4049 Pennsylvania AveCITY OF EAGAN l ., . 0 ,.
3830 Pllot Knob Road, P.O. Box 21-199, Eegan, MN 55121 •` '?' `
PH ON E: 454-8100 BUILDING PERMIT Receipt # -4 I ?•
To be used for ? F G"C-j/r;Al; Est. Value $ 13 . (3Uu Date I'!AY 10
Site Address 404'9 PBNNSYLVIIHIA AVL?
Lot 12 Block 4 Sec/Sub. 6TAF?M PLACF
Parcel No.
a Name n=*IEj! lRDWEST !i0WE3
? Address 3902 CEDAf.VALE DR
=
CitW EAGAN Phone 454-0433
w'
,o Natlne $?
? Q Address
? City Phone
?
W W
W
Name
F Address
? W City Phone
I hereby acknowled8e that I have read this application and state that the
information is corre t and agree to comply with all?applicable State of
Minnesota Statutes?nd City of Eagan Ordinances.,
Signature of Permittee ' y
A Byilding Permit is issued to: FitU'ME[{ .';I1i1.ILST NU?2E$
on tMe express condition that al I work shal l be done in accordance with all
applcable State of Minnesota Statutes and City of Eagan Ordinances.
.
Buitding Official
OFFICE USE ONLY
On Stte Sewege Occupancy R-3
MWCC System k Zoning R`1
On Site Well (ACtual) Const V-M
Ciry Water X (Allowable) Y-N
PRV Required # of Stories
Boaster Pump Length 401
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 466•00
Planner Surcharge 36.50
Council Plan Review 233•00
Bldg. Off. SAC, City 100•(X)
Variance SAC, MWCC g50s00
Water Conn. 550.00
+ Water Mgter 67.00
RoadUnit 325•00
i Treatmer? P1 24'?•?
y Parks 2_5" 7-So
TOTAL
CITY OF EAGAN
. `
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 -
PH ON E: 454-8100
BUILDING PERMIT Receipt
To be used for ' - Est. Value 17; 9tj0ki Date ,19 "
Site Address O FFICE USE ONLY
Lot ' BloCk Sec/Sub. 'r?T? ?'GnCt' On Site Sewaqe Occupancy
MWCCSystem 'Zoning
Parcel No. l
C
On Site well )
onat
(Actua
a Name City water ? (Allowable)
W
z
Address ` PRV Required ? of Stories
0 City Phone ~''-".33 Booster Pump Length '
Depth
p Mame S.F.Total
,
4 Address Footprint S.F.
?
P City Phone APPROVALS FEES
? W Name Engr./Assess. Parmit
Planner Surcharge
_ g AddreSS Council Plan Revfew
s W City 'Phone Bldg. Off. SAC, City
I hereby acknowledge that I have read this application and state that the
variance
SAC, MWCC
' '--
information is correct and agree to comply with all applicable State of Water Conn.
MinnesOta Statutes and City of Eagan Ordinances.
Water Meter
Signature of Permittee Road Unit
A Building Permit is issued to: - Treatment P1 '
on the express condition that all work shall be done in accordance with all
Parks
applicable State oi Minnesota Statutes and City of Eagan Ordinances.
TOTAL
Building Official _
Permit No. Permlt Holder Date Telephona ?
PIulnbing
H.V.Xc.
Electric
?
Softener
Inspect+on Date Insp. Comments
Footings I s ??
Footings II
Foundation S--23-P QS, /1/.r- 0 re4e
Framing .?.? S
Roofing
Rough Plbg.
Rough Htg.
Isul. •-I?+? S
Fireplace
Final Htg. ??P
Final Plbg. 7 ?M
Bldg. Final
Cert Occ. ?
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
, . . . . PERMIT #
• . • . MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: msy 19.1983
CONTRACT PRICE: PHONE: 454-8100
Site Address BLQG. TYPE WORK DESCRIPTION
Lot '-? Block Sec/Sub xx
xx
Res.
New
' Mult Add-on
m
-L
iQZII
Name
19
. IiSp,TING 6 C
h
Comm. Repair
?c 55
Address S
a,wnee RoBd
c City EaRan Phone 45 2-
1565 Other
FEES
? Name Fr RES. HVAC 0-100 M BTU -$24.00
c Address 3 ADDITIONAL 50 M BTU - 6.00
p City '?ggn Phone 454 -0433 (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS
MINIM
M
1 PER PEF
II
5
EA
(
-
N
n - 1.
.
U
0
TYPE OF WORK COMM/IND FEE - 1% OF CONTRRCT FEE
Forced Air 80+000 M BTU 24.00 APT. BLDGS. - COMM. RATE APPLIES
Boiler
M BTU TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU $ MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # $ 1.50 BEYOND $1,000)
Other
FEE 25.50 ?/(1'. F • ;' ,. ' f•
. 50
S/C: SIGNATURE OF PERMITTEE
TOTAL $26.001 1
FOR: CITY OF EAGAN
{T
? .J
• , , . ..
