4665 Penkwe Way
Use BLUE or BLACK Ink
Foi Office Use
I f
1 J
City of Eapn I Permit#:
I 1
I Permit Fee: I
1111
3830 Pilot Knob Road 1
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 1 I
1 Staff: I
Fax: (651) 675-5694 - - - - - - - - - -
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
'1 r_ r r~
Date: Site Address: L C
Tenant: Suite M
RESIDENT / OWNER Name: \ N Phone: a~ "t¢`gtot
Address / City / Zip:
CONTRACTOR Name: ``ti°aC~ License M
Address: a
State: Zip: Phone: d~2,D ^
Contact: Email:
TYPE OF WORK -New _Replacement _Repair -Rebuild Modify Space - Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Softener
Water Heater
Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main Lower Level)
Septic System Water Turnaround
New Y~~? a1
Abandonment Q R A-
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
'Water Turnaround (add $166.00 if a 518" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $
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.org
I hereby acknowledge that this information is complete and accurate; that the work will be in confo a ce with the rd' ances nd tles f the City of
Eagan; that I understand this is'not a p mit, but only an application for a permit, and work is of t st wit u a perm ; tha he rk will be in
accordance with the a proved pi ninth case of work which requires a review and approv pl s.
x~ x
Applicant's Printed Nam App ' t s Si natu e
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground -Rough-In _Air Test Gas Test Final
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA088494
Eagan, MN 55122 . Date Issued: 03/19/2009
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4665 Penkwe Way
Lot: 2 Block: 3 Addition: Johnny Cake Ridge
PID 10-39800-020-03
Use
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: Owner: - Applicant -
Donald Whitehead
4665 Penkwe Way
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature
CITY OF EAGAN Remarks
Addition joullim CAR RII)Q.$ ?EIM.MIN - Lot ? Btk 3 Parcel 10 39800 024 03
owner ?ct, ', IJJ601f.410L gtreet 4665 Penkwe Aiay scate Ea.gan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1975 323.14 21.54 5
* SEWER LATERAL
WATERMAIN
* WATER LATERAL lqRl
WATER AREA 19$0 268.55
65
.
STORM SEW TRK 5d1?
* STORM SEW LAT
CURB & GUTTER
SIDEWAI.K
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CASH RECEIPT
CITY QF EAGAN
3795 PILOT KN08 ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECfilVEC
FMOM
AMOUNT $ I
& DOLLAR!
+ao
E3CASH R CI-IECK
FOR
White-Payers CoPY
Yellow-Pocting Cppy
Pink-File Copy
Thank You
?6?__ BY _
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
, . ,. i iqy
,
PERMIT SUB,TYPE: TYPE OF WORK:
I
1%1:101AF7Kit A SCPAIRATF Pf'ItMI' C TS R[=QUfi:t tl t t i v lkNY 1 ' I 1 I M I t ' l N 1 ; 11R I I f I tkll AI 1.111 FtY
3 ?
Permit Holder Date Tetephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAI HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITV
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAI
DECK FTG
DECK FINAL
No. '3
CITY OF EAG/?N
3795 Pilof Knob Rood
Eoqan, Minimota 56122
P6ene: 454-8100
n ? PERMIT
Date:
Site /lddress: 4665 r'ellkw@ vla7
Lot Block ? Sub/Sec. J
Nome -'uri 'rJlliteheIId
.
? 4.la.a« , . . '.?, . .
a
City ? Phone:
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL tNSPECTIONS
Receipt No.: 2015
Single
Residentiol
Multi Res., Comm./Ind. ?
New//11ter./Repair
Cost of Installotion
Permit Fee
5.00
5n
Name Surcharye
.
? Addreu -I Calif,•,..14p
?
V .
City . . . Phone: - • _ - Totol This Permit is issued on the express condition that oil work sholl be done in accordonce with all appliaoble State af
Minnesoto Statutes and City of Eogon Ordinonces.
Building
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH O N E: 454-8100
BUILDING PERMIT Receipt# '
To be used for Est. Value ' Date ,19
Site Address ' ?? ? ; • ? . "; „`j t
Lot Block { Sec/Sub. JUHNNY CA&L R1lL
Parcel No
i't.ALD WtllTEiiFAU
a Name
= Address '
° City Phone
, o Name ?,
Address
? City Phone
?a
?
W Name
s a Address
0
!5 W
City
Phone
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 Mfnnesota Statutes and City of Eagan Ordinances.
O FFICE USE ONLY
On 5ite Sewage _ Occupancy
MWCC System _ Zoning
On Site Well _ Type of Const
City Water _ (ACtuaq
(Allowable)
# of Storles
Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Assessments Permit
Water/Sewer _ 5urcharge
Police Plan Review
Fire SAC, City
Engr, _ SAC, MWCC
Planner _ WaterConn.
