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4765 Pilot Knob RdCITY OF EAGAN Adr,;f;n„ Section 33 Udta? C!- Remarks y,%/Bw A-S 10 03300 030 03 Lot Blk Parcel Street 4765 Pilot Knob Rd. State Eag'an,,MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREETSURF, Z 1983 3687.77 368.78 10 _ STREET RESTOR. GRADING {?? 19$2 1311.56 87.44 15 SAN SEW 7RUNK !?.? 197 190.90 12.73 15 ISEWER LATERRL (, , WATERMAIN ATERLATERAL WATER AREA 'T`S@Y'VlOES H STORM 5EW TRK 610 1982 561.00 37.40 TORM SEW LAT 1982 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SA C PARK ?? 2- ?9 t.. 2006 RESIDENTIAL BUILDING rERMIT arrLicaTTON 70, e7b City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 DEC 2 12006 NewConsWCtionReauiremenfs . RertwdellReoeirReauirements OIfimIlssOnlv 3 registered site surveys shovdng sq. R W lot, sq. fl. of house; and II roofed areas 2 copies of plan shovnng Footings, beams, jasb Cert of Survey Recd Y _ N (20% maximum lot cove2ge allowed) 1 set of Energy Calculations for heafed additions h8e Pres Plan Recd _Y ._ N 2 copies of plan shaxing haam & window sizes; poured found design, etc. 1 site survey for addifions & decks Trea Pces Required Y._N 1 setofEnergyCalculatlons Add'eion-irMirate8onsifesepticsysfem Qnsite:S@ptlcSy&[em . _Y _N 3 copies of Tree Preservation Plan rf bt platled afler 711193 RimJoistDetailOptionsselecfionsheet (buildings with3orlessunit5) l X/?7 ? Minnegasco mechanical ventilation form ? l?-l 04e Date 12, / A /No Con stryction Cost ?1?t . -- Si Add - _ fi U iUS te ress n te Description of Wark r MuIU-Family Bldg _ Y? N Firepiace(s) _ 0 _ 1 _ 2 Propert Owner r aw p 'I Telephone #V15I) 4?-22--(ao y : Advaroed WaMrprouruB Contractor &Faiudufani?Da'u&lnc Address 157891dand Vfew pm f aCn MN 55372 City State j ?? ( ? Zip Telephone #?? ??'f?'C? . COMPLETE THIS AREA ONLY IF CONSTRUCTIN6 A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheel • New Energy Code Worksheet (J submission type) Submitted Su6mitted • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permif for a similar plan based on a master plan6 _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Gontractor Telephone #( Telephone # ( Telephone #( I hereby apply for a Residential Building Permit 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 5tatutes; I understand this is not a permit, but only an application for a permit, and wark is not to start without a permit; that the work will be in accordance with the apprayed plan in the c?e of work which requires a review and 4pproval of plans. ? ? A Applicant's Printed Name '-AVpiUanYs Sivhtur&T - " f . .-. Sub Tvoes DO NOT WRITE BELOW THIS LINE ? 01 Foundation ? 07 OSplex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex O 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 (screen/gazebo) 0 38 Multi Misc. ? 05 03-plex ? 11 10.plex O 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvues ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof 93 46 Windows/Doors ? 34 ReplaCement •Demolition (Enlire Bldg) - Give PCA handout ta applican! D@SCfIpYl011: Water Damage _ Yes Valuation Z/!3 40 • A o Plan Review 100%or 25°k Census Code SAC Units # of Units # of Bldgs Type of Const -16_ Occupancy A" 3 MCES System Zoning 1" City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width _ Foo[ings (new bldg) _ Footings (deck) _ Footings (addiGOn) Foundation Drain Tile Roof Ice & Water Final C? Framing _ Fireplace _ R.I. _ Air Test _ Final _ Insulation Approved By: Building Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit 8 Surcharge TreaVnent Plant License Search Copies Other Total REQUIRED IN5PECTIONS _ Sheetrock _ FinaUC.O. V. FinaUNo C.O. ? HVAC Other _ Pool Ftgs Air/Gas Tests Final _ Siding _ Stucco Lath _ Stone Lath _Brick _ Windows _ Retaining Wall Inspector RESIDENTIAL ?i BUILDING PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 NewConatruMion Reouiremenls • 3 registered site surveys showing sq. R. of lot, sq. %. of house; and all mofed areas (ZO % maximum lot coverage allowed) • 2 copies of plan showing beam & window sizes; poured found design, etc.) • iseto(EncergyCalculations • 3 copies of Tree Preservalion Plan it bt platted aRer 711193 • Rim Joiat Defeil Options selection sheet (bldgs wilh 3 or less unils) DATE 5--I-Oa SITE ADC TYPE OF APPLICANT COO Y9??1 EX?CI?'8, I11C• iULTI-PAMILY BLDG _Y _N FIREPLACE(S) _ 0 _ 1 _ 2 STREET ADDRESS C40tl ftDlds. MN 85M CITY STATE_ZIP TELEPHONE #7IF?}?.? ?ICELL PHONE # FAX #??'?S'?? ? PROPERTYOWNER? Y V?( JAJJDI`Q TELEPHONE#V5I"452 -?lJ-7 0 3' ----------------------------------------------------------------°----------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATF,GORY 1 MINNESO"PA RiJLFS 7672 (4 su6mission type) • Residential VenUla6on Category 1 Worksheet Su6mitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Air Conditioning Heat Recovery System --------------------------------°--------------------°----°----°-- I hereby acknowledge that I have read this application, state tha with all applicable State of Minnesota Statutes and City of Eagai Signature of Applicant OFFICE USE ONLY Water Softener Water Heater _ No. of Baths RemodellRenair Reaulrements ppp,,, 2 copies of plan • 1 set of Energy Calculations for heated additions ? • 7 site surveyfor exterior additions 8 decks • Indicafe'rf home served by septic syslem for additions _ Phone # Lawn Sprinkler No. of R.I. Baths VALUATION (V I 0 ? • ??i'? Phone # Fee: $90.00 ree: $70.00 Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 OFFICE USE ONLY ? 01 Foundation ? 07 05-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 O 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi ? 05 03-plex ? ti 10-plex ? 19 LowerLevel ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plhg_Y or _ N ? 25 Miscellaneous ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bidg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr, of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width ? . .. , '• `i•' -?`??> ?-'??1 REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof _ Ice & Water _ Final Pool _ Ftgs _ Air/Gas Tests _ Final _ Framing _ _ Siding Stucco Stone _ Fireplace _ R.I. _ Au Test _ Final _ Windows (new/replacement) _ Insulation _ Retaining Wall Approved By Base Fee Surcharge Plan Review MCIES SAC City SAC Water 5upply 8 Storage 5&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Building Inspector 2 CITY USE ONLY L c? BL ? RECEIPT #: ?I SUBD. RECEIPT DATE: ?11 7 1998 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAti 3830 PILOT KNOB RD cnrnu, AQI 55122 (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinklersystem FIXTURES EACH # TOTAL Shower 3.00 x = Water Closet 3.00 x = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x = Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x = Floor Drain 3.00 x = Gas Piping Outlet ' minimum - 1 3.00 x = Rough Openings 1.50 x = Water Softener ' for dwellings under construUion 5.00 x = Water Softener ' for existing dwelling 20.00 x = U.G.Spfi^klef 'T.rd:velfir:yunderconst. 3.00 _ U.G. Sprinkler ' for existing dwelling 20.00 = AItBf2ti0n5 ` to existing residence 20.00 = Water Turn Around ? 20.00 = 20. DO Private Disposal System ' MPC iic. 75.00 = (new and refurbished systems) Private Disposal Systems"nbanaonmem 20.00 = STATE SURCHARGE .50 TOTAL 2a. 5o ------- •-----------------------ad t----------------------------------------------------------------------------------------------------- - I hereby acknowletlge that I have rehis appliption, state that the iMOrtna6on is cortect, and agree to compy with all appliceble City of Eagan ordinances. It is the applicanPs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operetional and maintenance activities to the facilities construded under this pertnit within City property/right•of-wey/eesement. SITE ADDRESS: 4746'i1-o7- ICN o6 ,eo OWNER NAME: LFn17-}4N 7 V/LLELL/ INSTALLER NAME: S E 4- F TELEPHONE #: 4 5-0 `/ STREETADDRESS: '471. Se r 4 0-7'- 7V4?) D.t3 )PO ciTV: C-4c R-nJ STATE: A? A-) ZIP: SIGNATURE OF JS/FORMS BLDGlPLBG PERMIT (RESIDE/NTIAL) 199?6??J/ ..S ?0 Q?? & C(.J6a, 1,-dE?t fu+?Natb°"01 / ! Lot ? Slock ? P[D # L Q bI11- QgL D,?j Sewer lwater pennit 9q d Plat 11 Q?l?? l111 ? J Date Receipt # 7/'Y' 7L CITY OF EAGAN 1998 SEWER AND WATER CONNECTION & AVAILABILITY CHARGES EXISTING RESIDENTIAL PROPERTY vSewer Connection & Availability Chargesl ? Water Connection & Availability Chargesi Late benefit (a3 2130/ff $ Late`ial benefit (cr $21.50/ff $? Tnmk Q $860%onnection Ttvnk @,$895/connection SAC ,.f 1,100.00 Supply & storage (WAC) 807.00 Date paid Date paid Receipt # Receipt # Account deposit 15.00 Treatmentplant fy` 444.00 3ewer permit & surc 50.50 Water meter 111.00 Account deposit 15.00 Subtotal $ Water permit & sure ge 50.50 20 50 Subtotal Plumbin permit & surcharge . T?j $ Plumb' g permit & surcharge ?20.50 Sewer and Water Connection 8 Availability Charges Lateral Benefit @ $21.30 and/or $21.50/ff Trunk @ $860 and/or $895/connection SAC Date paid Receipt # Supply & storage (WAC) Date paid Receipt # Treatment plant Water meter Account deposit Sewer and water permit & swcharge Subtotal Plumbing permit & surcharge - Total 1,100.00 807.00 rle? ? na° Y_ Y?qJ?yg / 444.00 111.00 30.00 100.50 $??141.?D ^_`, ''• ?-..i jq.to + . sv $c1??o /a so OFFICE USE ONLY Property owner Address ? ? o L ?A,mN RA `?SO ? Phone number - 4 54 - Plumber S e- f'P PRV required /D Number of taps t7 Availability $? Ciry financed F ? Lot Block Plat P(D N Sewcr /watcr pcrmit #, Da[e Receipt CITY OF EAGAN 1998 SEWER AND WATER CONNECTION 8 AVAfLABILITY CHARGES EXISTING COMMERCIAL PROPERTY Sewer Connection & Availability Charges Water Connection & Availability Charges Lateral benefit @ 2130/ff Trunk @ $1,790/acre SAC @ $1, I OO/unit Date paid Receipt # Sewer permit & surcharge Subtotal Plumbing permit & surcharge Total $ Lateral benefit @ $27. I S/ff $ Trunk Q $1,875/acre Supply & storage (WAC) @ $2,955/acre Treatrnent plant @ $444/SAC unit Water pemvt & surcharge 50.50 50.50 5ubtotal $ $ Plumbing permit & surcharge 25•50 25.50 Total $ S Sewer and Water Connection 8 Avaitability Charges Lateral Benefit @ $2130 and/or $27.15/ff $ Trunk @ $1,790 ancUor $1,875/acre $AC @ $I,100/unit Date paid Receipt # Supply & storage (WAC) @ $2,955/acre Treatrnent plant @ $444/SAC unit Sewer and water permit & surcharge 100.50 Subtotal $ Plumbing permit & surcharge 25.50 Total $ The number of SAC units is determined by the Metropalilan Council Wastewater Services (602-1000). Property owner Address Phone number Plumber OFFICE USE ONLY PRV required Number of taps Avaitabilitv $ City financed , SPECIAL ASSESSMENT SEARCH SUNMARY AS OF: 04/28/1998 PROPERTY ID: 70-03300-030-03 S/Ak ASSESSNENT DESCRIPT. YEAR TM RATE TOTAL ANN.PRIN. PAYOFF CD 100304 SAN SN TR 1975 75 8.0000 190.90 0.00 0.00 CL 100422 YATER AREA 1979 75 8.0000 271.40 0.00 0.00 PP 700669 N,S,SS,264 1987 15 11.0000 4742.29 0.00 0.00 PP 100670 SS TR,264 1981 15 11.0000 561.00 0.00 0.00 PP 700671 GB,264 1981 15 11.0000 1311.56 0.00 0.00 DD 100728 ST 2648 1982 70 72.5000 3687.77 0.00 0.00 PP 102068 SS 466 1990 10 9.0000 7276.00 0.00 0.00 PP ------ SUMMRRY OF LEVIED 0.00 0.00 0.00 '*•"'* 1998 P81 CERTIFIEO -••--- SUMNARY OF DEFERRED 0.00 ------ SIRMARY OF LLOSED 17380.92 ------ PENDING ESTIMATE 0.00 Press ENTER; or fi, F4, F5, F7, FS .? ?j I ? ?'-- ?---.._-- -? ----_ --- r-- - -i? - - ? I ? T LFN[tR- --- __ _._ ---- o+oo lov.ZV 99 I87o I - - ;d - 6U,rE Fcow 1+JE ?- i ---?-- ---- -- - - - 9> /7 - J21_z8 d o.C or 7S Yaz 1.95 . ? --- -- D-r3> C7rY5" /oz3.96 ? 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UW.'~UN~~F MY AI~ {,T 5~lN(iRkiS~li~ !~9 fi~At t~Bd A i~U4t~ ~ ~ ~ . _ + . , ; Ckf~AWN , ~ R , ' ~ (~1~~ T~/M r~~a~~ eft~n ~~~~~~~~r~a u~a ~ ~ ?~Q~rs~ , G~r , , ~~M,- , ~~a~~~~~ ~ ~~~~~r, N~~~ ~ ~l~~ q . ; . .r fi T k,. ~ -~5 , s ~ _ t~: & 4 i .~1. ~VtLMN Q~h~ ~1~~1~ ~ , ; ;I rg , , . - ~ ~ ~ ~ sT• PAlll,~, ~vti~NMFS~TA GATE~ ~ ~ COMM. ~ ; ~ ARRIL 13 1981 ~ ~ ~ ~ ~ ~ ~ C,~ ~ ! ~ ~ ~~~~1~'~"""'" , A ~4V~0 ~ oa~r~ , ~ ~ ~ aEG ~qd~.~._ l " ~G~~ ~ ~ „ ~ w: , ~ ~ ~v,~ , . ~ b~ ti~nuaaa~= _ ~ , . , ~ ' " ~ 'r~ r , ~ ~ ~v y , ~ _ _ _ ~ ~ ~ , ~ , ~ ; C ~ ~ . ; ~ , . , , ~ , , ; , ; l, , , , ~ ~ ~ , . < < , ; ~~~~X~~N~~R ~ ~ ~~Y ca~r~~cr~ ~i~-~ t . r~ : ~ ~ ~ ~ ~ , y . ~ ~ ~ o- } ~ . ~ ~'4 ~ 4 1 a ~ 4 ~ ( ~ ...~w~~ _ . j e a. , „ . . . x ~ ' ~ ' . - ~ ~ ;~~..._;:-._:~.._~4........~..,.,~. e.~:.~~~ l . .~~~N~___:......,_.._ . ~ ..,_:.~;.:._....,~..._~~....W._ _ _:__.~,~,~..ww..~. . _ -~uw~~akrit~ad~~' , . . ;.:.i. - , ; . _ 1 . . , . ~ . ~ . , x ~ . . • . . . , . ~ . r wax. .wn „?~«µu,~.,v..~..~,.~~l~ ~ . . . _ . . ~ ~ ~ rY,~. . .n h . . . 'Ct uv.r .,x ,:e.vY1c c,. . . . . Date: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 RECEIVED DEC 1 9 2011 Permit #: (/ Permit Fee: Date Received: Staff: 2009 MECHANICAL PER IT APPLICATION Site Address: / �S Y (6( -- Tenant: Suite #: RESIDENT / OWNER (fi Name: 'e U 01LI Phone: S C �^-- tD i Address / City / Zip: �q S / 11 Q"Yl CONTRACTOR Name: Standard Heating & Air Conditioning 6:57 License #: 130 Plymouth Avenue North Address: Minneapolis, MN 55411-3445 City: 612-824-2656 State: Zip: Phone: Contact Person: TYPE OF WORK New Replacement Additional )( Alteration Demo!itiory t inta,ti 64je,F5-1--- dioln‘ ,f--- r.eute4-11 ek PERMIT TYPE RESIDENTIAL cbi ii Furnace - r - ► . MM ' SAE: " C 4'eo ill New Construction Interior Improvemt Install Piping Processed C Air Conditioner _Gas Exterior HVAC Unit Air Exchanger Heat Pump Under / Above ground Tank ( Install / Remove) _ _ " When installing/removing tank(s), call for inspection by Fire Marshal and Plumbing Inspector � JC Other RESIDENTIAL FEES: $50.50 Minimum Add-on or _ \\\ .aD alteration to an existing unit (includes $,St) State Surcharge) out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ S _ 00 TOTAL FEE $90.50 Fire repair (replace burned COMMERCIAL FEES: $70.50 Underground tank installation/removal $50.50 Minimum (includes OR State Surcharge) surcharge is $.50. increases by $.50 for each Permit Fee requires a $1.00 surcharge). Contract Value $ x 1% _ $ Permit Fee - If Permit Egg is less than $1,000, = $ State Surcharge - If permit Egg is > $1,000, surcharge $1,000 Permit Fee (Le. a $1,001-$2,000 $ TOTAL FEE I hereby acknowledge that this information is complete and accurate; that I understand this is nota permit, but only an ...lication fora permit, and rk is not to plan in the C of work which require; a r . r,^��. approval of plans. e work will be in co X )tt Applicant's Printed Name ance with the ordi tthe codes of the City of EFEagan; that accordance with the approved city of Eaaan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 E101 5 Z ItON Use BLUE or BLACK Ink � Four t)f�ice iJse T i^ I Permit #: Pemnit Fee: Date Received: 1 Staff: 0 2010 RESIDENTIAL BUILDING PERMIT PPLI A ION Date: / 043//3 Site Address: 4/76.E "c /'7 /� ,�)O '6;944) 3.7....? anent: o. -r E , mw suite #: RESIDENT / OWNER TYPE OF WORK CONTRACTOR Name: �i1 v�l /7`/�.ryt e. / Phone: 65'/-,0a275"©/r( Address / City / Zip: � DZ1 /4/1,01 /do; /C4,14,1) ///% 3.-05'?‘"Q;47 Applicant is: Owner X Contractor Description of work: G4.2/4-1°'©w,y Construction Cost /; a 8a Multi -Family Building: (Yes / No,) Name: a rm//vie <r/ . a/Povelie 'c Ise #: C,Q g 1/71/V9 t/<4 / LL � Address: c-33 9-3a ,AA 06u>q,Po d City: sST` /a (41. -IC 444 State: 1/14i Zip:/<,sS' S.S ro?(, Phone: 9 - 2J3- ‘,300 Contact i 7�q�C K Email: 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, dateand address of master plan: Licensed Plumber; Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Pians and supporting documents that yousubmtt are considered #o be the information maybe classified as hon public if you provide specificsreason -conekitle°.tha!t'the are trade secret; } CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that l understand this is not a permit, but only an application for a permit, and work is not to without a p it; that the work will be in accordance 'th the approovv d plan inthecase of work which requires a review and approval of pl x /Q /I! 1 /`7A/ C/� /leg Applicants Printed N e informaition, , PortIons of at *oula¢ flaunt lae'Cft r to Applicant's Signature Use BLUE ar BLACK!nk ��--��-���--��--- � For Offiee Use ' ^ � I C�� 0 j Pertnit#: .d'�-'7`! I y f E���Il , ; � Permft Fee: 3830 Pilot Knob Road i ,�� � �agan MN 55122 � Date Received: � ,1� Phone: (651)675-5675 i � JI Fax: (651)675-5694 I Stat�: �I �--------------- I 2015 RESIDENTIAL PLUMBING PERMtT APPLICATION Date: -7'�7-�� Site Address:y ��'� pi �t?T' �f'�Uf,� �pG*c� Tenant: [� � � � " /v���'� � Suite#: Resident/Owner Name: �'��� ���5 Phone: 7{��— �s�1�9� Address/City!Zip:_ i��Tr/�� ,P�'7 /J�j�`��" Name: �d�/���1� f��� i� � License#: /'������/ Contractor Address: O �L? / (p T � ' City: �G�lf���' ��� `� �^O�" �7 State: � Zip: � � Phone: Colo7 '-`� � � s� Conta �'1 Email: ��N t�l ��f ii�vy�i:�/iv�4.`,,�Y,'�+ �G�:�HH^� Type of WOrk —New Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. Description o'f wo'fk�r G� /(it!� k ('jdl��� �fi��'—" RESIDENTIAL Water Heater Water Softener Permit Type �a igation�RPZ/_PVB) Septic System Add Plumbing Fixtures(_Main/_Lower Level) New Water Tumaround Abandonment RIESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(inGudes$5.0o State Surcharge) $Ei0.00 I.awn Ir1'Igation(includes$5.00 minimum State Surcharge) $Ei0.00 Add Plumbing Fixtures, Se�tic Svstem Abandonment,Water Turnaround"(includes$5.00 State Surcharge) "Water Turnaround(add$210.00 if a 5/8"meter is required) � $'N 15.00 Sentic Svstem New($10.00 per as built)(includes Couniy fee and$5.00 State Surcharge) '� TOTA►L FEES$ C�ALL BEFORE YOU DIG. Call 6opher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you inte�d to dig to receive locates of underground utilities. www.aoaherstateonecall oru I h�ereby acknowledge that this information is complete and axurate;that the work will be in conformance with the ordinances and oodes of the City of Eagan; that I understand this is not a pertnit, 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 o lans. X �'!l� � " ����� x_ J// i�DO App nt's Printed Name Applicant's Signature FUR OFFICE USE Reviewed By: Date: R�quired Inspections: Under Ground Rough-In Air Test Gas Test Final ME3ter Related Items: Meter Size Radio Read Manometer Staff: T000/TOOOI�] oui �u��ensoxg TiiuIATnI� 0£6££9ZG05T X�'3 90�BT STOZ/�T/SO Use BLUE or BLACK Ink ' r_______�__._____--, I For Office Use I • � ������ I Clt of Ea �Il , Pe�,�t#:_ � Y � . � ���� � � Pertnit Fee: I 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Pho�e: (651)675-5675 � I � Fax: (651)675-5694 I Staff: • � I i 2015 RESIDENTIAL BUILDING PERMIT APPLICATION . ,- �. u Date: � � - �� Site Address: `'t�jD � ! � �l>��`-��o�j �� Unit#: Name: ��'�Q-l.C_L G� t�-( 64j/VLL L_ Phone:���`��'� ��3� Address/City/Zip: `T 7�� �t �-�� �W"u'�J �� �� �.�1�� Applicant is: Owner ,�Contractor Description.of work: ����--� ��� �� Construction Cost: � e � Multi-Family Building:(Yes /No ) Company: • % tt+'�Q �✓ Contact:�7�E�C/l���� Address' �P�� �%��a�� �(/� �i . ' Clty. �/�f.5 State��Zip: ���� Phone:�2 r , mail: ucense#: G,�O .���0¢3�-- �ead Certificate#: /✓��= 7 2 �1��—� If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) �� �L�-� COMPLETE THIS AREA C)NLY IF CONSTRUCTING A NEW BUILDING In the last 12 months�has the City of Eagan Issued a pertnit for a similar plan based on a master plan? _Yes �No If yes,date and address of master plan: Ucensed Plumber: Phone: Mechanical Contractor. Phone: Sewer 8�Water Contractor: � Phone: � CA�L BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 fo�protection agalnst underground utility damage, Call 48 hours before you intend to dlg to receive locates of undergrou�d utilitles. �erstateonecail.ora .- � I hereby acknowledge that this informaEion is complete and accurate;that the work will be in conformance with the ordinances and codes of the Ciry of Eagan; that I unde�stand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work wiii 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 buiiding permit issued in accordance with the Minnesota State Buflding Code must be ompleted within 180 days of permit issuance. • �� X � / X.. � r \ App{icanYs rinted Name Applieant's Signature � , Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA169799 Date Issued:06/09/2021 Permit Category:ePermit Site Address: 4765 Pilot Knob Rd Lot:003 Block: 003 Addition: Section 33 PID:10-03300-03-030 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Patricia A Hamel 4765 Pilot Knob Rd Eagan MN 55122 Keystone Builders Inc 11670 Fountains Dr, Suite 200 Maple Grove MN 55369 (763) 280-0568 Applicant/Permitee: Signature Issued By: Signature