4695 Penkwe WayCITY OF EAGAN Remarks
Addition -7010?NY CAKF? RTnf;F AI1nTTT(]N Lot 7 elk Parcel
Owner I:i)?,rl!if ?`. h1r r)u 1 n_ lii ?Iaid streec 4695 Penkwe WaY state BaBan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK ..1975 2
* SEWER LATERAL .S D
WATERMAIN
* WATER LATERAL -1981
WATER AREA a 7 is 0
STORM SEW TRK a 1981 670.68 134-14 670.68 C005860 10 15 80
* sraRnn sew Lar 1981
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. of it
BUILDING PER.
SAC
PARK
CASH RECEIPT
CITY OF EAGAN 3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DAT6 19
nacciveo
FROM
AMOUNT
& w 3
?e
? CASH ? CHECK - ?
FOR 7T-
White-Payers Copy
Yeliow-Postinp CoPY
Pink-File Copy
Thank You
C?? ?. sY ,
CITY OF EAGAN
' 3795 Piler Knob Road Eogan, MN SSIZ'l
R 1 PHONEs 454-8100
BUILDING PERMIT
Receipt #
N! 5686
To be wsd for' Est. Value Dote , 19
Site Address ; ?j •J'- ?, -? • ? Erect ? Qccupancy -
Lot Block ? Sec/Sub. `T??j?",''' Alter p Zoninfl
Repoir ? Fire Zor?e
Porcel
EnlarQe ? Type of Const.
?
W Narne n 'T`il0niPSnn 11 ar1PG Move ? # Stories
=
o Address Demolish ? Front ft.
Cit phone _ Grade ? Depth ft.
°C
0 Name APV?ovob Fees
?? Address `-
I
Nome _
Address
I hereby ocknowledge thot I have read this application and stote that
the information is correCt and agree to comply with cll opplitable
State of Minnesota Statutes and City of Eagan Ordinonces.
Assessment _1" ?. ; /
Water & Sew.
Police
Fi re
Enfl.
Planner
Council
Bldg. Off.
APC
Permit
Surchorge
Plan check . '?
SAC ` -
Water Conn. - :
Water Meter Total
Signature of Permittee I
A Building Permit is issued to: on the expreu condition that
oll work shall be done in aaordonce with cll applicuble 5tate of Minnesota Statutes ond City of Eagan Ordinances.
8uilding Officiol
Pumit # peH IsireA PMS11toe
Plumbing
Mechanicol
SC95_/?5'_s
INSPECTIONS DATE INSP.
Raugh-In
Fir?ol
Footings ?9% 2$-gv Date Insp. Date Insp.
Foundation Plumbing
-
Frome/ins. Mechonical ?
Final
Remarks:
. .
No.
Date:
Site /lddress:
Lot
Nome
Blxk 5 Sub/Sec. ILr;,
Orrin Th,.om--)ecm ;'orp-::
$ Address 3712 1iorkinu Crns"roar,
? `jrLnetor.?:F
City Phone:
Nome :rPT1Z@I.
.
? :oT:nebec: ?7r'.v?
? Address
V C;ty Phone: -
This Permit is issued on the expreu condition thot oll work sholl be
Minnesota Stotutes and City of Eagon Ordinances.
a.?
CITY OF EAGAN
3795 Pilot Knob Reed
Ee9an, Minnesota 551
Phoee: 454-3100
PERMIT
? INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
Single . I
Residential
I Multi Res., Comm./Ind. I
New /Alter. / Repai r
Cost of Installation
Permit Fee
Surcharge
Total
done in atcordonce with all appliwble Stote o#
Buildirg Official
• crrY oF E?CP?N
, 3795 Pilot Knob Road
No. Eogae, Minwesota 55122
Phone: 454-e100
PERMIT
Dote:
IAay 20, 1980
Site Address:
4695 Penkitve Way
.?
Lot 81ock Sub/Sec.
Jbn.y. Cak@ Ridi
Name ')TZ'iri T}]ompSOIl
Address i(-,- )1dns Crossron.d
J
City Phone:
:?r r
Nome ?. ':tielter '.3eat3ri,
g Address
e
City Phone:
This Permit is issued on the express condition that all work sholl be
Minnesota Stotutes ond City of Eagan Ordinances.
INSPECTOR NOTIFICATION
REQUIRED BY LAW
FOR ALL INSPECTIONS
Receipt No.:
$ingle I
Residential
Multi Res., Comm./Ind. I
New/Alter./Repair. -
Cost of Instollation
Permit Fee
Surchorge
ToTal =-?• i?
done in accordance with oll oppliaoble State of
Building Official
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHO N E: 454-8100 BUILDING PERMIT Receipt#
To be used for a Est. Value S i" ')(' Date ,19
Site Address
Lot ' Block ?
Parcel No.
Y,AY
iUNNirTYY
a Name 'UN PRINi?.",.1
z Address • f, ' `4Y
3 L54-iS?l
0 Ciry ' Phone
. o Name N:. ,•F.
? < Address
? City Phone ?31-0? yC
a
W Name_
Z Address
?
W City_
1 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.
Signature of Permittee
A Building Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City ofi Eagan Ordinances.
Building Official__
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System Zoning
On Site Well (Actual) Conat
City Water (Allowable)
PRV Required #of Stories
Booster Pump Length
Depth
S.F. Total
Foatprint S.F.
APPROVALS FEES
Engr./ASSess. Permit
Planner Surcharge
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment Pt
Parks
TOTAL 24. 541,
Permit No. Prrmit Nolder Dste Tslephone #t
Plumbing
H.V.AC.
ElectMc
Softener
Inspection Date Insp. Commsnts
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert Oca
Temp. LP
Deck Ftg_ -?? ?6)z /!
Deck Final l
We11
Pr. Disp.
