4699 Penkwe WayCITY OF EAGAN Remarks
Addition 3010M CILKE RTi1G8 ADnTTTQN Lot 9. eik 3 Parcel 10 39800 090 03
o,NnQr b1jrr ?. uUif i ?estreet 4699 Peakwe W scate EaAan, MA1 55122
Improvement Date Amount Annual Years Payment Receipt Dete
STREET SURF,
STREET RESTOR.
GRADING
SAN 5EW TRUNK
* SEWER LATERAL , y
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK ?a
* STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Rd. UNI 185.00 20608 8 25 80
WATER CONN. 305.00 20608 2$ HO
BUILDING PER.
SAC
PARK -
CITY OF EAGAN
3795 Pilot Knob Roed Eagon, MN 551? N? s ? ? T
PHCNE: 454•8100
BUILDING PERMIT Receipt
To bo used fee Est. Vulue Date , 19
Site Address ? Erect ? Occupancy
Lot Block Sec/Sub. Alter ? Zoning
Purcel '? ' Repair 0 Fire Zone -r
Enlarge ? Type of Const. `
? ,
Name Move Q # Stories
W
3 ,
Address
Demolish ? .?
Front ft.
o
Ci Phone ? rl.-7
Grode p
Depth ft.
? Name AvProvoh Fees
? .
Assessrrsent
Permit
u? Address ;
~ Ci php? Woter & Sew. Surcharge
Police Plan check
?
W ??
uv,W Name Fire •
SAC '
,
:
?Z
so
Addreu
Eng. ,
, u?
?f
Water Conn.
<uZ+ Ci phone Pionner Water Meter ;?
Council Rood Unit r1A
I hereby acknowledpe that I have read this opplication and state that gldg. O{{.
the informotion I5 correct and agree to comply with oll upplicable I ??, 5' 7 r
Stote of Minnesoto Statutes and City of Eagan Ordinonces. APC Total
Signoture of Permittee T I
on the e ress condition that
A Building Permit is issued to: xP
all work shell be done fn accordance with ell epplicable Stote of Minnesota 5totutes and City of Eagen Ordinonces.
Building Official
.wmlt # De.,,mw .""too
Plumbing i -
Mechanical
INSPECTIONS DATE INSF• Rouph-In Finol
Footings ??/6$D Date In:p. Dota InsD•
Foundation Plumbing
Frame/ins. Mechanical
Finnl
Remarks:
CITY OF EAGAN
3795 Pilof Knob Rood
Eayon, Minnesota 55122 INSPECTOR NOTIFICATION
No. _ Phose: 454-8100
REQUIRED BY LAW
FOR ALL INSPECTIONS
JFn t S nr PERMIT
DoTe: - ? Receipt No.:
Single I
Site Nddress: Residential
Lot Block Sub/Sec. j 1n" • I Multi
Nome O1'Z'iT. Thompson HoA1C:' New /Alter./ Repair
.
e Address
? Cost of Instollation
City Phone: ?44 _ ^ Permit Fee
` Nome Surtharge '
? Address Ci:LC£ii_O AVe.
City Phone: Total
This Permit is issued on the express condition that all work sholl be done in occordance wifh all oppltcoble State of
Minnesoto Stotutes ond Ciiy of Eogan Ordinances.
Building Official
cirY oF E?GAN
3795 Pilot Keob Rood
Eayan, Minnesota 55122
NO• Phewe: 454-8100
P1UIDb i.'. PERMIT
Date:
Site Address: /,(:c)9 Pe'?`-S';o '?`+ntr
.?a?
Lot k Biock Sub/Sec. ?y
Nome Oi`x'in ThOmg9o11 Fior:e^
` 1_7? ^ :iopkins Crprd,
g Address
O
City '! 7;Ste',;OIlkB, i;h. Phone. 544-73' S
.,___ ':'er.!?el `"echa;iical
INSPECTOR NOTIFICATION
REQUIRED BY LAIN
FOR ALL INSPECTIONS
Receipt No.: ?n?7?
Single
Residential ? - P`IdG
Multi Res., Comm./Ind. ?
.-, n. .
New/Alter./Repoir
Cosf of Installotior
Permit Fee
Surcharge
r
? Address 3600 KeTmebeC I1T' .