CONTRACT PRICE:
PERMIT # -
PLUMBING PERMIT
CITY OF EAGAN RECEIPT #
3830 PILOT KN08 ROAd, EAGAN, MN 55122 OATE:
PHONE: 451-8100
Site Ad rp?ss IL' S vlj_?
?
?'? ?Block, SeciSub
Lot
f
m Name, lCl(l' ii
r- ?
'
m a_
Address S S ? F
'
4
c °
Ciry
Phone
? Name
3 Address ?76 me'y iv U
p City Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
dl`7d
L
SI(3fJATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. X New
Mult Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
FIXTURES ?OTAL
Water Closet - $3.00 Bath Tubs - $3.00
Lavatory - $3.00 ?
Shower - $3.00 ? . DC
KitChen Sink - $3.00 ?• ?'?
Urinal l8idet - $3.00
-7"-Laundry Tray - $3.00 Q
-TFloor Drains - $1.50
?Water Heater - $1.50 -D
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
=Rough Openings - $1.50
FEE ? C?
STATE S/C:
`361 _5W,
GRAND TOTAL:
/
, --
(ger#if irafr uf (Orrupanry
Citp of eagan
ioPpmt1tPttt Af iltwm 3wPl'ti011
This Cenificale rssued pursuant to 1lre requirements of Secnon 306 of the Unijorrn Building
Code certifying that at the time of rssuance this strucrure was in compliance with the various
ordinances of the City regulaling building construction or use For tlre following.•
Ux CUs6finuon 4F DWG J GAR e? Pamit xo 14984
O-V-YTnx R-3 74mn DLWid R-1 ? V-N
? ._ _.. E'ron[ier Midwest -0'??rva e r.
B"ng
ace
July 22, 1988
DW:
POST IN A CONSPICUOUS PLACE
OF E{;G11N Permit No:_
Pilot Knob Road Meter No: _
3ox 21189 Reader No:
n, MN 55121
9576
Date:
Size:
Date:
5-13-88
,r Front ier ' `idvest CArp.
„l,???? 40?r pennsrlvania Avenue
rr.
Chg: - - Zoning: _
)ep: ' No. ot Units:
rmit Fee
rcharge: • 1'•ipd I agree to comply with the Clty of Eagan
Plant 264• nbd Ordinancea.
?ter.
sc.: By
WATER SERVICE PERMIT
? c
CITY OF EAGAN Permit No: 1 -' r'+''+ ? ' Date:
383i' Pa1411 enob Road B/ P No: ., '' Date: -' Z •
P.O. Box 21199
Eagan, MN 55121 ?
n,....,,.. ' r- •.°i . r. _,?.'^.:?. ;.. _ : i Vt'-„_ .....
Plumber. sr.ar YlUmhyn-
MWCC: 550. G??p?`. .•,
Zoning?
City Chg: '00. ?? No. of Units:
Acct. Dep: - 15. 00pd
Permit Fee: ? n ?i??,? I agree to cornply with !he Cfty of Eagan
Surcharge:
' Ordinances.
By
SEWER SERVICE PERMIT
CIT. = EAQpN Permit No: Date:
3830 oilot Knob Road Meter No: 3, 3? Size: S R?-
P.O. Box 21189 Reader No: 16 Date: 7-?- g C
Eayan, MN 55121
Owner. FrQntier ?'idwest Corp.
SiteAddress:_ 4049 Pennsvlvsnia Avenue L12 B4 Sta{Ford Place
Plumber Star Plumbinv,
Conn. Chg: 5 50 _0(tnri Zoning: F7
Acct Dep: 7 5- 00! ii No. of Units: 1.
Permit Fee: _ 1_ n nn'aa
Surcharge: Sn= ? I agres to com th of Eagan
Tr. Plant %n6 Ordin ss.
Meter.
W. _ . ?
WATER
CASH RECEIPT
? CITY OF EAGAN ?
?i
3830 PILOT KNOB ROAD
• EAGAN, MINNESOTA 55122 :
r• f
. DATE
1
AMOUNT
? . . . . & DOLLARS ro
? CASH *CHECN
I ,'. .
Thank You
ev
?
?q,r - : .
wmk,-re»n a;v
V 2 713 3 Yelbw-POS6n9 CVY . .