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: IA
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date issued:
(612) 681-4675
SITEADDRESS: APPLICANT:
4695 ? i Iit i?; ?tr{y .?? ? , ii?,'t ,1i?i? I•i . ?. ??;a .,
. ;1::- . .,. . Ftlf?iiF (ti1.?) A!-,4-l?1.?1
PERMIT SUBTYPE:
F
L
TYPE OF WORK:
Permit No. PermR Holder Date Te{ephone N
S/1N
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Commerrts
Footings I
Foundetlon
Framing Q t? ,fl1?ry /j? " G
Roofing /
Rough Plbg. ?
Rough Fltg.
Isul.
Rreplace
Rnal Htg.
Orsat Test
Flnal Plbg. Ptbg. Inspecta- Noti(q Plumber
Cortsi. Meter
EngrJPlan
Bldg. Final
Deck Ftg.
Dedc Flnal
wen
Pr. Disp.
3 1Piloe Knob Road
Ium r oF E,?c??M •-
n, MN 55122
ng:
er:
ress:
Address:
b@r:
I agree to wn+ply with the City of Eagon
Ordinanees.
BY ?
Date of I nsp.:
I nsp..
95 Pilo? Knob Raad
Iu Y OF EA6AN
an, MN 55122
ning:
ner:
dress:
Address:
mber:
Connection Churge:
Account Deposit: _
Permit Fee:
Surchurge:
Misc. Charges: -
Total:
Date Poid:
PERMIT NO.:
DATE:
No, of Units:
ii.ea t
?`" ? ?'' '?• -`-' -
eter No.: Connection Charge: •
i=e; ?
Account Deposit:
eoder No.: Permit Fee:
agrea to eomply with the City of Eagan Surcharge:
rdinanoes. Misc. Charges:
Total:
gy Date Paid:
Date of Insp.: Insp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units;
RESIDENTIAL
BUILDING PERMIT APPLICATION
? ? ? ? ? CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Construction Reauirements
• 3 registered site surveys showing sq. ft. of lot sq. ft. of house; an?tl roofed areas
(20% mazimum lot coverage albwed)
• 2 copies of plan shawing 6eam & window sizes; poured tound design, etc.)
• 1 set of Energy Calculations
• 3 copies of Tree Preservation Plan if lot platted after 711/93
• Rim Joist Detail OpUons selec6on sheet (bldgs wiN 3 or less units)
DATE JO`;?"O
JOB SITE
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY
TYPE OF
APPUCA
ADDRESS _
PAGER # _
?
? 8?. --7 5
RemodellReoairReauirements ? b- 3- d J
. 2 copies of plan
• i set of Energy Calculations for heated additions
• 1 site survey for exterior additions & decks
• Indicate if home served by sepfic system lor additions
VALUQION
Z.;4,06 . d 0
Z_ Z
61 REPLACE(S) _ 0 _ 1 _ 2
PHONE# lS/
/!/I/(/ z/ ZIP CODE SS/ z U
CELL PHONE # Gs/ `7 75-4 7Y? FAX # 9sa7SV-1r;"3
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category _ VIINNESOTA RUI.ES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNLSOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor:
Plumbing System Includes:
Mechanical Contractor:
Vlechanicail System Includes:
Sewer/Water Contractor.
Watcr Softencr
Walcr Heater
No. of Battis
Air Conditioning
Hea[ Rccovery System
All above information must be submitted prior to processing of application.
Fee: $90.00
Phone #
Fce: $70.00
PhW4V# "_ ' I I
I hereby acknowledge that I have read this application, state that the information is correct; an e to comply
with all ppplicable State of Minnesota Statutes and City of Eagan grjdiraagces.
SignatureafApplicant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 1/O7
Phone
I.awn Sprinkler
No. oF R.I. Baths
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 LowerLevel ? 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 Bidg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Enttre Bldg only) - Give PCA handout ta 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)
Footings (deck) Fina
Footings (addition) Pl
Foundation
Drain Tile
Roof Ice & Water Final Other
Framing _ Pool _ Ftgs _ Air/Gas Tests _ Final
Fueplace _ R.I. _ Air Test _ Final _ Siding Smcco Stone
Insulation _ Windows (new/reptacement)
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
W ater Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
FinaUC.O.
_ Wio C.O.
_ umbing
HVAC
Building Inspector
Total
`1
c
47
N
?,521,C???
Fepuest ?ate - Fir o, Pou h n Inpsection FaOUir .
nreatly)
sicall pBCta?wN
(YO u Inspectian Other Than Rough-ln
qeaGyNOw ? Will ' InspedOr
1
?
? Oa Pead
13
Ig licensed contractor D owner hereby request inspection of above electrical work at:
Job Adaress (StreeL Box or Roule No.) Ciry
4b S Fziojil
Secbon i Townsnip Name or No. Range No. County n
Occul IPRINT? Phone No. ??att'9 qg'
PowerSuppher Adtlress J '
Electncal Convaaor IGOmpany Nadi CqnVaqorS License No.
=al, k\tii 1 l = t-7
Mailing Aparess ICOnttaclor or Owner Making Inslallation)
LL^
,J 5? 3
,
Amhonze0 Siqna?ue Co . acmnOwner Mak:ng Insa?a^ila?rory / K?
?J?1 ?? _ Phone Number y
? `-+-+
MINNESOiA STATE BOARD OF ELECTHICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Mitlway BICB. - Foom S-173 V 6E ACCEPTED BY THE STATE BOARD
1821 University Ave.. St. Peul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Ppone(612) 642-0B00 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
q?7 ? Sae insVUCtians lor completing this torm on beck ot yellow copy.
