4616 Parkcliff Dr
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
FQr Office Use
Permit#: t ~S~✓
[ion
City of Ea Permit Fee: I "
I
3830 Pilot Knob Road
Eagan MN 55122 Date Receive
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff: I
io Z 211
- It
2011 RESIDENTIAL BUILDING PERMIT APPLICATION C --~A d
Date: Site Address: Unit
Name: CIO66 .y Gtr= Phone: 6S 1 - V5-z- 5-75-7
RESIDENT /
OWNER Address/ City/ Zip: 41(06 7A 1ZY.e.L-I
Applicant is: Owner Contractor
TYPE OF WORK Description of work: jC.kAe--V iLi~'~1a~70L
Construction Cost: 1) 000 Multi-Family Building: (Yes / No ✓ )
Company: a✓Att~ `J00t> Ztc~~ 1Nc, Contact: JOB- AP-~,J6 vim.
CONTRACTOR Address: \ b- ls- M\q-C- dcity:
(l
State: I" Zip: ~q Phone:
License Zcc>-577 ` 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 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.goi)herstateonecall.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 pl in the case of work which requires a review and approval of plans.
x x E lit 14 -
Appli ant's Printe Name Applicant's Signature
Page 1 of 3
q62 1~ ' ' k~I O 7
O NOT WRITE BELOW THIS LINE vv
O
SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
u Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
01 of - Plex _ Lower Level _ Pool _ Miscellaneous
Accessory Building I/
WORK TYPES F~f -o 7.x,.1 13 0 7a
- New _ 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 V u Ok> Occupancy MCES System
Plan Review Code Edition SAC Units
(25%_ 100%-~-) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Y Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In -Air Test -Final Windows
Insulation Retaining Wall: Footings _ Backfill Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: t , Building Inspector
RESIDENTIAL FEES
Base Fee!
Surcharge l~j~/y~'*~YfM~'
Plan Review
MCES SAC
City SAC f y
Utility Connection Charge J
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
- -ji
Receipt --' - MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee '
Fill in numberied spacea S/G
Type or Print /egibly Tot.
1. Date 2. Installation Cost
?
;:. .
Cl
?f
3. Job Address7 L'I' 0 Lot ---?' Blk. ? Tract '?_'• ` ?
4. Owner
r- -f:.
5. Contractor Phone
6. Address
7. City State i Zip -
8. Building Type: Residential Commercial ? Institutional O
9. Work Description: New LKl Add D Alter O Repair ?
r..
10. Describe Fuel Type - y:-" I 11'
No. Equopment STU - M. Ea.
Forced Air No. Equipment CFM
Ai
H
li
Mfg. r
and
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
? Mtg.
--? Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
cnmply with all ordinances and codes governing this 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 ?> s
a•-?
•? - ?
PLUMBING PERMIT Permit Na.
C1TY OF EAGAN _
Fee
Fill in numbered spaces S/C
TypB or Print legib/y t
T
. .
o
l. D7te 2.lnstal4ationCost
3. Job Address Lot?Blk. Tract;/'? ??-
G? ,
4. Owner vl?
?
5. Contractor /-a Phone
r'-
6. Address ?? .9? ? ?'? ? .S ? ? - - - - - - - - - -
r
7. City State Zip ???? .,•
8. Building Type: Residential frl Cammercial ? Institutional ?
9. Work Description: New ED Add O Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tuhs Septic Tank
Lavatory Softner
_ Shower Well -
? Kitchen Sink
Urinal/Bidet OthLr
: Laundry Tray
Floor Drains +
Drinking Ftn.
51op Sink
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.
5igned
Rough
Vnspections: Date Insp.
for
Final
Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
Addition PARK CLIFF ADDN. ?at 3 glk 1. Parcel --GUIli 'C'a-Z
Owner bl?? .?' Street 4616 Pdxk Cliff Drive State EaganR MN 55123
Improvement Date Amount Annual Years Payment Receipt Oate
STREETSURF, g •QO A0?124 j?-2 -8
STREET RESTOR.
GRADING
SAN SEW TRUNK 3'
-if ?4.(? Ao??4 4-'?-83
*SEWER LATERALs?f 3031.?10 n n
WATERMAIN
* WATER LATERAL
WATER AREA 224.02 AOZ2124 4-21-E
STORM SEW TRK 01.E6 AOM24 4-21-53
* STORM SEW LAT 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
I
250.00 441 4-2 -83
WATER CONN.
