4052 Pennsylvania Ave, T.-.¢f ; r. .
0 CASH RECEIPT 00
CITY OF EAGAN 3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
L
DATE I I I r 19 ?
??o .,i?-IkC?C4? ?? r,.? ? ?r?? j
FHpM
AMOUNT a
?; i,. ? rr ., ? i•t_ Il J' . '? i?J ?? '` DbLURS 1'/
? CASH LTCHECK
?,i1? jj -4' 1 ?-7 6.
G.?vh --? I f? i r;` 1?? ?? jl r r, a?.? f-' ?;, ? ? C? r.(J
Thank You . ?
BY
WMe-P.,ws Copy ?
C 195450
veilow-POSOs Copy
Pink-Fue capy
1 DATE: SEP 23, 1991
F, RF? *4 4052 PENNSYLVANIA AVE (TNE WINDWOOD CO INC)
X Your Sewer & Water Permit for the above property has heen completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Ptease pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
CITY OF EAGAN • w, ? ???Z
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 l
BUILDING PERMIT Receipt #
To be used
Site Address A051 EMsTI-VuN.tA ava
Lot I O.- Block -q SeclSub. aTAFFDRO P??rt
Parcel No.
W Name THR nNDWDM M ite
? Address P D 101 16329
? City APPI.E VwttBY Phone A41..4boS
Name AA19*
? Address
City Phone
?a Name
N Address
191 City Phone
have read this application and tate that the
agree to comply with all apabie State of
Minnesota Statutes ar
Signature of PermNee
A Building PermB is issued to: ZUA KiXWWUW GO ING
on the expres& condition Ihat all work shall be done in arxordarxe with all
appliceble Slate of Minnesota Stalutes and City of Eagan Ordinances.
Building OBicial
OFFICE USE ONLY
occuaancy R?-3 -H--i FEEs
Zoning Q=t
(Adual) Const -V-N Bidg. Permil 647.OD
(A1lowabla) X-N Surcharge 31,?
I or Stories
Length -611121 Plan Review La?A _ M
Depth SAC, City 100.?
S.F. Total - gqC, MCWCC 550,?
S.F. Footprinls -
On Site Sewage _ Water Conn 660i00
o„ site wea water nneter 93,
?
MWCC Syslem ?- ?
City Water
? qcct. D
?il • ?
PRV Required - S/W Permif 30*00
Booster Pump - S/W Surcharge • 50
Trealmenl PI 276.00
AMovaLs Road unit 370,00
Planner
il
G - Perk Ded.
ounc
g? Off. _
_
Copies
Variance - TOTAL 3,329.50
Permit No. Permit Holder Dste Telephone #
WATER ? ? • y 3
SEWEh
Pt.uMBirac
H.V.A.C. ?3-575
ELECTRIC
kmpection Date Insp. Comments
Footings I ^/ S q
Ixe S
FoundaUon 46?
Framing
Roofing
Rough Pibg.
Rough Htg. 2.S 411
Isul. 2 ?
Rreplace
Flnal Htg. Z
Orstat rest 7 1.9 ?
Fnal Plbg. 7_ 4-7/
Plbg. Inspector- Notity Plumber
Const. Meter
EttgrJPlan
Bldg. Final Z-
Dedc Ftg.
Oedc Final
Well
Pr. Disp.
? INSPECTION REC4RD
CIT.Y OF EAGAN PERMIT TYPE: ?I III I Nr+
3830 Pilot Knob Road Permit Number. .? i.
Eagan, Minnesota 55122-1897 Date Issued: ?t?l? •
(612) 681-46?5
SITE ADDRESS: ' ' " ' "' ':." '` APPLICANT:
1111 ik, I;< <ik?
f I lAMI, Y1. V11NlA AVt ??, i i, .i?:,4 PE4
,.1 : .,, {, ,{ a
PERMIT SUBTYPE:
?;, ,
f f. 1.' 1 4, H t .' i 41 I
TYPE OF WORK:
?
I
Pe?mk No. Pertnft Holder Date TNWphone 0
ELECTRIC '
PLUMBING
HVAC
Inspection Date Insp. Commerrts
FOOTINOS
FOi1ND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROU(3H
HEATING
GAS SVC
TEST
_
INSUL
GYP BOARD
FlREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAI
BSMT R.I.
BSMT FINAL
DECK FTG ?
DECK FlNAL . Z? ?' ?--
?