Vv ( 521 . •"X° Befow Work Covered by This Request
EB-0001-08
1S9
ew Atld Re . TypeoBuitding AppliancesWired EquipmeniWired
Home Range Temparary Service
uplez Water Heater Electric Heating
Apt. Building Dryer Loetl Management
Comm./lndustrial Furnace Othef (SpeciTy)
Farm Air Conditioner
Olher(syecilyl ConVactor's Remarks'
Compufe Inspection Fee Below: R 'c
# Olher Pee # ServiceEniranceSize Fee # Cimuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
SignS , Inspecmrra Use Only:
)
7pT
Irrigation Booms GC 4 O?O
Special Inspection
Alarm/Communication TNIS INSTALLATION MAY BE RED DISCONNECTED IF NOT
Other Fee COMPLETED WITMIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in ? Date
certify Ihat the above inspection has
been made.
OFFICE USE ONLY
This requesl void 18 momhs fram
mmnesoca awte aoara or ciecviciry ,
Griggs Midway Bldg. - Room N191
. 18^y^ Universiry AJe.. SL Paul, Minn. 55704 - Phone 297-2117
' REQUEST'FOR ELECTRICAL INSPECTION
CHECK BELOW WORK COVERED BY THIS REQUEST
iy,?-.wooo 0
S 64355
pe°of Building New Add. Rep. Check Appliances Wired For Check Fquipment Wired Fm
me
D.plex ? ?
? ?
? Range ?
Water ?
t
? Tempocary W'ving
LightingFixWfes ?
;
t. Bldg. ? ? Dryer k; , ? Electric Heating
mmeicial Bldg. ? ? ? Fuma ? Silo Unloader
dustrial Bldg. ? ? ? A'v C-?ditio Bulk M0k Tank
m ? ? List Lis[
hec ? ? ? p
Hehe?s? Heiers?
)
COMPUTEINSPECTION FEE BELOW
Sewice Entrance Size: # Fm Feedus&Subteedeia: it Fm C¢cuits: # Fm
0 to 100 Am s. 0 to 30 Am eres 0 ro 30 Am eres
101 ta 200 Amps. 31 to 100 Am res 31 to 100 Am eres
Above 200_Amps. Above 100 Amps. Above 100 Amps.
Transfoimers RemoteConvolCuc. Partialocotherfee J
Si ns Speciai Ins ection Minimum Cee S
Remarks
_ d
TOTAL FEE ?'• ? r
. J 0
I,the ElectricalInspec[or,hereby
(Final)
This request void
18 months from
has been made.
Date S - ,
JYa[e /v - o't -9 O
_ .,yuest void
18 months from
Date of this Request Fire No. S "435v
I, as 0-kicensed Electrical Contractor 0 Owner, do he by request inspe o of the above electri-
cal wiring installed at: ? 7 6 3 -
Street Address or Route No. PEN" Wlay City ??W
0- on Township Range County ?Afe?a
Which is occupied by
Is a roughin inspeciion required on this job? No ? Yes&&, Ready Now ? Will CalkK
Pawer Supplier ,Ed Address
Electncal Contractor 6ELV azG mfC' Contractor's License No.@519
(C mpany Namea
Mailing Address Iq(l ?---I? l?fl.
Authorized
7h16 Installatlon)
Phone No. gqa ?S?OS
(eletnlcal Concracior or ownar Makln9 TMS InstalNtlon)
?( r' ?VN ,? ??R? ???? This irnpeetian request will not 6e accepted hy ffie
otJ u?'a uu State Board unless proper inspection fee is enclosed.
CITY OF EAGAN ' Na 14 6 4 5
3830 Pilot Knob Road, P.O. Box 27-199; Eagan, MN 55121
BUILDING PERMIT PHONEr454-8100 Receipt # ?I (o D-e
Tobeusedtor DECK Est:Value $1,000 Date MARCH 2, ,19-8&__
Site Address 4695 PENKWE WAY
Lot 7 Block 3 Sec/SubJOHNNY CAKE RIDGE
Parcel No.
a Name DON PRIHODA
z Address 4695 PENKWE WAY
a City EAGAN Phone 454-7991
o Name AMRE
?a Address 1935 CO RD B-2
? City ROSEVILLE phone 631-0458
?
ww
w
M
Name
iz. Address
a W City Phone
I hereby acknowledge that I re thi ap ? ion antl st 'Ihat the
information is correct and gree to o I it all appltate of
Minnesota Statutes and ty of E r na ?
Signature of Permittee
.
A Building Permit is is ed to: A
ontheexpressconditionthatallworkshall tloneinaccordancewithall
applicable State of M[i?nnesota StatutesQand City ofE//agan Ordinances.
BuildingOfficial_?CYlg?
OPFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System _ Zoning
On Site Well _ (ACtuaq Const
City Water _ (Allowable)
PRV Requiretl - # of Stories
Booster Pump _ Length
DeDth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit 24.00
Plenner Surcharge . $0
CounCil Plan Review
81dg. Off. SAC, City
Variance SAC,MWCC
Water Conn.
Water Meter
ROad Unit
Treatment P1
Parks
TOTAL L4.,.$g- _
cITr oF Fa"N
9795 Pilot Kno6 Road Eegan, MN 53122
PNM[: 454-6100
BUILDING PERMIT APPLICATION
sire address 4695 Penkwe Wav
l.or7_ Biak3_ Sec/Sub. Johnny Cake
Parcei # Ridge
w iName nrri n ThmmPTCnn $npL-c
3 Address 1712 Hopkins Crossroad
----
c
r
Nome
Address same
Name
i hereby acknowledge that I have read this opplicotion and state that
the information is correct and agree to comply wlth all applicuble
SMte of Minnesata Statutes and City of Eagan Ordirwnces.
Receipt #
5686
?
e.ecc ?j occupa.rc.y R3
Airer ? Zoning Rl
Repoir ? Fire Zone I
Enlarge ? Type of Const. V
Move ? # Stories
Dertwlish ? Front fr.
Gmde ? Depth ft.
Approvale Feea
Asse55ment {,? -1 k5 ? H'
Wnter & Sew.
Poliw
Fire
Eng.
Planner
Gouncil
Bldg. Off. AIAISO
APC %
Permit 1 -4-4 - nn
Surchorge 73- Sn
Plcn check ti A - 50
5qC S95 _ f1f1
Water Conn. 3 ()5_ fl f1
Woter Meter.6 0..11.Q
Total 12 9 8. 0 0
Signoture of Permittee I
A Building Cermit is issued to: ?lri T on the express condition that
all work shall be done in acm th II h4e of Minnesota Statutes and Ciry of Eagan Ordinances.
Buildirg Offiefal ? ?
Zb He
CFTY VF.-EAGAN
BUILDING PERNIIT APPLICATION
? ,?" i;T -'ro
0.es%oeNCe Valuation
Site Address: licoqs Qc-1,3wWb Wkl
IDt B10Ck ?j 52C./SUb. So?ANrty CqKE
R1?Dl+E
Parcel #:
Address:
City/Zip Code:
Phone #:
Contractor: nRRIN TH()MPG(1N I-1O1MRc
Address: a Division of U. S. Home Corporation
}7}.2 +{g(yf,IN6 6R9SSf2BnB
Clty/ZlP COCle. MINNETONKA, MINN. 55343
Phone #: S44-1333
Arch./Eng..
Address:
City/Zip Oode:
Pnorie #:
\ „?V
Us?
For
Include 2 sets of plans,
1 site plan w/elevations s
1 set of erpsgy calcuPations•
Date
OFFI(E USE ONi.Y
Erect Occupancy
AItEr ZOT11I1g ? -
gepair Fire Zone 3
Enlaxge _ Type of Const.
Move # Stnries
Demolish Front ft.
Grade Depth ft.
APP%)UAIS FEES
Assess?nts . Pennit
Water/Sec,er Surcharge
Police Plan Check !o!A ?
Fire SAC
gng: Water Conn. 2 0 5"-°-v
planner Wdt2T MEt2L
council Road Unit
Bldg. Off.
APC --
To
T;?L
? l2 9
/?/3
4695
?I C.R. WINDEN a ASSOCIATES, INC.
V ? V!?" LAND SURVEYORS TfL 645•3646
For: 1381 EUSTIS SL, ST. PAULO MINN. 55108
U. S. HOME CORPORATION
/
/
Ig38? ??/
O /
\l L-
? \
P .
4 \
G `q
_ `y \ \
¢ \
? X
J?
Scale: 1" = 30'
O Denotes Iron
O
?P?
/
O
\
\
\
?
\ O
N
\
?9 \
'6 \
?a
k 02
C tOC gPl /?
? Q pJ /
? ? Gy,?oc•?
?
? ?A/ n?
E P
Lot.7, Block 3, 3ohnny Cake Ridge
Addition, Dakota County, Minnesota
WE HEREBY CERTIFY THAT TMtS IS A TRUE AND CORREGT REPRESENTATION OP A SURVEY Of TME
60UNDARIES OF THE LAND ABOVE DESCRIBED AND OF TXE LOCATION OF All 6UItDINGS, IF ANY,
TMEREON, ANO All VISIBIE ENCROACMMENiS, If ANY, fROM OR ON SAIO IAND.
Datad this 20 TH doy oF MAQ A.D. 1980 C. R. WINDEN b ASSOGIATES, INC.
,Or 6" ..4? kl-? .
Surryror, Minnowra RayiNrotion Mo. 77Z6
? 19$8 BUILDING PERMIT APPLICATION - CITY OF EAGAN
l? .?
SINGLE FAMILY DWELLINGS
V'
INCLUDE 2 SE'PS OF PLANS, 3 CERTIFICATES OF SURVEY, 7 SET OF ENERGY CALCULATIQNS
NOTE: ADDRESSES FOA CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
ZS DESIRED. NO CHANGES WILL BE 9LLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNTTS Il OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CAECK WITH BLDG. DEPT.,
1 SET OF ENENGY CALCULATIONS
COMMERCIAL
INCL[1DE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 7 SET OF ENERGY CALCULATIONS
To Be Used Por:
Site Address
'PECL
Valuation: '744?i) Date:
q(-IS RLL?-' cIJaT
Lot I B1oek -3
Parcel/Sub 1.d6.L `
Owner Ql.) f a
Address '"J bq5
City/Zip Code 51
Phone ?y ?
Contractor
Address
City/Zip Code f1. ?54.1?1?1rv -?S 1??
Phone L-35Y'
Arch./Engr.
Address
City/Zip Code
/0oo -- ur r .
-
On site sewage_
NIIdCC system `
On site well _
City water ,
PRV requ3red _
Booster PumQ _
APPROVALS
Dccupancy
Zoning
Actual Const
Allowable
al of stories
Length
?epth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, P7WCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
Engr/Assess
Planner
Council
Bldg. Off. ?3/1
Variance _
z o0
y,-
, So
Phone #
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: e u t t - o I N G
3830 Pilot Knob Road Permit Number. ? 7 0,t's i
Eagan, Minnesota 55123 Date Issued: 02 J 1?/ v 3
(612) 6814675
SITE ADDRESS: APPLICANT:
i.o7?: 7 aL ??c??? i
4695 PENKWE WAY VALLEY .[NVESTMEIVTS COP!SF
J('iHNIVY L'AKE f2I0CE (612) 454-5191.
PERMIT SUBTYPE: TYPE OF WORK:
t3A5EhlE14T F7:NI'SFI ALTEN.N7IUN
?