450.00
"
"
BUILDING PEA.
SAC ?r M
PARK
Eogan. MN 55122
Zoning: '
Owner:
Address:
Site Address:
PPlumber:
1 egrea to eornpiy with !he Gty of Eagan
Ordinanees.
By
Date of 1 nsp.:
PERMIT NO.:
DATE: ? -
No. ot Units: ?
Connection Charge:
Acwunt Deposit:
Permlt Fee:
Surchorge:
Misc. Gwrges:
Totot:
Date Paid: -
CI"['1f 9F E!?GAN WATER SERV ICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eogan, MN 55122 DATE:
-, -?
Zoning: -
No. of Units:
Owner:
Address:
Site Address: "' "1 i T r ?. : ° ' • - -
Plumber:
Meter No.: Connection Chorge: '
Size: Account Deposit:
Reader No.: Permit Fee:
1 agres to eanpiy with tbe Gty of Eagan Surcharge:
Ordinoneas. Misc. Charges:
Totcl:
By Dote Paid:
Date of Insp.: Insp.:
BUILDING PERMIT
Site Addrcu .
Lot 3
Parcet # -
?c
W
Z
9
g Name _
v? Addreu
t- ri..,
Nome _
Address
I hereby acknowledge that I hove read this
the information Is correct and agree to c
Stote of Minnesoto $tatutes ond Cify of I
Sipnature ot Permittee _
A Building Permit Is iuued
oll work shall be done in a
Building Qfficial
EAGAN
Eagow, MN 55122
?+??v 7:???
Receipt #
Erecr la Occuponcy r- 3
/?Iter ? Zoniny K-1
Repair ? Fire Zone IJA
EnlarQs ? Type of Const. V
Move ? # Stories
Demolish ? Length 6
Grode ? Depth --15--?Sq. Ft.
Aoarovais Fees
ond
all ,
_ nssessmenr
Woter & Sew.
? Police
- Fire
- Eny.
Council _
a°e BIdg.Off.
APC -
Permit 445_50
Surchorpe 57_ 5fl
Plon check 222 . 75
SAG 5?S.OG
Water Conn4 Sn _ nn
Water Meter ??? T-)
Road Unit 2 -''!' , ] ;'
rmol $2005. 7 5
on the exprcss conditlon thnt
ond City of Eayan Ordiranut.
Psrmit No. Permit Holdar Misc. Parmit No. Holder
Plumbin9 ( -, V COE ?
H.V.A.C.
w.n
wner
nEbc?tric
t?oSql-L
B 4-C t(ec,
5-40
-fs3
Inspection DKe Insp. Other
Footingt
Foundetion
Frsminp
?e -
Rouph PI69.
Rougoh HVAC
Inwlation
,
Final Pibp.
Final HVAC ?
Final /
Water Describe Locatiom _
Well _
Sewer
Pr. Disp.
? CASH RECEIPT ?
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEIVED
AMOUNT ? I
& DOLLARS
t00
E]CASH ? CHECK
? White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
T ank You
• ? , BY
CITY OF EAGAN - 795Q
3795 Pilof Knob Rond Eogan, MN 5512= lr ? PHONE: 4S4•8100
BUILDING PERMIT Receipt #
7e be wed fe¦ SF DWG/GAR Fa vm.a 5105.000 n.,,a Anril 25 1083
Site Address 4010 YaTKC112I llY1V2.
Lot 3 BI«k 1 Sec/Sub. park Cliff
Porcel # 10 56700 030 Ol
Bassaw Builders, Inc.
Z Address 19131 Orchard Trail
A r«, Lakeville e,___ 435-7472
p Name _
0
Address
Nome _
Address
I here6y acknowledge thof 1 hove read fhis applicotion and state that
the inlormotion is wrrect ond ogree to comply with all opplicable
51ate of Minnesota Statutes and City of Eagan Ordinancea.