. PiNk-Flle Capy •
BLDG. PERMIT NO.
l-..o-f- 1 Z-(?) (oeAc4
? 0 Li p0 A V{
01-3270 Bldg. Permit Oo
01-3422 Plan Check 3 00
01-3445 Surch./Adm. -75
01-3446 SAC/Adm. ? SC
OY-2155 Surcharge
75-3860 Road Unit
20-2275 SAC
20-3865 WaterConn. 55c CCz
20-3868 Water Trmt. co
20-3716 Water Meter Ue,
20-2252 Acct. Dep. -`)
20-3713 Water Permit ? C
20-3743 Sewer Permit
79-3866 Sewer Conn. ? C 0
28-3855 Park Ded.
0 '1
TOTAL - + -
1
CITY OF EAGAN Na 14984
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
' PFIONE: 454•8100 p ?? ? ?
BUILbING PERMIT Receipt# aJ
Tobeusedfor SF DWG/GAR Est.Value $73,000 Date MAY 10 ,79 88
Site Address 4049 PENNSYLVANIA AVE
Lot 12 Block 4 Sec/Sub. STAFFORD PLACE
Parcel No.
w Name FRONTIER MIDWEST HOMES
= Address 3902 CEDARVALE DR
' ? City EAGAN phone 454-0433
OFFICE USE ONLY
On Site Sewage - Occupancy R-3
MWCCSystem X Zonin9 R-1
OnSiteWell _ (ActuapConst V-N
City Water X (Allowable) V-N
PRV Required _ # of Storiea
Booster Pump _ Length 40'
Depth 4$'
S.F. Total
Footprint S.F.
a Name_
0
0Q Address
? City_
w
i
3
W
Name _
Address
C ltY _
I hereby acknowledge that 1 have read this application and state tha[ Ihe
intormation is correct and agree to compl with II pplicable S[ate of
Minnesota Statutes and C?iry of Eag anc .
Signature of Permittee '„
A Building Permit is issued to: FRONTIER MIDWF$'r__RQISE$_
on the express condition ihat all work shall be done in accordance with all
applicable State of??11 mnesota Stdtutes and City of Eagan Ordinances.
Building Official-!
APPROVALS
Engr./ASSess.
Planner
Council
Bldg. Off.
Variance
FEES
Permit
Surcharge
Plan Review
snc, ca
SAC, M WCC
Water Conn.
Water Meter
Road Unit
Treatment Pt
Parks
TOTAL
466.00
36.50
Z??QQ
1QOs94
_55Qs.Q0.
5.`74_09.
67 _nn
-32J?O4
204.00
2,531.`_^
Oi/eg'
E 16070
REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-os
N ?? 1
? Sea instructians lor completing this lorm an back of Yellow copy. ?•
"X" Below Work Covered by 7his Request
Fdd FleO: TyOe of 6uildinB AoVliuncea Wiretl Equlumenl Wired
Home Ranqe Temporery Service
Duplex Water Heater L htiny Fixtmes
Apt. BuilAing Dryei Electric Heatin
Commercial BIAy. nace Silo Unloader
Industrial BIAy. Air Conditioner Bulk Milk Tank
Farm oinrr oe?_i y (1ihe,lsnc?:?tv?
1 er 5ucuiv otncr Otncr
Cmmrinte lnsaection Fer. Below
p Fee Service EntrenceSize fl Fee Faxders/5ubfeaders k Fna Circuits
0 ro 200 Am 5 0 to 30 qm s tn 30 F1m )s
Above 200 qIrIpy 31 to 100 Amps 1 to 100 Am ,
$wimming Pool Above 100_Amps Ahove 100_Amp.s
Transtormers Irrigation Booms Partial- 0 WaL.Fee
SVecial Inspection
.el
cerlily Ihet the above
?ieM? inspaction ha5 ba0n
d/ maaa.
mre requeat.aa
This renuesl void l./!'1/? d
18 nnnlhs Irom ?L 7 O
E 16070 ,9./3/l
Re ¢etUate _ Fire N Houph-'n Vection
Reqmr
E]HeadY Now ?1MR?Nntity Insoeo-
es ?NO Ior When Peady
0?L1censed Eleclrical ConVador I heraby neQUast insoection ot ebove
? Owner elechical work instelletl at
$tree Ad ress, z oute I City
w /
?"!v
S. mn o. own hlp me ur No. HTnge o. Gnumy
Occupant IPpINT
.c3?i ?e •
tit Pho No.
s? o?
Power Su I er ?
1 C/ ?/ Address
Electrical Cnntraclor (Company Ny??t^
r ? L` 1371??
fill Cqntr:r.l ' Li?se No.
Q
Maili ess I?raN{ e 'n
1'? r ion)
55124
Authorizjk [ 1 er Makinp Installationl Phone mber
-
MINNESOTA STATE BOAPD OF ELECTRICITY THIS INSPECTION NEQUEST WIIL NOT
-- -' ' gE ACCEPTED BY THE STATE BOARD
Grigqs-Midway BId?.- Foom N:19'1" 1821 UnivertilvAVe.. SL Paul, MN 55106 UNLESS PPOGEN INSPECTION FEE IS
Phone(612) '642-0800 ENCLOSED.