Council _ Water Meter
Bldg. Off. _ Road Unit
APC _ Treatment Pt
Variance _ Parks
Copies
Signature of Permittee TOTAL
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesote Statutes and City of Eagan Ordfnances
Building Official
Psrmft No. Permit Holder Date Talephone s
Plumbing
H.V.A.C.
Electric
Softener
Inspsction Dat* insp. Commsnts
Footings I
Footings II
Foundation
Framing
Roofing
Rough Pibg.
Rough Htg.
Isul.
Fireplace
Final Htg.
ab
4
?
Pr. Disp.
BUltDING PERMtT
Site Address
Lot Block
CITY OF EAGAN
8795 PibF Knob Raad Ecgae, MN 55122
PHONE; 454-8100
Receipt #
DnrP i :ay
: Sec/Sub. r'? ,C?e Rdg
Porcel #
oe Name
W
Z Address •'o? ?':- ; src ? ..
o _. eton';._ -7
?
0
Z
ou
u?-K
?
Nome _
Address
Nome _
Address
I hereby ocknowledge thot I have read this opplicotion and state that
the informotion is correct ond ogree to comply with all applicoble
State of Minnesota Statutes ond City of Eagon Ordinances.
Erect 0 Occuponcy
Alter ? Zoning
Repalr ? Fire Zone
Enlorge ? Type of Const.
Move p,
, # Srories
Demolish ? Front ft.
Grode ? Depth ft.
Approrols Fees
Assessment 4/ J
Water & Sew.
Police
Fi re
Eng.
Plonner
Counci I
Bldg. Off.
APC
Permit
Surcharge
Plun check
SAC
Water Conn.
r. ?Wnter Meter '
Road Unit '
Total
5ignoture of Permittee ?
A Building Permit is issued to: on the express condition thot
ull work sholl be done in nccordance with all applicable Stote of Minnesoto Stotutes and City of Eogan Ordinances.
8uilding Official
N4 5801
.
Penett # peh ( ed PennlttN
Plumbing /70 ?
Mechonicul ? (p !l v
tpe.f.. . 5??39 l? b
z
INSPECTIONS DATE INSP.
Rough-In
Final
Footings I
-/yS(v Dcte Insp. Dote Insp.
Foundnti ? Plumbing
From ins.
6
-
Mechanical ?
Final '•i._ .
Remarks:
No. '109
.
LUMBINQ
cIrY oF EAGAN
3795 Pilot Kwob Road
Eagan, Mlnnesota 55122
Ption.: 454.8100
PERMIT
Date; TnEM May 27 , 1980
Site Address: 4665 PeTiltWe Wlqy
Lot BI«k Sub/5ec.
JIy. C[. -W
Name ... : _? &:lib /G11
? Address 1-712 :iU7?ki719 CppB'.T73d
City ••=T1I1@tOrijCSi"14 Phone:
Nome W?nze1
.
? Address 3600 K2Yiilebf-,C UI'tVe
City Phone:
This Permit is issued on ihe express condition thot oll work sholl be
Minnesoto Stotutes and City of Eogon Ordinonces.
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
5ingle I
Residential
Multi Res., Comm./Ind. I
New/Alter./Repair. ?
Cost of Instollotion
Permit Fee '
Surchorge
Torol 20• -
done in occordance witfi all oppllcable State of
Building Officiel
No
Date:
Site /lddreu:
Lor
cirY oF EAc,AN
3795 Pilot Knob Road
Eogae, Minneaota 55122
PUene: 454-8100
PERMIT
June 9, 19P0
4665 Penkze . ay
Block 5ub/Sec. TM?v.Ck. Rid.pe
"Yrf_n
Nome
•
?
Address - ? , _ _ ,,,.,?,:?s? •'
?
?
'. ?I'_7I11DtOIL'?{£l ,
City Phone:
iA
F;y l, e ', tp;- LZ-,
-? ?-
Nome . ,
?
i7
?
Address
?
-
•? ? ?-
-
Ciry Phone:
This Permit is issued on the express condition thof all work shall be
Minnesoto Stotutes and City of Eogan Ordinonces.
Receipt No
Single
Residential
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Multi Res., Comm./Ind. ?
New/Alter./Repoir
Cost of Instollotion
Permit Fee
Surcharge
Total
done in accordonce with ell eppliceble Stote of
Building Officiol
?
r OF EAGAN
SEWER SERVICE PERMIT
795 Pilot Knob Rood PERMIT NO.:
, gan, MN 55122 DATE:
oning: No. of Units:
ner:
d
dress:
ite Address:
lumber:
pgree M eoinply with the City of Eogan Connection Charge:
!Drdinanees. Account Deposit:
By
Dote of Insp.:
I nsp..
