4052 Rahn RdCity atEapu
3830 Pilot Knob Road
Eagan MN 55122 RECEIVED
Phone: (651) 675-5675
Fax: (651) 675-5694 OCT 0 8 2010
Use BLUE or BLACK Ink
Permit #:
Permit Fee: `v CJ
Date Received:
Staff:
2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
R ("LA -1 r\ lZ L -
Date: if® -7 10 Site Address: 4/®
Tenant:
1
Ma.lorve,
Suite #:
RESIDENT/OWNER
Name: Kc_4-8 e_ /-ia--ldne_S/ Phone: 6:5-7- 3V3- 7/3
Address / City / Zip: iia5-2_ RG-- L n Rd.
CONTRACTOR
Name: Weld & Sons Plumbing License #: d57g-2.21 /
3410 Kilmer Lane North
Address: Plymouth, MN 55441 City:
State: 763-475-Q
/ - -^Zip:
1S 7/%$, G
Contact: 7 'fLI Email: /7/41 /411.4'e/L .0 c1.50/1.5 ,
TYPE OF WORK
New Replacement Repair Rebuild X( Modify Space Work in R.O.W.
_ _ _ _
Description of work:
PERMIT TYPE
RESIDENTIAL
Water Softener
Water Heater
,K,Add Plumbing Fixtures ( Main / )( Lower Level)
Lawn Irrigation ( RPZ / PVB)
_
Water Turnaround
Septic System
New
_
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ .SS 00
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.gooherstateonecall.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 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 7-7‘h44. MD % fi-
Applicant's Printed Name
Applicant's Signature
CITY OF EAGAN Remarks -- * Cedar Grove Accruisition
Additio CEDAR GROVE #5 Lot 12 Bik a Parcel- _1() 16704 120 AtL
Owner tr?? 7'`. r.r ?L , Street 4052 Rah11 Road State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 31 1967 450.00 45.00 10 Paid
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL 1972 1304.00 52.16 25 Paa.d
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK 1970 70.00 3.50 20 Paid
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
* SAC 200.00 879 - - 8
PARK
'R .Y , ., I.t . t • ', i'; r
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-189
(612) 681-4675
SITE ADDRESS:
PERMIT SUBTYPE:
INSPEC'?ION RECORD
PERMIT TYPE:
Permit Number:
? Date Issued:
t, f 4?wi 1.'41 t9•i
APPLICANT:
1 r, 1.' 1 4!,.' ;: 1 ra4
TYPE OF WORK:
i??? ? t ?? i ra,?
yi
. . .
?x,q
, z
? -----?
- - - - - - - - - - - - - - - -
Permit No. Permk Holder Dete Telephone M
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FfG (0-
DECK FlNAL p, ?
CITY of EAGAN
BUILDING PERMIT
. l.x..?. ?... .?'.. sl . ........ ....
.. . ... . ..
... . .......... .. ...
owner ..
Address (P:ese ) ••••-•.???c?. .. .?...../..7.G.?...s......
Builder ...................?. •••--:...__.........•••••........_................_.........
Address ..........................••••••:---........._..........._....................................
DESCRIPTION
!i{y
N2 3989
3795 Pilot Knob Road
Eagan, Minnesota 55122
454-8100
n 8: .,?.-?e....? ?...1.?...7?
5tosies To Be Used For Fron! Depth Heigh! Esl. Cos! Permi! F e
! Aemasks
;7
?
?O
o
_. - . ? - • LOCATION
Sireet, Road or othes Description of, Location I Lo! ? Block ? Addition os Trac!
?
iz
This permii does not suihorize the use of streets, roads, alleys or sidewalks nor does it givel3he owner or his agea!
the righ! Yo create anp siYuation whieh is a nuisance or which presents a haaard to the health, safety, coavenience and
generai welfare 2o anyone in the communily.
THIS PERMIT MUST BE PT ON PREMISE WHILE THE WORK IS IN PRO?AESS.
This is to certify. 3hat.. -......,eA?- ............. has permission !o erect a?t:?P.-••---•••- •--?..... . X ....................upoa
the above describe e ise ubject fo the rovisions of all appl' e Ordina ces for fhe Eaga?.,
... Per ......... _.. .._ ..... .??...... ..........................
••• - - • .. .. ......
....4 .._..• -•• ....
Mayor Building Iaspector
, Eagan Township
• Dakoia County, Minnesota
` ` ? Appl'acation for Building Persnit
Tppe of building or work contemplated. Circle correct descriptions.
?
esidential Commercial Induslrial Olher_____________________________________________________________________
PERMIT NO?.<__??...`
Date .-?---?oc_?...??._. .
$uild Enlarg? Alter Repair Install Move Wreck Other.._......_... .............
? , 00 ?
Dimensions-•••-°?--?-•--•---?-•-•°?,-?--•--- Cos3.:...???C'-'-•-•--•••-
Details or remarks__....-•-•-----------•--•-----------•---------------------•-----•-•-•-•---•--•---•--•------••-•-------•------•-------------°-•---•----•-••---••---••----•---••----------•-°--•------ ----
Location
Number Street Between what cross streets Size Est. Valuation
?esa 0.1, ,? IQd? I I?? ??? ?oc?o, oa
Lo! Bloclt Additaon Rearrangement or Trac3
/ ? ?- . ?. ?%/?,,?,? ?"
Owner •----? - /•--°_....--•-__...°-•--------. Address .----??vco?•--•---------,11 ..?rL/------?
? -----•- ---- --° -
Contraclor -•---------- _?L?.l----------------•---•-•--•--•-•-•-------- Address ---•--------•--•-------°------•-•-------°-----••-----•--------------•
The undersigaed hereby makes application for a permit !o
$ : do work as herein specif'sed, agreeiag to do all work in stricY
Tofal fee collecied. accordance with the building ordinance adopted April 11, 1955
by the Esgan Township Board of Supervisors.
Permit fees are not ?
refundable.
•-•----°•----••- - • ------•-•--•--•---•-------°-•--•- - -•--•-•-- -- - -----•--
5igne
EAGAN TOWNSHIP
BUILDING PERMIT
Owner ....... ?-••-?.... 6 ??.
-•-•-•-• --•--•
Address (Presen3) ...r?".:----- Ilk•:-._d<1 .._-••-•••-----•-------•• ---•
Builder ............. •-•-•---•-----------•--....-•--------•-•• ..................•••-•---•------•-• ---
Address ---------------•--••-...-•••--------•--•---••---••-...-•-•------...-•-------•---._._....._._._
DESCRIPTION
N° 1833
Eagan Township
Town Hall
Date --• ---`,??--•?-
f_ .._ ...?.
5torie To Be Used For Froni Depih Heighi Est. Cost Permi! Fee Remarks
'T 8'e,
LOCATION
Sireet, Road or oiher DescripYion of Localion I Lo! Block Addi2ion or Trac2
This permit does not aulhorize the use of streels, roads, alleys or sidewalks no= does it give the owner or his agen2
the righ! !o creale any situation which is a nuisance or which presenis a hazard 2o the healih, safety, convenience and
general welfare to anyone in the communily.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is !o cerlify, lhai.... ?.,,?.....?.-:.. j4r?t?-?.has permission 3o ereci a------ I/ . .........
- --._ . . ................ ,- -..?... .upon
the above described premise subject 20 the provisions of the Building Ordinance for Eagan wnship adopidd April 11,
1955.
/ r
••---•--••-....---••- - ?---••-- .••-?-•--- ---• ......................••---. Pez .......... --
7--•--?.?- •--•--•-•
----`-?•••------ • - - - -•-•-•-----•--•-••-._
CCair an of Tnwn Board uild8 in Inspector
Q- , a.
Cities Di ig ta1 Quality Control
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Every effort was made to capture the content
from the original page.
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MASTER CARD
LOCATION
OWNER
STRUCTURE ANO
LAND USED AS
o, S-?Z--
Permit
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK
No.
Issued
?? - Issued To
Contractor Owner
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
Items Approved
(Initial)
Date
Remarks
Distance From Well
F00TING ? SEPTIC
FOUNDATION CESSPOOL
FRAMWG TILE FIELD FT.
FINAL
ELECTRICAL
HE/aTING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER ?
0 r
Violations Noted
on Back
COMMENTS: (? ?? `?? ?.vG2 l .(7?? 172P_ / ?•??2????{"/' ?Q ??1'?-i .
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. dATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
1-1 NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
1:1 ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
CE RTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
COAAMENTS:
DATE
23
INSPECTION RECORD
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
auxLozNG
025760
06/0T/95
SITEADDRESS: P.I.N.: 10-167e4-120-e4
LQT: 12 BLOCKs
4052 RANM Rp
CEqAR GRQVE 5TH
PERMIT SUBTYPE:
DECK
a APPLICANT:
BOQIN JAMES
(612) 452--3184
TYPE OF WORK:
NEw
INSPECTION .. . .A
FqQTINGS F'INAL
---?? CITY O'PEAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-16704-120-04
DESCRIPTION:
REMARKS:
FEE SUMMARY:
Base Fee $30.60
5urcharge .50
Total Fee $30.50
t:UN 1 FiAt: I VFi:
PERMIT
4052 F2AMN Rp
LOT: 12 BLqCK: 4
CEpAR GROVE 5TH
PERMIT TYPE:
Permit Number:
Date Issued:
DECK
NEW
u, 43111
BUII.pZNG
025760
06/07/95
? ?fi21 3; 51
t j.
VWIVtfi: - mpptacanz -
BODIN JAMES
4052 RaHN Rn
EAGaN MN 55
(612)452-3184
? l i ?-
APPLI ANT/PERMITEE SIGNATURE ISSUED BY: SIG ? U E ?
,
i6r1101995
?
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?
CITY OF EAGAN I
3830 PILOT KNOB RD - 55122
BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675 '
3 registered site sun?eys
2 copies of p{ans (inciude beam & window sizes; poured fid. design; etc.)
1 energy calculations
3 copies of tree preservation plan if lot platted after 7/1/93
required: _ Yes _ No
DATE: /e '" 1 2- 9n
????(1lGt (o " b
Remodel/Rerair Illteauirements
I
? 2 copies of l?plan
? 2 site surveys (exterior additions 8 dedcs)
? 1 energy c?l culations for heated additions
CONSTRUCTION C'OST: ? IIl? . 9t
DESCRIPTION OF WORK: A!A?SeO DEt-:,)K
STREET ADDRESS:
lOT ?&16 _ BLOCK -6?j SUBD./P.I.D. #: Ce-QAR .5
I
l?
PROPERTY Name: ? i art? ci.4me I46 Phone #:
OWNER ?T FIR&T
Street Address• r
Rf?n t'S5?D
49n
Ci
O Zi
1;l
t
A
S;R
St
M
ty: '
d p:
a
e:
A2_
-
4
CONTRACTOR Company: Phone #:
Street Address: . I
License #:
City: State: Zip:
ARCHITECT/ Company: Phone #-
ENGINEER ?I
Name: i? Registration #•
.
Street Address- ?
,
City: I?State: Zip:
&ewer 8 water licensed plumber: Penalty applies when address change and lot
change are requested once permit is issued. li
1 hereby acknowledge that I have read this application and state that the infonnation is correct and agree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. II
S +„hn.t1?? ? . '
Signature of Applicant: ...??? -.
OFFICE USE ONLY
Certificates of Survey Received
Tree Preservation Plan Received
Yes No
Yes No
ITR EGE OME D
I?I JUN 0 5 1995
-+rw r -MMI-i- M
OFFICE USE ONLY
BUILDING PERMIT TYPE
0 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
0 04 SF Porch ? 09 12-plex
a 05 SF Misc. ? 10 = plex
0 11 Apt./Lodging ? 16 Basement Finish
? 12 Multi Repair/Rem. ? 17 Swim Pool
0 13 Garage/Accessory o 20 Public Facility
0 14 Fireplace ? 21 Miscellaneous
? 15 Deck
WORK TYPE
--cf-31 New a 33 Alterations ? 36 Move
0 32 Addition . o .34 Repair . . . : 4 ? ,37 : ; Demolition .. .. . ?
GENERAL {NFORMATIDN
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main level sq. ft. City Water
UBC Occupancy •• sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories ? , • ,sq..ft. • . Booster Pump
Length sq. ft. Census Code.
Depth Footprint sq. ft. , SAC Code
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SNV Permit .
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other Copies - '
Total:
f.7Y
o/
c
% SAC
SAC Units "
?
" C8 1
?
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-- -- .-1
,i.
MEMO
_ city of eagan
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN
DATE: AUGUST 23, 1993
SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5(208 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1,1993 to the property owners in Cedar Grove No. 5 Addition.
Block 1, Lots 1-22 22
Block 2, Lots 1-19 19
Block 3, Lots 1-11 11
Block 4, Lots 1-16 16
Block 5, Lots 1-25 25
Block 6, Lots 1-22 22
Block 7, Lots 1-25 25
Block 8, Lots 1-5 6
Block 9, Lots 1-2 2
Block 10, Lots 1-23 23
Block 11, Lots 1-14 14
Block 12, Lots 1-9 9
Block 13, Lots 1-15 15
208
The City is currently being biUed by Dakota Electric for streetlighting in the above listed
subdivision.
Edward J. irsc t
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
EAGEiAT TOWNSHIP
3795 Pilat KL-iob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONIVEC^ti0ri
DATE: -,?
.
PLUMBERNUfTB2R 409
OWNER '
.?ddress ez ? g?
TYPE OF PIPE
DESCRIPTION OF BUILDING
Industriail Cammerciall Residential I Multiple Dwelling I No. of units
I
Location of Connections:
Connection Charge
Fermit Fae
Street Repairs
Tota 1
Inspected by:
Date
Remarks•
By
Chief Inspector
In consideration af the issue and delivery to me of the above permit, I
hereby agree to do the pxoposed warit in accordance with the rules and
regulatians of Eagaa Tocanship, Dakota County, Minnesota
BY 167
.?x• ?Q, n
Flease notify when ready for inspection and connectiort and befare any portion
of the work is covered.
l
2007 RESIDENTIAL BUILDING rExMIT arPLicaTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements .
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and ail roofed areas
(20% maximum lot coverage allowed)
1 Soils Report if proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
RemodeURepair Reauirements
2 copies of plan showing footings,;beams, joists
1 set of Energy Caiculations for heated additions
1 site suroey for additions & decks
A ddition - indicate if on-site septic system
? 60
Office Use Onlv
Cert of Survey Recd _ Y_ N
Soils Report _ Y _ N
Tree Pres Pian Recd' Y_ N.
Tree Pres;Required _ Y _ N
On-site Septic System _ Y_ N
P[ans are considered ublic infiormation unless ou state the are trade secret and the reason.
Date Construction Cost ? ] ?00m ?
Site Address ? Z Unit/Ste #
Description of Work ROO Fl AJC,
Multi-Family Bldg _ YZ N Fireplace(s) ? 0 _ 1 _ 2
Property Owner _S?IA t,? Telephone # ( 615" ) 3'??- O4 ?I' ?
Contractor lllAL61V<?
Address _-5;7pr/1 6 City
State A4/(> Zip SS? Z Z Telephone #( ) $dC> A^C-
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category 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
ln the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master pfan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the intormation is complete ana 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 perrnit, 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.
Applicant's Printed Name ?-
Applicant' Signature
-,
DO NOT WRITE BELOW THIS LINE
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
0 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. Aft - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
0 05 03-plex ? 11 10-plex ? 19 Lower Levei ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building 0 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to appiicant :
DeSCPiptl011: Water Damage Yes
Valuation Occupancy MCES System
Plan Review 100% or 25% Code Edition
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width ,
REQUIRED INSPECTIONS
_ Footings (new bldg) _ Sheetrock
_ Footings (deck) _ FinaUC.O.
_ Footings (addition) _ FinaUNo C.O.
Foundation HVAC
llrain Tile Other
Roof _ Ice & Water _ Final _ Pool Ftgs Air/Gas Tests Final
_ Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
--------------------------------------------------------------
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
City of Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
oicse
Permit #: 9/ 3
Permit Fee:
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
4" $ Z- ,14h RC)
Tenant: /dijf} Z--j"Al
Suite #:
RESIDENT / OWNER
Name: , ,9 iv /tiel G il7E-y
Address / City / Zip: �Z ,4/(�
Applicant is: Owner Contractor
Phone
t$-/) Z69- Z '3)
TYPE OF WORK
Description of work: S1 /)f C'?
Construction Cost: Multi -Family Building: (Yes / No )
CONTRACTOR
Name: License #:
Address:
City: State: Zip:
Phone: Contact Person:
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 and supporting documents that you submit are considered to be public information. Portion:
the information may be classified as nonpublic if you provide specific reasons that would permit the City
conclude that they are trade secrets.
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 witho , 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 S-tiq/7 n 1,
Applicant's Printed Name
x
Applica s S' . na r
Page 1 of 3
411'
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: ! z_
Permit Fee: /� c a C-
Z.,
Date Received: / —f
Staff: /1)
/� 2012 RESIDENTIAL BUILDING PERMIT
APPLICATION
Date: /C) ) Z / 12 Site Address: 5 /WN c --?.."914%.C` Unit #:
Name: A.1 a ve �,J 4. J[ Phone: Ste 7/ S
140 \
Address / City / Zip:, / /LV\ ROA c'
Applicant is: Owner t' Contractor
Description of work:
Construction Cost:
A
\D )er Wtdi!%t-4-2 c
Multi -Family Building: (Yes / No )
(f' 3 _5 Contact: 7CG'°1 '" t
Company: bii-14' <� � ..X Z-�
Address: D-09`3 - � � �J t' v� � '_ City: _Cvtit.t ik4 fi il:)
State: MA) Zip: A-2502— r Phone: \ 1 t L C) £ ,(g (
License #: 6,344-0O3-4
Lead Certificate #:
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 and 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.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 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.
Applicant's Signature
Applicant's Printed Name
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115451
Date Issued:09/26/2013
Permit Category:ePermit
Site Address: 4052 Rahn Rd
Lot:12 Block: 4 Addition: Cedar Grove 5th
PID:10-16704-04-120
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Amanda Mendoza
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Katie E Maloney
4052 Rahn Rd
Eagan MN 55122--286
Exteriors Of Excellence
4580 Scott Tr
Suite 204
Eagan MN 55122
(952) 239-0560
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115827
Date Issued:09/30/2013
Permit Category:ePermit
Site Address: 4052 Rahn Rd
Lot:12 Block: 4 Addition: Cedar Grove 5th
PID:10-16704-04-120
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Amanda Mendoza
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Katie E Maloney
4052 Rahn Rd
Eagan MN 55122--286
Exteriors Of Excellence
4580 Scott Tr
Suite 204
Eagan MN 55122
(952) 239-0560
Applicant/Permitee: Signature Issued By: Signature