?1
?4 610 ?is
Requesi Date ir qough-in Inspedion
Fequiretl'+ ReaOy Now ? W II NoGty Inspactor
G Yes ? No When Ready?
icensed contractor ? owner hereby request inspection of above elecVical work at:
Job Atldress V 1. x r oytp,Na ? City
L ' ?
SMion No. Townsnip Name or Nfo, ange No. Cou
Occu0an11PRINT ? PhoreNO- -
I C(.
Pawer Suppirer AtlErass
Elechical Conllac r'C Nam
I ? Cont clor5 License No.
?. o
Uadmg AOtlr ra or Owner kin In falion)
1
,
Aulhoriiea Signat Ira m wner M i g Insialtatio ? Ph Number
MINNESOTA STATE 80ARD OltELEC ICITV ? l THIS INSPECTION REQUEST WILL NOT I
Griggs-MlEway BIOg. - qoom 5.113 BE ACCEPTED BY THE STAtE BOARD I
1821 University Ave.. SL Paul. MN 5 100 UNLESS PROPEF INSPECTION FEE IS
Plrone(612)6<Y-W00 ENCLOSEO.
?' ? ?? REQUEST FOR ELECTRICAL INSPECTION
J5401 ? See insVUCtions lor mmpletinq I?is lortn on back oi yellow copy.
'X" 8elow Work Covered by This Request
J EB?.j00C0/p1-0?8+
/?/ TT/
?.?
ew Atld' Fep: - TypeofBUiiding AppliancesWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater Eleciric Heating
Apt. Building Dryer Other (Specity)
F omm.llndustrial Furnace
arm Air Conditioner
Other(specity) Op ractor's RemaMS: Compute Inspection Fee Below: I'll
# . Olher Fee # ServiceEnirenceSize Fee # Circui[s/Feetlers Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Trensformers Above 200 _ Amps Above 100 _ Amps
SignS Inspecror5 Use Only: TQ7
Inigaiion 8ooms ev
Special Inspection ?
Aiarm/Communication THIS INSTALLATION MAY BE ED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MON'fHS.
I, the Eleclrical Inspector, hereby RO°9n-'" Daw
cenify that the above inspeclion has
6een made. F,,,ai r osre ?
OFFICE USE ONLY ?
This request vaia 18 months from '
? ? 4E)
D. ?,90
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Canstrucfion Reouiremmts
3 regtstered site surveys showing sq. fl. of l04 sq. R of house; and all rooted areas
(20%maimum lot coverage allowed)
1 Soils RepoR'rf qopased bmlding is lo be placed on disNNed sal
2 apies of pan shawing beam 8 winMax sizes; poured lound design, eta.
1 setof Enragy Cakulations
3 mpies M Tree Preservation Plan if lot platled afler 711193
Pom Jolsl Detail Oplions selectian sheet (buildings with 3 or less umis)
Nfinnegasco mechanical ventilation fortn
RemodeVReoair Reauirements
2 capies of plan showing footings, beams, joisLs
7 sel of Ene`gy Calculabons fa heated additians
i site survey fw addifions 8 dedcs
AddPo'on - (ndicate ilm-site sePtk sysfem
Offze Use Onh
Cert ofSurveyRecd` ' _Y _ N
ShcsRepat. - -_Y._ N
TreeRresPlanRecd Y-7_ N,
Tree Pres Required' Y N
OmiGeSepticSystem'. _'Y.._ N
Plans are considered ublic information unless ou state the are trade secret and the reason.
Date 42 / 1,Z / 44 7•
Site Addreas Construction Cost ?
UniUSte #
Description of Work la r
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0_ 1 _ 2
Property Owner Ti../i. /_/ Telephone # ( d?'/?2
Contractor u: vlc G,
99 m?e
1
Address
State /Sf? c L `r? City ,?l o
Zip Telephone #(6!d ) P/P ?-sd 6?F
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventiiadon Category 1 Worksheet • New Energy Code Worksheet
(+l submission type) Submitled Submllted
. Energy Envelope Calculalions Submitled
In the lasi 12 monihs, has ihe 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 Telephone # ( )
Mechanical Contractor Telephone #( ?
Sewer/WaterContractor Telephone#( )
apply for a
Permit and acknowledge that the
complete and accurat
e;
that the work will be in conformance with the ordinances and codes oT the City oi r;agan ann me 6iate oz rviN
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.