. r aF enGaN
7q5 pilot Knob Road
gon, MN 55122
oning:
ner:
dress:
ite Address:
' lumber:
Meter No.:
Size:
,Reoder No.:
I a9ree to Comp{y with !he City af Eagan
-0edinanees.
? BY
; Dote of Insp.:
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Date Paid:
WATER SERIVICE PERMIT
PERMIT NO.:
pATE:
_ No. of Units:
Connecfion Char9e*
qccount Deposit: _
Permit Fee:
Surcharge:
N1isc, Charges: -
Total:
pute Paid:
minna50ia a[8W OOaIO oT e1BC[flCi[y n
Griggs Midway Bldg. - Room N191 n? EB-00001-02
1 niversity Ave., St. Paul, Minn. 557C" - vhone 297-2111
' REQUEST FOR ELECTRICAL AC'rIXTION ?
CHECK BELOW WOKK COVERED BY THIS REOUEST Sr)F.5 3 R
?ype of Building New Add. Rep. Check Appliancea Wired For Check Equipment Wired Foe
Home 0 ? Range ? Tempotary Wiring ,??,
I7uplex 0 - ? Water Heatex ? Lighting Fixtures
?
Apt. dldg. ? ? ? Dryet ? Electric Heating
Commercial Bldg. ? ? ? Furnace ? Silo Unloader ?
Industrial Bldg. ? ? ? A'v Conditionec El Bulk Milk Tank ?
List ) List
Oth [ ? ? ? p
}
Hehers) p
Flerels?
COMPUTE INSPECTION FEE BELOW
Setvice Entrance Size: # Fee Fceders& Subfeedecs: # Fee C'ucuits: # Fce
0 to 100 Am s. to 30 Am eres 0 to 30 Am eres ". O
101 to 200 Am s. to 100 Am res 31 to 100 Am eres
Above 200_Amps. ++ ove 100 Amps. Above 100 Amps.
Transformers Control Ci:c.
Remote
Signs cial [ns cction Minimum fee $5.00
Remazks _
• TOTAL FEE r?
d, L n
I, the Electrical Inspector, hereby certi t th e ihspection has been de: ,.?
(Rough-in)_ ?j Date ?'7
(Final) Date - oZo7 -O
This request void
18 months from
This request void ?n{.nr y CvI/L (zc?fe.^x?t,,, „ Cq '?'i. Cia
18 months from
/3 3 665?8
Date of this Request Fire No.
I, as O Licensed Electrical Contractor, wner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. ?p ?O S ??1VGU ? w 6'i/ CityL?A"
Section Township Range /County
v ?^
Which is occupied by?/JI?L7 K J
-? i7.Cl-o H-t' j
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will Call ?
Power Supplier ! /iKC MQE1ZIC. Address
Electrical Contractor „/)-s-vaz-e? Contractor's License No. _
(Campany Name)
Mailing Address
Authorized
Making
Phone
(Electrlcal Contractol or Ownsr Making 7hIS Installatlon)
((?f ?VE p5Dnno C?P? This inspection request wiil not be aceepted by the
v fd /Fil Stete Board unless proper inspection fee is enclosed.
minnesoca aece wara or ciecviclry
t- Griggs Midway Bidg. - Room N191
1821 University Ave., Sc. Paul, Minn. 55104 - Pirone 297-2111
FZEQEJEST FOR ELECTRlCAL INSPECTION
CHkK BELOW WORK COVERED BY THIS REQUEST
1 w$g-Q09D 1-02
?e O
S 64392
Type of BuBding New Add. Rep. Check Appliances Wired For Check Equipment Wired Foi
.Home ? ? Range 0 TemporaryWiring ?
Duplex ? ? Wat
r ? LightingFixtures ?
Apt.Bldg. ? ? ? Dry
1 Electric Heating ?
Commeicial Bldg. ? ? ? FuAIL)
? Silo Unloader
Industrial Bldg. ? ? ? W Bulk Milk Tank ?
List L
ist )
O her ? ? ? p
HeierS? p
Heiets}
)
COMPUTE INSPECTION FEE SELOW
Service EnUance Size: # Fee Feedeis&Subteeders: ax Fee Cixcuits: # Fce
0[0 100 Am s. 0 io 30 Am eres 0 to 30 Am exes
101 to 200 Am s. 31 to 100 Amperes 31 to 100 Am eres
Above 200 Amps. Above 100 Amps. Above lOQ_Am s.
Transformers RemoteControlCiic. Partialorotherfee
Signs Special lns ecdon Minimum fee . 0
Remarks
TOTAL FEE 172.30
?
I,the Electricaltnspectoi
(Final)
This request void
18 months from
hereby certify t}SSfj43v?abo,d?} t?on h been made p
w e
P Date
? ` ? ? ? , ., i1Y ?