(gtx#ifixa#t of (Orxupanry
Cirp of (Eagatt
B"rtmm a# Bui1d'uag 3wertimt
This CertlJuaatr issuad pursaan[ !o [he requir+ementr of Semon 306 of the Unijornr Buildirig
('.ade m?ifl?in8lJiat Qi !he time of issuance this struGUne tNas in cam,pfiance wilh Ihe various
ordurenc+es of the (aity regulating bu:7ding consbuction or use. Far Ae foUowing.
tim ckmiacmdw SF DHG/GAR owg. PinN,, 19702
O-gp„-Y7pa x-3 M-1 zowivDhisict R-1 ryxc„m V-N
p,,,,,vctga&C THE WINDWOOD CO Add. P[1 R[lx 1 G129
B.um,,d&,:,. 4052 PENNSYLVANIA AVE?. w Lia, BL STAFFOBD PLACE
DECEMBER 19, 1991
P0.ST IN A CONSPoCUOUS PU1CE
0. ,
7m
`.-.
SEWER & WATER PERMIT
CITY OF EACAN
3830 P?tot Knob Rd.
Eagan, MN 55122-1897
DATE 5EY 19. 1991
?•' , SITE ADORESS 4052 1'T_:NtYSYLVANIA AYE
-, LOT 10 BLOCK 5 SECISUB STAFFORU RLAC::
x
. APPLICANT:
, ADDRESS:
CITY, STATE ZIP ?
PERMIT REOUESTED
x SEVtilER x WATER - TAPS
- COMMIIND .X__ RESIDENTIAL
x NEW EXISTING
? Lawn Sprinkler Meters are to be Installed
PLUMBER: Y' MATTHEW DANIELS INC Ahead of Domestic Meteys" on Wa(ter Line.
ADDRESS: 1•5185 CAR011SEL WAY Credit-WLL NOT be given for De¢Udt Meters.
ZIP 5506$
CITY, STATE `:tOSE?iOUIJT MN
PHCINF. 423-.730 ? ? l.?iL:!!-i? .•rLr" '??? _
1 AGREE TO COMPLY WITH
OWNER: TriE W'LNDFIC3QD CO Ift(; EAGAN ORDINAN ES
ADDRESS: P 0 BGX 14329
CITY, STATE AFPt.E VALLEY MN Zip 35124
PHONE: $g1-4?0r, " S GNATURE WHEE? METER ISSUED
r __r_.
, yU; ? ? : ?..? / , ? r ;.;_' ; .' .- ; .") -
PLEASE AKLdW`1`VI?? WORKIG DA?1fS FOR PROCES IdG. CALL 454522a FOR INSPECTIONS. FOR STORM
; SEWER PERMITS, CONTACT ENGINEERING DEPT.
1
PERMIT
Rd.
A7E SEP 19, 1441
,.?.._.-
.??
OFFICE USE ONLY
METER #?qil q0 f°2 4 PERMIT DATE 019123191
CHIP # ?? 71/ 13 PERMIT # 12310
METER SIZE e? s B.P. RECEIPT #(T
ISSUE DA# - B.P. RECEIPT DATE
- PRV - BOOSTER PUMP
.s?.-..-a.MN=wc --.....•*w- +r . - , ,.. ... - _ ",x. . w. .. . . „ .
OFFICE USE ONLY
METER # PERMIT DATE 09/23/91
CHIP # PERMIT # 12310
METER SiZE B.P. REGEIPT #
ISSUE DATE B.P. RECEIPT DATE
_ PRV _ BOOSTER PUMP
TE ADDRESS 4052 PENFiSYLVANiA AVE
)T 10 BLOCK 5 SEGSUB STAFFORD PLACE
PERMIT REQUESTED
X_ SEWER X WATER _ TAPS
STATE
ZIP
BER: '• MATM'ii' DAIiIELS iNC
ESS: 15185 CAROUSEI, i?AY
STATE RUSEMOV?T 14N ZIP 5506£
E: 423-3730 ?
rHE wiNDxoon co
,STATE
LLEY M*I Zip 55124
COMM/IND _X__ RESIDENTIAL
X NEVY _ EXISTING
Lawn 5prinkler Meters are to be Installed
Ahead of Domestic MeteFS on Water Line.
CredittNiLL NOT be given for Deyiuct Meters.
IAGREE
EAGANI
CITY O?`
SIGNATURE WHEN METER ISSUED
.EASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
:WER PERMITS, CONTACT ENGINEERING DEPT.
CITY OF EAGAN No .19702
? 38:0 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Feceipt # LI;5 .1
Tobeusedfor SF DWG/GAR EsLValue $102,000 Date SEP 19 , 1991
_
Site Address 4052 PENNSYLVANIA AVE
Lot 10 Block 5 Sec/Sub. STAFFORD PLACE
Parcel No.
w Name THE WINDWOOD CO INC
3 Address P 0 BOX 14329
° pity APPLE VALLEY phone 891-4605
joj Name SAME
?Q Address
? City Phone 651 Name
Address
aw Ciry Phone ,
BuildinqOllicial?uHi OFFICE USE ONLY
I hereby acknowlege a ve read this ap ication and?+ ? that the
inlormalion is correcree to comply ith all ap IIE a State of
MinnesoW Sfatutes a f Eaga ?' ? in nces.