? CITY OF EAGAN PERMIT
3830 Pilot Knoti Road PERMIT TYPE: Bu I Lc! r_ N e
Eagan, Minnesota 55123 Permit Number: 020337
(612) 6814675 Date Issued: G?': / 17 J yj
SITE ADDRESS:
4695 PGIVKWE Wfl'Y
LO'ie 7 3l[1CK: 3
JOFiNIV,1' fFKi; RT7CiE
P_S.h!<, 10-39800-070-03
DESCRIPTION:
' BuiidA9 Perm:i*. 'i'Ype
? BttiTcJingAaJnrk TYPe
'" IF?C t?ecup?nVy
i
ir
_ p
BFl5'EhIGN i P:[NISH
AITFRATTUN
!?-3
??\i L;. ? / ? n r- t ? I ^- ? -??l
'?
REMARKS:
FEE SUMMARY:
E3ase Fee „asoeo-)
5 u r c I'i ary U ?._....._._._...._.._._?._.5_0
rot:al r-esa $35.50 ?
CONTRACTOR: - Fipp l.iaanr - s-r. i-jcOWNER:
VHLLLY IPdVESTMLIVT"l CpNS'(" 14545191 0001241. PRTHOI!R UQN
2401 LEk]:NClOiti Fd'V,= 5 4635 pEMKWE WR'!
ME.NGt5T7a NTS mN 55120 EAGAiV MfV 5512'
( 612) 1.54_.51c17- (6i2)4: q_.; ^91
T iiereby aclzravwled'ge th7L- I kravice rea8 this app:t.icatiran and staee that the
infor^matiarr Is cUrrecG and agree r:v ec,mply w5th ;:l.i spplicable ,;tate vf Mn.
IStatute.s and Caty bf Caqan Orr1S.nanc,es.
I A ?
r ?
? ??1
?APPLICANT ERM EE SIGNATUFE ISSUED Y: IGNA RE
REACTIVATE _,
PERMIT # koNA fl
CITY OF EAGAN
1993 BUILDING PERMIT APPLICATION
681-4675
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architecturat & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month-
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date /Z / ?L Valuation of work
Site Address: 4/!o
STREET SU1TE /
Tenant Name: (commercial only)
IAT BLOC& SIIBD. 7
? P.I.D. ?P
U5 2
Descri tion of work: i?kFLac N ? Aw ?-J W&
The applicant is: ? Owner Contractor ? Other (Deseribe)
Name P_,t+vYJPr noni Phone ?110-7%W
Property usr F1R5T
Owner Address 4/6 Prywy- +.0 6 l,tA4?
STREET STE N
'?5?? ?
YVI
?
yC Zip
"? State
City V
Company I/AiL F-'`? 'C,vv?S i rti ,n, f S LppyS ?, Phone
Contractar Address Lv(-)z i?(?i.??? .Si?. License #11,)Y1 Exp.ci 5
City lU wt9t)ir4 /? i 1, Ni 5 State G'11h/ Zip ?
Company Phone
Architect/
Engineer Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
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.
Signature of Applicant:
9
11?
y
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
,0.05 SF Misc.
WORK TYPE
? 31 New
O 32 Addition
? Ob Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
933 Alterations
? 34 Repair
GENERAL INFORMATION
? 1
10
? 11 Apt./Lodginy :
? 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace _
? 15 Deck
? 35 ienant Finish
? 36 Move
1.I6 &asjement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Water
UBC Occupancy 2nd F7. sq. ft. PRV Required
Zoning 5q. Ft. total Booster Pump
#i of 5tories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code y c
Depth On-site sewage SAC Code
t
APPROVALS
Planning Building Assessments
Engineering Variance
REGtUiRED INSPECTIONS
? Site ? Footing )R?Framing ? Insulation
? Wallboard Cg Final ? Draintile ? fireplace
Permi t Fee 36, 0a v.iuas;on:
Surcharge so
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total: ?
SAC %
SAC Units
t
CITY OF EAGAN
EARLY UTILITY CONNECTION PERMIT
4695 Penkwe Way L7 S3 Johnny Cake Ridge
Address Subdivision/Parcel
I hereby 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 understand the require-
ment to cap the sewer service to prevent any unauthorized use.
In accepting this 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: WENZEL MECHANICAL -tL?-
Owner • .? ?.., ?
Developer•
Suilder
Dated: 5/27/80
6 L1L14i 1
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
COND05 WHEN PERMITS ARE REQUIRED FOR EACH UNTT.
NEW CONSTRU ION
_?` ADD-CaN .4/C ?t?c SL,1 A?Tx o 1Ll oL?
ADD-ON FURNACE
FIREPLACE INSERT
DATE 7-0-4+-f
FEES
HVAC: 0.100 M BTU $ 24,00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (E)asrnvc CoNSntucrtoN) $ 20.00
STATE SURCHARGE .50
TOTAL cl?_
Sii'E
OWNER NAME:4g24 grzhh" V TELEpHONE #: L1Sd- 7541
INST.
HEqiING 8 AIR CONDfiIONING C0,
ADDRESS: 8910 WE iH 71VE .
MINNLAPOLIS, MN 55420-2853
Cj'I'y: 881•9000 STATE: ZIP CODE:
TELEPHONE #:
9ivi?AT'JFcEOr ?ERIvf7l7EE ?Y?2«
1994 MECHANICAI, pptMlT (RESIDEIVTI;aII,)
CITY OF EAGAN
3830 PILOT HNOB RD
EAGAN MN 55122
(612) 681-4675
1994 MECHANICAI, pHtM1T (COMMERCIAL)
C1TY OF EAGAN
3830 PIIAT HNOB RD
EAGAN MN 55122
(612) 681-4675
PLEASE COMPLETE FOR ALL COMNIERCIALdIINDUSTRIAL BUII.DINGS. ALSO COMPLETE
FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMII,Y BUILDINGS WEEN SEPARATE
PERMTTS ARE NOT REQUIRED FOR EACH DWELLING UNTf.
t'?* ?r nn T?. ?