Signofure of Pertnittea
A Buildina Pemir is issued ro: Bassaw Builders, In
olt work sholl be done in acmrdonce wifh oll oppli e StaM f
Building Officiol
Erect )[[$ Omupancy R-3
Alter ? Zoning R-1
Repolr ? Fire Zone NA
Enlorge ? TvPe of Const. V
Move 0 # Stories
DemoHsh ? Length 66
6rode ? Depth 35 Sq. Ft.-
Aoorovala Faes
Assessment Permit 44S.-') U
Woter & Sew. Surchorge 52.50
Police Plan chetk 222.75
Fire SAC 525.00
Erp. Woter Conr650.00
Plonner Woter Meter 66.00
Council Road Unif 250.00
Bldg. Off.
APC Twol $2005.75
on t he exOresf conditlon thm
?ipfa5tatutes ond City of Eoppn Ordinancea
REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
' Sae instructions br compleM1ng this form on back of yel low copy.
"1(" Belo? W110FR 121 by This Request 315 -7 3 a
evv AAtl HeD. TyOe oi Bwltling Appl.ances Wnretl Eqmpment Wved
Home Aange " Temporary Service
Duplex Water Heater Lighuny Fixtures
Apt. Bwiding Dryer Electnc Heatin
Commercfal Bldg. Furnace Silo Unlodder
Industrial 01dg. Air Conditioner Bulk Milk Tnnk
Farm oin, oe<:? v omu, isueo:tvi
[ha.r Spen y Other Othur
Compute lnspection fee BeJow
N Fee ServiceEntrance$ize k Fee Faxtlars/SabfeeAers Grcurtg
0 to 200 qm s 0 to 30 Am s 0 tn 30 Am s
Above 200 qmpy 31 to 700 Amps t 31 to 100 A s
Swining Pool Ahove 100_Amps Above 100_Amps
Transiormers Irrigation&ooms PartiaVOtherFee
Signs Speciallnspection S "'o
T
Rem?rks OT L FEE
? 'f nn
gj? Rou9h-m ( D:'r,? % ?y3 I. [ha Elec " " -
Y? Q Inspactor, hereby
certity that the abova
Final (' D.I. {?qinspection has been
r-(,? ? maee.
ThIS raquasl vald 18 monlhs irom
,h,=,e4uest void S-(D L3 L B l ?PcJ.1- ai F?
1B rtronths fmm
bV0 59127
?-7 <OV
Request Date Fire No. ReQgbed?lnspecvnn
E]ReadY Now 5?Wili NuviY Inspe?'-
'5:^ (4 "' g-L
1 J
'gYes ?No
mr When ReadV
gLicensed Electncai Conlraclor I heraby request inspecnon of above
? Owner elactncel work installad ar
Stree[ AdAress. Bax or N e No. Gty
J
ecLOn o. Townshiu Name or No. Ranye
. Count
Z-V?
Occupai PRINT) Phnne Nu.
Power S pber Address
Electrc Cqnhactor ICOmpany Namel Contractur's License No.
?? L ? bYo?3S°
Mailin0 .?r.[d
Jress lConVactor or Owne/r Makine l nst
a/1?'lahunl
?
J 2 V ? C?C .
PV`!4- E-7-
AuNonzed Signat e (C or/Owner Mak? InstaliaLOn) Phone Number
/a
Lc/ L `
MINNESOTA STATE BOA F ELECTAICITY THIS INSPECTION PEQl1E5T WILL NOT
Griggs-Midwav Bltlg. - oom N-191 BE ACCEPTED BV THE STATE 80AHD
1827 UniversitY Ave.. St Paul, MN 55104 UNLESS PqOPEX INSPECTION FEE IS
oo, i'll ENCLOSED,
'Ib Be Used
Jr-
CzTY OF EAGAN
BUILDIM
Cn. a ,r--
Site Pddress ?
Int 3 Block / Sec./Sub.
Parcel #: ! D S(9`10o d 30 o
Ovmer: -;
Address:
City/Zip
Phone #:
Contractc
Pddress:
City/Zip
Phone # : rf ? 5 = 7f 7,;Z-
Arch./Ehg.:
Address:
City/Zip Code:
Phcne #:
Include 2 sets of plans,
1 site plan w/elevations &
1 set of energy calculations.
_ nate ? - "2-0 - ,g •3
e CiFFICE USE ONLY
Erect -- occupancy --v PT-?3Alter Zoning K r _
Repair Fire Zone A) A
Ehlan3e _ 'Iype of Const.
