4235 Pilot Knob RdCITY OF EAGAN
3795 Pilot Knob Rood Eogen, MN 55122
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be uad for -r r.cDate
N4 4461
7185
Site Address t? ''ob Ered E] Occupancy
Lot Block Sec/Sub. Alter ? Zoning
Porcel # Repair ? Fire Zone
Enlarge p Type of Const.
W Nome Move p # Stories
Z Address Demolish p Front ft.
Grode f-1 Depth ft.
w
Nome
?
0
?U Address Assessment -
Water & Sew.
Ci Phone
Nome Police
Fi
F W
?0
Address re
Eng.
<W Ci Phone Planner
Council
I hereby ocknowledge thot i hove reod this application ond state that gldg. Off. _
the information is correct ond agree to comply with a!I applicoble
State of Minnesota Statutes ond City of Eagon Ordinonces. APC
Signature of Permittee - ?
Permit '•`?''
f '•;
Surchorge
Plan check
SAC
Woter Conn. _
Water Meter
? Total 1 j• ?
A Building Permit is issued to: on the express condition that
all work sholl be done}(? accordance with all applicable State of MinnAs.ta Stotutes and City of Eacan Ordinonces.
? /
Building Officiol - - -
rawk # poM lawd hroIMw
Plumbing
Mechanical
INSPECTIONS DATE INSP. Rouph-In Finoi
Footings Date Irnp. Dota Insp•
Foundotion Plumbing
Frame/ins. -a.- 7 Mechonical
Fincil
Remorks:
- ?
Rmaipt -PLUMBING PERMIT P?rmit IGo. -!
CITY OF EAGAN Fee
fill i» numbered spsces SJC
Type a Print /egib/y TaL , .
r_
1. Date 2. Installation Cost
3. Job Addreas • ``=. r: Lot ?. Blk. Tract
4. Owner
6. Controctor
6.
7. City Stsie Zip
8. Building Type: Residential,d Commercial ? Institutionsl ?
9. Work Deacription: New ? Add.4 Altar 0 Repair ?
10. DlSCYIbC • ' y,-) f' i ..L_ 1,L?? j
' i
11.
No. Fixtures
Water Closet No. Fixtures
C
l/D
i
ld
fi
Bath tubs easpoo
ra
s
n
ti
Se
T
k
Lavatory p
c
an
S
h
Shower o
ner
ll
W
Kitchen Sink e
Urinal/Bidet h
O
Laundry Tray er
t
Floor Drains
Drinkiny Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I swee to
comply with all ordinances and codes governin9 this type of work.
Sign°d : _ for
Rouqh Fi I J`
Inspections: Date Inap. Date 'Z'1[.,?nsp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464,8100
Permit Holder Date Telephone 1t
SEWER/
WATER
PLUMBING
HVAC ?
Inspsction Date Inap. Comments
FOOTINGS
FOUND
FRAMING
ROOFINO
( T 0
L?K!
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
a
CITY OF EAGAN
ilot Knob Road
Eagan, Minnesota 55122-189
(651) 681-4675
SITE ADDRESS: , . ?
PERMIT SUBTYPE:
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
7 Date Issued:
nqw+r? vrr,a a
?? ?s1 cick
APPLICANT:
TYPE OF WORK:
.. ,: .? 1. .,
? ---?
_a-oo
VIA
? ? ?
CITY OF EAGAN Remarks (_"- dcfz )
Addition CARLSON ACRES Lot 6' R?k 1 Parcel 10 16400 060 00
Owner -ST f-Ag-Street 4235 Pilot Knob FtDdd State EaQ?, MN 55122
_
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TFUNK LL 1973 175.00 8.75 20
SEWER LATERAL C003509 10-14-77
WATERMAIN
WATER LATERAL ?tc?, 1977 ?380?00 138•00 ? pald coo2453 2
WATER AREA 1977 160.00 10.66 15 Paid Coo2453 7 27 76
-l B? 1983 1? ?q
STORM SEW TRK •-; 19
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. Qp
BUILDING PER.
SAC ?:u . .< .
PARK ? ?
CITV° JF EAGAN WATER SERVICE PERMIT
'795 Pilot Knok Roud PERMIT NQ.:
iN 55122
'
Ea
an DATE
g
,
.
Zoning: No. of Units:
Owner: - - `
Address: h ?- -
Site Address:
Plumber: _
Meter No.: Connedion Charge:
Size: - Account Deposit: ,
Reader No.: _ Permit Fee: - y•
1 agrae to comply with the City of Eagan Surchorge: ?
Ordiwanees. Misc. CFwrges:
ti
Total:
?.
gy Dote Poid:
Date of I nsp.: I nsp.:
t!F EAGAN SEWER SERVICE PERMIT
Pilot Keot Rood PERMIT NO.: _
, MN 55122 DATE:
I: No. of Units:
Address:
La rae
?t;I1Ql:G INTO fi(3"!E BUT CAAPP 2 : -
fo aompiy witb the Gty of Eagan
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Chorges:
Total:
Date Poid:
of Insp.:
CASH RECEIPT
,
CITY' OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
ts
R6CEIVED
FROM
AMOUNT ? I
& DOLLARS
?oo
? CASH ? CHECK
?l
i-, / i
FOR
10
NUMERICAL FILE COPY
? " ' BY
CASH RECEIPT ?
. ?