This request void 161 /0,?
18 months frozo
Date o ttiis Request 51 71 Ir6s? Fire No. S 641392
I, as Lcensed Electrical Contractor OOwner, do h? g r e b y re uest ' s? p, g c t i On of the above electri-
?l w i ? in g installed at: C„? u ?( ? O E! C? 0
? /
StreetfAddress or Route No. ?I (ofo5" P?Nr--WE WPH ? cityEMJ
Section Township Range Counry
Which is occupied by
ls a roughin inspection required on this job? No ? Yes{j-PK- Ready Now ? Will CalIT-5,
Power Supplier P4 Address F&-t% WG-m?
Electncal Contractor ReU' e?eG-T/ C Contractor's License Nol'3EN
Mailing Address 1111 f. -_ Q-)1Je
(Ele€ cal ntr r ar Owner Making Thls InstallaUon7 Q
Authorized Signature ? ?i? Phone No. 1D '-SS?
(Electrical Contractor or Owner Makin9 Thls Installatlon)
? j??
? ?O ,n ?)1311? ???? This inspection request witl not he accepted by tlhe
? ll WJ ii=.1 Stete Board unless proper inspxUan fee is enclosed.
/?/f///? REQUEST FOR ELECTRICAL INSPECTION nee.ooom-oa
1027 •/ I? See insimctions for mmpleting this lorm on back ol yeilow copy. _ f?`/j
(/?7"L7
IAU1 7 ` "X" Sefow Work Covered by This Request ?•??'?
ew AE Rep. TypeolBuilding AppliancesWired EquipmenlWired
Home Ranqe Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm./Intlustrial Fumace
Farm Air Conditioner
Omer (syecily) Comrector. Remerks'.
r {'.(/Zr.?,c,?.d
Compule Inspection Fee Below:
# Other Fee r viceEnlrance Size Fee
# # Circuits/Feeders Fee
Swimming Pool 5
0 t00 Amps 0 to 100 Amps
Transtormers Above 200 _ Amps Above 100 _ Amps
Si9n5 Inspectar's Use Only. TOTA
Irrigation Booms
2U ?
Special Inspection
/
niarm/Communication THIS INSTALLATION MAY BE OR ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 M S. ?
1. ihe Electrical Inspector, hereby ROUgh-in 1
certifY that the above insPection has
been matle.
r777
Date
?9 y
OFFICE USE ONLY i
This :epoest void 18 monins Irom
/O/P! ???/
9 43417 4
Re0uesl Date
?' / 1.7141 Flre No. oug??in Inspection
fleq ' edP
? Reatly Now Wili Notify Inspecmr
n R
tl
?
es =No e
ee
y
1 ? ycensed contractor wner hereby request inspection of above electrical work at:
Job Atloress (Sireet. te No.I Ciry
5 f
11116
Seclion No. Townshlp Namg or No. Rangeyb. County
Occupan T)
?h+ Phone No.
a
an l.
Power SuoOlier Aotlress
Elecmcai Contractor (Company Name) Comraclor§ License No.
w,? r
Maihnq Adtlress (GOm
ractor or p.vnar Making Instellation) '
I'
Vt-
AmSig -amsre ?ICO?vaciovOw r M ?yn nslalla?iom
?0 Phone N(umber
? ?
"?'?
?? ? ? J ? ?
MINNESOTA STATE BOAPD OF ELECTRICITY THIS INSPECTION FEOUEST WILL NOT
GrigqsMitlway BIEg. - Room S-173 BE ACCEPTEO BY THE STATE BOARD
1841 Unlversity Ave., St. Peul. MN 55100 UNLESS PROPER INSPECTION.FEE IS
Phone (612) 602-0800 ENCLOSED.
CITY OF EAGAN N 0
13 8 8 5
-
3830 Pilot Knab Road, P.O. Box 21-198, Eagan, MN 55127
PkIONE:454-8100
--? -
4 Vc-l
3
BUILDING PERMIT
Receipt
To be used for DECK Est 4alue $2,000 pate JGLY 9 87
19
Site Addiess 4665 PENKWE WAY OFFICE USE ONLY
Lot Z 81ock 3 Sec/Sub. JOHNNY CAKE RIDG On Site Sewage _ Occupancy
MWCCSystem _ Zoning
PefC01 No. On Site Well _ Type of Const
(ACtuan
Ciry Water
_
a Name DONALD WHITEHEAD (Allowable)
w
z
Address SAME # of Stories
?
City Phone 456-4325 (yJ) Lengtn
Depth
To[al
S
F
.
.
, o Name SAME 454-5535 FootprintS.F.
?? Address APPROVALS FEES
¢ City Phone qssessments Permit ?3
?
f ? Water/Sewer _ Surcharge
W W Name Police _ Plan Review
? z
x-
?