Nbve # Stories
Demlish Front G ft.
Grade Depth 3s ft.
APPROVALS FEES
Assessrnnts PeLZnit
?aater/Sewer Surchar9e S,2
Police Plan Check r26c a
Fire sAC Sa ,5-
EnJ •
water Conn. yS-U
Planner Water Meter /o6
Council Road Unit .%°
Bldg. Off.
AFC
=AL 4:v???? 1
?'.
;ZFs
?
I (7 ? ? ? 0
ti
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C:r. rY Cli- C"Ai:;AN
MSFI'CL::R; :iS i[::Riti:CNAI. h!fl: 340
11F)1':";; C)s'si16/99 T'iMl';.: 32:Mc49
SD.,
P!A;4..c rON[:;li:!'rL1AL DkSTG;t4
'.Sc::lC1 9(:10'I. q{ilf, F'AF:F:L'I_:LF ii 125 .r'?5
2155 9f.Hl:l. 4E>lE- 1='ARh:rL21°' I) .;,fIO
'iot.i:l. hec:eip+ Amni.erN;:
Cfil9.5452.
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n??'M?kY,<?t7%W'K%KYF:{;:{C?k?>FjFAciKY,'3[?kNcm.?7?i:'?.'?:3Kk?$ k'M%FA+?A?#
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1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL) .. •
CITY OF EAGAN '
00 3830 PILOT KNOB RD - 55122 651-681-467t
New Conshucfion Reaukemenh
D 3 regisfered sRe wrveys showing aq. H. d lot, sq. tt, of house
aMl Q rooled areas f20% maximum bT covewae albwed)
D 2 copies of pinns (show beam a wfndow sizes; poured ind. design; etc.)
D 7 sef of energy caiculationa
D 3 copies of hee presenaNon plan H IW plaMed after 7/1/93
DATE: Z!&A
DESCRIPTION OF WORK: %^64?L - CIt?2or? ?.?ia-?G. D•4
STREET ADDRESS: SLGI G FVCC CCi"ff- /?Ci
LOT: '?l BLOCK: I_ SUBD./P.I.D. #: ?a
Remodel/Reoalr Reaulremenh
2 copies of Plan
0 1 set of energy cakutafbns for healed addNfom
1 sNe suney fa extarior addifions 3 decka
CONSTRUCTIONCOST: ?/X'cu
PROPERTY
OWNER
Name: ?r//Q-> L -jUNn/ Phone #: r- 1
Lasf First
Sfreet Address: 41616 A21C /e;?y ?, ?'e
City 4? 4-/ State: 141" ° Zip:
Company:?yf?'1'?fi??yj?(., /,?& /? Phone #: ???( r 3,3&
(area code) Y31 - 33!93
CONTRACTOR
ARCHITECT/
ENGINEER
SheetAddreu: &4p?- /?? 4-9 S7' ?jeaT LicenseExp.
Cliy State: _ZVN'
Company: Name:
Telephone #: area code ( )
StredF
CiFy
Sewer 3 water Iicensed plumber (reaulred for new conzhuction onlvl:
State:
Penalty applies when address change and lot change is requested once permN is issued.
Zip:
I hereby acknowledge that 1 hwe read 1hh applkaHon, state that the Informofion is cortect, and agree to comply with all applicabl
State of Minnesota Statutes and Cffy of Eagan Ordinances.
Slgnature of ApplicanY.
Certificates of Survey Received _ Yes
Tree Preservation Plan Received _ Yes
OFPICE USE ONLY
_ No
_ No _ Not Required
Registrafion #:
', .. -. ..
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex 0 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool 0 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant impr ? 39 Gas Line Only 13 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Afleration ? 37 Demolish Bldg.* ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
• Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Engineering
Census Code
SAC Code
No. of Units
No. of Bidgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee -),?
Surcharge 3. C)
Plan Review
License
MC/ES SAC ;
City SAC
Water Conn.
Water Meter
Acct. Deposit
5/W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
TotaL• t -3- .