ApplicanYs Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? Ot Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? OS 03-plex
? 06 04-piex
Work Tvpes
? 31 New
? 32 Addition
? 33 Alteration
? 34-Reptacement
? 13 16-plex
? 16 Fireplace
? 17 Garage
? 18 Deck
? 79 Lawer Level
? 20 Paol ? 30 Accessory Bidg
? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 24 Storm Damage
? 25 Miscellaneous
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Buiiding ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building' ? 43 Reroof O 46 Windows/Doors
"Demolition (Endre Bldg) - Give PCA handout to applicant
DCSCripf1011: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const W dth
REQUII2ED INSPECTIONS
_ Footings (new bldg) _ Sheetrock .
_ Footings (deck) _ Final/C.O.
_ Footings (addition) _ Final/No C.O.
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool Ftgs AidGas Tests Final
_ Framing _ Siding _ SNcco Lath _ Stone Lath _Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex
? 08 O6-plex
? 09 07-plex
? 10 08-plex
? 11 10-plex
? 12 12-piex
Building Inspector
Y
1988 HIIILDING PERMIT 6PPLICATION - CITY OF EAGAN'
SINGLE FAMILY DWELLINGS lqqiq
?
INCLUDEX 3ETS OF PLANS,-?CERTIFICATES OE SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSES FOR CARNER LOT3 - CONTR6CTOR/SOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESZRED. NO CHANGES WILL HE ALLOWED ONCE HIIILDING PERMIT IS ISSUED.
M[7LTIPLE DWELLINGS RENTAL [INITS FOR SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITA BLDG. DEPT „
1 SET OF ENERGY CALCULATIONS
COI•MRC2AL
INCLODE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 7 SET OF ENERGY CALCULATIONS
To Be Used For: (' U(?15l- Valuation: r)3. wV
Site Address i/QI?l?k A(1`l) OFFIi
Lot -LL Block ? On site sewage_
Parcel/Sub ??CQ1? D LACC
Owner NkJ?,)& Ar'I e1GIa ? 11r4Wn Amffi
Address Io7Db Ij ? 30,5?
City/Zip Code Bb0 1, d61 6540
Phone Zzq- 11-41
Contractor 6VnL?-Q? ?i/1`)1+?6!
Address (? qo-7- I ?jft'1/GL J? klY
City/Zip Code ?A/aA-h F"I Vl
T
Phone qJrq' 64 J ?
Arch./Engr. )"ZLLGLp ?1?C • _
Address ?,?? ? ?7 RhhN) Ktbvl ?
City/Zip Code rhmmlb'IC-?GGt (11 "?S2c)
Phone IF 6,ai901
M47CC system ?
On site well _
City water _
PRV required _
Booster Pump _
AM MAR 9 Sgg
nate: 3bS ?8'
Occupancy ?-?
Zoning
Actual Const V-P
Allowable U-0
# of stories
Length
Depth rl R'
S.F. Total
Footprint S.F.
APPHOVALS FEES
Engr/Assess Permit 4 t&100
Planner Surcharge 36. ,;L>
Council Plan Review 233.00
Sldg. Off. ?31 SAC, City 100,oJ
Variance SAC, MWCC SSO,DO
Water Conn 50100
Water Meter ?
Road Unit 325.W
Treatment P 1 2oy,--o
Parks
Copies
TOTAL
. ?.
I
I, .
,.
EXTERIOR ENVELOPE R'lERAG"c "U" COMPUTATION
OYtNER
SITE AQORE55
CrRYn????. .
dCNeewat? Z x ?
CONTRACTOR 4;R{r.;.0lt DATE ' ? - P}iOHE -d 3
Deternine worlcing square footage of each.
1. Total exposed wall area ...... 2z $g.lc% sq. ft. x .11
2. Total roaf/ceiling area .... I O$ 6_ Sq. ft. x .a?!?= ?
Total exposed wa71 area abave floor =sLj 9B,(aCo
a. Total wa11 window area ..................:....... 125.3
b. Total door area .................................
c. Total sliding glass dnor area .................... .?fa
d: Total fireplace wall area........................ 449
e. Total wail framing araa (averagelOa)............. ? a S.R(o
f. Total ne:.wa?1 area above fioor ................. i (?5L.88
g. Total rim joist area ........................... 11i8
Total exposed foundation area = ?F5.3 3
.
h. Total foundation window area.....................
i. ToaI net foundation area a6ove arade ............ ], ,5 33
Oet=rmirte "U" value of each wa11 segment.
a. i as.-S x„U„ ,35 = Y?,SS
b . 3g.(0a X „u„ ..y5 = i -I.83
C. yD- _ X „U„ , 4[S
d. y8 x "U" .3b = 1 -1
e. e3 a.I.SG X „U"
?f. I l0 5(a. $IZ X „u„
e- I q 8 x ,tu,l
h.
X "U"
03 =
e o3Co = S•3:5
x „U„ . I?t = 6•5
3 ...................................... Total
If item #3 is the same as, ar less than item #1, you have utet the intent
of SBC 6006(c)2.