?
City -'":1• Phor:e: 452-156`.? rorol .
This Permif is issued on the express condition thut all work sholl be done in accordance with all epplicable State of
Minnesoto Stotutes and City af Eagon Ordinances.
Building Offlcial
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
Recarveo
19
AMOUNT $ I
4 DOLLARS
7oo
? CASH ? CHECK
IOR
White-PaYers CoPY
Yellow-Posting Copy
Pink-File Copy
Thank You '
BY ?
CITY OF EAGAM
3795 Plfat Knob Raad
Eogan, MN 55122
Zoning:
Owner:
Address:
Site Address:
Plumber:
I agreo to compty with the City of Eagon
Ordinances. ;
By
Date of I nsp.:
ClTY OF EAGAN
311$ pilot Knob Rood
oan, MN 55122
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
_ No. of Units:
zrnng: -
,hvner.
Address:
Site Address:
Plumber:
Meter No.:
Sixe:
Reader No.:
I agreo to eomply with the CieX of Engon
prdinonces.
By
Date of Insp.:
Connection Charge:
Account Daposit:
Permit Fee:
Surcharge:
Misc. Chorges:
Totol:
Date Poid:
WATER SERVICE PERMIT ?
PERMIT NO.: 'DATE:
No, of Units:
Connettion Charge:
Accounr Deposit; _
Permit Fee:
Surcharge:
Misc. Charges: -
Total:
Date Paid:
This request void ?? ?'3i " ? C?"- ?' QC B ?? UV
1_8 months from a31 ? ? a S 99310
Date of this Request FireNo.
I, as Licensed Electrical Contractor OOwner, do hereby request inspection of the above electri-
ring installed at:
Otre'et Address or Route No. 401 t63 k-K-4 City EAW
Section Township
Range County bAJCA)4-A
Which is occupied by
Is a roughin inspection required on this job? No ? Yeg Ready Now ? Will CaltX
PowerSupplier I44 Address f ZRhIVblW
Electdcal Contractor
Address 19 1 v
Contractor's License Nd. ?W
or Owner Making Tnls Inatallatlon) /??
`- Phone No. 67V53zS
not he accepted by the
oRection fea is enclosed.
?. Gr nesoW State 6oaM of Elechicity
ggs Midway Bldg. - Room N791 ?Q EB•00001-02
7821 i7niversiry Ave., St. Paul, Minn. 55104 - PFpne 297-2117 ?C
REQUEST
THIS EOUEST INSPECTION a z $ 99310f
CHECK AELOW WOAKOCOVERED BYELECTRICAL
,Jype of Building New Add. Aep. Check Appliances Wired Fm Check Equipment Wimd Fm
r me ? ? Range NZI Temporazy Wiring ?
uplex ? ? Water Heater Lighting Fixmros Ci!
Apt. Bldg. ? ? El Dryex ? ElecVic Heating ?
Commercial Bldg. ? ? ? Fumace ? Silo UNoader ?
Industriat Bldg. ? ? ? A'u Conditioner Bulk Milk Tank ?
Farm ? 0 ? List ) List
Other
?
?
? p }
Hehersf p
He[ersl
COMPUTE INSPECTION FEE BELOW
Serice Envance Size: # Fce Feedrss&Sub[ceders: # Fee Circuits: # Fce
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Amps. 31 to 100 Am res 31 to 100 Am ces ,lU
Above 20 ? p, , Above 100 Amps. Above 100 Amps.
Ttanstor e M E emoteControlC'vc. Pactialorotherfee . .?
Signs - aLq ? J; ecial lns ction Minimum fee $5.00
Remazks TOTAL FEE (PJ-0 ??LP
I, the Electrical Inspector, hereby certify that
has been made
a -s o
(Final)
This request void
18 months from
CITY OF EAGAN
" 3795 Pilet Knob Road Eogan, MN S5722
PHONE: 454-8100
BUILDING PERMIT APPLICA710N Receipt #
N°?j 6117
To be uud fer SF DWG Est. Value 4ly,000 Date 8-25 , 19_80-
---
Site Address 46QA PPn1cwP Wa3' (3R ) Erect iEk OccupancY R3
L
t 9 `n1T?y. Cake Rdg.