Valuation:
SAC Units
% SAC
T?Wci
i:
(1
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Tbr,clc c'?sBD ?9?c Rr?E?9 AIquJE Fzocie =?/y?..3
(-a) 7'orNc. wAc.c wi?v?v 446w
6 0) TorRc DooiC A/leFiq = 3v • 9
(0) ror?9c. 5u0i?v& 6mc4ss Doort .9•¢e'A = .j3 - 8
C°? J ToTAt FilLEP?RC.C' u.yqu. i92Ey = G/ s- s'
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CLE?o?1/ ,w
CITY USE ONLY
PERMIT #: qw& RECEIPT DATE: ?-I3 `0'
RESID£RTIAL blECfiAAICAI. i'ffiMIT APPLICATiON
6?
/ crrYoFEAsAv
ssso PaoT icxaa itn
e,e?sMauv ssi22
651-8$7-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: 03 j 0 5.1 0 I
SITE ADDRESS: _q f,p f(p p/l 1- K G ?? t-? ? r i? P
OWNER NAME j0 ?Vl paJ)-I 6Li- vV 1-ed ! TELEPHONE #: &51 H59 " 5105
(AREA CODE)
INSTALLER NAME: _Wohlers Southside Htg. & A/C, Inc.
16950 West 146th Street, Suite 106
STREET ADDRESS: _Apple Valley, MN 55124
CITY:
TELEPHONE#' ?So1 t'I3?'???nl
(AREA CODE)
.,F.,P?. -- ' ZIP:
Place a theck mark next to the oermit work tvoe
_ New residential dwelling unit under constructionand not owner/occupied $ 70.00
X_ Add-on, modification or alteration to existina dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
• other
Natureofwork: Y`P»lQCC ftkYrCtcP Q iY' C.vYA 'i -44 oYlPi'-
State Surchar e $ 50
Total ^
Reminder: C¢Il for inspections.
Upda[ed 1101
SIGNATURE OF PERMITTEE
CITY USE ONLY
PERMIT #:
APPROVED 6Y:
INSPECTOR
RECEIPT DATE:
COMMERC1i4L MECHkNICAI. PEitMiT ihPP11CATIOR
CI1'Y oF $tgcslkN
3$30 PILOT KAOB itD
KAfiiR1V, MN 55122
651-6$1-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #: -
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLI'):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
WORK TYPE: _ New construction
_ Interior Improvement
_ Processed Pipmg
PHONE#: -
(AREA CODB)
STATE:
Z8:
Install U.G. Tank
Remove U.G. Tank
Specify Nature of W ork:
When installing/removing underground tank, ca[I 651-6814675 for inspection by Fire Marshal and
Plumbing Iinspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaVinstallarion = m;nimnm fee
Contract price: $ x I% _$ (Base Fee)
State surchazge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated 1/Ol
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
?--
O-Ni-ce--Use -----------
? For ?
I
j Permit
; Permit Fea: L7) ?
? Data Received.
I StaH: t ?1' f I
-----------------?
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 7.01l, 1 G.( kc1 .'ff 0{
Tanant: 'F^ 4- A!v ?i vAk-- Suite#:
RESIDENT f OWNER Name: !;.I w? phone:
Address / Ciry / Zip: 4t 110 pa"C-G W p/1 Je M 1i1
Applicant is: ? Owner _ Contractor
' ij
A
j
TYPE OF WORK U
e
Description of work: (e Iy)D
Construction Cost: +lO -30 o Multi-Family Building: (Yes No ?
CONTRACTOR Name: -' W i1r iZ License M
Address:
te: Zip:
City: Sta
?
Phone: ?I"`'IDJ' ?`39G' ContactPerson: / (Scy"e- d I , riZ
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
EnCrgy COd6 • qesidenlial Ventilation Category 1 Worksheet • New Energy Code Worksheet
CatCgory Submitted Suhmined
(4 SUbmi9sion type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permk for a similar plan besed on a master plan?
_Yes ,dNo If yes, date and address of master plan:
licensed Plumber: Phone:
Mechanical Contractor; Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents thaf you submtt are considered to be public informetion. Portfons of
the lniormation may be class7fled as nonpublic if you provide specNfc reasons that wouW permlt the Ciry to
conclude that the are trade secreis.
I hereby acknowledge that this information is Comple[e and accurate; Ihat the work will be in Conformance with the ordinances and codes ot the Ciy af
Eagan; that I understand this is not a permit, but only an application for a permit and work is not to start withaut a permit; thal the work vnll be in
accordance with the approvetl plan in the case oi woHc which requires a review and approval of plans.
x C-X' x???1-?f??
Applicant's riMed Name J r?4ppt?caM's
I? gnature a? 1 of 3
? U
MAY 2 - 2008
` DO NOT WRITE BELOW THIS LINE
? . SU8 TYPES
? Foundffilon ? 05-plex ? 16plex ? Accessory Building ? Paol
? Single Family ? Obplex ? Flreplace ? Porch (3-season) ? Ext. Alt. - Multi
? 01 of _ Plex ? 07-plex ? Garage ? Porch (4season) ? Ext. Alt. - SF
? 02-Plex ? 08-plex tg Deck ? Porch (screen/gazenwpergola) ? MuRi Mlsc.
? 03-Plex ? 10.plex ? Lower Level ? Storm Damage
? 04PIex ? 12-piex ? Miscellaneous
WORK TYPES
? New 0 Interior Improvement ? Siding ? Demolish Building'
? Addition ? Move Building ? Reroof ? Demolish Interlor
? Alteration ? Fire Repair ? Wlndows ? Demolish Foundatfon
2K Replacement ? Egress Window ? Wster Demage
' Demolihon (entire building) - give PCA harWout to applicant
DESCRIPTION: n
Valuation Occupancy MCES System
Plan Review Code Editlon SAC Unlts
(259/6 _ 100% %?j Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feei PRV
# af Buildings Length Pire Sprinklers
Type of Const. A7- Widih
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock
Footings (deck) FinaUC.O.
?
Footings (addiiioa) ? FinaUNo C.O.
FOUndation HVAC
Dreln Tlle Other:
Roof: _Ice & Water _Final Pool: _FOOTings _Air/Gas Tests Final
Framing Siding: _Stucco Lath _Stone Lath _Brick
Fireplace:_R.I. _AirTest _Final Windows
Insulaiion
-
- Retaining Wall
//--
Reviewed By: Bullding Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utllity Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
okl-,W&
Page 2 ot 3
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PRAPo`°E? ?. ? ?
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Sev^-II'mh -3 ? ?Q(d
tpp ,7 Propaoed garage floor elevatian
'n {0O1jE_ Propoaed xop of block elevation
? _=L7- Propoaed basement floor elev.
?'e
/Lo Denotee iron pipe monument
g Denotes setback monument
lwrj,ZDenotee exiating elevation
?Denotes propoaed finish grade elej
? Denotes direction of surface
drainage
N 1
I hereby certify that thia is a true and
correct representatioBlockala PARKCLIFFhf
boundariea of Lot 3, ,
? the County RecorderecDakota County fice o:
Minnesota.
Also showing the proposed location of
a house as staked thereon.
7op 400
PAs+1 .- lDD7,8
Top leap? 90•00 5101°3000 E" ??j ^Ie9
? = tioo?•1. -?__------'!^ ; oo
Y
Dated: April 22, 1983
? LREOSTRA(TI?%
NESOTA DN NO 86?
tBassliw Conetruction
19131 Junelle View
Lakeville, Minnesota
55044
!
DELMAR H. SCHWANZ
lANOS RVEVON9I INC•
RpistoW U s of TM StaU of MinMSOta
/
2878 - 1A67}f STNEET W. - BDX M NT. MINNBSOTA 86008
*p, y? S ? 5UR_E R'SCERTIFICATE
r ? l
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(Y')
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?8` •. d?°' '100p? ?
°? ?pp'1.? m ae o
`?`• = Qp,.oPo'bFA
(11 ? ?}A?e ??,.4F
? ,.,
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?I1w-?+
, ?De????F ?
UTuxr`( EMSEMen'
I
19
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1
Also showing the proposed location of
a house ae ataked thereon.
a114,10? Top "ua
Ei.sd < <?CZB
eI
- ?-? °)Q. 00 5(o{030 00? E _' op ?eoa
Top 1Qaa ? , ? = 10069
VA_PA= 1oa9•1: _------ 0
3
:
0
d
0
N
BK 4?6/49
PHONE 812 473-1780
SCa?e^l i'nc=30 ?ed
1 8 7 P'ropaoed garage floor elevation
? 1001.1 _ Proposed top oP block elevation
J=Jff- Proposed basement Ploor elev.