Address Fire SAC, City
-
?
5 w
City PhOnO Engc _ SAC, MWCC
Planner
WaterConn,
_
Council _ WaterMeter
I hereby acknowledge that 1 have read this application and state Bldg. OH. _ Road Unit
thattheintormationisconectandagreetocomplywithallapplicable APC - TreatmentPl
State of Minnesota Statute d Clty of Eaga Ordinancgs. Variance _ Parks
Copies
SignatufC Of PBfmittBC ?Oil[ TOTAL $38" 50
A Builtling Permit is issued to: DONALD WHITEHEAD on the express condition that
all work shall be done in accordance with all appliceble of nnesota Stat?? s, and qCity of Eagan Ordinances
Building Official
c
CITY OF F6Ac;AN Include 2 sets of plans.
1 site plan w/elevations s
BUILDING?PII2NLiT APPLICATION 1 set of esergy calculations.
Zb Be Used For Rss%oEHCe _ Valuation'?_q6?r6D _?te D?R%u 23y 19Rn
Site Pddress: y?,(c QEU"E Cw1A,?v (mn0eL SOGp) OFFICE USE ONLY
i,ot siocx 3 sec./sL,b. aw+NNv cAKe Erect oC occupancy tp3
d 0.%uy£ Alter ZoniTra
PdrCEl #: i . .. .t r_e,,?l?d<?.f'
Owner:
Address:
City/Zip Code:
Phone #:
Contractor: (1RRW THnMPSf1N I-1l1AAFC
Addi05S: a Division of U. S. Home Corporation
,,,' "^^; „Ns-sRossReAe
City/Zip COdE: MINNETONKA, MINN. 55343
Phon2 #: Syq•1333
Arch. /F1ng. :
Pddress:
Gity/Zip Code:
Phone #:
Repair . Fire Zone -3
Enlarcje _ 'Iype of Const. 1/
Nbve # Stories
Dmiolish FYont SO ft.
Grade DePth 3y ft.
APPRC7VAiB F'EES
Assessments ? Pennit J J ) '?:L
Water/Sec.er Surcharge 3
Police Plan Checlc Y$ g-°
Fire ? 'Ca'r -
glq, Water Conn. 0,57-
--3
Planner ?
?r
Water Meter
Council Road Unit
Bldg. Off.
APC
Tl7PAL )331
?/
CITY OF EAGAN
3795 Pilm Knob Road Ea9ao, MN 55722 N2 5841
PHONE: 454-8700 ?J??
BUILDING PERMIT APPLICATION rteceiPr # ?
To be vaed hr SF Dwla/Garage Esc.vaiue 75,000.00 Dpte May 5, , 1 q Lo
Site Address 4665 Penkwe WaV Erect M Occupancy Ri
Lot 2 BI«k 35ec/Sub. Jhny,Cake Rdg. qiter ? Zoning Rl
Parcel .#' Repoir ? Fire Zone TTT
Enlarge ? Type of Const. V
w NGme Orrin Thomnson Hcm125 Meve ? .# Stories
; Addre sst712 Hopkins Crossroad pe„wlish ? Fronr 50 fr.
? Minnetonka Grade ?e h 34 N.
Ci Phone 511?1-733? ? ?
? Name SAME Approrals Fees
? - -- -
oU
u4?
?
Nome _
Address
I hereby acknowledge that I have ead this
the intormation is correct and gree to c
State of Minnesota Statutes d City of
$Ignature of Permittee T '
A Building Permit is issued to: ?
all work shall be done in accordan
Building Official
ond stote that
oll applicable
Assessment 4/G:)/OV
Water & Sew.
Police
Fire
Eng.
Planner
Council
BIdg.Off. 4 2 80
APC
Permit sl f uv
Surcharge 37.50
Plan check $$ • 50
snc 525.00
Water Conn.305 • 00
Water Meter 60.00
Rood Unit 185.00
7orol 1.378. 00
HOID2S on ihe exprew condition that
of Mfnnewta Sjatutes and City o{ Eagan Ordinances.
PERMIT# L-V -J ) --).-
RECEIPTDATE: ?5- - I (?,
8008 RUIDEVTIAL PLUM$INH PEiiM1T APPLICATION
crrY oF Ens,vv
9$30 PILOT KNOB RD
£AHAN, MP 551E8
651-681-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITEADDRESS: "TIYtpLP P60Kwi
OWNER NAME : CIIA<Sl;I/+Z l?LL7P J TELEPHONE #: c(6?) y5'1 ^Q 0-)51
(AREA CODE)
INSTALLERNAME: NOY6IbYY1 `'IL,1,VAbi?4 TELEPHONE#: (0iz"$2-7 "' if o33
STREET ADDRESS: 20iO$ C.?arf e.td ??h We- SO Ll-}'li (AREA CODE)
CITY: ,v`LS. STATE:
Mn1 Z,P; 5540$
_ SEPTIC SYSTEM, new/refurbished (requires two sets of pians and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCL0.IDING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit (+ 5!8" meter if needed -$116)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener X water heater $ 15.00
State Surcharge $ .50
Total g 15.50
I herebyacknowledge ihat I have read this application, state that the informatlon is correct, and agree to complywith all applicable Cityof Eagan ordinances. It
is ihe applicanPS responslbllity to nolify fhe property owner ihat lhe City of Eagan assumes no liability for any damages caused by the City during its normal
operational and mainlenance aclivities to the facilities constructed under this permit withln City property/right-of-wayleasement.