Total exposed roof/ceiTing area = { O$$
;
- Total grass roof/ceiling area =
J. Total skylight area .................. ...
k. Total roof/ceiling framing area ....
i. Total net insutated wof/ceiling area....... q -1 q, Z
De*ernine "U" value for each roof/cailing segment.
J•
X "U"
k. IhS . R X„uts .C? Z 1 ' `Z . Zrri
1. c(-I_`l.2 X?lu" OlCt = I S.(o
4 ..................................Totai = 2 . 8
Ifi total af u4 is the same as> or less than f2, you have met the intent of
SBC G006(c)S,
To utiiized the total envelope system method, the values.esta6tished 6y the
sum of items a3 and #4 shail noc be greater than the svm of itezs #1 and 742.
MAT'ERSALS
l. ?,5 I,7.? + 2. 2g.ZR = 23O,oa
3.-Na\.o5 + 4. ZD,16?C = Z11.93
Thera. Eesistance "R^
Exteriar 9iT
S£ding.Mzterial
Sheathing 3/?l" Zkat?* '5.'ef
SO
Sheetrock , .5$
Int erior .1i.r . (e l
Studs 2rr. .G.g?
Rim l,gq
Conc. Blks.
C-r.
?
s. Tµ?ritAX
3k" .Ssy.
5. SIOIJV G GZ
6. E?e =ar a? ::1? • 0.27
roeal (ay.1 9_
' . . V+ e0,.
.
1. Inta-,,. ,;_ f ,zS • 0.68'
2.. 4YT3D •45
1 s. y
5. alQ?Nr, -CeZ
6. Ex:esio= ai= izlm 0.17
7b Gal
],. Int=_rior ai= f?lm 0.68
l
3_ Z.x?_,?ais ? ?•S?
5. ???IN4 - .•?'Z.
6. Ex'?arfor L? film 0.1? .
. Total • a?,?6
• I. Zntericr ai- film 'O.G8
2. 1 R1G1D 1
j 3. : . . , .
• 4, GOtdC E60 G4C l.Z
5. •
b. E7c:er?or ais Fi2a ' 0.17
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rr+ • ? "°'valce, ciec'`. a:
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--
t
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.
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i . PesC flov ? . 1• S?+tcrior air film ? 6.61
' _zzad ..L n • 2_ G-t P.?D
• ?y 3 S
Z x y l a.lSU L.
i ' ' • ? • 4. Extc?'ios air filu? (sezl i
i . . ? , , . , . . . Tota1
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f ventad 3'
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crrv aF E.AUAN
CAt3HIE.Fta 5 TI-FtMINAL.. MU: 695
DATE: . 07I1,3/3:7 T];NEc 12:i'7:06
II:1:
NFlME: LlNITED fy00I= [NG TW]:M C77Tf.-:S
3210 9001 4049 F E:NNSYI.VAN 97.25
21.55 9001 404•3 I'l:NNSYI.VAN i?.UO
ro+,aa atecfltir.;,; Atiioijnt,: 99.2S
CR 1.138;1. i
L!SE:R II:u MANCY
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
ClTY OF EAGAN
3830 PILOT KNOB RD - 55122 g.
651-681•4675 I
New Conshucfion Reaulremenh Remodel/Reonir ReaulremenN
? 3 regisfered sRe surveyt showing sq. R. of lot, sq. H. of howe
and all roofed areas (20% maxlmum loi coveroae allowsd)
? 2 copfes ot plans (show beam i window skes; poured fnd. deaign; etc.)
? 7 set of energy calculaTlons
? 3 copies of hee preservaHon plan H lot platted ufter 7!1/93
DATE: 7ra`?-q / ?
DESCRIPTION OF WORK:
STREET ADDRESS:
City State: A- ZIP:
ti
LOi: ?Z BLOCK: "i SUBD./P,LD. #:
? ?s 1 7
Name: PhoneN:
PROPERTY tast Ftrst
OWNER
Sheet Address: 't I TZ
?
Ciiy _ ?State:
Zip;
Company: Phone #: `" /!?? 1?0 (area code)
CONTRACTOR
Street Address: License #??Og??6g Exp.
ARCHtiECT/
ENGINEER
Telephone #: area eode ( )
r
Name:
Stree7 Address: RegistraHon #:
City State:
Sewer 8 water Itcensed plumbei [reaulred for new eonshuction onlvl:
PBnalty appiles when address change and lot change Is requested once permR Is issued.
I hgreby acknowledge that I have read ihis applicafion, state that the Information is
S1ate of Minnesota Statutes and CHy of Eagan Ordinanees. 1-75111
Signafwe uf ApplkonY.