Bl
k 3 S
/S
b Alter ? Zoning PD
o ec
u
x
.
c
l n
f1
8n Repair ? Fire Zone 3
parcel .# 3
a
n nAn
3
Enlorge ? Type of Const. v
rc Name Orrin Thompson Homes Move ? # Srories
z Address 1712 Hopkins CT'SI'C). Demolish ? Front 62 fr.
9 Ciry Mn tkai Mn._ Phone544-73.33- Grode ? Depth 26 ft.
? Name ".?•??.?
s? Address 52IIl2 ?
AssessANt -
.?
Water & Sew.
Ci Phone
Police -
F
Ww Name Fire
rZ
4 Address Eng.
?
<'Z" Ci Phone
L
Planner -
Council _
I hereby acknowledge that I have read this application ond state that gldg. Off. _
the informotion is correct ond agree to comply with oll opplicable
State of MinnesoM SMtutes ond City of Eagan Ordinances. APC
Feea
Permit ? •?v
SurcFarge 22.50
rion check 62.75
snc 525.00
Water Conn. 305.00
WaterMeter 60.00
Rood Unit 185.00
Toroi 1.285.75
Signoture of Permittee I
A Buiiding Permit is issued ro: Orrin Thompson HOID2S on the express condition that
all work sholl 6e done in cccordance with all gppliwble State of Minnesotu Stotutes and City of Eogan Ordirwnces.
Building Officiot
.• . ? I CITY OF EAGAN Include 2 sets of plans,
? l? II ` ' 1 site plan w/elevations &
Yh BUILDZNC; PERMIT APPLICATION 1 set of energy calculations.
?? -
7b He Used For Rt \DEucQ Valuation -9 Ll ag O p. 0 O Date S- t$-9O
$1t.2 AdCIY255: 4Lqq {'p N wF ' )
Lot Cl alock 3 sec./sub. soHNNv cnxe
„ E
p?l #: aS
Owner:
Address:
City/Zip Code:
Phone #:
Oontractor:
a Division of U. S. Home Corporation
Address: 1?12 1 ;d.vur•is srtessrteAe
Gity/ZlP COde: MINNETONKA, MINN. 55343
Phone #: SYq•9333
Azch. /Eng. .
Address:
City/Zip Code:
Phone #:
OFFICE USE ODLY
Erect pC OccupancY
A].ter Zoning U
Regair Fire Zone ?
Enlarge _ 7ype of Const. V
Move # Stories
Damlish Front ft.
Grade Depth -15G ft.
Assessments
Water/Sewer
Police
Fire
En9 •
P1 er
Pentiit _ /.?S ?
-'
Surcharge 'QXZ
Plan Check
sAC sas ?
WatEr Conn. 3 o S?
Water Meter
ann
Council Road Unit
Bldg. Off.
APC
mrAL o' / 2- ?5 ig
S-qo.c)o
M of Eatan
3830 Pilot Knob Road
Eagan MN 55122
Phone:(651)875-5675
Fax: (651) 675-5694
A 4433
----------- ;
; -----?- ?
? Permit #: I
? pertnft Fee:
1
? Date Received: ? I
I S[att: ?
? I
------------------?
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 111 D`3 Site Address:
4?qR PCNKwE. I
TenaM:
?A LL P K In ??1G.A1 b"Ci
Name: ??
RESIDENT I OWNER
I Address / City / Zp:
? Applicant is: Owner _kContractor
TYPE OF WORK I Description of xrork: K E`?1 ??
ConsUvction Cost: 5?_100 I?
CONTRACTOR I Nsme:
Suite #:
Multi-Famity Building: (Yes_I
License
Add2ss:
Cfty: 3411ICJ.'YkJrPC State: MN ziP: S?`J
Phone: Gra ' L4-AC(• Contact Person: K()Cao
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Mb.,nvanta qules 7670 Cateoorv 1 Minnesota Rules 7672
Energy COde • Reafdendal verrolation.Category i Waksheet . NaW E^oW Coda woAkaheet
Cate9ory sudnmed subrnitted
(4 submi9slon type) • Energy Envelope Celaiations Submitled .
In the Iast 12 morrtha, hes the Cky of Eegan issusd a pe+mLL tor e simllar plan based on a master plen?