SIGNA E OF PERMITTEE 7/02
4665
'e"*; ' ? 91"
For:
U. S. HOME CORPORATION
PE/yXwF
tNAY
t. Ip.YX/
? o
?
Scale: 1" = 30'
O Denotes Iron
O
O
I I,D,jerhang b
z9.'1
PropoSea 1 u,
? z NDUSE ? t-.
?
:
S ?- f
o ?31.29
/
Lot 2, Block 3, Johnny Cake Ridge
Addition, Dakota County, Minnesota
N
WE HERE6Y CfRTIFY THAT TMiS IS A 7RUE AND CORRECT REPRESENTATION OF A SURVEY OF THE
60UNDARIES Of THE tAND A90vE DESCRI6ED AND Of iHE IOCATION Of ALL lUIIDINGS, IF ANY,
TMEREON, AND All VISIBLE ENCROACNMENTS, If ANY, FROM OR ON SAIO IAND.
Datad thii?doy of , A9AR A.D. 1980 C• R• W? ?ASSOCMTES, INf.
br ?•,-
Survayor, Minnowlo Raqistrotien Ne. 7724°
C. R. WINOEN & ASSOCIATES, INC.
IAND SURVEYORS Ttl 645•3646
1361 EUSi15 SL, ST. PAUI, MINN. SSIOB
FERMIT
CITY,QF EAGAN
383G Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMITTYPE: BuzLnzNG
Permit Number: 0 3 3 A 2 9
Date Issued: 0 9 J 2 3/ 9 8
SITE ADDRESS:
P.S.N.: 10-39800-020-03
4665 pENKWE WAY
LOT: 2 BLOCK: 9
JOMNNY CAKE RTDGE
DESCRIPTION; R E R o oF
Bui??&r".Permit Type
B,4!Id4ng`14o,rk Type
?
?
w?
a+. ' ? m
STORM DAMAGE
REPAIR
434 ALT. RESIDEN7TAL
Z?N
rv? ?? .t p ? ? E w? S :.?=.
?" . ?y r
?,'.' t
I '?.E ± ?? ?' 4 ? „';Ey;
;? .
REM4R!!?-$ARATE pERMIT IS REQUIRED FOR ANY PLUMBING QR ELECTRICAL WORK
FEE SUMMARY:
'R'??1Yft?i"C'R"'S' BES7 INC,nrryy17970100 29139703 l7HI?EH?AD DON
2400 INTERLACHEN DR 222 4665 PENKWE WAY
SpRING PARK MN 55384 EAGAN MN 55123
(612) 707-0100 (651)545-5535
a , . . " ..:?
? ' . :.
?G f?er?b? ??kns??l?dq?. ?h?? ?.6ve z?ea?€ tFris ,4 Pp]?i catiort at?a_stato tirat kJ?e
K
inf4rmatlan is corr.eot and agreo tu oomply with all applicatale 5tate of Mnd
st
atut;es aod C.a.ty of EagAtn Ortiiraanco-s,
? ? -
APPLICANT/PERMITEE SIGNATURE SSUED BY: SIGNA URE
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
7 / CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
681-4675
New Construction Requirements
? 3 registered ede surveys
• 2 copies af plans (include beam & window saes; Ooured fiC. design; etc.)
? 1 energy wlculations
? 3 copies of tree presenation plan rf lot pWtted after 7l7193
required: Yes _ No
DATE:
?
DESCRIPTION OF WORK:
STREET ADDRESS:
LOT: P, BLOCK: 3_ SUBD./P.I.D. #:
RamodeVRepair Requirements
? 2 copies of plan
? 2 site surveys (extedor adtlitians 8 decks)
? 1 energy ralculatians for heated additionsCONSTRUCTION COST; LIJ`! f
Nameb-X?,- L ? t,Q P1. + JC7? Phone
PROPERTY Laz First
OWNER
Street
City State: Zip :
Company: .0idn eV Phone #: Y-IC>?'? -0 E Q?
CONTRACTOR I
?