Signature of Permitee
A Buildinq Permit is issued to: T INDWOOD CO INC
on Ihe express contlition that all work? all be done in accordance with all
applicable State of Mi'nne,,s?ota Statutes antl1CMiry ? /of Eagan Ordinances.
Occupancy R- 3 M-1 FEES
Zoning R-1
(ACtuap Const --jd 61dg. Permit 647.00
(Albwable) v-N Surcharga $1.00
M olStories
Lenglh 461 PlanReview
n
470.0
Dapth 36 ' SAQ City 100.00
S.F.TOtal - SAC.MCWCC 650.00
S.F. Footprints -
On Site Sawage _ Water Conn 660.0
0
On Site Well - Waler Mater 95.00
MWCCSyslem x
Acct. Deposit
30.00
Ciry water g_
PRV Required _ S/W Permit 30.00
Booster Pump - SN? Surcharge • 50
TreatmeM PI 276.00
APPROVALS RoadUnit 370.00
Planrrer - park Ded.
Council
BIdg.Off. _ Copies
variance - ToraL 3,329.5^
-J 01 s89 v a`?s°?°S?
Pepuest Dale
?
( Fire Rough-in Inspection
Requir ?
es ? No
? ReaEy Now AI Notity Inspeciw
When Peady7
I L?l censed contractor ? owner hereby request inspection of above electrical work at:
Jo0 AtlEr s ireet?o or Route o.
L
V City
$ection N?
/
f T nsf?jpryame
T
J Rang County
OccupantV T) Phon9Alp.^/
? G../
? T?Ln
Power Supplier
2? PdErass
Eiecmcal ract 1 ompany N )
a . ConVaaorS lcense
7
Mailin Atl ress ICOnVatlor nar Making InsWllatiOn)
2
O
,
Aulhor Slgnalure ConVa or ner Making Installali
7? 55 o re, m0er
l
o-
MINNE T TATE 60AND OF ELECTRI?Y THIS INSPECTION REQUEST WILL NOT
Gtlgqa Itl ay Bltlg. - R.O. S173 BE ACCEPTED BY THE STATE BOARD
1821 Univenity Ave., SL Paul, MN 55100 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSEO,
11116'15Fj REQUEST FOR ELECTRICAL INSPECTION '' ? N_a E13-00001-08
? See Inslructions lor mmpleting IM1iS Iortn on back ol yellow wpy
X" Below Work Covered by 7his Request ??• "?6? ''
_J 01189 '
-ew, tld Rep.. TypeolBuiltling AppliancesWired EquipmentWired
Home Range Temporary Service
Duplez Water Hea[er Electric Healing
Apt euiltling Dryer Olher (Specity)
Comm./Industrial urnace
Farm Air Conditioner
Other (syecilyl Contractor5 FemaMS:
Campute lnspectian Fee Below:
# . Other Fee 8 ServiceEniranceSile Fe # Cimuils/Feeders Fee
Swimming Pool 0 to 200 Amps l (J 0 to 100 Amps
Translormer5 Above 200 _ Amps Above 10D _ Amps ?
Signs Inspectw4 use onry: L
Irriqation 8o0ms
Special Inspection
Alarm/Communication THIS INSTAILATION MAY BE ORD IS?ONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 M HS.
I, the Elearical Inspector, hereby Rough-in ? are Il,?
certitythattheaboveinspectionhas
been made. F;nai ace ? 2 ?
OFPICE USE ONLV
This reQUest eoid 18 montM1S Imm
Address:4052 PENNSYLVANIA AVFJ-ot 10 Blk 5 Sec/Sub STAFFORD PL,ACE
These items were/were not complete at the time of the final inspection.
Yes No Z . p_..
Final grade (6" from siding)
Permanent steps - garage
Permanent steps - main entry ?
Permanent driveway
Permanent gas
Sod/seeded grass
Txail/curb damage
?
Porch ?
Basement finish
Deck
Please verify vith the builder tha removal of roof test caps from the plumbing
system andthe shut-off of watez supply to the outside lawn faucat before
freeze potential axists. ?j
??
vxciamnx.
White - City copy Yellow - Resident copy Pink.- Contractor copy
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
851-881-4675
tlew Constructbn ReaulremeMe HemotleVpeoelr Heaulrementa
• 3 registered sKe surveys showing sq. IL ol bt, sq. tt. of house; andAl roofed arees • 2 copies of plan
(20%maxlmumbtcoveragealbweA) • 15elofEnergyCalculatbnsforheatedatlOnbns
• 2 capies of plan showing 6eam & window sizes; poure0 found design, etc.) • 1 site survey lor ezterior addtlbns & tlecks
• 7 set ot Energy Cakulatbns • Intliqte N hane Served by sepfc system for addtlbns
• 3 copies of Tree Preseivation Plan If lot platled afler 7/1/93
• Rim Joist Detall Optbns seleclbn Sheet (bidgs wMh 3 or less unlts)
DATE -<17-9I0A VALUATION J@1W' yvrSZ '
SITE ADDRESS 4052 P£)-JN Su I VA N I A A VE MULTI-FAMILY BLD6 _ Y !/N
NPE OF WORK NEW 200 C::' FIREPLACE(5) X- 0_ 1_ 2
APPLICANT f l\Y l..C) I r l'Sr Of4- ( ffL?I r,U c utv
STREETADDRESS 3,501 LVnuaele Avr SAJIti CITY IY) ?nn • STATEMtj ZIP ,S W
TELEPHONE # 6 31 °21Z-9?= CELL PHONE # FAX # 51 ??{,54 1 3_
PROPERTYOWNER 0 c?(?GI?C:.f 1•Y TELEPHONE# 454"779S
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIKNFSOTA RULFS 7670 CA1'EGORY 1 MINNFSOT.q RUI.ES 7672
(4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Caleuletione Submitted
Plumbing Conhactor: Phone # ?_
Plumbing system includes: Water Softener _ Iawn Sprinkler Fee: $90.00
_ Water Heater No. of R.I. Baths
_ No. of Baths
Mechankal Confractor: Phone #
Mechanical system includes: _ Air Conditioning Fee: $70.00
Heat Recovery System
Sewer/Water Contractor. Phone #
------------------°--°---°--------°--------------------------°-------------------------------- --------------------°
I hereby acknowledge that I have read This applicatlon, state thaT fhe infor 'on is correct, d agr o comply
with all applicable State of Minnesota Statutes and City of Eagan Ordin s.
Signature of Applicanl
D
............. _._---.... --...... ----------_...... ...... _.__.___--------------._..._----- ------._._._.
OFFICE USE ONLY MA1' 3 0 2002
Certiflcates of Survey Received _ Tree Preservation Plan Received _ Not R ved _ .
OFFICE USE ONLY
O 01 Foundatbn O 07 OSplex ? 13 16plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 27 Porch (3-sea.) ? 31 Ext. Alt - Multi
O 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex 0 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex 0 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. O 42 Demolish (FOUndation) ? 45 Fire Repeir
? 33 AReration ? 37 Demolish (Bldg)" ? 43 Reroof O 46 Windows/DOOrs
? 34 Replacement *Demolkfon (Entlre Bidg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings(deck) FinaUNo C.O:
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Ges Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply 8 Storage
S&W Permit & Suroharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
lqqO
1991 BIIILDING PERMIT PLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - 6 STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFIGATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS SEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: Single Familv DetaLdAigation: ? Date: 9/9/91
Site Address 4052 Pennsylvania Ave.
Lot 10 Block 5
Parcel/Sub Stafford Place
Owner The Windwoocl Company, Inc.
AddressPO Box 24329, Apple Valley, MN
City/Zip Code Apple Ualley, MN 5512
Phone 891-4605
Contractor The WindwnDd Cotnpany, Inc.
AddressPO Box 24329
City/Zip Code Apple Valley, MN 55124
Phone 891-4605
F. r ch . /Engr .
Address
City/Zip Code
OFFICE USE ONLY
/O2? Oaa ^
Occupancy 1?-'3 M'1
Zoning K -I
Actual Const V- M
Allowable V-N
# of stories
Length ? r-
Depth 35?a'
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System ?/
City water -Lef'
PRV _
Booster Pump _
APPROVALS
Planner _
Council
Bldg. Off.
Variance
FEES
Bldg. Permit ?q?,oo
Surcharge S/.o u
Plan Review y Xo.o-1
SAC, City l00"00
sac, rtwcc 650,00
Water Conn. 660, 00
Water Meter s10 J
Acct. Deposit 30,00
S/w Permit 30,DJ
S/W Surcharge •S"O
Treatment P1. b, UJ
Road Unit 370,Oe
Park Ded.
Trail Ded.
Copies
SUBTOTAL
Penalty
Lot Change
TOTAL
Phone
? agrees that all work shall be done in accordance with
' (Sign e of Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
. . VA L u"'?
GA?tA6t
22x2z = yf34 u 15' = r12?0
gSMT .
Z8 yc2y ? 6'72
I k /1 ? (r i)
?3vL? 13i2? rs2 - ;
843 x 1y= I?SsnZ
?N 0 ?7l.ouyL-
Z'6 x Z4 = G72
! ? f2 = 12
._.--
??yx 53 = 3?z5"-L
?
( sr F,_,o o t2
.?i
i'12 ?/ 2Vz= )01
8?2 ?c 53 = yb,Z? 6
ld lJ
.
! PERMIT
,
'
' 4W
?IP`
C1T
Y OF EAGAN "
i3830PilotKnobRoad PERMITTYPE: auxLpzNG
IEagan, Minnesota 55122-1897 Permit Number: 026175
(612) 681-4675 Date lssued: g g/ 0 7/ 9 5
SITEIADDhESS:
I 4052 PENNSYLVANIA AVE
LOT: 10 BLOCK: 5
I S7APFORD PLACE
P.Ii.N.: 10-72500-100-05
6p3ld3na'`J?,ermit Type DECK
@ruilding Wcs??L4 T y p e NEW
? ? . . . . ? .:.°y?
st?
?
i
Y ?ai?.A?u ? d E
?
4?? gr..FK ??s
( t. k Y } a? H d ?. a
REMARKS:
FEE
Blase Fee $30.00
5iurchar9e $.50
Total Fee $30.50
CONTRACTOR: OWNER: - qpplicant -
' JOCKETTY J05EpM
I 4052 PENNSYLVANIA AVE
EAGAN MN 55123
, (612)683-2301
3 n cereb,y acknowledge that.I.have read thit appl.icat3:on a=nd: st7te that tho
infctrmatibr, is c€aerect and. agree to comply with ,#11 appYictibla Statg of 140.
'.S'tatwtes and Ctty of EaqanUrdinances.?-
rn?APP TlPERMI NATl1RE ISSUED BY SIG TURE ?
v v "INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
suzLozNG
026175
08/07/95
SITE ADDRESS:P•I•N.: 1e-7250e-1ee-e5
1.07: 10 BLQCK:
4052 PENNSYLVANIA AVE
STAFFORD PLACE
PERMIT SUBTYPE:
DECK
APPLICANT:
5
JQCKETTY J05EpH
(612) 6$3-2301
TYPE OF WORK:
NEW
, . _ . -., . . _ .? ,. _. ? .. , ...- . .. . _ . . . .
,
. . ,. . . . , ..
,
E .?
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 0
1995 BUILDING PERMfT APPLICATiON (RESiDENTIAL)
6814675
New GAnstruGion Reautrement RemodellReoair Reauiremarrts
? S repistered site aurveys ? 2 copies of plan
? 2 wpiea o/ plens (Wude beam & window aaes; poured fid. design; etc.) ? 2 sRe surveys (exterior addiUons & dacks)
? 1 mrorgy ceialations ? 7 eneigy calwlations for Aeatod additions
? 3 copies ot fiee pieservation plan it loi pletted after 7!1l93
roquired: _ Yes _ No
DATE: 7f31AS CONSTRUCTIONCOST; APPRoX. ?L500.00
DESCRIPTION OF WORK: NEW /6'X 20' D£CK
STREET ADDRESS: 'fQSZ PFrvNSYLYf1A//A Ar.
LOT _AP BLOCK S SUBD./P.I.D. #: 2I14md
683 - zso/ li/oPX
PROPERTY ntame: TcxE-rry Phone #: 4O 778? Home
owNeR ?. ...
Street Address• '¢OSZ PCVNSY4_Vi9A11A AVE.
City; E40,4N State: mAl, Zip: 6-3-IZ3
CoNTRACTOR Company: SECF Phone #:
5treet Address: License #•
City: State: Zip-
ARCHITECTf Company: Phone #•
ENGINEER
Name: Registration #•
Street Address-
City: State: Zip:
Sewer & water licensed plumber:
change are requested once permit is issued.
Penally applies when address change and lot
I hereby aeknowledge that I have read this application and state that the infortnation is correct and agree to comply with all
applicable Stste of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certfiptes of Survey Received
_ Yes _ No
Tree Preservation Plan Received Yes No
OFFICE USE ONLY
BUILDING PERMIT TYPE
w. ? ?! 1
.,.. ,. ... ?s;, w,.?.
0 01 Foundation ? 06 Duplex o 11 Apt./Lodging ? 18 Basement Finish
0 02 SF Dwelling ? 07 4-piex o 12 Multi RepaidRem. ? 17 Swim Pool
0 03 SF Addition o 08 8-plex o 13 GaragelAccessory o 20 Public Facility
0 04 SF Porch o 09 12-plex o 14 Fireplace o 21 Miscellaneous
0 05 SF Misc. a 10 _ plex ?G15 Deck
WORK TYPE
??31 New o 33 Akerations o 36 Move
n 32 Addition o 34 Repair ? 37 Demolition
GENERAL (NFORMATION
Const. (Actual) BasemeM sq. ft. MC/WS System
(Allowabie) Main leve l sq. ft. City Water _
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. 4/3 y
Depth Footprint sq. ft. SAC Code o/
Census Bidg /
Census Unit ?
APPROVALS
Planning
Building
Engineering Variance
d
Permit Fee Valuation: $ ?
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
SNV Surcharge
7reatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
64? 76
ti?^'o
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. AISO, FOR TOWNHOMES AND
CONDOS WHEN PERMTTS ARE REQUIRED FOR EACH UNIT.
W CONSTRUCTION
T.-IVAC: 0-100 M BTU
ADDTTIONAL 50 M BTU
ADD-ON A/C
ADD-ON FURNACE
FIIZEPLACE INSERT
DATE
GAS OUTLETS
STATESURCHARGE
TOTAL
J.
STTE
OWNER
(E]cIs'1'uvG
2 -1 O G/CP--
FEES
$ 24.00
6.00
$ 20.00
TELEPHONE #: ? 1 f' ??
?
12481 Rhode' Island Ave. So.
ADDRESS: Sauaga, h9N 5$?,?T3.?
CI,T,I,: 894•0005 STATE: ZIP CODE:
TELEPHONE
OF PERMITTEE
l51Y4 Mr;(;liANl(;Al. YEKMIT (Kr;51DENTIAL)
CITY OF EAGAN
3830 PII,OT KNOB RD
EAGAN MN 55122
(612) 681-4675
1994 MECHANICAL PERMIT (COMMERCIAL)
" G'1TY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL CONIlIERCIAUINDUSTRIAL BUILDINGS. ALSO COMPLETE
FOR APARTMENT BUII.DINGS OR OTHER MULTI-FAMII.Y BUILDINGS WHEN SEPARATE
PERMTTS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
DATE:
NEW BUILDING
INTERIOR IlvIPROVEMENT
WORK DESCRIPTION:
1% OF
FEES
FEE $
PROCESSED PIPING:
MINIMUM FEE:
STATE SURCHARGE
TOTAL
$25.00
$25.00
CONTTtACT PRICE:
$.50 FOR EACH $1,000 OF FEE.
$
SIT'E ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (naxovEMErrrs orrt.Y)
INSTALLER:
ADDRESS:
CIT'I':
TELEPNONE #:
STA
ZIP CODE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
CITY OF EAGAN
r `v 3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
wompx: `mm
FOR CITY USE ONLY
PERMIT #
RECEIPT # /03995
DATE: 1111,1191
PLEASE COMPLETE QPPER PORTION ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH IINIT.
WORK DESCRIPTION
NEW CONST _
ADD ON
REPAIR
I -
OWNHR NAME:
SITE ADDRESS
IAfi; /0 fiL'uCK Jr SUBD.
FEES
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
,n ,t?-r ' SUBTOTAL:
? r-T STATE SURCHARGE:
BWELLINGS &
$15.00
24.00
6.00
3.00
1?2i o O
.50 "
T "' $aS-C?
INSTALLER: S ?
?
ADDRESS: SIGNATURE lj PERMITTE
CITY: ZIP: ?
PHONE #; -
TPLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUIL62NGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE
NOT REQIIIRED FOR EACH DWELLING UNIT.
° ________________________--_____.__..---__________--------_'
CONTRACT PRICE: FEES ,
OWNER NAME:
SITE ADDRESS:
LOT': BIACK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIp:
PHONE
FOR:
18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
PROCESSED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STASE SURCHARGE
TOTAL:
(SIGNATURE)
CITY OF EAGAN
CITY OF EACAN FOR CITY USC ONLY
3830 YILUT KNOB ROAD -
FACAN 55122 PERMIT #
PHONE (612) 454-8100 RECEIPT #.-?
PLUMBING PERliZT DATE: ?
j?SIDENTZALi YLEASE COMPLETH UPPER PORTION ONLY FOR SINGLE FAHILY DAELLINGS '8
TOWNEIOMES/CONDOS WHEN PERKITS ARE REQUIRED FOR EACH llNIT.
-
-
------
---_°
---------------^-------- --------------------
WORK DESGRIP2ION ----------- -
---°------
COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
NEW CONST ? ADD-ON MINIMUM 15.00
ADD ON 1 SHOWER 3.00 00
REPAIR 3 WATER CLASES 3.00 `l..oo
7 ° °
? BAT3t TUB 3.00
3 IAVATORY 3.00
OWNER NAME; ?-Jcno?w? tlom?s I KITCHEN SINK 3.00 3.0?
I IAUNDRY TRAY 3.00 3.ou
SITE ADDRESS: HOT TUB/SPA 3,00
I WATER HEATER 3.00 ..oo ,
l 0 BLOCK S SUBD. 5-'q?Fa2 o PL.RcE
LOT: _ I FLOOR DRAIN 3.00
GAS PIPING OUT.
INSTALLLR: ?ni?LS ? (MINIMUM - 1) 3.00 3• o0
3 ROUGH OPENINGS 1.50 f7•6J
ADDRESS: OTNER
WATER SOFTENER 5.00
CITY:??Sewou-+ ZIp; PRIVATE DISP. 15.00 .
U.C. SPRINKLER 3.00 '
iorae r.: ?z3 3?3a
C -
SUBTOTAL
,
?
J-
?
? URCHARCE 50
lC?o.)( ?
-e
-a--
uc
• ST. S .
SI ATURE OF PERMITT
EE yQ•5p
TOTAL: -"? -
COrfM$RCIAL%INDUSTRIAL;° PLEASE COMPLETE TNIS PORTION FOR ALL COMttERCIAL/INDUSTRIAL BUILDINCS AHD
HULTI-FAMILY BUILDINGSWFiEN SEFARATE PERMITS ARE NOT REQUIRED FOR CH
DWELLING UNIT.
CONTP.ACT FRICE;
OWNER.NANE:
SITE ADDRBSS:
LOT: BLOCK ? SUED. _
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
CI'I'Y OF EkGAN ,
ZIP:
FEES
18 OF CONTkACT FEE.
STATE SURCNARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $_
STATE SURCHARGE $_
TOTAL:
(SIGNATURE)
? _
I, i Llil
2007 RESIDENTIAL BIIILDING PERMIT APPLICATION
City Of Eagan L?
3830 Pilot Knob Road, Eagan MN 55122 ?-
Telephone # 651-675-5675 FAX # 651-675-5694
NewConstmcliaiReauirements RemadeVReoeirReauirements Oflice UseOnH
3 ieglstered site surveys showing sq. fl. of lol, sq. fl. of house; and all roofed areas 2 cnpies of plan shawing foatings, 6eams, joals Cerl of Survey Recd _Y _ N
(20% maximum lot cove2ge elbwed)
' 1 sd of Energy Calculatiom for healed additlom Soils Report _ Y_ N
1 Soils Reparl
rf proposed bullding is to 6e placed on disWrbed soil 1 sile survey far additians & decks Tree P2s Plen Recd _ Y_ N
2 capies of plan shouving 6eam & wlndow sizes; poured tound design, elc.
AddWon -indirafe ff onafte sepdc system
Tree Pres Requlred _
Y
N
lselofEnergyCalcula6ons OnslleSeptkSyslem _
_
_Y _N
3 copies of Tree Preservation Plan "rf lat plalted after 711193
Rim Joist Detail Options selection sheel (buildingswith 3 or less units) ,
Minnegasco mechanical ventilatian form . .
Plans are considered pubiic information unless vou state thev are trade secret and the reasnn_
Date /Z, / Q2 ConstrucHon Cost 7i z C' ?• rO 12,
SiteAddress _ YO S.L /?enns d??ca n?' A,-+e Unitlste #
DescripHon of Work kePNp p[
Multi-Family Bldg _ Y IfN Fireplace(s) _ 0 _ 1 _ 2
Property Owner ` 1? R Telephone #( C?y [) 3 4' E3 - O?i o?
Conlractor /eOV Wl/u t- m o C c' ? S
Address Yy!/ $!a z?cr' City
? State &JL
i
1 Zip J?1?/ Z, Z- Telephone #(6%rn 87-1418o
COMP6ETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateeorv 1 Miimesota Rules 7672
En6rgy COde Category . , ResideMial Ventilation Category 1 Worksheet • New Energy Code Warksheel
(J submission lype)' Su6mitfed . Submitted
• Energy Envelope Calculations SubmiUed
In the IasT 12 months, has the City of Eagan issued a permit for a similar plan based on a master planB
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
I hereby apply for a Residential
Telephone #(
Telephone #(
Telephone # (
Pemut and acknowledge that the information is complete and accurat
e;
tHat the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a pernut, but only an application for a permit, and work is not to start without a
pernut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
' Z?U.-r 4-.;., e r -,,( q /l 42%? ?---_??
Applicant's Printed Name Alp icant's Signature
Nnsl?? 76( 0. CS?NSU?.TINU ENU?NFERS ,e /6P?RNNEfIS anJ ANU ?Io6 55
? IUUU EA91' IbGlh &TflEET, UUFlN6VILLE. MINNE80TA 6633T PN 432'3UUO
? Certificafie of Suruey
'Legal Descriptivn : LoT /O, Bwcae 51 STAF`DRP PLACE,
OAKOTLI COUNTY, M1NNE507.4.
C f?Z9-Q) DENaTES EXISTING ELEVATION
(89o•o ) DENUTES PROPOSGD [LEVATION
-. INDICAT[S pIRCCTION OF SURFACC DRAUJAGE
890„3 = FINISHED GARAGE FLOOR CLLVA71UN
882.62 = BASEMENT FLOOR ELEVATION
f3`Jo, 65 = TOP OF BLOCK ELEVA'rION
SCALfl : 1' = 30'
3o FT F,wAvT 6v/GD/N6
SETBLIC.C? L1NE ----?
DKA/NA9E AND
UT/L/TY E.4SE/Y/ENT
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7!'? "
f? ?
889.6 ? :?
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KAGiK: LAM`aiKRd4ib? ?X,#,F
I hereby certlly Ihal thia la n Izue anJ correcl repmesenlallun of a trficl of Innd ns shuwn
.? Jxy ol 6EPl6/>lB?4?- ,19 , 71. .
and deacrlbod heteon. As piupnred by tne on lhla rN
s-11 1?do0
.1 R
IiOD? ?NGINCEflING
CornPflNy, iNC.
? IUUU EA91' 118111 BTflEET,
J?1/iNOW?D HO/j1a
# 3766. ?/
CS7NSU4TRN0 6Nt3INfEfIS aK /63
Pl(INNEfIS unJ IflNU ?l1RVEYORS Na, P6 55
uuRNSVILLF:, MINNEBoTA 6635i PIi 4aE-9ou0
Certificate of 5urve.y
Lega[ Description : zor ia, awc.e .5; srAF?o,eo PLACE,
OAKOTA , CpUN7Y, .M/NNESOTA .
(Z?Ya) DENOTES EXISTING ELEVATION '
C89a.o ? DENUTES PROPOStD ELEVAT)ON
-? INDICATES DIRCCTION OF SURFACE DRAINAGE
890.33 = FIfJISHED GARAGE FLOOR CLEVATION 88242 = BASEMENT FLOOR ELEVATION
690, 66 = TOP OF BLOCiC ELEVATION
SCAIE t t' a 30' DRA/N.4('aE ANO
UT/L/TY EA9E/ylEN7
C?} ?696• 9)
-VFT. ?5eoN7' 6U/4D1N6 1( J I ?' ? ,
S6TB?1C.? LiivE L-" 09
7 Zo
83 ? /__j ?` . ? ?• ? I
..?? \? I
,p1 1 ?•0? /o90i0 d
0o1w
l
R?- n 10 ..&? 1?N? o O A w ?? ? I Cqt
j ?
Z o 3a? A.So 1 R3?' ?'-? - ?
kc?qo,L? O I
?
?:.?'o J .22.?
i i
? a ;N'? o I ?o: ? , ?s'?o•°? 'S/ .fi? ?5
•`? $ O "? /22. Z6
; W1 ? 889. b? i 85 ?
30. oo ? l
c?. / ? ?r l l
I hareby cerl{ly Ihnt thls fa o ltue nnJ correci representollau of a iiact at land ns shuwn
alld desctlbed haieon. Ae pinpmed by tua on thlsdny ul
r;Pv. 1-10.
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA143955
Date Issued:07/06/2017
Permit Category:ePermit
Site Address: 4052 Pennsylvania Ave
Lot:10 Block: 5 Addition: Stafford Place
PID:10-72500-05-100
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Brian W Crossley
4052 Pennsylvania Ave
Eagan MN 55123
Great Plains Windows & Doors
6866 33rd St N, Suite 100
Oakdale MN 55128
(651) 207-4571
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA175414
Date Issued:04/01/2022
Permit Category:ePermit
Site Address: 4052 Pennsylvania Ave
Lot:10 Block: 5 Addition: Stafford Place
PID:10-72500-05-100
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
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. When a weather barrier is installed or
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
Jennifer Johnson
4052 Pennsylvania Ave
Eagan MN 55123
(512) 809-4947
Eagle Siding
1301 East Cliff Road
Suite 117
Burnsville MN 55337
(952) 746-3046
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA179450
Date Issued:10/05/2022
Permit Category:ePermit
Site Address: 4052 Pennsylvania Ave
Lot:10 Block: 5 Addition: Stafford Place
PID:10-72500-05-100
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 Total:
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
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 -
Jennifer Johnson
4052 Pennsylvania Ave
Eagan MN 55123
Applicant/Permitee: Signature Issued By: Signature