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
2 coples oF plan
1 set of energy cokulWlons for heafed addNions
1 aMe survey for extertor cddHions i decka
CONSTRUCTION COSE
Iip:
and agree to compiy wHh all applicabl
-i VL=Q uvL =,i
?- '
R? ? JU. I 21999 11
7ree Preservation Plan Received - Yes - No ^ Not Required
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-piex ? 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
? OS 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool D 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition D 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bidg.' ? 41 Wood Stove ? 45 Fire Repair
0 34 Repair ? 3$ Demolish (Interior) ? 42 Reroof
` Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
VVidth
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Buiiding
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinktered
Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC ,
City 5AC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge ;
Treatment PL '
Park Ded. .
Traiis Ded.
Other
Copies
Total:
SAC Units ?
% SAC
APFLICATION FOR PERMIT
SEWER AND/OR WATER GONNECTION
....,.. . , ..., ,
. .
? NOT'E: PAYNIIENNf OF PEE AT TIFII: OF
? APPLICAIION W6 NOT CObI- t
? STINIE APP(tlTJAL OF PERtUT. i
?
? TI6PFZTION OF SEWER APD/Oi WA1II2 •
?.
? II1SlAidAliONS WJId. NOT BE SCELULID ?
? C?NPIL PIIthIIT HAS BEFN APPROVID. :
dtV tf f 4iYYkietif pYt f f f!#ItRif 4# f wfiYlfff f#!f f
oF eagan
(PLEASE PRINi`
1) PROPERTY ADDRFSS: ..10
LI
T,FY:AT• DESCRIPTION: (Lot B occ S vision or Tax Parcel ID
IF EXISTING STROCTL?RE, DATE OF ORIGINAL BLILDING PERMIT ISSUANCE:
Mon Year
PRESIIVT ZONING/PROPOSID USE:
Q CO[VA7ERCIAL/RETAIL/OFFICE U?(R-1 SINGLE FAMILY
Q INDUS2RIAL 0 R-2 DLPLEX ('t4,o L?nits)
Q:INSTI'ILrfIONAL/GOVII2NMENP ? R-3 TOWNHOUSE (Three.+. Units) ( Lnits)
Q R-4 APARTMENT/CONIDOMINIUM ( . . Units)
.
z) NAME: r11?4
ADDREss: ?39a7- CecCa.V! e Vv
CIT'Y. STATE. ZIP: LA4 \- tjp1 .5I z,z.
PHONE:
rvi ?lLy u5e
3) NAME: Pl ru ems I.icense:
AoDRESS: tU18 /?GGtwD ?lo?i I Pv?al'.f? Active
Expired
CITY. STATE, ZIP: ( I Not recorded
PHONE: - MASTER LICENSE # l12,2,2
.. St?
e • ?.
4)
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
5) ? ? • d •?• • u :.i ??
q CONNECTION TO CITY SEWER FICON[g,'CTZON TO CITY WATER O OTHII2
6) ? ? ?/zgJBB'
****?******?********* ***********************?*********?*??***********?*******?*******?*******?;
THE GOID COPY OF 7M PERMIT WILI, BE SIINr DIRECTLY TO PUBLIC WORKS 7U FACILZTATE M= PICK-OP. ?
PLEASE ALS.OW 1WD WORKING DAYS FlDR PROCFSSING. SONIECINE EROM TM CITY WILL CONrAGT YOU IF TIIERE *
* ARE ANY PROBL04S. ?
?**?*+****?**+*****+?*?+***,r?***:***?******,?**?****+**??+**+**:e***********?+******+?*+***#********?y
: FOR -CITY USE ONLY
PERMIT # ISSOED
Pd w/Bldg. Permit FEES:
$ rb- Sa $
$ /0-.5_?) $
$ ?7•00 $
$ $
S S
$ ?? ' GrZJ $
$ $
$ S.Sb•crv $
$ l SO 'D l? $
$ $
$ $
$ $
$ $
s aa ?. ov S
$ $
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/ODTSIDE READER
WATER TAP (INCLC'DE CORPORATION STOP)
SEWER TAP
ACCOLNT DEPOSIT - SEWER
ACCOONT DEPOSIT - WATER
WAC
SAC
TRLNK WATER ASSESSMENT
TRCNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRONK WATER
WATER TREATMENT PLANT SLRCHARGE
OTHER:
$ Z-• o ? $ TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE,EXCAVATION IN PDBLIC RIGHT OF WAY?
F__j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PDBLIC
Q
. ROADWAY" MUST BE ISSQED BY THE ENGINEERING
NO DIVISION. LIST AS A CO[VDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE :
?