" CITY OF EAGAN --`
P. O. BOX,21-199
EAGAN, MINNESOTA 55121
r /I"[
DAT6 19
`
Y
ieccavro
rwoM
AMOUNT ? $ I ?
C] CASH ? CHECK
DOLLARS
1 oe
FOR ?
White-Payera Copy
Yellow-Portiny COpy
Pink-File Copy
4y
Thank You t'r
ev -?., ,
P 592 747 071
RECEIPT FOR CERTIFIED MAII
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reveise)
?
?
?
O
a
0
N
?
s
?
Yl<Q?Y ?
str
7
P. tate and I P Code SryL
.Y
Postape $
Certifled Fee .
Special Dellvery Fee
•
Restricted Delivery Fee
Return Recefpt Showing
to whom and Date Delivered
Retum recefpt showing to whom,
Date, and Address of Dellvery
TOTAL Postage and Fees S
Postmark or Date
N
?
?
T
?
m
U.
9
`o
LL
?
STICK POSTAGE STAMPS i0 ARTICLE TO COVER FINST CLFSS POSTA6E,
CERTfFIED MAII FEE, AND CHAR(iES FOR AHY SELECTED OPTIONAL SERVICES. (s" haA)
1 it you wam tnts receipl pastmarkea. stick the gummetl stub on the ieft portwn ot the atlOress side of the artfcle
ieaving the receipt attached ana prasent tne articie at a post oftice service window ur hantl 1t to your rural carrier.
(no extra charge)
2. If you do not want this receipt postmarked, stick the gummetl stub on the left ponion ol the adtlress siCe o1 the
aNcle, date, detach antl reTain the receipt, and mail the article.
3. Ii you want a retum receipt. write the certifiatl maii number and your name and address an a retum receipt card,
Form 3811, and attach it to the iront of the article by means o1 the gummed ends if space permits. Otherwise, attix
ro back at articie. Endorse tront o1 artile RETURN RECEIPT REQUESTED adycent to the number.
4. il you wam oelivery restncted fo the atltlressee, or to an aulhorizetl agem of the atldressee, endorse
RESTRICTED DELIVERY on the front of the arlicie.
,
5 Emer fees for the senices requasted in the apOropriate spaces on the trom of this receipt. If reium receipt is re-
quested. check the applicable blacks in iiem 1 af Form 3811.
6. Save this receipi and present rt it you make inquiry.
Thiareq!Woid IS months from
Date of this Request Dec. 13, 1979 S28516
I, as 19 Licensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 4235 Pilot Knob Rd. Eagan
Citv_ _
Section Township
Which is occupied by Mr. Tom Kuhista
Range County Oakota
(Name of Occuoanq
Is a roughin inspection required on this job? No 6dc Yes ? Ready Now Rx Will Call ?
PowerSupplierO.E.A. pddress Famrington, min.
Electrical Contractor Corrigan Electric Co. Contractor's License N837673
(COmpany Name)
MailingAddress 3065 145th St. W. Rosemount. A1inn_ 55p6R
.'I IElactrlcal Contrattor or Owner.Makina Thls Installationl
Authorized
57foATE L'?J???D COPY
Phone No. 423-1131
This kdpection request will nat 6e axepted 6y the
State Board unless proper inspxtion fee is enclosed.
Minnesota State Board of Electricity
"1954 lfhiversity Ave., St. Paul, Minn. 55104-Phone 645•7703
REQUEST FOR ELECTRICAL INSPECTION
CHECK BEIAW WORK COVERED BY THIS REQUEST
/ 7/`'ri e-z
s %T ?' ?
Type of Bullding New Add. Rep. Check Appliancea Wired For Check Fquipment Wired Fm
Home ? )Q ? Range ? Temporary W'ving ?
Duplex ? ? ? Water Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryer ? Electric Heating ?
Commeicial Bldg. ? ? ? Fumace ? Silo Unloader ?
Industrial Bidg. ? ? ? Au Conditionec ? Bulk Milk Tank ?
Farm ? ? ? List / n rage List
Other
?
?
? ptheis}
Rthers Y ? Rthers
Here
COMPUTE INSPECTION FEE BELQlV \\'.v\ -""Z? '
Service Entrance Size: # Fee F: eisR.S?lbteedecs: n Fee C'vcuits: # Fce
0 to 300 Am s. 0' o? 0 Am res 0 to 30 Am eres
101 to 200 Amps. -
` 81 t k00 Am eres 31 to 100 Am eies
Above 200 Amps. brne 100 Amps. Above 100 Amps.
Transformers -Remote Control Ciic. Partial or other fee
Signs Specia] Ins ection Minimum fee S5.00
Remarks TOTAL F 8.50
I, the Electrical Inspector, hereby certify that the above inspection has been ni'd ?.
(Rough-in)_ Date
(Final) Date 1.7 a y- ??
This request void 18 months from
?
' METER READING SHEET
Cify of Eagan #
/
THOMAS T. KUBISTA 15a0 ?? G 0?? a o a
4235 PI?T KNOB RD.
EAGAN, MN 55122 06-
Check every year ?5D
X(Sewer brought $nto house but 0230
capped off) over
METER: 23169545 READER: 606257 1" Met
DATE READING coHSUMrrtoH REMARKS"
?
