ?
?
?
? Daze Fk?ived: ?
? i
? ----°----------?
2008 RESiDENTIAL BUILDING PERMIT APPUCATtON
Datm Add.: 32 Ll PA z.,
TenaM:
RESIDENTIOMMER Name:. NIC*'' 3fk Ku [?hLJ:?4C?? ??
Address 1 Cdy! Lp:
Appkent is: _ Owmr -)?,. Contmcw
TYPE OF WORK DescriPtion of woAc:? 01 4 K.Ic i2 oG?% a? SG2
Cw4truction Caec S C?O .oo _ Mulu?FamdY 8u?ne? (?'?-! No?}
i?oenset ??r4.zt?fa't
CONTRACTOR Neme:
Address: '
•
Phone: ?O6I "'i3!ADlJ Contact Person: TsL lL`Ll -
CpMpLETE TtUS AREA ONLY IF CONqMUC'l1N0 ANEW BUILDING
t?hmoffi Rules 7670 Cataaorv t ' Mb Rutes 7672
En9Y Code • peWdaftVe4mwn.rar?ar t WorW,ea • naw rmWcodewonmh@d
cowgory &6010d : suam?a
(d submtaaan tYPe) • &m9r Erwelope Cdmdafte &bYftd .
tn tho tW tz monthss has tha Cty Of Ea9an isaued t p0rnlit fer a sbNW plan b98W oR a IMatK pbn?
_Yes No If yes, daFe and addcess af mfl8ter ptan:
Licensed Plumber• Ph='
NecbaniCal Contractor: _
Sewar ? wamr Confractor.
X?. ?I?c I?l F?1 Ltf?c X 1 1 1 l'?ti
AppifcaM's Printed Nanfe APPOCOW$ SlOrMn
pap td3
------------------
? FQr£}ffi?usa ?
I
I
j Permit #:
? Permit Fee:
I
I
? Date Received: ?
I ?
I StaB:
I
-----------------
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: .5 - &'-' / Site Address:
Tenant:
Suite #:
RESIDENT/OWNER Phone: ros?- ?s5i (-aa7
Name: 21ZJ
n
AddresslCity/Zip: .39?0 / °7?
-
?
Applicantis: v Owner _Contractor
r
TYPE OF WORK Description of work:
Construcfion Cost: Multi-Family Building: (Yes _! No
CONTRACTOR Name: License#:
Address:
Ciry: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 CateqoN 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheel • New Energy Code Worksheet
Category Submittetl Submitted
(4 submi5sion type) • Energy Envelope Calculations Su6mittetl
In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Cantractor: Phone:
Sewer 8 Water Contrector: Phone:
NOTE: Plans and supporEing documents fhaf you submit are considered to be public - informafion. Portions of
fhe information may be classified as'non-pablic if you provide specific reasons that would pemrif the Cityfo
conclude that the are trade secrets. :
I hereAy acknowletlge that this information is complete antl accurate; that the work will be in confortnance wilh the ordinances and codes of the City of
Eagan; that I untlerstand this is not a permit, but only an application for a permit, and work is not to staA withoul a permk; Ihat the work will be in
accordance with the approved plan in the case of work which requires a review and appmval of plans.