L.4in: ... ?3'? ..,4 ?._...,.,.
NEW BUILDING
INTERIOR IlAPROVEMENT
WORK DESCRIpTION:
FEES
1% OF C9]? FEE
PROCESSED PIpING:
MINIMUM FEE:
STATE SURCHARGE
?'nT l? r
$
$25.00
$25.00
;.,?
$.50 FOR EACH $1,000 OF ..9.:.:.U'... FEE.
?
SITE ADDRFSS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS oNLY)
INSTALI.ER:
ADDRESS:
CITY
TELEPHONE
STATE: ZIP CODE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
? 2004RESIDENTIAL BIIII.DINCPERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
9? Telephone # 651-675-5675 FAX # 651-675-5694
,5`70 .0 0
New Cons4vction Reauiremen5
3 registered sife surveys shaving sq. ft o( lot sq. fL ot house; and all roofed a2as RemodeURepair Reouirements
2 copies of plan UsE?tjrj
Ce?t,gFSUn?? 0MA A 3'1
(20%maximumlotcoverageallowed)
etc
beam & windax sizes; poured found design
lan showif
ies of
2 co lsetofEneyyCabulaGonsforheatedaddNOns
1 site survey for additions 8 decks
,
.
g
p
p m
t
d
ti
t
ddN
i
dk
'rf
1 set of Energy Cak,ulaGons a
ons
e sep
c sys
e
A
On -
n
e
3 copies of Tree Preservation PWn if lol platled aRer 777/93
Rim Joist Defad Options selecUon shcet (bldgs with 3 or less units
Date al/ mc.v v Construction Cost
?y
Site Address n1!, ?'J 5-e)(?Y-kl?Q. x-"\ UniUSte #
• ,
Description of Work w
?
Multi-Family Bldg _ Y>< N Fireplace(s) _ 0_ 1 _ 2
i l-
Property Owner -- _t ??_Yl ?1f?1 ?QYnS ? nG( v, Telephone #(j 6
O O' -V
? RMA HOME SERVICES INC.
Contractor ? Home Depot Installed Sales
i 3200 Cobb Galleria Pkwy., Ste. #200
City
Addrese Atlanta, GA 30339
State 763-542-8826 Telephone # ( )
BC-20268257 ?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan
?`
fee applies. Fn T??
Licensed Plumber
II? At'R
Mechanical Contractor
Sewer/Water Contractor By
plan8 _ Y _ N If so, 25% plan review
?
Telephone #( )
_ Telephone #( )
TelephoneffF&?T? Fjg1qR
I h it
0.
APR 2 1 'uu4 a?e I hereby apply for a Residential Building Permit and acknowledge that the info tion is complete anaccurthat the work will be in conformance with the ordinances and codes of the Ci of Eaganand the of N1N
Statutes; I understand this is not a permit, but only an application for a permit, zii o s without a
permit; that ttte work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
1
?N,::)
s, ICLAa
ApplicanYs Printed Name pplicant's Signature
OFFICE USE ONLY
_,
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of_plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
# of Units
# of Bidgs
Type of Const
_ Fookngs(new bldg)
_ Footings (deck)
_ Footings(addirion)
Foundation
Drain Tile
Ronf Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous
? 30 °ACCessory Bidg
? 31 Ext. Alt- Multi
? 33 Eut. Alt - SF
? 36 MultiMisc.
? 35 Int Improvement ? 38 Demolish Interior ;? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building• ? 43 Reraof ? 46 Windaws/Doors
`Demolition (Entire Bldg) - Give PCA handout to applicant
Occupancy MCES System
Zoning City Water .
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
_ FinaUC.O.
_ FinaUNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Building Inspector
l,1? 3 1-t q ?
%`-Io,c) i
2004 RESIDENTIAL BUII.DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
NewConsVUCtlonReauirements RemodeVReoairReauirements ceceUseN _
3 registered sde surveys showing sq. ft of bt sq. R of house; and a0 roofed amas 2 copies of plan £eArofSur`vey ReW 4 _Y, ?L N
e
(20%mazimumblwveregeallawed) isatMEnergyCalculaGonsforheatedaddiAOns ir
ePrgsPlanRecd L _Y N
2 copies of plan slwwing beam 8 window s¢es; poured found design, etc. 1 site survey for additions & decks Tree P2s Reqared .?_V N,
'
N
isetafEnergyCakuhdons AddNOn-irMicateHon-sdesepticsystem On-sifeSephcSysfem;„„;==?
3_.-
3 wpies of Tree Preservation Plan if bt plaCed aNer 711193
Rim Joist Detail Options seleqion sheet (bldgs wiUi 3 ar less unils
Date I (? / 1' `OA /0_ Construction Cost 1 ? J U UIn
SiteAddress [n95?} .Pnk,W -Q? ? Ocw UniUSte #
Description of Work 1\DYkaC.Q p? 1?J1 G?U W J L_4_j11 Y t__l'
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner Tx'l,q`(\{rhalft ??'MS•t1\G?h Telephone#((OJru
RMA HOME SERVICES INC.
Contractor 'Home Depot Installed Sales
3200 Cobb Galleria Pkwy., Ste. #200
Address AUanta, GA 30339
State 763-542-8826
BG20268257
City
lephone # (
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeory 1 _ Minnesota Rules 7672
Energy Code Category , Residential Ventllation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) SubmiUed Submitted
• Energy Envelope Calculations Submitted
Have you previously consTructed a building in Eagan with a similar plan? _ Y _
fee applies.
Licensed Plumber Telephone #(
(
Mechanical Contractor 'k" r?' Telephone #
• ?
6
Sewer/WaterContractor Telephone #(
N If so, 25% plan review
I hereby apply for a Residential Building Pemut and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans. I/ ?
ApplicanYs Printed Name A13"plicanYs Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 O6-plex ? 16 Firepiace ? 21 Porch (3-sea.) ? 31 6ct. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
0 32 Addition ? 36 Move Building ?.42 Demolish Foundation ? 45 Fire Repair
? 33 Alteralion ? 37 Demolish Building` ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolitlon (Entire Bltlg) - GWe PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories ' Booster Pump
# of Units Sq. Ft. PRV
# of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings (new bldg) _ FinaUC.O.
Footings(deck) _ FinallNo C.O.
Footings (addition) _ Plumbing
Foundation _ HVAC
Drain Tile Other
Roof Ice & Water Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ praming _ Siding _ Stucco _ Stone _ Brick
Fireplace _ R.I. _ Air Test _ Final _ Windows
Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
Installed
Siding and Windows
LIMITED POWER.OF ATTORNEY. , -
CUUN'1'Y UF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sales located at 660 Mendelssohn Avenue North, Crolden Valley, MN
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Inc. ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "LVork").
The powers conveyed to the Agent by this Limited Power of tlttcmey are
limited solely to the express powers delineated herein and apPly solely to the Work.
This Limited Power of Aftorney`shall expire and automatically be revoked on the 21st
day of May, 2004, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WITNESS WHEREOF this Limited Power of A±torney is eaecutcd this
21 st day of May, 2003
t '
David . Katz
S WORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this
21st day of May, 2003.
X. Zga.
Notary PQlic in for the State o eorgia
My Commission Expires: January 21, 2006
3968I6.v3 Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cob6 Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toli free (800) 79-DEPOT
installed
Siding and Windows
LIMITED POWER OF ATTORNEY
cOiJNTY OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of ItMf1 Home Services, Inc., DBA Home
Depot Installed Sa1es loca±ed at 660 Mendelssehn Avenue North, Golden. Valley, MItiT
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-Jones Building Permit Service, Ina ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be sequired by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repur of windows and siding (the "Work").
The powers conveyed to the Agent by this Limited Power of Attorney are
limited sotely to the express powers delineated herein ancl app?y solely to the Work.
This Limi*,ed Power of Aftomey shall expire and automaticaliy be revoked on the 21st
day of 1b1ay, 2004, which date is one year from the execution hereo£ Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
aizy time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WIT'NESS WIIEI2EOF this Limited Power efAttorne-y is e._3ecutcd this
21 st day of May, 2003
M ?
David . Katz
SWORN TO AND SUBSCRIBED BEPORE ME by David N. Katz on this
21 st day of May, 200?
.n
Notary P ic in for the State o eorgia
My Commission Expires: January 21, 2006
396816.0
Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79-DEPOT
Use BLUE or BLACK Ink
For Office U6@ I
I I
city of Eajan ~ Permit
I Permit Fee:
0 '
3830 Pilot Knob Road D C 3 2009
Eagan MN 55122 I
'
I Date Received: 1
Phone: (651) 675-5675 1
Fax: (651) 675-5694 I` Staff: l
- - - - - - - - - - - - - - - - - J
2009 MEC~ _H(~ANIC L PERMIT APPLICATION
Date: G V c7 Site Address: IC l1-D .ln
Tenant: Suite
RESIDENT I OWNER Name: rl f~' ie4v Phone:
Address ity/ Zip:
r-~
CONTRACTOR Name: r 4 ` License
Address:
City:, r~ State: M-~44 Zip: 4 1
Phone: 4" l -001IContact Person: L~s~ l!V tMJ& r~,
TYPE OF WORK New Replacement Additional Alteration Demolition
NOTE: Roof mounted and ground mounted mec anical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace New Construction _ Interior Improvement
Air Conditioner Install Piping ^ Processed
Air Exchanger Gas _ Exterior HVAC Unit
Heat Pump -Under/ Above ground Tank L- Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ b TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,00142,000 Permit Fee requires a $1.00 surcharge).
_ $ TOTAL FEE
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.nooherstateonecall.orn
I hereby acknowledge that this information is complete and accurate; thf1he 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 rmit, 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 ap roval of plans.
x N \ P, x
Applicant's Printed Name ppli ant' gnature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground _ Rough In ___,.Air Test -Gas Service Test -In-floor Heat -Final
Exterior HVAC Screening Inspection
01/12/2010 13:03 JEFFERSON HOMES + 6516755694 NO.824 9002
bn 1 b'(5 nby4
01/12/2010 11:38 ERGPN ENG+COM DEV 4 94296351 NO.011 901
Use BLUE or BLACK IRK
i
i Perm* 4 f
City of Eajan ; Permit Fee'
3830 Pilot Knob Road ~ gate RecGi,►ca: 1
I 1
Eagan MN 65122
Phone: (651) 076.66751 I Slate 1
Pax: (651) 676-66Si4 _ / -
mo RESIDENTIAL BUILDING PERMIT APPLICATION
Date= .-1/12/09. Site Address: 4695 penkve Way, Eagan, MAT
Tenant_ Sulls
RESIDENT I OWNER Name. Kent Je eKson Construction Phone: (612) 670-3686
Addmss r city J zip: 4530 Highway 61, White Bear Lakes 14N
Appacant is' X Owner X Conva0wr
TYPE OF WORK Description of work: Replace sheetrock in Lower Level
Conevuetion Cost" $ 51000-00 Multi-FamNy Building: (Yos i No
CONTRACTOR Name: Jefferson Romes t_icensee 2090
Address'. 4530 Highway 61 City: _ White Bea-c_Lake,_
state:- MN Zip! 55110 phone: (612) 670-3686
Contact Kent Jefferson Email: tjefferson4530@aol.com
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
in the tact 1 Z months, has the City of Fagan Issued a permit for a s4rdlar plan based on a master plan?
YPg __No If yes, data ana address of master plan:
-
Licensed Plumber; Phone,
Mechanical Comactor Phone:
severer 6 Water Contractor. Phone:
MUTE.- Pfans and supporting documents That you submit eerie conskWed to be lvubffc information. portions of
the information may be classifled as non-public NY" pt'ovide speefflC r"Sons that would permit the City to
conclude dwt are trade secrets.
CALF. BEFORE YOU DID. Call Gopher Slats One Cali at (651) 4544002 for protection against underground utility damage.
Call 48 hours bolors you intend to dig to receive lutes of underground utilities. M=-_QoVtMMt&teon9cali.om
i Hereby acknowledge that this in[wmMlon is complete and accuma. UW the v wil be in contormenoa V* on trances and codes of the City of
=agar: that I unders16-4 this is not a permit, but only an application for a permit, and wont Is not to steel vKlhout a permit: that the work vAl be In
acmaance with the apprc;xd plan 0 ine case of work which requires a review and approval of plans.
>c Beverly Osborne, Controller
Applicant's Printed Name Appt n s to
for: Kent Jefferson Construction Page Iof2
ABA: Jeffersun.11Hmmes
01/12/2010 13:03 JEFFERSON HOMES 4 6516755694 NO.824 P003
01!12/2010 11:38 EAGAN ENG+COM DEV 4 94298351 Nfl.071 ~We~
DO NOT WRITE BELOW THIS LINE
SUB TYPES Stann Damage
_ _ Flrepiace Porch ("Own)
Foundation -
Singes tionily Garage Posh (4-Season) Sxtorior Alteration (Single Family)
Multi Deck Porch (ScreenlGazebolPergofa) , Exterior Alteration (MuIt1)
01 of _ Plex _ 1_awsr Level _ Poo! Mlscellarieous
A06e6Sory Building
WORK TYPES V' Demolish Wlding•
Now _ Interior knProvemOnt _ Siding
_ Addition _ Move Guliding lteroof Demolish Interior
VAndows pernotlsh Foundation
y[ Alteration _ Fire Repair
T Replaco Repair _ Egress Window Water l3amays
Retalning Wall *DoenoNdon of entire building - >itv& PGA handout to spp>iciint
DESCRIPTION-
Valuation 4 00 Occupancy MCES System
Plan Review Code Edition SAC Units
(25%-100°k-~) zoning City Water ~-T--
Census Code Stories Booster Pump
N of Units Square Feet PRV
# of Buildings Length Fire Sprinklers.
Type of Constriction V Width
SQUIRED INSPECTIONS
Footings (New Building) Sheatrack
Footings (Deck) Fined I C.O. Required
Footings (Addition) Final I No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: -lee & Water Final Pool, Footings ~AIrIGas Tests -Final
Framing Siding: Stucco Lath ___,Stone Lath -Brick
Fireplace: Rough In Air Test Final Windows
Insulation Retaining Wall: Footings 6ac"ll _ Final
Meter Size: Radon Control
Erasion Control
Reviewed By: suilding Inspector
k
RESIIaENTI& FEES
Bass Fee
Surcharge f .1.s
Plan Review
MCES SAC
City SAC f
Utility Connection Charge /
S&W Permit & Surcharge
Treatment Plant
Copies ,
TOTAL Page 2 of 2
Use BLUE or BLACK Ink
µ~R 10101'1 i Ica i
City of Ea ian ; Permit*
1 Uv 1
3830 Pilot Knob Road i Permit Fee:
Eagan MN 55122 1 Date Received: Z ;
Phone: (651) 675-5675
Fax: (851) 6754694 I State ;
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Slta Addreaa m ~
Tenant:
suite 1f:
RESIDENT I OWNER 'Name: 0. Gt dA Phone: J - 3-3c3
Address I City I Zip. Cil L Ulm
MIN ID-
OF C;L
CONTRACTOR Nave:.NMERT COMPANY INC.dba CUWGAN % TER
Address: 1801507" ST EAST city, ' INUEIt GROVE'~i=
statb• MN _Zip;_ 55.077' Phone: 65,1 '45t-2241
Contact BILL.MILBE~tT` Email:
TYPE OF WORK _ New' replacement _Repair Rebuild _ Modify Space _Work In.R.O.W.
Descrl Ion of wo .
rk•
PERMIT TYPE RE§IDENTIAL
Water Heater Water Softener
Lawn Irrigation L_ RPZ I_ PVB) Add Plumbing Fixtures Main / _ Lower Level)
Septic System Water Turnaround
_ New
-Abandonment
RESIDENTIAL FEES.
$55.00 Minimum Water Hoter, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00. Lawn Irrigation anckldes $6.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment. Water Turnaround' (Includes $5.00 State Surcharge)
'Water Turnaround (atld $166.00 Ifa 518" meter is required)
$105.00 Septic System hm~ ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace fumed out appliances, ductwork, etc.) pncludes $5.00 State Surcharge) ZOO
TOTAL FEES $
CALL BEFORE YOU Did. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before yott intend to dig to receive locates of underground utllities.• www.oopherstateonecall.oro
I hereby acknowledge that this h$rmation is complete and accurate; that the work will be in conformance with the ordinances and codes of ft City of
Eagan; that I understand this le riot a perms. but only"an application 'tor a permit, and work Is not to stag a permit; that the work will be In
accordance with approved pla In the case of work which requires a.nvlew and a pla
x h l-m ' -t?
10
Applicant's Printed Name cant's•Signature
FQR OFF . S F~ev ewe $,y
>f
Req~r rei ` nape I.... `
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