-I? 6 1
r ? 3
Z? ? d
is? I c? ?- ? aad
. c)
?.. I 6 $ ) 00
2SL ?l "aU
S1? b2 I 3 Z ob ,1
a _, ? ? ?? ? ,
'` W gRO 1 I lP l Ok
Must connect to sewer by June 17, 1984.
l
:
C' METER R. .AG SHEET # C.
City of Eagan -
Ddp - ovSa
KUBISTA, THOMAS T• $15.00 - Water Only
4235 Pilot Knob Road
Ea4an, Na1 55122 L. 6 Bd C-4
? (sewer brouqht into house b}u8t ? ._
capped off)`54 '?--._
J ??/`-C.s-?.c__.,-?_.'. ..?F_•a? L ?..'?.tt?'Z^t''
fl„?ae...an625?1" Meter
coNSUMPTIoN
'? a1 L1 g/
?, "',
D
*1k U- i,- l: `sC7TM
oa 0
RESIDENTIAL
BUILDING PERMIT APPLICATION
S
? I C{ ?? CITY OF EAGAN I
7 ? 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Reauiremente
• 3 registered sire surveys shaxing sq. A. cf lcf. sq. ft. ol hocse; and all roote0 areas
(20°6 maeimum l01 coverage allowea)
• 2 copies of Olan showinq heam & wir.aow aizes; poured 1owU desgn, etc.)
• 1 setofEnergy Calculations
• 3 copies of Tree Preservalion Plan if lot platted afler 7A193
• Rim Joist Detail Op6ans selection sheet (hldgs with 9 or less units)
DATE o B Ia'113D-
RamodellReoair Recuiremenh
• 2 ccpies of plan
• 1 set of Eneryy Calcula6ons for healed adtlitions
• 1 site survey for extenor additions & decks
. Intlicate if home served by sepGc system for additions
VALUATION 4 ? 9 ":? •
SITE ADDRESS '4'kt"?f P??-? ? 402> ? MULTI-FAMILY BLDG Y N
iYPE OF WORK_cI_C:ZV?-OF? ? kt,- kWF FIREPLACE(S) _ 0_ 1_ 2
APPLICANT
STREET AD
iELEPHONE #
CELL PHONE #
Phone #
PROPERiYOWNER ?V ?t 121, TELEPHONE 5I
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIN\F:SO"C.\ RUI1•:S 7670 CA"t'1•:GORY 1 N(IVNESOT.1 R1;I.1:S 7672
(d suhmission rype) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Enveiope Calculations Submitted
Plumbing Contractor: ____
Pluinbiug systcm includcs:
Mechanical Contractor:
Mcclcmic:il svstcm includc;:
Sewer/Water Contractor:
-- .-1ir CondiUoning
- Hcal Rccovcr} Systcm
Mti/ ZIP J`' S 4 ( C
Fee: $90A0
?f?(?f?n ('r I?
e,#AU6 2 8 2J02
00
i hereby acknowledge that I have read this applicotion, state that ihe informatihis correct,- 'd-agr2e'to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordin
Signature of Applicant
OFFICE USE ONLY
_ Watcr Soltcncr _
Watcr Heater
No. of Badu
PllOtll' #
Laim Sprinklcr
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex O 13 16-plex ? 20 Pool O 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plax 0 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
0 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF
? 04 02-plex p 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex O 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or _ N 0 25 Miscellaneous
? 31 New ? 35 Int improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) 0 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolltlon (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning Ciry Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Foorings (deck) _ FinaUNo C.O.
_ Footings (addirion) _ Plumbing
Foundadon HVAC
Drain Tile Other
Roof
Ice & W ater Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_
_ Framing _ _ Siding Stucco Stone
Fireplace
R.I. Air Test _ Final _ Windows (new/replacement)
_
_
_
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
PERMIT # 1-4 C? (_) IS 7:)
RECEIPT DATE: ` I- lo • V I
#iESIDENTIl4L PLUMBINfi f'EfiMIT APPLICATION
crrYoF EAsAx
3830 Pu.or xrros Rn
EA6AN, biN 55122
651-6$1-4675
Please complete for
SITEADDRESS: )
? single family dwellings
z townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
OWNER NAME: :
INSTALLER NAME:
STREET ADDRES°
CITY: / i' eA)
ZIP: ?19 4?_
New residential dwelling unit under construction and not owner/occupied $ 90.00
v Add-on, modification or alteration to existina dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• water turnaround
?i
w?
k
?? la'aae;:: e
N
t
f
/
p
:
a
ure o
wor
Septic System, new/refurbished - $ 225.00
• includes County & Consulting Inspector fees
• requires MPC license
Water tumaround - existing dwelling unit, including: $ 50.00
• 5/8" meter 115.00
$ 165.00
State Surcharge -
?.'. $ .50
rotal
Remender. Schedule inspections of alterations, i.e. water heaters, water softeners, water turnaround, etc.
I herebyacknowledge that I have read this applicaCOn, state thatthe informaGon is correct,and agree W complywith all applicaOla Cityof Eagan inances. It
is the applicant's responsibiliry to notity the property owner that the City of Eagan assumes no liability for any damages raused by the Ci d ng its nortnal
operetional and maintenance activities to Ihe ficilifies wnstrudad under tlhis permit wthjrfCfly,proper}yMahtd-/easen}ent,-,) ?
SIGNATURE OF PERIWI'fTEE Wdated 9101
P(ace a check mark next to the oermit work rice
CITY USE ONLY
PERMIT #: Ll 7 p cSl? RECEIPT DATE: 'V 'a 3
ii£SIDEPTIAL MECB"Ci41. PERM1T APPLICATION
crrY oF Eaem
3830 Pu.oT xxoa xn
EAswx anv ssi ss
651-6$14675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date:
l
SITE ADDRESS: ?z G 5 7 ?,r I I C
OWNER NAME: Iw r'UA0I S
INSTALLER NAME:
STREET ADDRESS: V 1 0 +
ciTV: (f, l-n
TELEPHONE #: an
(AREA CODE)
TELEPHONE#: 7q3D
(AREA CODE)
STATE: C?f ZiP.
DI...... a nhnn4 ...?A4 ns..11.. iMn ? rnil wnr4 fvnn
New residential dwelling unit under constructionand not owner/occupied $ 70.00
Add-on, modification or alteration to exfstina dwelling unit $ 50.00
. furnace replaramwnf
• air exchanger
• air conditianer
• other VIi?
I??
Nature of work: ?/GC(?d///?vf ? O? It???? C?P
i S i 'r. ;. J i I I I
?
+
IBY
-
State Surchar e $ .50
Total S !? • S O
Reminder: Cal! for inspections.
zfi?z? __?v -
N O TTEE
Updaced I/Ol
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
COMbIERCIiRL MECRANICAL PERMIT A"LICATION
CITY Oi' EA6m
S$SO PILOT KNOB iiD
EAsM, buv 55122
651-6$I-4675
Please complete for: ali commercialfindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME: PHONE #: -
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLI'):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER;
ADDRESS: PHONE#: -
(AAEA CODE)
CI1'Y: STATE: ZIP:
WORK TYPE: New conshuction Install U.G. Tank
_ Interior Improvement _ Remove U.G. Tank
_ Processed Piping
SpecifyNature
When installing/removing underground tank, call 651-681-4675 for inspectron by Fire Marshal and
Plumbing Iinspector.
Fees: 1% of conhact price OR $50.00 minimum fee, wlrichever is greater.
Underground tank removallinstallakon = miuimum fee
Contract price: $ x 1% _ $
State surcharga
TOTAL
$
(Base Fee)
calculate at $.50 for each $1,000 Base Fee
SIGNATURE OF PERMITTEE
Updated 1/Ol
? ---
1
2/84
t
?
C
M CITY Or.EAGAN
?
1
?,
?
IN( APPLICATION FOR PE2MIT
SEPIER AND/OR WATER CON`1ECTIODT
(PLEaSE PRIHi)
1) PF?OPr_Y?"Z ADDRES5: A
rFraI. D°..=rICV: ?.D{ (1 d
(Ir?t /Block/Subdivisicn or Tax Parcei 1.2). ,]L:;Z>er)
STF?;C?'!.*:'cE. Da7ME OF CRLGiT"„aL rciIT?.P,L??? .:__':li ISJ?.ttC:: ??IS ??
,,.^„T?Y;/?p.Or^CSm L'•S': AK R-1 Si;GL:: : P_%tILY .
? R-2 CU:== ('?':O U.1I'SS)
. O cZ-3 'ICivtNECUcr
? R-4 L-LAl:5i
p CCtTMiE?CL?S./??.':?II?Cr 'I?
? =I:.'ST_2I?.L
? L?TSTI.? I?"?L./Gv"V.=..'??ti+F'\r
Z) A7Pi.T`_?T (PLEAJC FRlii(J
?r''?- TNDri944 S /. I?G1? 157i4
,
.?L'iDRESJ_ 'T?? S YI J? '-
cr:', smaT--, zzP: /1/1 1 -
PHoNE: s73 9
3) piz-.m-m . (PLEASE PRI9T) FOR CITY lJSE OALY
NAi'E:
PDD:?SSe PLUMBERS LIC.4SE:
= Active
CIT'?, „STA?E, ZIP: ? Ezpired
- PHONE: Not of Record
• PLUNBER LILENSE N
' arr ;ntcta
(YLtASt f'X1NI r?F,?' ?: % f/U/s1?.sn / /.JK3 (1?Tzr?
ADDFtESS: 4?Ic v'T 0,bA 7C Tl
CIT"l, STATG. ZIP: EAC?i7 nI /1/
PfiU`IE: 4.S-/ - 5;1 f
5) INDIG.TE W1IICH PERi•SIT IS BEItiC, REQUESTID:
a CC;I,IECTION TO CIT"1 SE;^7ER
? C0.].-IFcTZC:I 'Ib CITY I9ATE4
? ?""? (PLCASE D S BE)
. P*--r:,SE f?OID APPP.OVID PER"4IT EYJR PICi:-L"c BY CNE OF AFiGVE
L1J °T--E? :.?JL APPROVED P&F?-fIT T`'J 1, 2, 3, 4 AHpVE
A (Circle one)
7)
DATy: 7 --?'L,F-1
?
v
? R a1:aLanfs?.a ?? ea E?a? a? ?a A ts s??a a? s s rG?a:a :a a s f.e ?r?+syf? ?? Bc ? aR,?saa?
F O R C I T Y U S E O N L Y
ISSiIED
.rEE$: $
?
$
$
$
$ z 5'
$
S
.S c? .?, a o
$
$
$
$
$
$ .
S S , ?o
$
s 5"ys, ?o.
CL::in nr.?t1TT ?I?t..T....:iL SUP.C :A^:LJ
SPAmrR pFR:IZ'^ (I.:CiuDE SuRC?:ARGc.)
FiATER MET°R/COPFERHORN/OUTSID: REi,DE?
WAT°' TAP (I.IC:.?DE CORPORATION STOP)
SL.'= LAP
AC^Cu\'T DrPC`SIT - PIAT°R
W?,C
SIC
T3i;_`IK S•7AT°R AS :=552'-:iT
TRli?IK SE::EB ySSESS?iE?iT
LATERyL HE:vEFIT/TRUidK SE?= '
Ln:c.:tAL BP,ti'cFI,/TP.U:IK j4ATz'o
WATER TREATMER'T PTA:\T SURCHARGE
OTHER: ?Iuw+brna (e-fw?i%
TCT?L
tiMooNT Paz:)/???Z--p^ n
DOcS UTZLITY CONNEC:ION REQUIP.E EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THE.`I n"PER.IIT FOR W0RR WITHIN
PUBLIC ROADL4AY" MUST BE ISSUED BY THE
? NO ENGZ:IEERING DIV:SZON. LIST AS A CONDI-
TION.
SUSJECT TO THE FOLLO[4ING CONDITIOR'S:
APPROVED BY:
T I': Lc : y5? =? ?? ? r t
DAT°: 7 /a As- -
we amsa wM sN mk?r mm sa wom wr?wwi r wlw"1 w? w*w w:ti poow -m Rso ?t? w r sa si? Ra R? w sr wM
PERMIT
?IT* OF EAGAN
383o Pilot Knob Road ? PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 3 3 7 7 5
(651) 681-4675 Date Issued: 10 ( 2 6 J 9 8
SITE ADDRESS:
P.I.N.s 10-16400-060-00
4235 PILOT KNOB RD
LOT: 6 BLOCKv
CARLSON ACRES
DESCRIPTION:
T.O. & REROOF
Bua`1din9 Permit Type STORM DAMAGE
Buildin4 Work T,ype REPAIR
,Eensus Code ? 439 ALT. RESIDENTZAL
%
.?
%
%
,
?e .A .?• i '! -/ _
?. i . . . . i ? .
REMARKS:
FEE SUMMARY:
CONTRACTOR:
ftELIABLE BLDRS INC
3745 DREXEL CT
EA6AN MN
(651) 681-1902
- Applicant - ST. LTC
16811902 0001241
55123
OWNER:
KUBISTA TOM
4235 PILOT KNOB RD
EAGAN MN 55123
(661)454-5739
I hereby acknowledge thaL T have read this application and slate L'hat the
infiormation is correct and agree to comply with all applica6le State of Mn.
5tatutes and City ofi Eagan Ordinances.
L
APPLICANT/PERMITEE SIGNATURE
04s'?
SSUED BY: SIGNAT RE
998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
? CITY OF EAGAN
? 3830 PII.OT KNOB RD - 55122 c?
es i-ae7s 10
New Construdion Reauirements RemodeVReoair Reauirements
• 3 registered sde surveys ? 2 eopies of plan
• 2 copies of plans (inGude Deam 8 window sizes; poured fnd. design; etc.) ? 2 site surveys (ezterior adddions & dedes)
? 1 energy wiculations ? 1 energy wlculations for heatetl atldRions
? 3 copies of Gee Dreservation plan if lot platted aRer 7/1193
required: _ Yes _ No
DATE: U 175d' CONSTRUCTION COST; -5?/GW. ,O
DESCRIPTION OF WORK:
STREET ADDRESS:
61
LOT: & BLOCK: 0_ SUBD./P.I.D.
?( '?? ?'J ? S Ve,
Name: W 4?1t /y z tj +-, Phone
PROPERTY Lsst Fim
OWNER
Street Address:
City R?- u' 4 e State: Zip: S"SJf 3
Company: Phone#: ??IItO?
CONTRACTOR 'l
Street Address: ? 7 y? L1"",/ (,Y' License # 1,?, $ /
Ciry _ ?4y ei,. State: .Z/,??l?. ZiP. S';3'l1 3
ARCHITECT/
ENGINEER Company: Phone #: _
Name: Registration #:
Street
City
Sewer & water licensed plumber (new construction ony):
and lot change is requested once permit is issued.
Zip:
Penairy applies when address chang
I hereby acknowledge that I have read this applica6on and state that the intortnation is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. 'oe
Signature of
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received - Yes - No - Not Required
State:
U ; ---- --
0CT 2 0 IJ98
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation O 06 Duplex
? 02 SF Dweliing ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _ plex
WORK TYPE
? 31 New 0 33 Atterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Pertnit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
13 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
sq.ft.
sq. ft.
Footprint sq. ft.
Building Engineering
Valuation: $
s
•
16 Basement Finish
17 Swim Pooi
20 Public Facility
21 Misceilaneous
MC/WS System
City Water
Fire Sprinkiered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Variance
% SAC
SAC Units
.;
EAGAN TOWNSHIP
BUILDING PERMIT
Ownee ....... _l") .....fH^-...^-f -------- q---? ....B.....................................
Address (preseni)
Builder ................ --------------------------- .------------------------- ---- ........
Addresa ...................... ...-'----.___..----°----------.._.._._..._.......-'---°--
D£SCRIPTION
N° 1633
Eagan Township
Town Hall
?..?.......---
aasa _.Q(/
Siories
-- To Be Used For
? ?? " Fronl
- Depih
-
- Heigh!
-- Esf. Cosi Pe mi! Fee Remarks
LOCATION ` C?
Slreel, Aoad or other Descriplion of Locafion I Lo! Slock ' Addition or Ttac!
,r;o-?"- /f'.n?-.?L-- ?{ , I !o i a.
This perrait does aoi auihoriae the use of slreeSs, roada, alleps or sidewalJcs aor does if give the owner or his agenf
the righ! So creale any siiuafion whieh is a nuisance or whiah psesenls a hasard !o the healih, sefefp, convenience and
general welfare to anpone in the communily.
THIS PERMIT MUST BE KEPT ON TIj$ PAEMISE WHILE THE WOAK IS IN PROG ESS;
This is !o eesiifp. lhsf..V? ._..... °.'?'•.J ,------'-........ has permission to eree! .- -°- .. .............°-•---•-- ? upon
.... . . ..........
the above deserihed premise subjecf !o the provisions of the Building Osdinanee for Eag Township opfed April 11,
1955. (} ?/
'-""-"""-.'-"-.--..?.::..?....... .----- Per .........-----'--'--_'-' -' ....... ........ ........
?? Chairman of Tnwn Board Building Snspeelor .
, ,
' ?,?--{?- /6 ,3 3
, . . . Nv ?Tt? , 7?• /rU ,a ? SK,? _
, . _ ? G ,v - ?.?-,.-?
??-
V( •. -.
C-:.. ?.. C.
-METER READING SHEET
City of Eagan #
C?
TAOMAS T. RUBISTA 15•00 WATER ONLY
,A235 PIT:OT INOB RD.
EAGAN, MN 55]22 06-
Check every year 0050
X (Sewer brought #to house but
capped oPP) over
ME'PER: 23169545 READIIt: 606257 1" Metf
-?5l
14e
-if.,
C1t1eS D1Ly1
ity Control
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CITY OF EAGAN
PUBLIC WORKS QEPT.
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55172
e
DALE S. PETERSON
Bui/ding& l/tility lnapeeror
WII.LIAM H. BRANCH
Superimmndent o/ PoWic Works
PHONE 450-8100
I, Thomas T. Kubista, of 4235 Pilot Itriob Road do hereby aqree to
connect to the taunicipal sewer system within seven (7) years of this
date, June 17. 1977 , and pay said connection charges.as
are in effect at that time;.PRQVIDED the City of Eagan allows my
bringing the sewer up to my residence to be capped off. Stould the
?
property be sold during this peYiod, the sewer will be connected at
the time of purchase by new owner.
if sewer should be connected aithout the knowledge of the City of
Eagan, I will be subject to a fine in the amount of $300.00 plus
double permit fee.
Thomas T. Kubi?
.?. -v • - ?/?/y-s??-?? s? 6. 131+r 1
william H. Branch
Public Works Superintendent
Atteated: vi
Alyce . Holke, Clerk
Dated: June 17, 1977
cirr oF Ee,GaN
3795 Pilot Knob Road Eogan, MN 55142
PHONE: 454-8100
BUILDING PERMIT APPLICATION $5,000. Receipt #
Pssessment _
Water & Sew.
Police -
Fire
Eng.
Planner -
Council _
Bldg. Off. -
APC
Te be uced for Gaia¢e Date e......e r 94 , 19?Z.
Site Address 4235 Pilot RIIOb _ Erect
C3C
o«u?ncY?-
6
Lot Block Carlson Acres
Sec/Sub. _ Alter ? Zoning BL
Porcel # Repoir 0 Fire Zone
Enlarge ? Type of Const.
w Name Thomas Kubists Move ? # Stories
o Address- 1,n.??-•2'i5 uil..?t Knaai,R,g_._ Demolish ? Fronf ZZ ft.
Ci Phone 454-5739 Gmde ? Depth 30 N.
p Name c_ e AvPr"ols Feea
f
?? Address
t' nn.
Name _
Address
I hereby acknowledge that I hove reod this application and state that
the infortnotion is torrect and agree to comply with all applicoble
State ot Minnesota $tatutes ond City of Eogon Ordinances.
$i9nature of Permittee -
A Building Pertnit is issued to:
aIl work shall be done ' o
Building Official '
N? 4461
7185
Permit Lo.vv
$urchorge 2•50
Plan chxk
SAC
Water Conn,
Water Meter
Totol 20.50
Thomas Kubista on the express condition that
r,?,t)af()3pplicable $tate of Minnesota Statutes ond City of Eagan Ordinances.
DATE /- ;? / - / 7
BUILDING PERMIT APPLZCATION
include 2 sets oP plane, 1 aite plan w/elevations and 1 set of energy calculations.
To be used for sD 9?o
Valuation ? ?O/5)
Bite Address:
Lot Block Sec. Sub. Parcel Number
b a,e',,e?
Owner -rhomas T xublS?GL
Address y913S P1lot hno b Rd
Eaean .SJ/ZZ
?
Contractor
Address
Arch./Enq.
Address
Telephone q5'i - ur739
Telephone
Telephone
OFFICE USE
Erect
Alter
Repair
Enlarqe
Move
nemolish
Grade
occuPancy V
Zoninq
Fire Zone
Type of Const.
# of Stories
Fmnt ? y
Depth
OFFICE USE
Date of Approval & Initial
Assessment
Water/sewer
Police
Fire
Er+9 •
Ylanner
Council
Rldg. Off.
A.P.C.
J OrJ
Permit
Surcharqe 2 ?
Plan Check
SAC
Yiater Conn•
Vlater Meter
?
1,OTAL ,2L7
Cities Dijzital
itv Control
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OF
3830 PILO7 KNOB ROAD. P.O. BOX 21199
EAGAN, MINNESOTA 55121
PHONE: (612) 454-8100 February 4, 1985
MR THOMAS T KUBISTA
4235 PILOT KNOB ROAD
EAGAN MN 55122
Re: Connection To Sani
DeaY Mr. Kubista:
CERTIFIED MAIL
BEA BLOM9UIST
Mayor
THpMASEGAN
JAMES A SMITH
JERRY THOMAS
THEODORE WACHTER
Cwncil Membars
THQMAS HEDGES
City Admirtishalor
EUGENE VAN OVERBEKE
City Clerk
Sewer Service - Lot 6, Carlson Acres
On January 4, 1985, I forwarded to
letter with the attached agreement
of time from a previous agreement
to the sanitary sewer system. As y?
that you execute this agreement and
by January 15, 1985.
your attention the enclosed
providing for an extension
relating to the connection
)u can see, I had requested
return it to my attention
As of this date, I have not received any response or communication
from you as it relates to compliance with this previously agreed
to extension.
I wpuld appreciate it if you would execute and return the agreement
to my attention by February 15, 1985. I am sure that this has
just been an oversight on your part and that you will promptly
comply with this latest request.
Again, if you have any questions
me for further discussion.
Sincerely,
omalbert, P.E.
Director of Public Works
TAC/jj
Enclosure
.
or concerns, please contact
THE LONE OAK TREE. ..THE SYMBOL OF STRENGTH AND GROV?TH IN OUR COMMUNIiY
u
Ity OF
3830 PILOT KNOB ROAD. P.O. BOX 27199 EAGAN, MINNESOTA 55121
PHONE: (672) 4548100
. .
January 4, 1985
MR THOMAS T KUBISTA
4235 PILOT KNOB ROAD
EAGAN MN 55122
Re: Connection to Sanit
Dear Mr. Kpbista:
RECEIVED FgB 9 9 IW-
BEA BLOM9UIST
Moya
THOMASEGAN
JAMES A. SMITH - JERRY THOMAS
THEODORE WACHTER
C?il Members
THOMAS HEDGES
Ciry Adminishofor
EUGENE VAN OVERBEKE
ary cierx .
Sewer Service - Lot 6 Carlson Acres
On December 13, 1984, I forwarded to your attention a notice
to connect to the sanitary sewer service by January 12, 1985,
in conformance with an agreement you executed on June 17, 1977,
whereby this connection was to have been completed by June 17, 1984.
Upon receipt of that letter, you contacted me requesting an
extension due to the complexity and cost associated with complying
with the conditions of that agreement. After discussing the
problems in further detail, it was agreed that a one-year extension
to June 17, 1985, would be granted to provide you with the time
to make the necessary arrangements.
Therefore, I have prepared a supplemental agreement pertaining
to this extension that I would like to have you execute and
return to my attention by January 15, 1985. Please be reminded
that the deadline of June 17, 1985, is for the completion of
the connection to the sanitary sewer system. Therefore, please
ensure that the application for the sewer connection permit
is processed and the work scheduled by a plumber well in advance
of the deadline to ensu.re compliance with this agreement.
If you have any questions or concerns pertaining to the City's
request for compliance with this agreement, please contact me
as soon as possible.
Sincerely,
homolbert
Director of Public Works
TAC/jj
Enclosure
cc: Lorna Olson, Utility Billing Clerk
Joe Connolly, Superintendent of Utilities
THE LONE OAK TREE. ..THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNItt
.., ?
?
.
SANITARY SEWER CONNECTION AGREEMENT
I, Thomas T. Kubista, of 4235 Pilot Knob Road (Lot b, Carlson
Acres) do hereby agree to a one-year extension to a previous
agreement dated June 17, 1977, pertaining to the connection
to the municipal sanitary sewer system subject to the following
conditions:
1. All work associated with thi
inspection by City officials
J
17, 1985. 3e)
,_d
2. All sewer connea.?ction permits
be paid in accordance with
time of permit application.
connection including proper
shall be completed by June
-61 aV---' 7 -k -".
and related charges shall
the rates in effect at the
3. If the connection to the sanitary, sewer system is not
completed by June 17, 1985, the City of Eagan shall have
the right to initiate the quarterly sanitary sewer user
fees that would be due and payable if this sewer connection
had been completed.
4. The City shall have the right to levy a$300.00 per year
penalty to the sewer and water bill, effective the first
quarter of each calendar year, for any portion of a previous
year where the sewer connection had not been completed.
5. All perspective purchasers of this property shall be informed
by the present owner of this future obligation of the
property in question.
6. If the sewer is connected without the proper permits being
obtained from the City of Eagan, the City shall have the
right to levy a fine in the amount of $300.00 plus double
?permit fees.
7. This agreement may be recorded with the Dakota County
':=COT'Cjc'-i a+1d t.]lc 04JIlEi :,t`idll pTOJiu2 cl'ia eXEClit2 i1T1'f d.`.7d
all documents necessary to implement the recording of
this agreement.
8. The parties mutually recognize and agree that all terms
and conditions of this recordable agreement shall run
with the land herein described and shall be binding upon
the heirs, successors, administrators and assigns of
Thomas T. Kubista.
Dated
?Thomas T. K b t a/?
APPROVE
Dated A+?d0
Thomas A. Colbert
Direotor of Public Works
.
?.
oF eagan
3830 PILOT KNOB ROAD. P.O. BOX 21199
EAGAN. MINNESOTA 55121
PHONE, (612) 454-8100 CERTIFIED MAIL
December 13, 1984
MR. 'T"HOMAS T. KUBISTA.
k 35 PILOT KNOB RD l F-
G21N'M-5512'2
l o/(o ? bb -olov - v U
Re: Connection to Sanitary Sewer Service
Dear Mr. Kubista:
BEA BLOM9UIST
MoyOr
THOMAS EGAN
lAMES A. SMITH
JERRV THOMAS
THEODORE WACHTER
Gbuncl Members
THOMAS HEDGES
Ciry AdmlNSfrotor
EUGENE VAN OVERBEKE
Ciry Clerk
On June 17, 1977, you entered into an Agreement with the City of Eagan whereby
you agreed to connect to the municipal sewer system by June 17, 1984. A recent
research of our records indicate that no permit has been taken out to provide
for this connection.
Therefore, pLease make the necessary arrangements fox this connection to be
performed within the next 30 days in conformance with this Agreement.
This will require the application and acquisition of a sewer connection permit
from our Utility Billing Dept. The fees aseociated with this permit are as
follows:
$.10.50 Inspection Fee
550.00 Sewer Availability Charge (SAC)
15.00 Account Deposit
$575.50 TOTAL
If you have any questions pertaining to the information contained within
this letter, please contact me. Your anticipated cooperation in complying
with the request of this letter and the conditions of the Agreement wi11 be
greatly appreciated. A copy'of this Agreement is enclosed for your information.
Sincerely,
T omasert, P.i
Director of Public Works
TAC:jbd cc: Lorna Olson, Util. Billing Clerk
Enclosure Soe Connolly, Supr. of Utilities
THE LONE OAK TREE. ..THE SYMBOL OF STRENGTH AND GRONRFI IN OUR COMMUNIN
,
.
r .4•
:.
??. _..
..,w.?.? . .i
' .':A"w„??J'4o'?b'?x,wi.Y ^1= ?p?? . ... . . ?e. .. e y
• ?' R .? ., - a 'q'' ,
. w.... _. ... ?,?.. a. , _ . ?... . . ? . _.
I. Thomas T. Kubista, of 4235 Pilot Knob Road do hereby agree to
connect to the Municipal sewer system within seven (7) years of this
date, Sune 17, 1977 , and pay said connection charqes as
are in effect at that time; PROVIDED the City of Eagan allows my
bringing the sewer up to my residence to be capped off. Should the
property be sold during this period, the sewer will be connected at
the time of purchase by new owner.
If sewer should be connected without the knowledge of the City of
Eagan, I will be subject to a fine in the amount of $300.00 plus
double permit fee.
Thomas T. Kubista I
..G.y ---iA.?-, ..._/.'? /??e?.-?
------------
William H. Branch
Public Works 5uperintendent
?
Attested: ' Q ?gi , y
Alyce. Bolke, Clerk
Dated: June 17. 1977
WAIVER OF HEPRING
REQUEST FOR UTiLITY
I/L!e hereby request of the City Council9 ' City of Eagano
Minnesota, utility impxovements on and over property owned by me/us as
follows: (Mention type of improvement, e.g. waterl sanitary sewer, etc.).
WATER LATERAL BENEFIT FROM WATERMAIN
The location of said utility improvements shall be generally as followsg
Carlson Acres, Lot 6
200 feet at $6.90 FF = $1380.00
Pa.rcel 10 16400 060 00
I/V!e hereby waive notice of any and all hearings necessary for the
installation of said improvements and further consent to any assessments
necessarily levied by the City of Eagan for such improvements.
I/We further agree to grant to the City of Eagan any eas'ements neces-
sary for the installtion of such improvements.
It is further understood that this request shall be reviewed by the
City Council of The City of Eagan or its agent and I/we will be given
reasonable notice as to whether this request is possible under present
utility planning as to timing, location' etc.
DaCed: 'J?q- A=-
_?? ?". PAki.?•?o-?-
'enuest accepted by /,d, S"e? Date
Citv of Eagan
Reo,uest refexred to "'it3•
Copies: 1. City
Z, Ci.ty Engineer.
3. Applicant
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA166256
Date Issued:12/23/2020
Permit Category:ePermit
Site Address: 4235 Pilot Knob Rd
Lot:6 Block: 0 Addition: Carlson Acres
PID:10-16400-00-060
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 Total:
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 -
Thomas T & Ruby H Kubista
4235 Pilot Knob Rd
Saint Paul MN 55122--182
(651) 454-5739
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(763) 852-1044
Applicant/Permitee: Signature Issued By: Signature