14wmdom
-siA?F,;Q_o j YYhoJe Ho+rse WwArsho
z+?.-•---- iwWwn? Nrr?ior
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NEATINO . ? f w CooMno T?? py?? ?? ? f
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• WyA ?IW 111
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hor
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' •f`clps?twnyvOWrsOM IrM r?y? a?w WrMMWn
WPr ?rww Wi?w??rW ?4tl
iipw? doors w u?rw r r,Ayiy?r
?A/N ? e111I1 ?MI??r1 ?I?I?r?Y ??W
r
wtrw?rrup
r . .. _ -- - .
LP3 b33 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION ? 1S5D
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date 1 I 23
DENMAN, JULIE
Site Street Address I 4049 PENNSYLVANIA AVENUE Ulllt #
? EAGAN, MN 55123
(651) 454-6427
Property Owner Telephone # ( )
.
Contractor (612) 827-4033 Telephone # ( )
address 2905 GARFIELDAI/E. SO. city state zip
MiN .
The Applicant is: _ Owner Y-LContractor _Other
Alterations to existing dwelling $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
Water Softener 1 Water Heater $ 15.00
V_ repiacement _ additional
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ 50
Total $ 1$. S?J
i hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and approved.
MO'rblaAk ???? --- ApplicanYs Printed Name Apls ignature nffg
? Q`,
•° . II ?
FFg 0 n
'f-
sut?ve?or?s ecrtificate
SURVEY FOR: Frontier Pfidwest Homes Cornoration
DESCRIBED AS: Lot 12, Block 4, 5TlIFPORll PLACH, City of F.agan, Flennenin
County, Afinnesota and reserving easements of record.
87b.8 \
i I '-1
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Y1
? ? .
', 819. ? ?'' '? ? ? 550, 1 ?,????
\ ? ?6 \<
? i
2?y 9 g? ???
aO V
? 8Ao,0
PROPOSED ELEVATlON$
7op of Foundaflon . 0880.2
I Garape Floor . g?q, g
Basamsnf Floor
Appro¦. Sewar Service Elev..
Propoted Etevaliona
Ezistinq Elevallons .
; Oroinaqe DlrscNons ?.....,..r
Denoles Ofifef Slaka ? q
? /l'EA OLUND
Planning Errgineerarg Surveyirtg
? f?ID?EMIboNiplmFnwN.?/?p MMw?w?OM]0
?MM??MMW MW ?
?
? ?7.?
1
:
?
SCALE: 1 Inth a 30 feef
\
.
°o ?
30
' y ?781 . 7
BENCHMARK,
;MIN. SETBACK REOIREMENTS
Front - 30 Hane Sbe - 10
Roor -15 6oraqe81do- S
r n.r•ey eertlly Mol thb wrwY. Plan a nporl Mao OnporoA by me JOB NO.:
sr under my dlntf supnNdon ond tAOf I om o AuIY Reqlstend a
LanA ewvro. uoa.r me a.s ef m. 8tan ef Mlnnnola. V
BOOK'
UOI*C 3 I'Zl/ 58
uaM..
PA6E:
-li5
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0
?
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA162004
Date Issued:06/22/2020
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
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: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Julie M Denman
4049 Pennsylvania Ave
Eagan MN 55123
Lightning Restoration Llc
7600 147th St W, Suite 202
Apple Valley MN 55124
(763) 202-9473
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA162004
Date Issued:06/22/2020
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
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: 10,000.00
Fee Summary:BL - Base Fee $10K $191.75 0801.4085
Surcharge - Based on Valuation $10K $5.00 9001.2195
$196.75 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 -
Julie M Denman
4049 Pennsylvania Ave
Eagan MN 55123
Lightning Restoration Llc
7600 147th St W, Suite 202
Apple Valley MN 55124
(763) 202-9473
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163694
Date Issued:09/10/2020
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Reroof & Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic.
Valuation: 15,000.00
Fee Summary:BL - Base Fee $15K $265.50 0801.4085
Surcharge - Based on Valuation $15K $7.50 9001.2195
$273.00 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 -
Julie M Denman
4049 Pennsylvania Ave
Eagan MN 55123
(612) 382-8308
Lightning Restoration Llc
7600 147th St W, Suite 202
Apple Valley MN 55124
(763) 202-9473
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA164579
Date Issued:10/02/2020
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
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 -
Julie M Denman
4049 Pennsylvania Ave
Saint Paul MN 55123--158
(612) 382-8308
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA172736
Date Issued:10/14/2021
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Angeli L Huie
4049 Pennsylvania Ave
Eagan MN 55123
(612) 208-8882
Milbert Company (culligan)
1801 50th St E
Inver Grove Heights MN 55077
(651) 451-2241
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174581
Date Issued:02/04/2022
Permit Category:ePermit
Site Address: 4049 Pennsylvania Ave
Lot:12 Block: 4 Addition: Stafford Place
PID:10-72500-04-120
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Angeli L Huie
4049 Pennsylvania Ave
Eagan MN 55123
Champion Plumbing Llc
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature