4056 Pennsylvania AveCARH RECEIPT r? -•?'?
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
?
DATE 19
?
7
AMOUNT
ioo
? CASH klCHECK
DOLLARS
White--Peyers Copy
1 }y
T
?) ? ? CC 9 ( Yelbw-Posting Copy
Pink--File Copy
. .?1?' ' . . . . , , . .,. .... . . .... . . . .
Thank You
??i"- "
BY ? (:f
BLDG. PERMIT NO.
: ? ?• j'[_4%;. ?. ? ` ?. 'i?(/JL
01-3210 Bidg. Permit
01-3422 Plan Check
01-3445 Surch./Adm.
01-1 SAC/Adm.
01-: 15 Surcharge
75-3 60 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit
79-3866 Sewer Conn.
28-3855 Park Ded.
d0
/GC,?1 /7i
?
?
TOTAL
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used for $F D1iG/GAR Est. Value $74,000
i -?l 39 7
Receipt
Date .:C1
.Y 2?; ,18 ?=!
Site Address 4056 PENtiSYLVANIA AVE
Lot 12 glock 3 Sec/Sub. S AgFORD pLACE
Parcel No
a Name FPOtdTli:R h;IflWEST ROMfS (:GY.r'
; Address 3902 CEt'iAPllAL9 DR
° City EAGAt'y Phone 454--n433
Name SM >
Address
a
W Name_
Z Addres.s
Z Clty _
W
I hereby aCknowledge that I have read this application and state that the
intOrmation fs correct and agree to comply with all applicable State of
Minnespta Statutes and City of Eegan prdinances.
Signeture of Permittee
A BuTiding Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicablu'State of Minnesota Statutes and City of Eagan Ordinances.
Building Officlal
OFFICE USE ONLY
On Site Sewafle Occupancy R" 3 1` -- 1
MWCC System X 2oning R-1
On Site Well (Actual) Conat V-N
City Water (Allowable) V-N
PRV Required # of Stories
Sooster Pump Length
Depth 7'
S.F. Tatal
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 474•00
Pfanner Surcharge 37'00
Council Plan Review 735•00
BIdg.Off. SAC,City =00•00
Variance SAC, MwCC 550.00
water Conn. 5 50• 00
Water Meter 67.00
Road Unit 325•()U
Treatment P1 204•00
Parks
70TAL 2,538'00
1
CITY OF EAGAN 'S 15 7
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for DECK Est. Value i
Site Address 4056 PLMYI.VANi• w
Lot I I_ Block -S- SeclSub. STAFFORn PtACF
Parcel No.
W Name .tOB WSwVER
? Address 40S6 PENN3YLVAIQi_? w11E
0 City Phone 6S1_9mn
, o Name !?l?RK iLBAGLt?ER1 -
?? Address 16549 TRnilCx?sz AVE
City ROSE!lDUIPi' Phone 432-4042
Name _
Address
Phone
I hereby acknowlege that I have read this application and state that the
inlormation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permitee ?
A Building Permit is issued to: MAR1C ICAAGENARINCs
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Stalutes and City of Eagan Ordinances.
8uilding Ofiicial 1,1?',?.;E? ' w
OFFICE U5E ONLY
Occupancy - FEES
Zoning _
(Actual) Const _ Bldg. Permit 25,W
(Allowable) - Surcharge •?
* ot Stones _
Lertgth 4*9 Plan Review
Deplh 4-2-1 SAC, City
S.F. Total - SAC, MCWCC
S.F. Faotprinis -
On Site Sewage _ Water Conn
On Sile Well - Water Meter
Mwcc systerr, -
City Water _ Acct. Oeposit
PRV Required _ S!W Permit
Booster Pump - S/yy Surcharge
Treatment PI
APPROVAIS Ro2d Unit
Planner - park Oed.
Council
BIdg.OH. _ Capies
Variance - TOTAL 2 S.50
Permit No. Parmit Holder Oate Telephone +M
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
k?speetion Date Msp. Comments
Footings I
Foundation
Framing
Rooiing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orstai Test
Final Plbg. Pibg. Inspector - Notily Plumber
ConsL Meter
EngrJPlan
Bldg. Final
Oeck Ftg.
(O ! n
Dedc Final S•/Z'g ?S h ea? j ny yha f ? i1 ? ` 7-/O-? .
Well ?
Pr. Disp.
CITY QF EAGAN '? 97 .
. 3830 Pifot Knob Road, P.O. Box 21-199, Eagan, MN 551 21
PHON E: 454-8100
BUILDINtG PERMIT
Receipt # ,
To be used for . Est. Value . ?`• ??'? '?1 Date 119
SiteAddress •-?%? - ' '`' l'v OFFICE USE ONLY
Lot = 1 Block ' Sec/Sub. i^' , :'a.A(7'," On Site Sewage Occupancy
MWCC System ` Zoning
ParCel No.
On Site Well (Actual) Const
a
vr:'
Name ' . City Water ` (Alloweble)
? °-r?
w
=
Address PRV Required # of 5tories
3:
?
City Phone Baoster Pump tengtfi
Depth
o Name S.F.7ota1
,
? Q Address Footprint S.F.
?°C- City Phone APPROVALS FEES
? 4% C? .•f.;
a
vw
W Name Engs.lAssess. Permit ;?n
37
?- Z
_g
Address Planner Surcharge .
Q W City Phone Council Plan Review
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 Osdinances.
M
W
t
er
eter
a
Signature of Permittee Road Unit '
A Building Permii is issued ta Treatment P1
on the express condition that all work shall be done in accordance with all
Parks
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official TOTAL '
Permit No. Permit Holder Date Telsphona #
Plumbing o
H.Vac.
L', ?9?10?
? 40
? 9
Electric /7 , . ? s ?• ??
Softerrer
Inspection Dats Insp. COmments
Footings I
Footings 11
Foundation
Framing '
Roofing
Rough Plbg.
Rough Htg.
ISUI.
VM? n
Fireplace C</C<./
Final Htg. 6 3_d
Final Pibg.
Bldg. Final -
Cert. Qcc. y
Temp. LP
Deck Ftg.
Deck Final
Vuel I
Pr. Disp.
-71
? .
?' ' • • PERMIT #
MECHANICAL PERMIT
IPT
RECE
#
CITY OF EAGAN
3830 PILOT KN08 ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 454-8100 O
Site Address ` f' L
k
"Bl
`
L
S
/S
b a- BLDG. TYPE WORK DES RIPTION
?
T
ot
oc
• ec
u Res New
Name ` A C . Mu?- Add-on
m
Address
14
LI)
6 Comm. Repair
c City QN r"07" Phone •? 1? - 1 94--5 Other
ES
_
`4 , FE
Lo')
-'+? 1 !
Name « %, ^11
5 HVAC 0-100 M BTU -$24.00
RES
c AddreSS f??? `? w• .
ADDITIONAL 50 M BTU - 6.00
p City ?'???J°? Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
50 EA
GAS OUTLETS (MINIMUM - 1 PER PEkMIn - 1
TYPE OF WORK .
.
EE
TA
FE
C? ?;,?J
Forced Air M BTU ?700 COMM. RA E APPLIES
AP
BLDGS.
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
V
t
CFM STATE SURCHARGE PER PERMIT - .50
en
. (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # s BEYOND $1,000)
Other $
'
FEE: ; - ? o ? ? •
? .
S/C: U SIGNATURE OF PERMITTEE
TOTAL•
FOR: CITY OF EAGAN
h' • ' PLUMBING PERMIT
CITY OF EAGAN
3830 PILOT KN08 ROAD, EAGAN, MN 55122
PERMIT # 0
RECEIPT q 1?i (?'7 • Z16FC
DATE: 6 49!8 :i
Lot_
? Name !vc??z?l rie:.nai
?
Address .1159 ;ihatncet
?
c City
Name rrautlar tton
3 Address 390$ Slbley
0 City
COMMlIND FEE - 1°rb OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - FiES. 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)
BLDG. TYPE , WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
y0. FIXTURES T,OTAL
Water Closet - $3.00
-r-_Bath Tubs - $3.00 $
1 Lavatory - $3.00 ? • '
?Shower - $3.00
1 Kitchen Sink - $3.00 -l •'%?
Urinal/Bidet - $3.00
-I---
Laundry Tray - $3.00
T-
Floor Drains - $1.50
r-Water Heater - $1 50
? • ?'?
Whirlpool - $3.00
3-Gas Piping Outlets - $1.50 >•'
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
?-
' JO
Rough Openings - $1.50
30.00
FEE:
STATE S/C: .50
GRAND TOTAL• jU. 50
/ .?
•?
v '
(9rrfif irat.e uf (Orrupttrtry
Citp of (tagan
????? of "bhu3 .???ivn
Tiris Cerrifrcace issrced pursuant 10 the requiremenu of Secdon 306 of the Uniform Buildrng
Code ceMifyrng that at the time of issaance thrs struclure was in complrance with tlte varrnus
ordinances of lfre City rngulating building construction or use. For the following.•
uw ah.&Wio. ST DWC,/? ' mag. Nmit e?o. 15397
Occw.ncy Type R37t'? Zou;ng Disuic, R I 7yp, C,,n, VAi
owou or sdua;a? Fft'?':TEI' ,.; Ad&. 3902 OMkRVAI.E i3f?, EAd'?A1?T
&u7dirW Addras tZ.?1tr i;_i1 '!?'' ? LnnGry ?. Z 1, BJ * .`??'? P{.?
pW: cY'_7C1F?3t G ? i??Af3
ewaa?s officw
POST IN A CONSPICUOUS PLACE
CITY OF EAGAN
3830 Pilot Knob Road
P.O. Box 21199
Eagan, MN 55121
Site
Date: 7 '20-Date: 7 '28 BS 3taffard Place
MWCC: "?.Q ci
City Chg: 100. C'(1pd
_ _ . -Mpd
Acct. Dep:
Permit Fee: '
Surcharge: . t
Permit No: ,-096 '
B/P No: '._)6093
M-idwest Cvrp
sylveuia Avs
By
CITY OF EAG,AN.:,,
3830 Piloi Khob Road
P.O. Box 21199
Eagan, MN 55121
SEWEA SERVICE PERMIT
Permit No:_
Meter No: _
Reader No:
2oning' n1
No. of Units: 1
I agree to comply with ihe City of Eagan
Ordinances.
Date:
Size:
Date:
Site Address: _;;;y.?- 'rpnasevl vA,i- •, , ?.i IL?. `•- t*° f t '1 T',C
Plumber. -'Y-r b1•-?rin?
?
Conn. Chg:
Acct Dep:+.?
Permit Fee:
Surcharge:
Tr. Plant _ Meter.
Misc ' ' -•
Zoning: _.
No. of Units:
I agree lo comply with lhe C(ty of Eagan
Ordinances.
WATER SERVICE PERMIT
I
CITY OF EAGAN:
3830 Pilo3 Knob Road
P.O. Box 2t199
Eagan, MN 55121
Permit No:
Meter No: 15/0 7 4"6 Z o? /
Reader No: p-SR 216 a 7 3
Date: 7-29'088
Sixe:
Date: ?
?-.7 7-
Owner. rLrn..r taT ;4iAves "orp
Site Address: ILn4G T 11 g5
Plumber
Conn. Chg:
.
Acet. Dep;
Permit Fee: ?
Surcharge: '
.
Tr. Plant
Metec ' P
Misr • pLt
Zoning: _
No. of Units:
y af Eagan
t a!tw
Orey WATER SERVICE PE MIT
CITY OF EAGAN N2 15 3 9 7
? 3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121
? PHONE: 454•81 00
BUILDING PERMIT Receipt# 0 (p
To be used for SF DWG/GAR Est Value $74,000 Date .iIIL•Y 28 ,19_$$-
Si[e Address 4056 PENNSYLVANIA AVF OFFICE USE ONLY
Lot 11 Block 5 Sec/Sub. STAFFORD PLACE OnSiteSewage _ Occupancy R-3 M-1
MWCC System X Zoning R-1
Parcel No.
On Si[e Well _ (Actual) Conat V-N
a Name FRONTTER MTDWEST HOMES ORP Ciry Water X_ (Allowahle) V-N
w
z
Address 3902 CEDARVALE DR PRV Required # of Stories
-
° City _F.AC[?N Phone 454-0433 BoosterPump _ Length 43?
Depth 47'
.ao Name SAME S.F.7otel
?a Address FootprintS.F.
P City Phone APPROVALS FEE5
t-a
w W
Name Engc/ASSess. Permit 470.00
?x Address Planner Surcharge 37.00
? w City Phone Council Plan Review 235.00
Bld9. Off. SAC, City 100.00
I hereby acknowledge that I have red this application and state that the Variance SAC, MWCC 550.00
intormation is correct and agre comply wi g all applicable State of Water Conn. 550.00
Minnesote Stetu[es an City a an Ordin 6es.
.p
Water Meter
67.00
Signature of Permittee _ . '
RoadUnit
.3.75.00
A Building Permit is issued to: FR TIER MIDWEST HOM Treatment P1 204.00
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. Parks
n
r 70TAL za53$.00
^"
`o
Building Ofticial ?,
? v_. ? ?q ? '
t
BUILDING PERMIT
To be used for DECK
CITY OF EAGAN Np ? 9257
3830 Pilot Knob Raad, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 p I/ j0o?
Receipt # L?' ??
Est.Value $1,000 Date JIJN 17
Site Address 4056 PENNSYLVANIA AVE
Lot 11 Block 5 SeGSu6. STAFFORD PLACE OFFICE USE ONLV
Parcel No. occuPancy - Fees
Zoning _
w Name JOE WEAVER (ACtuap Const Permit
81dg ZS•0?
_
.
o Address 4056 PENNSYLVANIA AVE (Allowable) - ?
City EAGAN Phone 451-9000 +? of siodes Surcharge
_ •
Plan Review
Lengih 19L
o Name r1AKK KRAGENBRIN oepm SZ SAG Cil
Address 16549 FRANCHISE AVE
s.F.7otai y
-
?
City ROSEMOUNT Phone 432-4042
S.F. Footprinfs snc, McwcC
-
C
W
On Sile Sewaga ater
onn
?w Name on Site weli w
M
? ;
Address
Mwcc sysiem -
acer
arer
-
`aw Ciry Phone Ciry Water _ Acct. Deposit
PRV Required _ S/W Permit
I here6y acknowlege that I have read this application and state that ihe Booster Pump - Siyy Surcharge
information is correct antl agree to comply with all applicable Staie ol
Minnesota Stalutes antl Cit? Eag Ogdir?a c. Treatment PI
Si9naWre ot Permitee UV APPROVALS Road Unit
A Building PBfmil is i55ued to: MARK BRTNG Plannar - park Ded.
on Ihe express condition ihal all work shall be done in accordance with all Council
applicahle State of Minnesota Statutes and Ciry ol Eagan Ortlinances. Bldg. Off. Copies
,I
Building Official ? - ?1?j1??.I m n Va?iance - TOTAL L5.$0
Ihis roquesc voitl q ?/ p
18 months lrom /`?/O
E 28388 ///i?J
0 j', _-) °-o
, __?..
fleUUiP` C]HeaAY Now ,11 Nntity. InsPec-
? ? (1Nn tur When Ready
[6KZensod Eleclrical Conva[tm 1 hereby reQUeat inspaetion ot ebova
?Owner ' electrical work installedat
Sveet dress, Box oute N. • Citr-?
L7
edi n o. ownshi0 Name or No. a 0e No. CownYD ?
Oc nt INTI 1
T Pho e No.
?.7
?=
E r _D
?
Fowe, lier Atldress
ElectFical Contractor (COmVany Name) ConVar.tor' License No.
M ra rV, O k nB Instailationl
AuN
ationl
a,G?yS?
ylyly?g jC
Ow
nw'
a
n Phone Number
AY
rLt:
VA
LLEY
W
i
551
24
, 1
MINNESOTA STATE BOAXD OF ELECTRICITY THIS INSPECTION qEQUEST WILL NOT
Gripps-y BItlB. - ponm N-791 BE ACCEPTEO BY THE STATE BOAND
UNLESS PNOPER INSPECTION FEE IS
1821 Universitv Ave.. St. Veul. MN 65104
ae- iaigi an,.nann ENCLOSED.
?j/j/j/j;? REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-.orts?
, See iostructions for compieting this form on back ol yellow copy.
E "X" Belaw Work Covered.by 7his Request ?
r j
dal Neo. TYOe al BuilAing ADPliancen Wired Equiumanl Wired
Nome Range Temporary Service
' DuplFx Water Heater iyhtiny Fiztures
Apt. BuilAinc? Dryer Electric Heaun
Commercial Bldy. 41, Fumace Silo Unloader
InAustrial Bldg. Air Conditioner ? Bulk Milk Tank
Farm me, ig_vWify) ?ner ISneciWl
t .r svecifv t c, olncr
Comnute lnsoection Fee Below
p Fee ServiceEnVenceSixe tt Fee Ferders/Subfenders N Frte Cvcuits
U to 200 qm s 0 to 30 Am s 0 to 30 An! s
Above 200 q?npy 31 to 100 Antps 1 to 100 A
Swimming Pool Above 100-Amps Above 100_Am?x
Transtormers Irrigation Booms PartialOther Fee
Signs Speciallnspection
TOTA FE
Aemerks
?? , / a « e
V?
flough-in ? 1e s , ue EI '
? -`??^ ? ??? ? Inspecloq hereby
certity tMt the above
Final ?j???e ' oection hes baen
-J `=J /U?,,/S mada.
TMa repuest roi01B manOm trom
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Constnuetlon Reauirementa
• 3 reg'stered sNe surveys showing sq. ft of l04 sq. ft. ot house; and all roofed areas
(20% manimum lot coverage allowed)
. 2 copies of plan shmving beam & windax sizes; poured found design, elc.)
. 1 set of Eneryy Calculations
• 3 copies of Tree Preservation Plan if lot platted after 717193
. Rim Joisl DetaA Oplians selection sheet (61dgs with 3 or less units)
DATE V115 A -L
RemodellReuairReauiremeMS 1-71' IS
. 2 cropies of plan
• 1 set of Energy Calculafare kr healed additions
• i sile survay for e#erior additions & decks
• Indicate if home served by septic system for additions
VALUATION "P. j 64 / ?
SITE ADDRESS '-!o ?(o /De?v_1vsy1c,,a.,. a/)ut MULTI-FAMILY BLDG _ Y _VN
TYPE Of WORK ?e {2- d/-? FIREPLACE(S) _ 0 _ 1_ 2
APPLICANT /d-/co-,-e
,
STREET ADDRESS d CITY f F?ro.v .c STATEw_ZIP 5-13yb
TELEPHONE #`1 S-J- 97y ross CELL PHONE # FAX # 9-0 - 9 7l ?5__7Y
PROPERTY OWNER
TELEPHONE #
------------------- ------------------ -------- ------------ ----------- ----°---------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNCSOTA RULES 7670 CA7'F.GORY l 11
(Jsubmission type) • Residential Ventilafion Category l Worksheet Submitted •
• Energy Envelope Calculations Submitted
Plumbing Confractor: `_
1'lmnbing sys[em inchides:
Mechanical Contractor.
Mechanical sysCem includes:
Sewer/W ater Contractor.
Air Condirioning
HeaC Rccovery Systcm
I hereby acknowledge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan Or<
Signature of Applicard
--------------°- ° ----
and agree to comply
oFFIcE usr,
_ Water Soflener
WaYer Heater
No. of Baths
Phonc #
Lawn Sprinkler
No. of R.I.13adis
Phone #
Phone #
k6•I$ &E
a 15 20025 1
JL
Pcc: $90.00
rec: $70.00
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg only) • Glve 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 Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings(new bldg) _ FinallC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addiHon) _ Plumbing
Foundation HVAC
Drain TIle Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing. Siding Stucco Stone
_ Fireplace - R.L _ Air Test _ Final _ Windows (new/replacement)
_ Insularion _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanicai Permit
License Search
Copies
Other
Total
Building Inspector
7988 BUILDING PERMIT APPLICATION - CIT7f OF EAGAN
SZNGLE FAMILY DWELLINGS 10605 9 pi
? i
INCLUDE 2 SETS OF PLANSt 3 CERTIFICATES OF SURVEYt 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/EOMEOWNER MOST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWBD ONCE BUILD2NG PERMIT IS ISSIIED.
MULTIPLE DWELLINGS RENTAL ONITS FOR SALE UNITS # OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SUAVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
GOMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRiICTURAL PLANS,
i SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
To Be Used For: L?.o 0pRxMlAfilDlt) Valuation: te:
Site Address
Lot I I Block 5
Parcel/Sub 5-MqaFb¢-b 4k-pm?p
Owner G9AMPE4 4ir
Address y6l g 6Q&)AryVtA6hE ?L
yp00 OFFICE USE ONLY
On site sewage
MWCC system l/
On site well
City water ?
?PRV required _
Booster Pump `
City/Zip Code -G3?p) ? '?.a? 551??
Phone S'Q(7-(?954APPROVALS
Contractor Frontier Midwest Homes Corp.l Engr/Assess
Planner
Address 3902 Cedarvale Drive Council
Bldg. OfF.
City/Zip Code Eagan, Minnesota 55122 Variance
Phone
9rch./Engr. Phillips Plan Service
Address 14530 Pennock Avenue
City/Zip Code Apple valley, MN 55124
Oceupancy V?'3 /1-/
Zoning ?-
Actual Const
Allowable V/1/
1F of stor3es
Length
Depth y).33
S.F. Total
Footprint S.F.
FEES
Permlt ?z2l7
Surcharge 3 2
Plan Review 23S
!271"I13SAC, City / 00
SAC, MWCC SS-d
Water Conn 7W-
Water Meter G)
Road Unit 326F
Treatment Pl zokl
Parks
Copies
TUTAL ?' S?i •OO
Phone # 432-2044
Cities Di itg a1 Quality Control
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surUe7fors certificate
SURVEY FOR: Froatier itidwest Homes Coro.
DESCRIBED AS: *11, Block 5, STArFOP.D PLACE, City of Eauan, Hennenin
':ountv, ;':innesotq and reserving easement; cF rec^rd.
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PitOPOSED ELEV4TIONS
Top of Foundatien a 89-7,1
6ma" flox a 39-7. 3
BoUf"nf floor a 399.5
Approa. Sew Srr1d EMv. ¦ e94,'
Proposed ENrations
EruaHng ElwMlons .
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Planning Engrneeiing Survsyrng
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Lsna SurreTS unuer the law of tM 91ate of Minwesota. 800K
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Total CxpCSZA waii tirna abrvc Cinur= .la.t:; =
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a. Total wall windc;r area ...:....................................... --
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k. Total foundation winQow area ....................... -
1. Total net `oundation area ahcve qrade .............. -Z.- -^
Dzt=_r?tir:e "u" value of eatn wall segmant
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1991 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS
i ;
COMMERCIAL
2 SETS OF PIANS 2 SETS OF ARCHITECTURAL
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH BLDG. DEPT.) 1 SET OF SPECTFICATIONS
1 SET OF ENERGY CALCUTATIONS 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.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MIIST DESIGNATE'WHICH -ADDRESS IS
DESIRED. NO CHANGES WILL SE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS 25 TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: Pr-G k Valuation: ? v Date: (f:7
.
Site Address f-LA)rt,ISYL-VAAJIA f?
?
Lot Block ?
m
Parcel/SubSTAFFbiQD PLatC-
owner -3oC VJGAVF_2
Address-ADS (C FtN111SYt-?r1rJ,s, ft.VE.
City/Zip CodeC-AVfaiJ 551 Z 3
Phone 45) ' ct (DO U
Contractor h1RP-k- ke,At,c,,)(3r-WC>
Address (V[ ra4-9 F-P-ArJc H,SC. AvG.
Gity/Zip Code
Phone 43 Z - 40 4Z
Arch./Engr. AnR-ir-
Address
City/Zip Code
Phone #
E OFFICE USE ONLY
FBES ?S? ??
Occupancy Bldg. Permit .
2oning Surcharge
Actual Const Plan Aeview
Allowable SAG, City
# of stories SAC, MWCC
Length j2 Water Conn.
Depth Water Meter
S.F. Total Acct. Deposit
Footprint S.F. 5/w Permit
S/W Surcharge
On site sewage_ Treatment P1.
On site well _ Road Unit
MWCC System _ Park Ded,
City water _ Trail Ded.
PRV _ Copies
Booster Pump _
8 SUSTOTAL
APPROVALS Penalty
Planner Lot Change
Council TOTAL ?Bldg. Off. b-//- / ,S
Variance
agrees that all work shall be done in accordance with
(Signature of Contna tor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
, i::. 'Tr I Lfr+'?c u JV N
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? sur?ve?or`s Gertlj"?te
wRVEY FO? rroatier Plidwest Homes Corn.
DESCRIBED AS: r.ot 11, Block 5, STAFFORD PL,1CE, City of Ea?an, Hennenin
t;ountv, ;;innesota and reserving ease^nent_ ^f -
. ?ecord.
30
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PROPOSEO ELEVATIONS
Tai ot- FamaoHan ¦ sq-7.1
GOrOOf F100/ 6391.3
OON/Mllf FMYf • j94.5
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PrOPOsod Elorafiena . O
Esustln# Hlwofiem .
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NIN. SETBACK' R£OIREMENTS
Front - 3a Matwe SidO -:o
Rear - , 5 Go?e" SWM - _
I Mnep orMyr flrt 046 wNlS Va v ryyK- WAS yrpk*y bg w F185P61 B NO r r.au wy ar.et oo..blen aa root t w a wh Rpi.r.ru .P- 34 0
1.ma Svv? u?q?r ?N law of fM lfaN af YI"„ota. 00K
Gan:.:' t ,1 e "-'
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APFLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
,
?
.
i NOTE: PAS¢-]ENP OF FEE AT TIME OF
w APPLICATiON DOFS NOT CON- ?
? SPZTSTi'E APPA('iJAL OF PER[4T. i
:
? INtPtxMON OF SEWER ADD/OR WATEEi
?
IPiS7'AIdATIOIYS WII.L [d7P HE SCEJUIFD ?
? [!NPIL PII7PffT NAS BFE2] APPRCNID,
dtV #i4}4ti#4e#'l4fti}ifYYlf?til?tl*I??Yliiit•
OF eagC8P9
(PLEASE PRINT
1) PROPERTSt ADDRFSS:
i'Ff:AT• DESCRIPTION;
IF EXISTIW, STRL'CTC7RE, DATE OF ORIGINAL BLILDING PIItMIT ISSLANCE:
PRESENT ZONING/PROPOSID USE:
Q_COAMlEE2CIAL/RETAIL/0FFICE
Q INDLSTRIAL
Q INSTITCrI'IONAL/GOVERNNIENT
Nbnt Year
r
2 R-1 SINGLE FAMILY
E] R-2 DUPLEX ('iWO Cnits)
Q R-3 TOWNfiOUSE (Three + Units) { Units)
Q R-4 APARTMENT/CONDOMINIUM ( L'nits)
2) ? NANE: -FebY.Tn eK,
ADDRESS: 39 L? b IZA.1? .
CITY. STATE, ZIP: ??qw . My? 551"?3
--?
PxorE: as?-ba33
3) NAME: _ 5Z-A?R_: ?1urn13i.-^rw
AbDRESS: iC?l? V-?oUa>D ???aS T'?'YZPAC-E
CITY, STATE, ZIP:
PHONE: MASTII2 LICENSE # 33a GI
rlumoers Lacense:
Active
< < Expired
I_1 Not recorded
St Initia
4)
NAME:
ADDxFSS: 4,513 B L? i r,»am IZ '?. ?E 7M? C-
CITY, STATE,,ZIP: tftt?
PHONE: $Gr,-
5)
F?Cj CONNECTION Tp CITY SEWII2 EKT CONNECTION TO CITY WATER O 0'IHM
6) ?Mraw'7`t??ier'???-????CZc.,? 7
***?************?****?*******?*?*************????***?#???**???.***?*******?*,?**?*?*********??**??*
TAE GOLD COPY OF THE PFd2NIIT WILL BE SENP DIRDCIS,Y TO PUBLIC SvMKS '1C) FACILITATE METII2 PICK-UP.
PLFA.SE ALIAW 'IWO FARKING DAYS FOR PROCFSSING. SOMEONE FROM TfIE CITY WILL CONi'ALT YOp IF 7HERE *
* ARE ANY PROBIEP1S. *k
"? ?*?+**???,r*?:r??*,r***,r,r****?*,r********?x,r,rx+** *,r**+* **:r x**r:r*****?***** *?*?**++* *?* *+?* ??* ***,r*****r
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit FEES: '
$ 1D '5--b $ SEWER PERMIT (INCLUDE SURCHARGE)
$ $ WATER PERMIT (INCLODE SDRCHARGE)
$ $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLLDE CORPORATION STOP)
$ $ SEWER TAP
$ /D--o $ ACCOUNT DEPOSIT - SEWER
$ 1,5- «) $ ACCOONT DEPOSIT - WATER
$ ,? ?? • C? $ WAC
$ $ SAC
$ $ TRLNK WATER ASSESSME[VT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ ?2 6'`( $ WATER TREATMENT PLANT SLRCHARGE
$ $ OTHER:
$ Z o $ TOTAL
??GC / /
RECEIPT RECEIPT
DOES UTILITY CONNEC TION REQUIRE EXCA VATION IN POBLIC RIGHT OF WAY?
Q YES IF YES, THEN A" PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSLED BY THE ENGINEERING
Q
NO DIVISION. LIST AS A CONDITION.
SL BJECT TO THE FOLL OWING CONDITIONS:
APPROVED BY:
TITLE:
DATE : ?14? 2 Z Fe
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City of Eapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: /C3/74 4-(S/ (S"
Permit Fee: /65-84-S—
Date
Received: D •.- 13
Staff: 46
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -e.)?—!2) Site Address: 40 C-6 '"5 /L 4v Unit#:
Resident/
Owner
Name: �r Phone:
Address / City /Zip:
110 � �e4nS � Al 4 Awe ,
Applicant is: ✓ Owner Contractor
Atni s -r/
Type of Work
Contractor
Description of work: 1,4,44-11-0S
Construction Cost: I v (a 1 0 Multi -Family Building: (Yes / No )
Company: �'bU& ..__ Contact: pi k gi -(OK1
Address: i
►! City: (Ld
bk-
State: v!L `t / Zip: S /d Phone: 7(03— ,/
License #: (D io a Co p? -7- 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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work of to sta hout a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval 4 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code ust be completed within 180
days of permit issuance
x MVM. c r .e,,( F v&o\J
--Applicant's-P-Tinted-Nam e
x
Ap
gnatur
Page 1 of 3
qo -
Use BLUE or BLACK Ink
For Office Use
37
My ; Permit t
of Eap tro _
Permit Fee, I
3830 Pilot Knob Road
Eagan MN 65122 Date Received: 910 ;
Phone: (651) 675-5675 1 1
Fax:. (651) 675-5694 1 Staff:
1
- - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
i'
Date: Site Address: &~D JCUIMA V Unit
I-A
Name: f)C/ Phone: f/ o_`s!'"`ES
Resident/ Ix CU Owner Address / City / Zip: Applicant is: Owner _k Contractor
Description of work: \ m (1 + (Y
Type of World r)--z '
Construction Cost: ®V Multi-Family Building: (Yes No
i Company: 10,0Q Contact Ic/
Address: CA' li I I A io kity: w
L-k) I b
Contractor
Q' G} G~
State: Zip: Phone: [ S l ~.1 g /
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit am considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they aro trwk 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.aooherstateonecall&W
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that 1 understand this is not a permit, but only an application fora permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota S ' ding C ust be corn within 180
days permit issuan i;
x
X 14y,
Applicants Printed Name A i nrs Sig tur+e
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA136045
Date Issued:04/21/2016
Permit Category:ePermit
Site Address: 4056 Pennsylvania Ave
Lot:11 Block: 5 Addition: Stafford Place
PID:10-72500-05-110
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Weaver Family Revocable Trust
4056 Pennsylvania Ave
Eagan MN 55123
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA159437
Date Issued:12/17/2019
Permit Category:ePermit
Site Address: 4056 Pennsylvania Ave
Lot:11 Block: 5 Addition: Stafford Place
PID:10-72500-05-110
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
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 -
Weaver Family Revocable Trust
4056 Pennsylvania Ave
Eagan MN 55123
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA168487
Date Issued:04/22/2021
Permit Category:ePermit
Site Address: 4056 Pennsylvania Ave
Lot:11 Block: 5 Addition: Stafford Place
PID:10-72500-05-110
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Includes Skylight
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. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
*Roof permits issued between December and March will be inspected in the spring or when weather warms up.
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 -
Weaver Family Revocable Trust
%joe & Rebecca Weaver
4056 Pennsylvania Ave
Eagan MN 55123
(612) 518-8583
Elite Restoration Pro
1120 E 80th St, Suite 201
Bloomington MN 55420
(952) 322-7773
Applicant/Permitee: Signature Issued By: Signature