0 Denotes iron pipe monument
e Denotes setback monument
lon2 Denotes existing elevation
? (93)Denotes propoaed finish grade ele,
Denotes direction of surPace
N ? drainage
I hereby certify that this ie a true and
correct repreaentation of a survey of th,
boundaries oP Lot 3, Block 1, PARKCLIFF,
,$s on Pile and of record in the office o
the County Recorder, Dakota County,
Minnesota.
Dated: April 22, 1983
? f
MINNESOTA HEfi1STRATION NO. 86
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA082370
Eagan, MN 55122 . Date Issued: 03/27/2008
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4616 Parkcliff Dr
Lot: 3 Block: 1 Addition: Park Cliff
PID 10-56700-030-01
Use
Description:
Sub Type: e-Windows/Doors Construction Type:
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: A framing inspection is required when installing a Bay or Bow window or if the opening is altered. Smoke detectors are
required in all sleeping rooms prior to final
inspection. When wall studs or ceiling joists are exposed, hard-wired detectors are required. Battery operated types are
acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: -Applicant - Owner:
Renewal Andersen Gregory T Siwek
1920 County Road C West 4616 Parkchff Dr
Roseville MN 55113 Eagan MN 55123
(651) 264-4777
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.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA097219
Date Issued: 11/30/2010
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4616 Parkcliff Dr
Lot: 3 Block: I Addition: Park Cliff
PID:10-56700-030-01
Use:
Description:
Sub Type: e-Fireplace Construction Type:
Work Type: Gas Fireplace (new)
Description:
Census Code: 434- Occupancy-:
Zonin,:
Square Feet: 0
Comments: Improvements to the home may require smoke detectors in all bedrooms. Chimney flue must be inspected prior to
concealin,.
Carbon monoxide detectors are required bn law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Heath and Home Technologies Gregory- T SiNvek
2700 N. Fairview Ave 4616 Parkcliff Dr
Roseville MN 55113 Eagan MN 55123
(61)633-261
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
V, A i
Use BLUE or BLACK Ink
For OfficeUse-----__--
Permit ) ~ I
City of Eap I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 I Date Received: j
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -J Site Address: Unit
~ Name: X"' Phone:
RESIDENT I
OWNER Address/ City/ Zip: i/'e'~~
=Applicant is: Owner Contractor
4 TYPE OF WORK Description of work: et.z off- ~tr~
Construction Cost: 1/ '.2-1 & ` s O-~ Multi-Family Building: (Yes ! No )
Company: . S fc .flit Contact: Sm j4 YO
Address: 7~ 7--✓V AVE ~ City: _5)01__ J`'!W 41d
CONTRACTOR
State: / Zip: 5--:511-7 Phone: C. y!1
t
License J ~Vo~ o9 ~ Lead Certificate IVA7 11
II~ 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:
I ^NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe 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.oopherstateonecall.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 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 M neso late Building Code must be completed within 180
days of permit issuance.
ry► cF S E
x x
Applicant's Printed Name App@§#as Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type: Building
Eaaan. Permit Number: EA103883
Date Issued: 04/23/2012
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4616 Parkcliff Dr
Lot: 3 Block: I Addition: Park Cliff
PID: 10-56700-01-030
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Replace
Description:
Census Code: 434- Occupancy-:
Zonin,:
Square Feet: 0
Comments: Kara Benson
9533 - 367th Street
North Branch. MN 55056
651-674-1766
Fee Summary: BL - Base Fee $500 $40.00 0801.4085
Valuation: 3.452.00 Surcharge - Based on Valuation $500 $0.50 9001.2195
Total: $40.50
Contractor: - Applicant - Owner:
Renewal Andersen Gregory- T SiNvek
1920 County Road C West 4616 Parkcliff Dr
Roseville MN 55113 Eagan MN 55123
(61)264-4777
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 Cite of Eaaan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA151961
Date Issued:09/19/2018
Permit Category:ePermit
Site Address: 4616 Parkcliff Dr
Lot:3 Block: 1 Addition: Park Cliff
PID:10-56700-01-030
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Jacob N Vanscoy
4616 Parkcliff Dr
Eagan MN 55123
Liberte Construction Llc
1406 West Lake St, Suite 202
Minneapolis MN 55408
(612) 999-7663
Applicant/Permitee: Signature Issued By: Signature