X NxCI? k,U 8 o wS/? ? X2'l.f.Ad
ApplicanYs Printed Name ApplicanYs Si ature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
_ Single Family
Muiti
01 of Plex
_ Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
_ Retaining Wall
Valuation
Plan Review
(25%_ 100%_)
Census Code
# of Units
# of Buildings
Type of Construction
_ Fireplace _ Porch (3-Season) Stortn Damage
_ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
_ Deck _ Porch (ScreenlGazebo/Pergola) _ Exterior Alteration (MuIG)
Lower Level Pool Miscellaneous
_ Interior Improvement _ Siding _ Demolish Building'
_ Move Building Reroof Demolish Interior
_ Fire Repair Windows Demolish Foundation
_ Repair _ Egress Window _ Water Damage
'Demolition of entire 6uiltling - give PCA handout to applicant
Occupancy MCES System
Code Edition SAC Units
Zoning City Water
Stories Booster Pump
Square Feet PRV
Length Fire Sprinklers
Width
REQUIRED INSPECTIONS
_ Footings (New Building)
_ Footings (Deck)
_ Footings (Addition)
Foundation
Drain Tile
_ Roof: _Ice & Water Final
_ Framing
_ Fireplace: _Rough In _Air Test _Final
_ Insulation
_ Meter Size:
Reviewed By:
_ Sheetrock
Final / C.O. Required
_ Final / No C.O. Required
HVAC
Other:
Pool: _Footings _Air/Gas Tests _Final
_ Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall
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
Page 2 of 3
5
of Ealan I ftffd Fec
3830 Pilot Knob Road Date Received: Eagan MN 55122 t I
Phone: (651) 675.5675 t Sat
Fax: (651) 675.SM
Zoos RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 3 V7 PA u t~ s )
Tenant: Suite
RESIDENT !OWNER Iv tG'fi~ Phone:
Name: fit, K t
Address / City / Zip:
Applicant is: Owner „ Contractor
TYPE OF WORK Description of work: TF-A 0 C P _ _ r z
Construction Cost: ,ta , Muni-Family Building: (Yes / No}
t
CONTRACTOR Name:
License Address:
Stm: 7*:
Phone: (SE ' 4) !-L y Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateoory 1 minnesam Rules 7672
Energy Code • Residential ven on.category I wodeheet • New ! code WO eet
Category $Wxrftd s
(d submission type) • Energy Envelope Umilatiors Submitted
in the last 12 months, has the City of Eagan ,,Sued 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:
i hereby admowledge that this information is complete and aogirate; that the work will be in confoRrance with the ardwmx= and codes of the CIty of
caw; that t understand this is not a permit, but ongv an application for a permit, and work is not to start without a perml that the work wE be in
aocordaisce with the approved plan in the ease of work wh ragtlves a review and approval of piers.
x
Applicant's Printed K%me
: Applicant's Signature Page 1 of 3
Use BLUE or BLACK Ink
t f For Office Use Ciy o ~l Permit ~ ~ pl:~'
1 1
3830 Pilot Knob Road Permit Fee: `I
Ea
gan MN 55122 13 ,
Phone: (651) 675-5675 j Date Received: 1
Fax: (651)675-5694 1 I
I Staff: ~ I
l 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 113 13 Site Address:
Unit
i Name:
! Resident/ Phone:
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: -T~l ~erCY
Construction Cost: ,
- Multi-Family Building: (Yes / No
Wi ?lq
Company: X~S~t_ Contact: _ I .1 4-11
S r q1
may, (1r1 l
Contractor Address: City: I(,aJer
I
! f State: . '13
' N Zip: 55Q7'~ Phone:- &51 - ~ 9 -90
I
License qxq Lead Certificate #:N►"r I
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 8, 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.ao_ oherstateonecall ora
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 1 understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
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.
Applicants Printed Name Applic /t's ure
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA126374
Date Issued:08/22/2014
Permit Category:ePermit
Site Address: 3967 Palisade Way
Lot:1 Block: 9 Addition: Cedar Grove 8th
PID:10-16707-09-010
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the 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: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Nickolas A Jakubowsky
3967 Palisade Way
Eagan MN 55122
Weatherguard Construction
10860 60th St N
Stillwater MN 55082
(651) 439-4320
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA162216
Date Issued:07/02/2020
Permit Category:ePermit
Site Address: 3967 Palisade Way
Lot:1 Block: 9 Addition: Cedar Grove 8th
PID:10-16707-09-010
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description: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 -
Nickolas A Jakubowsky
3967 Palisade Way
Eagan MN 55122
(651) 454-6227
Wenzel Heating & Air Conditioning
4145 Old Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA162216
Date Issued:07/02/2020
Permit Category:ePermit
Site Address: 3967 Palisade Way
Lot:1 Block: 9 Addition: Cedar Grove 8th
PID:10-16707-09-010
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description: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 -
Nickolas A Jakubowsky
3967 Palisade Way
Eagan MN 55122
(651) 454-6227
Wenzel Heating & Air Conditioning
4145 Old Sibley Memorial Hwy
Eagan MN 55122
(651) 894-9898
Applicant/Permitee: Signature Issued By: Signature