_Yes _No If yes, date and address of master
Ucensed Plumber:
Mechanieal
Sewer & Water Contraetor.
Phone•
t hereby atkno'xlad9e that Nis iNOrtnatlon is complele and aowrate; tliat the work xdll ba in croMOrtnance wNh tlm ordinances ?codes?of d?ye ? d the Eagan; that I un? this is not a pam?ft, but onh' a^ a?icaUon tor a peiml4 and work is not tostart witMut a pertn ;
aacordance wim me apprared Wen in tne case m work? ahich requiRS a review arnd approval 01 Wans.
_I?'-Ci?MM11C? x ?Y?r+e? n.n I?u
x
ApplieaM's Printed Name ApPl"cant S SigmwfO Page 1 of 3
------------------
,
j Permit#:
? Permit Fee:,/
? Date Received: ?
I I
I StaR: I
I
Oate: Site Address:
7enant:
RE5IDENT I OWNER I Name:
Phone:
Address / Ciry / Zip: _ ,,/
Appiicant is: _ Owner ? Con[ractor
TYPE OF WORK Descnption of work: ? f
Construction Cost: 4?121 416 Multi-Family Building: (YesN
CONTRACTOR Name: 0 Mh)CHCO License #:
Address: JI0`1 I I 1 IP(Yl(7C i0,Y ttVF' I U.
City: SE I I (kxYk(?r State: MV Zip: '?'? 5)80
Phone:?O6I"1,;I•`7??;Q ContactPerson: KQre11
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Cade . Residentiai Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Su6mittetl Submitted
(4 submission type) • Energy Envelope Calculations Submitted .
In the last 12 months, has the City of Eagan issued a pertnk for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer 8 Water Contractor:
Phone:
Phone:
Phone:
I hereby acknowledge that this infortnafion is complete and accurate; that the work will be in confortnanCe wi[h the ortlinances and codes of the Ciry ol
Ea9an; that I understand this is not a permlt, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance wiih the approved plan in the case of work which requires a review and apprpval of plans,
x X < 0?/VJ
Appli ant's Printe Name ApplicanYs Signature ????
Page 1 of 3
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
.. V • • ? ? r
For: / ???
U. S. HOME CORPORATION
?
'o
/
/
/0
C. R. WINpEN 3 ASSOtIATES, fNC.
LAND SURVEYORS f1l 846•3648
1381 EU5TI5 St, ST. PAUI, MINN, 56100
/ Y
Scale: 1" = 30'
O Denotes Iron
\
\
?Q ?" \ at0?y ?ti
/`95r
4y p \ 3 ?4)
<7P%5L?,?
Lot 9, Block 3, Johnny Cake Ridge (r.
Addition, Dakota County, Minnesota
.?
/
a?
y
WE MEREBY CERTIFY THAT TMIS IS A TRUF AND CORRECT REPRESENTATION Of A SURVEY OF THE
60UNDARIES OF TME IAND ABOVE OESCRI6ED AND OF TME IOCATION Of ALL 6UILDINGS, IF ANY,
TMEREON, AND ALL VISIBIE ENCROACHMENTS, Ii ANY, FROM OR ON $AID LAND.
Dotad this.f.u_doy ofAuausf A,.D. 1950 C. R. INDEN 3 ASSOCIATES, INC.
!
:t • n
by UA?,.
Su.•aror, Minnewte Yoyiurotian No.222L
ie
\\?O
r:
******************#*********R*********R
CITY OF EAGAN
CASHIER: JS TERMINAL N0: 699
DATE: 08/25/00. TIME: 09:44:15
ID:
NAME: ABC - PERMITS
3210 9001 4699 PENKWE WAY 167.25
2155 9001 4699 PENKWE WAY 4.50
Total Receipt Amount: 171.75
CR136490
USER ID: JAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) 5 CITY OF EAGAN 1705
3830 PiLOT KNOB RD - 55122
? I 651-681-4875
New ConshucMon ReaWremenh Remodel/Reoair Reauiremenfa
> 3 reglsfered tife wrveys fhowlny eq. H. o( bl, eq. fl. ol house
aM QH rooled areas tTOx mmdmum Im covemae allowe?
> 2 coples of plana (ahow beam & wlndow alzes; poured Ind. deflgn; etcJ
> t ser a eneryy calculaHOru
> 3 copiea ol hee preservalion plan il lot platfed alter 7/1/93
DATE: Zaa d
DESCRIPTION OF WORK: l1[.o.A -
-iwrr i-
$ ?m °v
STREET ADDRESS: 110 '' w
LOT: 9 BLOCK: v SUBD./P.I.D. #: Q nn Q,.kl.
l
Name: GlA" ?. vga'? Phone g:
PROPERTY tast Flni
OWNER
Sheet Address: q6q q Pa?'k'?
Cify &&I..= Sfate: 44, " Lp: rri Zz
Company. Aw? c.?-.. Phone #: ?,S
(area code)
CONTRACTOR
Sheef Address: I ZZLI7 .f/? ti-de7B 45- ucense a 201 by383 exp.
CHy state: vin vi Zlp: Sl5` 33 7
ARCHITECT/
ENGINEER Company: Name:
Telephone #: ( )
Sheet Address:
Cfly
2 coples d plan
t set ol energy cdcWaHOns for heatetl addlMau
i tile wrvey for extedor addlHons d decks
CONSTRUCTION COST:
State:
Zip:
Sewer/water licensed plumber (if installina sawer/waterl: Phone iR: (
I hereby aeknowledge Mw1 I have read this appllcafbn, afafe that 1he infortnaHon is conect, and agree to comply wNh a0 appAcable Sfafe
of Minnesola Stalutes and Cily of Eagan Ordinances.
Signature of AppllcanY.
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Regishatlon #:
Tree Preservation Plan Recelved - Yes - No - Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 07 FoundaUon ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 Poroh/Addn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex ? 1 S Deck ? 23 Porch (screened)
? 04 02-plex ? 10 08-plex ? 19 Lower Level 0 24 Stortn Damage
? 05 03-plex ? 11 10.plex Plbg _Yor_N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex O 20 Pool ? 30 Accessory Bldg.
WORK TYPE
O 31 New ? 36, lylove Bidg. ; C8 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' 1!?; 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
O 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
` Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories sq. ft.
No. of Units Length sq. ft.
No. of Buitdings Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MClES System
UBC Occupancy sq. ft. Ciry Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC •
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 37 Ext. Alt - Mutti
? 33 Ext. Att - SF
? 36 Mutti
SAC Units
% SAC
66)Z () MECHANICAL (RESIDENTIAL)
Permit Application
_ City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
- Telephone # 651-675-5675 FAX # 651-675-5674
,
' Please complete for. Single Family Dwellings
Townhomes and Condos when permi[s aze required for each uni[
?•?
/
'Date ...,,.,._ . ... _ ;"
Si[
Add U
it
#
e
ress n
:
.
Property Owner AmV r UV ' Y J(ig.F/?{^ Telephone #( 7(2-'`)
Contractor
Add ??I?J ?
?
t '
? g ? Cit
Street
ress f?t;
y
• J?,
?i
y
State r ? ? / ? Zip T2?_ Telephone # (tpq
/
The Applicant is Contractoi _ Other
_ Owner -X
Add-on, modi6cation or alteration to eaisting dwelling unit $ 30:00:
? fumace replacement
air excha nger
? air conditi oner
other
J LS ??'? l
? I
I 1'1 LS $ 50
State Surcharge
.
.
JUL 0 2 Z003
T
t
l J
$
?
o
a ? L
I hereby apply for a Residential Mechanical Pemut and aclmowledge that the information is complete and accurate; that the woik willf ..
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I undetstand tlus is not a..:
permit, but only an application for a permit, and work is not to start without a pemut; that the woioF will be in accordance witli the
approved plan in ffie case of work wluch requires a review and approval of p :
. (? V1??(S1`i -?I,??_( ?, ,
' Applicant's Printed Name ApplicanYs Signature '° "._
Use BLUE or BLACK Ink
-----------------i
I For Office Use
I L/) I
City of Eno ;Permit#
k ' t~ I .s
Permit Fee:
3830 Pilot Knob, Road ~C+ I I
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 1 - -
Fax: (651) 675-5694 i Staff:
2012 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: _
Tenant:
Suite -
Name:May t-t~t-t-- - Phone: L61 -5 I " 68, Q
RESIDENT / OWNER
Address / City / Zip: Lq kw~ ~ _ ~1~
Name:- 1C<;~~5 T- IU C ---License
CONTRACTOR Address: __-a City: Q ' n
State: qq Zi : Phone: -
Contact: Email:
TYPE OF WORK New k Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Water Softener
PERMIT TYPE Lawn Irrigation RPZ / PVB)
Septic System Add Plumbing Fixtures Main / Lower Level)
_ New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $189.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
TOTAL FEES $_lpC~r ®v
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X-da _r e _ v
Applicant's Printed Name A P ant's Si nature
FOR OFFICE USE Reviewed By: Date: _ _
Required Inspections: _ Under Ground Rough-In _ Air Test ___Gas Test __Final
411*
City of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675.5675
Fax: (651) 675-5694
Date: `f -
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
0 /3 Site Address:
KWg WA. Unit#:
Name: (1_2.41 /--714"/ 1.
RESIDENT /
OWNER : Address / City / Zip;
TYPE OF WORK
CONTRACTOR
Rt . /cL Phone: 6.51-6137-8$
Applicant is: Owner Contractor
Description of work ix (A / 3 &JIM ctob-iS ti --7-74/
IPJ ►3
Construction Cost: dt-57".
Multi -Family Building: (Yes / No l0 )
Company: (�ir i&JIM:L J S.drrecontact:
Address:Aa:I0
II �j5City: �r
State: 711 1) Zip: $s i 4-- Phone: • A: •/ 34 )
License #: f) (c 1 j4•.2. 7 Lead Certificate #: 232-91—
If
32-91—
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
c/NA 1 /()
l
i
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:
OTE: Plans and supporting documents that you submit are considered to be public information. Portions of
e 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. can 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.aooherstateonecalLorg
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 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 - 'Id i � , must be completed within 180
days of permit issuance.
rooTr
Applicant's Printed Name
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112029
Date Issued:07/24/2013
Permit Category:ePermit
Site Address: 4699 Penkwe Way
Lot:9 Block: 3 Addition: Johnny Cake Ridge
PID:10-39800-03-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Window or Door:door
Jennifer Haagenson
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Frances M Blastervold Olson
4699 Penkwe Way
Eagan MN 55122
(952) 891-3400
Great Lakes Window & Siding
14690 Galaxie Ave
Apple Valley MN 55124
(952) 891-3400
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA123414
Date Issued:06/06/2014
Permit Category:ePermit
Site Address: 4699 Penkwe Way
Lot:9 Block: 3 Addition: Johnny Cake Ridge
PID:10-39800-03-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes .
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Frances M Blastervold Olson
4699 Penkwe Way
Eagan MN 55122
Great Lakes Window & Siding
14690 Galaxie Ave
Apple Valley MN 55124
(952) 891-3400
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
. . �________________�
I For Office Use . I
� � Permit#: � � �� �
Clty of �a��� ; . � �
Permit Fee: � I
3830 Pilot Knob Road � I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
�ate: ��l �Y Site Address: Unit#:
r Name: �a�cc1S ��r�'c��� ���"� Phone: ,S�'7.,�/6—f%��"�-
Resident/ ��� � �� �
Owner ' Address/City/Zip: �.�c � �y
,
Applicant is: Owner �ontractor
Type of Work Description of work: /Cc��- o��� d �� —✓�c} �
Construction Cost: �r7� `� Multi-Family Building: (Yes /No�
.^----
Company: �N ��P�"r�'��-�'T�e"`rrr S Contact: �id y �/,s.c�,
C011tt'BCtOC Address:��YQ" � `R�y�,., �e. City: �� !�l�SG/
State:/'�/�Zip:,S'��.3� Phone: 657.-�7Y,�`�O�mail:��7�/9Y�✓,�p�s°`�'�c����ti.r�„
': License#: ,$G-�rCl�°� Lead Certificate#: ✓U��-�i'�`.f 3 y''- (
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 antl 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 they 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.qopherstateonecall.org
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 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 State Building Code must be completed within 180
days of permit issuance.
X � �� �---�
� X --�
ApplicanY Printed Name Applica ' Si a re
Page 1 of 3