? ? f 13n"Lk
Su?eetAddress,
-
{dn..?-K 4J License# ?-
t )
City ?i(l(I?`Q 4l/ 1ti. State: 1' Y??1 Zip:
ARCHIT'ECT/
ENGINEER Company: Phone
Nacne: Registration #:
Street Address:
Ciry State: Zip:
Sewer & water licensed plumber (new construction onty):
and lot change is requested once permit is issued.
Penelty applies when address chan(,
I hereby acknowledge that I have read this application and state that the information is correctand agree to wmply wRfi all appiicat
State of Minnesota Statutes and Ciry of Eagan Ordinances.
Siqnature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Yes
No
D [9 DC'??
A Stp ? ; ;?ags? I?? 1?
Tree Preservation Plan Received - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? OS 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 = plex
WORK TYPE
O 31 New ? 33 Aiterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft. MC/WS System
_ Main level sq. ft. City Water
_ sq. ft. Fire Sprinklered
_ sq. ft. PRV
_ sq. ft. Booster Pump
_ sq. ft. Census Code.
_ Footprint sq. ft. SAC Code
Census Bldg
Census Unit
Building Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
% SAC
SAC Units
.
1987 BOILDING PERHIT 9PPLICATION - CITY OF BAGAN
SINGLE FAMILY DWELLINGS
INCLDDB 2 SEfS OF PLANS, 3
OF SQItVEY, 1 SST OF ENERGY C9LCQLARIONS
NOTE: ADDRESSES FOE CORNER LOTS - COPTRACTOR/HOMEOii[JEa MQST DESIGHATE WHICH 9DDRESS
IS DESIRID. NO CH9NGSS WILL BE ALIAWED ONCS BQILDING PERHIT IS ISSOSD.
MOLTZPLS DiiELLIAIGS - RLrSIDENTI9L RfiNTAL OAITS FOR S9LE IIl1IYS
INCLUDE 2 SETS OE PLANS, CERTIFICATE OF SDEVEY - CHSCB ftITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COlyR76RCIAL
INCLIIDE 2 SETS OF ARCHITECTURAL & STRQCTURAL PLANS,
7 SET OE SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
w
To Be Used For: Ok'MM2 Z)e? Valuation: ?• Date:
Site Address W-ks rENrFtJE WAY'-
r.at 2 Biock 3
Parcel/Sub TM1J?)y C(rKE ?DCxE/CPtP,'flo?
Owner?O??.p J SUSWL WEh.7'b-K-*%1
Address ??•(r,(p? ??k?.,? WArl
City/Zip Code Qk(.," MA
Phone(6iz). ??-SS3S .. 432 r
Contractor 5p'[?
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone ll
On Site Sewage_
MWCC System _
On Site Well _
City Water _
arraovA.s
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Varianee
Oecupancy
Zoning
Type of Const
(Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
Fsss
Permit 3 T -
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
4565
C. R. WINDEN d, ASSOCIATES, 1NC.
LAND SURVEYORS TOL 648-3646
d 'C7
1381 EUSTIS ST., ST. PAULP MINN. 55108
For:
U. S. HOME CORPORATZON
N
PENKwE WAy Scale: 1" = 301
? O Denotes Iron
O '-
?
z" # 46E5 ? a ?
o
I
? ?:Qoih;.t '= \ Cn
lp
Z?- 3
„
b.b'?
?
-Xy ?f
r -- ?: ---
-f L_-
o /31.29
/
Lot 2, Block 3, Johnny Cake Ridge
Addition, Dakota County, Minnesota
WE MERE6Y CERTlFY TMAT THIS IS A TRUE AND CORRECT REPRESENTATtON OF A SURVEY Of THE
80UNDARIES OF THE tAND ABOVE DESCRI6ED AND Of TNE IOCATION OF All 6UIlDINGS, IF ANV,
THERfON, AND AILVISIBIE ENCROACMMENTS, IF ANY, FROM OR ON SAID IAND. -
Datad this dar oF M?P, A,D. 1980 C. R. WI DEN 3 ASSOCIATES, INC.
r70V5c L Orp 1EG? May 20, ?JnG?' `'F,'`?! ?'[ ?i?aG?tAr..c.?'?
bY
Svr?ayor. Minnewea RopiNralion No. 77ZC,
i?a - r3
ciTY oF Encaia
EARLY UTILITY CONNECTION PERMIT ?
4665 Penkwe Wav L2 B3 Johnn}? r ka u;,Rlg-
Address Subdivision/Parcel
I heYeby request permission from the City of Eagan to connect to the
sanitary sewer and water lateral line in the public right-of-way. I
understand that the City has not yet completed, inspected and/or accepted
the sewer and/or water lateral. I agree not to use, test, or connect these
individual services to any interior plumbing and undetstand the require-
ment to cap the sewer service to prevent any unauthorized use.
In accepting th3s permit, it is agreed that I will hold the City and its
agents harmless from any damage that may occur due to this early connection.
It is understood that no Occupancy Permit will be issued or water allowed
to be turned on until the City utility system has been declared operational
by the City Engineer.
Signed by - Plumber:(U2Ytz2e MeCh0.i2iCa2 X-
% ?
Owner:?,; '
Developer:
Builder:
Dated• 5123180
G11'Z U! LAtaM !VA "1I UAG VpLi
3830 PIIAT RNOB ROAD
EACAN, lIlA 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT N O
nogINGgmm DATE:
YLEASE COMPLETE IIPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS 6
TOWNHOMES/CONDOS WHEN PERMI'*S ARE REQUIRED FOR EACH IINIT.
-----------------------
VORK DESCRIPTION .,
1QEW CONST
ADD ON
REPAIR
--°-----------------°-----------_____
COMPLETE THE FOLLAWING:
N0. FIXTURES EA. TOTAL
ADD-ON.MINIMUM 15.00 19-00
_ SHOWER 3.00
_ WATER CLOSET 3.00
BATH T[TB 3.00
? LAVATORY 3.00
OWNER NAME: i?dA_)A'+-O jt;I^( (TEtfC.`?? KITCHEN SINK 3.00 3.00
SITE ADDRESS: ?
? PL?IJK?%t.-- wlk _ HOTN TUB/SPAY 3.00
q WATER HEATER 3.00
IAT: g BIACK -4- SUBD. _ £LAOR DRAIN 3.00
GAS PIPING OUT.
INSTALLER: Uw1Vt-?g_ ,
ADDRESS;
CITY
ZIP:
PHONE #: 7 JY- S5 3? _
. ? . _ ., ? ..
SIGNATURE OF PERMITTEE
y-/-?? ?# a?e? - ??
rf r, fc e•
_ (MINIMUM - 1) 3.00
_ ROUGH OPENINGS 1.50
_ OTHER
WATER SOFTENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
SUBTOTAL S I?S , OR
ST. SURCHAKGE .50
TOTAL: S / § -AD
MO.MMERGWiNDIIST&IA1.?? PLEASE COMPLETE THIS PORTION FOR ALL COlIMERCIAL/INDUSTRIAL BIIILDINGS AND
MULTI-FAMILY SUILDINGS itHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
----------- ---------------------------- -__----
CONTRACT PRICE:
OWNER NAME:
SITE ADDRE55:
IAT: BIACK _ SUBD.
INSTALI.ER:
ADDRES5:
CITY: ZIP:
PHONE
FDR:
FEES
1t OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRAQT PRICE x 18
STATE SUACHARGE
$
TOTAL:
(SIGNATURE)
CITY OF EAGAN
City of Eaf
Date:
Tenant °
D
? s;. ? ,?, 5 2oos
? ?2008 RESIDENTIAL BUILDING
RESIDENT / OWNER I Name:
Address / City / Zip: ?&&!5
Applicant is: _ Owner --VConUactor
TYPE OF WORK Description of work: i/y3hac. U40,2 60`-
Construction Cost: ?j U00 , U"(.J
CONTRACTOR Name: DAGfMO ??LS 4 7`iek
Address: ? o/ ? P&? ? e_bn
City: f /70 O44
?----------------- I
j Permit #:
? Permit Fee: ?
? Date Received:
? ? ro 1
I Statt:
I
APPLICATION
Sulte
Phone:1475/-
1 YI fi'1 A=rn
Multi-Family Building: (Yes _ / No V--)
License #:
State: 1"A) Zip: 5-5?t (o
Phone: & 0, 3 5g-&&0° Contact Person: C? ti
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Catectorv 1 Minnesota Rules 7672
Energy Code ?. Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 SUbmISSlOt1 type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a pertnit for a simflar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber:
Mechanlcal Cantractar:
Sewer & Water Contractor:
Phone:
Phone:
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 tor a permit, and work is not to start without a permit; that lhe work will be in
accordance with the appmved plan in the case of work which requires a review and approval of plans.
X ?i?tkl I?-o??Ts x &41_
ApplicanYs Pr' ted Name ApplicanYs Signa re
Page 1 of 3
PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd Permit Number: EA088494
Eagan, MN 55122 . Date Issued: 03/19/2009
(651) 675-5675~~~ EPermit Category: ePermit
www.ci.eagan.mn.us lflflUl tflflLLL
Site Address: 4665 Penkwe Way
Lot: 2 Block: 3 Addition: Johnny Cake Ridge
PID 10-39800-020-03
Use
Description:
Sub Type: e-Reroof Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
Valuation: 3,000.00
Total: $90.00
Contractor: Owner: - Applicant -
Donald Whitehead
4665 Penkwe Way
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature