4879 Richard Lane*.
City of Eagan
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694 JUL
Flu
Use BLUE or BLACK Ink
I For Office Use
Permit #:
sS 7
Permit Fee:!
ate Received:
I Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATION CA 6 ,
Site Address:
Unit #: �✓
RESIDENT
OWNER ,
Name: e+ /4. VI:r 124&4't e...Z. r ? Phone: (3) 6-Y-7. 9 Y/.J�
Address /City /Zip: y ..../...4...0...-e__ ,r-/�� L%// 2
Applicant is: Owner L Contractor
TYPE OF WORK
r r / / r
Description of work: ,r/ ✓�c,�, � 9 S.71) -/-0e v er/
Construction Cost: _ Multi -Family Building: (Yes / No v
CONTRACTOR
Company: eA,,, it/ /0,,, (. i.i tir jjn Contact:�h cc
Address: /Jc)`f /.S 74)f �a City: /444.5 -41/r// -E''
State: Zip: 5,70‘ Phone: 9 �2 V„.2.5�- l-' 67T (.4,--/7 y/ 9 ^/6 ,5'
License #: 06? 6S 7 2_ Lead Certificate #: /U//
If the project is exempt
J/ r
from lead certification, please explain why: (see Page 3 for additional information)
��; /a//�r�/.6 2d4t tv�eet hese M-1 5 iz'N
,6%,;:i J24.�/r /e rr �� ^fir
In the last 12 months,
No If
/
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_Yes
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 plan .
x
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
L) DO NOT WRITE BELOW THIS LINE
tOCXE 57
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New
pf Addition
Alteration
Replace
Retaining Wall
Fireplace
Garage
j' Deck
Lower Level
Porch (3 -Season)
— Porch (4 -Season)
Interior Improvement
Move Building
Fire Repair
Repair
DESCRIPTION
Valuation 134119
Plan Review
(25%100%_Zr
Census Code
# of Units
# of Buildings
Type of Construction
x/
2.05
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: _Ice & Water _Final
Framing
Fireplace: _Rough In
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FE
Air Test
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Siding
Reroof
Windows
Egress Window
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
14,?
R-1
5-39
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
mama_.
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: Footings _Air/Gas Tests
Siding: _Stucco Lath Stone Lath
Windows
Retaining Wall: _ Footings _ Backfill _
Radon Control
Erosion Control
, Building Inspector
Final
Brick
539 al& rily0
Final
?DV -
Page
Page 2 of 3
4
•_
JUL 2 8 21
dagi
DELMAR H. SCHWANZ
LAND SURVEYOR% 1
Registered Under Laws of The State Of Minnesota
2978 - 146TH STREET W. - BOX M ROSEMOUNT, MINNESOTA 55008 PHONE 612 42314709
SURVEYOR'S CERTIFICATE
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EAGAN
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DING N—,t--.CTIONS DIVISION
/147Zt
MINNESOTA REGISTRATION NO.8625
?
CASH RECEIPT t ?
CITY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
DATE ? 19
ReceIvcn J'--?
FROM
AMOUNT Is I, `
& DOLLARS
I oo
? CASH CHECK
r-
FOR ?? '? • \ ?,j r? ?-- ? J __
{
!LC /,-) ?JL "- / //. O As t . _ '4-
FUND CODE AMDUNT
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Than u
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? YVhite-Payers CoPy
Yellow-Posting Copy
Pink-File Copy
, r
BUILDING PERMIT
Ts V rmed fet ..:1' '
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E : 454-8100
50,000
N°' 894 r
Receipt # ??? ? ?
f%-_ APRIL 6 ,,, 84
site Address 4879 R ICHIIRD LN. Erect
a =3
?cu??
1 HILLC ?ES''
Lot Block Sec/Sub. Alter ? Zonin9
Parcel No. 10- 3 i'. 9 7;-1 2U- C 1 Repatr ? Fire Zona N
Enlarpe ? Type of Corut. V
W Name '•• : U'I"l'(\i:fi COi•iS`I`. Move ? * Srories
? Address 9 6 0 ,,1R'1 i; f-z k ORD DR.W. pemolish ? Length 4
-
City j' AGF'r' Phone 4 5 2- 3 0 ti 3 Grode ? TT1 sq• Ft.
Depth
? S t 1i., T: Approvals Fees
Zo Name
O
Address
Assesunenf ? ?
Permit
?
u? City Phone Water & Sew. Surchorge '-' '??Q
1 a
50
Police .
Plan check
W Name Firo SAC 525.00
P
_? Address Enp. Water Conn. 4 7 0. U 0
u
? W City Phone
plan?r
Woter Meter 03.00
Council Road Unit 260.00
I hereby acknowledge that I hove read this appiicution ond state that Bid . Off.
the inlormnfion IS Correct and cgree to comply with nll op l itable $ ? ) • 50
Stota of Minnesoto Stotutes ond Gt? pf Eagan Ordio6n ^PC Tota)
, i
Sipncture of Permittee
; r. -?'T-Tr?TFn orlFT.
A Bu{Iding Pertnif Is issued to: on tM ezprcss tondiHon thnt
oll work sholl be done in acco?donce with oll oppliau of Minnesota Statutes orkd City of Eapon Ordi?wnces.
Buildirp Offlciol
Permit No. Permit Holdsr Misc. Parmit No. HoFder
Plum6inp
J
H.V.A.C. y4j C? ? ? ?-b 7
w.u
W?ter
Disp.
Sawer
Elect.ic tiJoS3 D ?,• S??Z(? .S?
Inspection Dats Insp. Other
Footingt
Foundation
FreminQ
Rou? Plbg. ?2 ?
Rouph HVAC 4 ?
4Plbg.
jd
R
Final HVAC
Fi
nal
/W f
L(J?
Water W?cribe Location:
YVell ?
Sewer
Pr. Disp.
Receipt ' 1O rl
JIECHANICAL PERMIT Permit No. `
CITY OF EAGAN Fee
Fil/ in numbered spaces S/C
Type or Print legibJy
Tot.
1. Date 2. Installation Cost
3. Job Address '. Lot Blk. ? Trect
4. Owner -
' Ph
5. Contractor one
6. Address
7. CitY State +- Zip
8. Building Type: Residential ? Commercial O Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe r Fuel Type
11
No. Eauinment 8TU - M. Ea.
Forced Air No. Equiament CFM
Air Handlin
:
Mfg, g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg,
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
?
Receipt PWMBING PERMIT
-Permit No.
CITY OF EAGAN
Fee
, ?-
Fill in numbered spaces S/C
Type or Print /egibly
Tot.
. ate 2. Installation Cost 3. Job Address Lot Blk. Tract ?! . i'-
,
4. Owner
5. Contractor Phone
., ?
6. Address
7. City State Zip
8. Building Type: Residential 0 Commercial ? Institutional ?
9. Work Description: New 12 Add ? Alter ? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
; Kitchen Sink
l3rinal/8idet Other
' Laundry Tray
Floor Drains
Drinking Ftn.
SIoP Sink
Gas Piping putlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes governing this type of work.
Signed : - ' for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt r PLUMBING PERMIT Permit No. ?
CITY OF EAGAN
( ' D 7 Fee
!? 7 Fill in numbered spaces S/C
Type or Print legibly
Tot.
?-
1. Date ? 2. Installation Cost
?
3. Job Address ?l Lo?Blk. ?,L1T Tract/-/'
4. Owner _L2Z?
?
5. Contractor d:? /,-, Phone
6. Address _ ' e-7 " j k`
7. City State Zip
8. Building Type: Residential ? Commercial O Institutional ?
9. Work Description: New ? Add 0 Alte,? Repair ?
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory ? Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
5igned :
Hough
Inspections: Date Insp.
for
Final
Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarksi --' ?
Addition HLLCRESZ' IIDDITIbN Lot 12 aik i Parcel +10,52975-12-??k3
owner street 4879 RICHARD [.IWE siate EIIG/W MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. S 1985 2450.15 490.03 2450.15 C00 20 10-18-84
STREET RESTOR.
GRADING
SAN SEW TRUNK 1976 183.08 12.2 1 Zs 73-28 A 014266 7117184
*SEWERLATERAL 1985 4361.74 872.35 5 4361.74 C00 820 0-18- 4
WATERMAIN
ATER LATERAL 1985
WATER AREA ip 19.62 2
*Services 1985
STORM SEW TRK 5 1984 804.56 160.91 5
'tiSTORM SEW LAT 1985
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT 260.00 #42387 4-6-84
WATER CONN, 470.00 i' 11
BUILDING PER.
8945
s,ac 525.0
PARK
CITY OF EAGAN SEyVER SERVICE PERMR
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55VI pATE;
Zoni I`1
??
Na. of Untts:
.r?? u ner ons
-
Owner.
/lddress:
Site Address: 4679 Richaris Lane L12 b c.reet
Plumber: ar PIFp
4-6-84 423>' . ,
Ioe+. eo .ewpy wNU Nu CNy .i fq.. Cor,nwcrton O,arQs: 425.00 pcI
Ordl..sea. Accaxit Depodt: 5.00 pd
Pennit Fee: 10.00 pd
Suniwrpe: • 50 pd
BY Misc. CharpeR
Dote of Irop.: Totol:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199
Eagan, MN 55121
Zoniny: ? .!
pM,ner_ FhI. f,uttner Con.1
Addross:
Site Addmss 4879 Richarda Lr
Plumber: Star Plbe
Meter No..
Stze!
Reoder No.;
1aynse ro canolp wqb 1iN Cify ei Faqan
Ordinanees.
By
Date of Insp.:
Connection Charpe: 4 I U. UO pd
Aooount Deposit: 15. 00 pd
Permit Fee: 10.00 pd
Surchcrge: .50 pd
Mlac. Cha?yes: meter
Totnl:
Date Poid:
CITY OF EAGAN
WATER SERVICE PERMIT
3830 Pilot Knr,b Road
P. O. Box 21199 PERMIT NO.:
Eegan, MN 55121 DATE:
Zoninp: j' l No. of Units: 1
ayner. WTf't Ihl COI15 t
fE53: ? S
ite Mdress• Z?ek??,?:l?crw
L 12 L l t' i 1 1_ ,- r e
s t
,?Plumber:
?teter No.• otl?tion Charye: 47?.00 r;il
Siu: r P AomLy,t Depcsrt: 15. 00 pd
Reoder No.: I??irh't Fee: 10. Ol? Dd
1 pm te aomPly wilh !iw Ciryr ei Ee"¦ Surcharpe: .50 pd
Misc. Chorpes: 63.00 p dr, :. ;er
Totol:
By Paid:
Dote of Insp.: 4-11 Insp.: WATER SERVICE PERMIT
PERMIT NO.:
DATE: :'S F.4
No, of Units: _
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
PHONE: 461-8100
BUILDING PERMIT
N° 8945
Recelpt # 4" -7
Te M wed For SF DWG/GAR Esr. Volue $ 50,000 pOfe APRIL 6 1 q 84
SiteAddress 4879 RICHARD LN. Erect a Occuponcy ? R3
Lot 12 elock 1 Sec/Sub, HILLCREST Alter p Zoninq Rl
ParcelNo. 10-32975-120-01 Repolr ? FireZone N A
E I T t C a V
Name WM. HUTTNER CONST.
Address 9 60 WATERFORD DR. W.
City EAGAN phone 452-3088
? Neme _
su Address
r City -
Name
Address
City _
SAME
Phone
Phone
n orge ? ype o nst.
Move ? * Stories
Demolish ? Length 4 7
6mde ? Depth 4 6 Sq. Ft.-
Approvala Feea
Assessment _
Woter & $ew.
Police -
Fire Eng.
Planner -
Councii _
1 hereby acknowledge that I hove read this opplication and state that BId9. Off.
the inlormalion is correct and n9 e to wmply with II ap licoble -
State of Minnesota $tatutes di f Eagon }d' ??an APC
c°?
Sipnature of Permittee
WM TTNER CONST
Perrnit +S 283.00
Surcharge 2 5. 00
Plan check 141. 50
snc 525.00
Water Conn. 470 . 00
Water Meler _63 00
Road Unit 260-00
7oeal $1,767.50
A Building Permit Is issued ta: ?,? • HU • on the express cordition thnt
oll wark sholl be done in acco{aar/cq with, nll p?g?fonblo-State of Minnewfo Sfalutes ond City af Eogon Ordinancea.
Buildinp Officfal
?ne.?' ?a?c. Sa.r?e. as . ?.y / ?S
? ?P?a'lioas - ?? ?
'?? L,? A?!/e?j??? ?xN. , • f?e 'n?HTY oF EacAN Include 2 sets of plans,
/ ??%ot?/o?IQ?' Certificate ofo:Survey &
P"0 "SP e"' i gUILpING PERMST APPLICATION .l set o.`_ energy cal.culations.
'Ib Be TTSed For
Site Pddress: `fe7y KiC?a?
Lot / 2- Block Sec./Sub.
Parcel #: ? n- 3 a9 7 5
Owner:
Pddress:
City/Zip Code:
Phone #:
? Valuation Date -/7" 3 -?
?..k OFFICE USE ONLY
Contractor: 61 44 #' Pilr eCw?ll
Address: 96 o G(l? rd . Dr< o.
City/ZiP Code: E.d? SS 12 Z
Phone #: qSL -30rr
Arch./Fng..
Adclress:
Gity/Zip Cocle:
Erect ? Occupancy
Alter Zoning
Repair Fire Zone .?I
Enlarge Type of Const.
Nbve # Stories
Demolish Front ft.
Grade Depth ?v-ft.
APPRDUALS F'EE6
_ ¢3
Assessments Pexinit 8L
Water/Sewer Surchame
Police Plan Check /
Fire SAC sc
Eng, water Conn. y;
Planner Water Meter ?
Council gy Road Unit 5;?4
Bldg. Off.
P.PC
nYi'AL ?? 7 l 7 /S7)
-
?
v
1yIq S REQUEST FOR ELECTRICAL INSPECTION EB-00001.04
' See instruetions for completinq this torm on back ot Vellaw coa.,. g? zzr? ?y
?? j ,
'"X1 " Be???o??red by This Request
ov4 Add Nap. Type ol Builtling APOliances Wired Equipment Wiri
Home Ronge Temporary Service
Duplex Water Heater Lightiny F(xtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Sito Unloader
Industrial 81dg. Air Conditinner Bulk Milk Tank
Farm omer oer,i v 1ne:, lsned(vl
L 9! pCCI(y QLhCf 01F1Cf
omUUte lnspection Fee Se/ow
M Fee ServlcaEntreneeSize p Fee Featlars/5ubfneders # Fee Circvits
I 0 to 200 qm s 0 to 30 Am s 4 0 to 30 Am s
Above 200 qmps 31 to 100 qmps / 31 to 100 A s
Swimming Pool Above 100_Amps Above 700_Amps
Transformers Irrigation Booms Partia6`Other Fee
Signs Speciallnspection S
3
TO
Remarks 8.a,
?
?
Roueh-in '-
j , th rical
I Inspactoq hereby
Final D? / 7/?made.?tion,hesbeen. I
Thla reuueat vold 18 monlhs irom
Thisraqueslvoid y3y59
10mo nths w
tm
IA! 0$3225 ua- 6
5lzz-ISy
3? .5 0
Request Date Fire N7 kouBh-in InsOec[ion
epu etl?
?Ready Nu ?Will Notifv InsPec-
S? s ?NO ?or When Ready
C3 Licensetl Elecuical Contrector I herebY request insoection oi ebova
? Owner elactricel work inslelled at: ?
Sireet Address, Box or Roqte No.
L CitY
E
a??.
7 /??cf?a'd , std-
ac ion o. Township Name or Nn.
R,,nBc o.
unty
Co
1 H
G
// •T
Occvpa t IP
I
R
N
T) ' Phone No.
`
/
{?
.
_
s.C • / h4 ?
Power SupDlier ? ??• _
'G Address
EI cvical Convactor (COm any Name) Comractor's License No.
ling Address ICOntra tor or Owner Makinp Ins ilatlonl
C.?0e7
Making Install io
Authoriz Signatur I Phone Number
? Gv-G t
MINNESOTA STATE BOARD OF ELECTHICITY THIS INSPECTION HEQUEST WILL NOT
Gri98a-MidweV Blde. - poom N•791 BE ACCEPTEO BV THE STATE BOAHD
1821 Vniversity Ava.. St. Peul, MN 55104 UNLESS PNOPEH INSPECTION FEE IS PAnna IB'121291.2111 ENCLOSED.
t r?? RESIDENTIAL BUILDING
?d?/? Z PermitApplicatiou
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
fI??q:i S
?y nLe•?, /b/Z?Jps
New ConsWctiai ReouiremenCS RemotleVReoair Requirements Office Use Oniv
3 registered site surveys showing sq. R af bt, sq. ft of Irouse; and all raofed areas 2 copies of plan CeR of Survey Recd _ Y _ N
(200h maximum bt coverage allaxed) 7 set af Eneigy Calculations (or hpated additions Tree Pres Plan Recd _ Y _ N
2 copies o( plan showing beam & wirMow sizes; paured found design, etc. 7 site survey for additions & decks Tree Pres Reqd Y N
lsetofEnergyCalalatlons Addition-indicafei/on•sitesepGcsysfem OnsdeSepdcSystem _Y _N
3 copies af Tree PreservaUan Plan if IM platted after 7l1193
Rim Joist Defail Options ulecWn shcet (bidgs with 3 or less unBs
Da[e LfL l/S l 03 Construction Cost
Site Address a 4/ Unit/Ste #
DescriptlonofWork '4d'Q,'2,L ;.., 7v rr fi?A v/?G- wwr ir?ry
I
,
61
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 1 _ 2
Property Owner J, oC d- I uuH n ? fr ? r? h Telephone #. ( 6J-/ ) 6,y1 - 97
7?
?
Contractor cJC
v h
Address //0 ?4 /S ,7- ?1 J-/, ? City
State Zip S 5 70 6 Telephone # (qSZ
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Cqde Ca[egory , Residen6al Ventitatlon Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously consiructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber ----- - -• - Tele hone #(
Mechanical Contractor Telep'hlbne # (
1. 3 cD03 I
Sewer/Water Contractor ? Telephone #?
IF
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 ardinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
Applicant's Printed Name Applicant's Signature
OFFICE U5E ONLY
Sub Types
.- 1 o
? Ot Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
K 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multl
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4- sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screeNgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Yor _N ? 25 Miscellaneous
Wo rkTypes 1?L1ti? Awr-a ?'?G}y")"L`til ?yIlbl
?r?..v,-q-i& .tlV77rY?,
? 31 N ?ZL?
?
ew ? 35 Int Improvement ? 38 Demolish (Interior) l1
? 44 Siding
? 32 Addition O 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
/K 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement 'Demolition (Entire Bldg) - G ive PCA handout to applicant
Valuation ?C7
Census Code 14 -1'
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const VK/ _
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
_ Footings (new bldg)
Footings (deck)
? Footings(addirion)
7Y Foundarion
Drain TIle
Roof Ice & Water Final
X Framing
X Fireplace ?C R.I. :? Air Test -?S, Final
? Insulation
REQUIRED INSPECTIONS
FinallC.O.
FinaUNo C.O.
_ Plumbing
_ HVAC
Other
_ Pool Ftgs Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall
Approved By T Z , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
5&W Permit 8 Surcharge
Treatment Plant
l.icense Search
Copies
Other
Total
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MNcheck COMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 3.0
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? Permit #
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COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 10-14-2003
DATE OF PLANS: 8/28/03
TITLE: CONTRACTOR
PROJECT INFORMATION:
APPROX. 1,300 SQ. FT. ADDITION TO EXISTING HOME WITH UNFINISHED WALK
OOUT LOWER LEVEL, INCLUDING APPROX. 330 SQ. FT. OF ADDITION TO
EXISTING GARAGE AND CONVERSION OF EXISTING KITCHEN & LIVING ROOM TO A
MASTER BEDROOM/BATH. PROJECT ALSO INCLUDES REPLACEMENT OF EXISTING
HOUSE WINDOWS. JOB LOCATION: 4879 RICHARD LANE EAGAN, MN
(LOT 12 BLOCK 1, HILLCREST ADDITION)
OWNERS: DAVID & SUSAN PETERSON
COMPANY INFORMATION:
CHAD MILLER CONSTRUCTION 1104 157TH. ST. E. BURNSVILLE, MN 55306
PH. (952) 435-4049 LIC.# 20044247
NOTES:
ALL AREA NUMBER TOTALS INCLUDE EXISTING HOUSE AND NEW ADDITIONS
COMPLIANCE: PASSES
Required UA = 968
Your Home = 698
27.9% Better Than Code
Area or Cavity Cont. Glazing/Door
Perimeter R-Value R-Value U-Value UA
CEILINGS: Raised Truss 2349 38.0 0.0 59
WALLS: Wood Frame, 16" O.C. 4791 19.0 4.0 244
BSMT: Conc. 9.0' hU8.5' bg/9.0' insul 628 10.0 0.0 38
GLAZING: Windows or poors, Above Grade 422 0.350 148
DOORS 28 0.350 10
SLAB FLOORS: Unheated, 40.0" insul. 289 10.0 199
HVAC EQUIPMENT: Furnace, 85.0 AFUE
COMPLIANCE STATEMENT: The proposed building design described here is
consistent with the building plans, specifications, and other calculations
submitted with the permit application. The proposed building has been
designed to meet the requirerrl? of the Minnesota Energy Code.
BuildedDesigner6&&ZL9 Date /o v
1
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L '~ 2/84
y I
1' CITY OF EAGAN
APPLICATION FOR PEF2MIT
SESdER AND/OR WATER CCNNECTIO.T
(P ASE INTJ
1) PF.OPER'PY ADDRFSS: >,.
r_FraI, DES=I'IC.I: ? 67' /„z V '
(Ir?t/Block/Subdivision or Tax Parcel I.D. NL=ber)
lc EtI ;ST:?L'CP :2E, Drl 7-- 'E GF ORIGi :AL :=L.^,L`iG ZcSU?.`;C::
iS=: SLiGL:: cP-M.I:Y ' -?- -- --" .
? R-2 DUPLEY ('IiCO L'NITS)
? R-3 'ICistiNII-iCYJSE (TILFE""' + WITS) ( Wi I';'S)
[I R?4 APAR=`:S/CC:IDCi°LIIUM ( CNZTSj
? CCYMME.T2CI;L/^2EfAII,1OFFT_CE
p IINDos-L-RLAs
? IbISTI2L'PSO.V?L/GGV7EFL\fi=
2) AppLSG?NT PLEHSE PRINi)
?
?
NFu?lE: .?
ADDRESS: (.?
CITY, STATF.', ZIP: ? -
PHONE:
3) PjrxBER (P PRINi) FOR CITY USE ONLY
NF4ME:
ADDRESS: 0 ? T
!O PLUN&ERS IICENSE:
Attive
CITY, STATE, ZIP: Qyn??-Ywe? C] Expired
PHODIE: uSca
y?yPL11MBER LICENSE It.232
2 Q Not of Record
1 arr nttla
4) OCCUPp17r/a'7NER tME: tYLtFJtYX1N1f
ADDRFSS:
CITY, STATE, ZIP:
PHONE:
5) INpIGyTG WHICII PEPhLiT IS BEZ\G RDQUESTID:
19 CC:u"VECTZON 'ID CITY SE.TrIE.R
E[ CC:I[VECrION TO CITY WATER
? di'f'.ER (PLG'1SE DESC2IBE)
6) C:z:
7) SI=4L.'RE:
?
?
PLP.ISE F?OID APPT.2GIED pgt,11IT FOR PICi:-UP BY ONE OF ABMIE
°LEaSE tifAIL APPROVD PER.titIT TC) 1, 2xL--V 4 ABGVE
(Circle one)
DATE:
?` ?
MO M! OIil??A:OWM A!l?JE?s ON a! il?:r?'? 41 f? !! s??tt n
F O R C I T Y U S E O N L Y
PERMIT ° ISSUED
I I
rT`SC $`
.. Q r'.;?J DrA\(T^+ T`i
?lrr.
?-- C:.:.vL
$ /n . S- U WATER PERP4IT (INCLUDE SURC:?ARGr.)
$ WATER METER/COPPERHORN/OUTSID° READE3
$ WATER TaP (INCLUDE CORPCRATIC:; STOP)
$ SEWER T=_?
$ ACCOUNT DEPOSIT - SEWER
$ /S- d-d ACCOUNT DEPOSIT - WAT°_R
$ ?7lG. i-D WAC
$ sac
$ TRUNF WAT°.°, ASSES52•?E:IT
$ TRli:1K SEWER ASSESSMEVT
$ LATERAL BENEFIT/TRUNK SEWER
$ LATERAL BENEFIT/TRUNK S9ATER
$ OTHER
$ TOTAL
, $ AMOUNT PAID/RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCi1VATION ZN PUBLIC RIGHT OF WAY?
? YES IF YES, THEN A"'PERMIT FOR WORK WITHZN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGZNEERING DIVISZON. LIST AS A CONDI-
TION.
SUIIJECT TO THE FOLL0:9ING CONDITIONS:
APPROVED BY: c???. Q --
DATE :
M+w-mww_ow w=sm skow ucm am Ww?w wtw wm RS-aa wwOaaMaawWrfONwcM V*WMasM wM
?.
ItV OF
89-15Q0
3830 PILOT KNOB ROAD T 2 4 9 2 4 9
EAGAN. MINNESOTA 55122-1897
PHONE: (612) 454-8100
FAX:(612) 454-8363 Special Asaessmeat Search
Datfl: November 14, 1989
RequeateQ By:
Re: 10-32975-120-01
Lot 12, Block 1
Hillcrest Addition
First Security Title
VIC ELLISON
Mvy«
THOM0.5 EGM1
DAV1D K. GUSTAf50N
PAMEL4 McCRFA
THEODORE WACHIER
CouncilMembars
7HOPMS HEDGES
Cify Pdminishofor
CUGENE VAN OVERBEKf
CM C??
On the attached form is the City's response to your search
request on the identified property. The information includes the
original amount of the assessments and the payoff amounts of the
assessments on the parcel. In addition, pending assessments are
included for improvement projects that have been ordered to be
installed by the City Council as they may affect this parcel.
The levied and pending assessments may or may not reflect the
complete assessment obligation based upon the parcel's current
use or zoning. Certain parcels have not been assessed at the
appropriate rate per their zoning/use. The City's policy is to
review the assessment obligation of parcels at platting, replat-
ting, rezoning, waiver of platting, and prior to the issuance of
conditional and special use permits and certain building permits
and in other unique situations. A condition of approval requires
the parcel to assume its additional assessment obligations that
have not previously been levied for existing public improvements.
The City's Engineering Division can provide further clarification
of this policy, if you desire.
WAIVER/DIBCLAIMER:
Neither the City of Eagan nor its employees guarantees the
accuracy or completeness of the information provided which was
required by the person or persons indicated. Nor does the City
or its employees assume any liability for the correctness
thereof. In consideration of receiving and using information on
the attached form and for all other consideration of any nature
whatsoever, any claim against the City or its employees rising
therefrom is hereby expressly denied. Pending assessments cannot
be paid until levied. Levied assessments can be paid to the CITY
OF EAGAN.
Very truly yours,
SPECIAL ASSE5SMENTS
Attachment
THE LONE OAK TREE...THE SYMBOL OF STRENGTH AND GROWfH IN OUR COMMUNIN
Equal Opportunity/Affirmative Action Employer
SPELIAL FSSESSMEhIl' SEAhCH SLJMh9AF;Y
AS OF; 11/14!1989
F'FlOF'F_RT Y]: U A5SESSMENT TYF'E
10-12975-120_01 **** CLOSEU ?***
S-fa # ASSG:SSt-1EPJ-t DESCRIPT. RFaTE TO"TAL ANN.F'kIN. PAYOFF
100=04 S(aN Sld l R 8. UC!OUI 163. Ct6 0.00 0.00
YEAR: 15 OF 15 Y'E•r`,RS
100668 W TF;-264 11.0000/ 294.33 U.O(i 0.0U
YEAR: 04 0(= 15 vEIzF:S
100E65 S S'iR;:: 10.0000"! 804.56 C>.C>U U.Ui)
YEAR: t;it:r Of 05 V'I"cAkS
100434 :_bJSBI_AT.??y ]0.50t00°f. 4361.74 0.00 0.00
YEAR: 00 OF 05 YEHRS
100935 ST ;?c 7 r]_ 5000°!. 2450. i5 0.00 0.00
YEAR: 00 7 l.lP 05 YEtiRS
------ sur•7is7Far:Y oF cLosEn e093,$s 0.00 0.00
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
cIrr oF eacaN
3830 PILOT KNOB RD - 55122
651-681-4875
New Cornfiuetlon Reaulrementa Remodel/Reoadr Reaulrementa
> 3 reglatered Ate wrveys alwwinp t% ft d bf, a4 fl. Ot house
ontl ga roofed areaa 12096 maxlmum bt coveraae allowed)
? 2 coples of plans (stww bedm 8 wintlow ahes; poured Ind. tlealgn; etc.)
> 1 set ot energy calculaHons
> 3 copies ol hee presenaHon plan B lot pialterJ aRer 7/I193
DATE:
DESCRIPTION OF I
STREET ADDRESS:
LOT: /)-
4 14z5
..??
2 coples W plan
i set of energy calcutoHOns for heated additlons
1 site wrvey tor exteda addlNana d tlecks
CorisrRUCnoN Cosr: ? S-s' Sd - ?
Name: V ?56y-? °-?a/e- Phone#:
PROPERiY tast Flrst
OWNER
Street Addresa: ? 5-4-?
City Siafe: ZiP:
SELA ROOFINQ & REMOQELING, fNC:
company: 41[K7 EXCELSIOR BLVD. Phone t: 9SZ ? z 3-?a
ST. LOUIS PARK, MN 55416 (area code)
Corrrw4CTOR iD soooio5o
Street Address: ucense #/?D 'QO Exp.
Cffy
State:
ARCHITECT/
ENGINEER Company: Name:
Telephone tl: (
Shee1 Address: Re9istratio^ #:
Cly
State:
Sewer/waterlicensed plumber (i} InsWllino sewer/watarl: Phone #:
Zip:
Zip:
I hereby acknowledge ttwt I have read thfs applicatbn, state Nwt the infortnalion is cortect, and agree to comply wiM ap aPPUcable SfatF
of Minnesoia SMlutea and City of Eagan Ordinancea
Signalure of
OFFICE USE ONLY
Certificates of Survey Received _
Tree Preservation Plan Received _
Yes No
Yes _ No - Not Raquired
11
BLOCK: ? SUBD./P.I.D. #: Y71 II ('YP C7
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 08 06-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.)
? 03 01 of
plex ? 09 07-piex ? 18 Deck ? 23 Porch (screened)
? 04 _
02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 11 10-plex Plbg _Yar_N ? 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bidg.
WORK TYPE
? 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair O 42 Demolish (Foundation) ? 46 Windows/Doors
` Give PCA handaut to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories SG. ft•
No. of Units Length sq. ft.
No. of Buildings Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEQUS INSPECTIQNS
? Stucco/Stone
APPROVALS
Planning Building Engineering Variance
? 31 ExLAIt-Muw
O 33 Ext. AR - SF
? 36 Mum
Permit Fee
Surcharge
Plan Review
License
MC/E5 SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
SAC Units
% SAC
PLiIMBING (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 pemvts aze required for each unit
1% ts"O . SV
Date /I 1 .C3 l ?(, 3
Site Address V$79 Unit #
-? ?
Property Owner )/Uu? / JVN • ? ?5Lf L f?? Telephone # (667 ) 6?, 13 - 9API.3
Car.t:acia: WaALL?? LW?iiQ?4 ?n •
-- -
?
Address ,L?i'p ('4 Lk_.±vric_ 4_ .1t'o L Ujn City
State ? yi Zip s567Yo$' Telephone # (i6J) h?3 7i • L3'y.30
?
The Applicant is Owner
Conhactor _ Other
Septic System Mew _ Refurbished Submit 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional consultant fees may apply.
Alteratio s To Existing Dwelling Unit, Including $ 50.00
Adding fixtures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
Water turnarou
nd
(+ 518"
meter if needed -$121.00
_
n
, A
/
? > n ? A
Other: , ?C.()(,?,t,c.? ?/,P.t9LC.
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigarion sys[em
_ Water soFtener _ Water heater $ 15.00
_ replacement _ additional
D?
$ .50
State Surcharge 17 2003
Total $ 'a-6D
I hereby apply for a Residential Plumbing Pemut and aclnowledge 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 with the Plumbing Codes; that I understand dus is not a
pernut, 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 requues a review and approval of plans. •
Ekme M. ku.kowi'ex? &.,,,`h(.
Apphcant's Printed Name Appli t's Signa e
( fI a?S S' 2004 RESIDENTIAL MECHANICAL PERMIT APPLICATIOPi
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 c y- ?
aqw34
Please complete for: single family dwellings & townhomes/condos when permits are required for each unit
Date )_ / aD / 04
s<<e Address 4279 ?i chQd ?R_ Uo,t #
PropertyOwner PeiQrs01't Telephone#( )
Contractor -------------------
Street Address o2 ? ?3L4 G ? ffpyl Qe? v 2.i City ?!
State fn1?1?? Zip 0a Telephone# ( f,p`?'JI )qb "'7gc2?
Bond #: Eap3res:
The Applicant is _ Owner ? Contractor _ Other
Add-on ar alteration to effisdng dwelling unit
' $ 30.00
? fumace ?Addltional _Replacement ?
~ - -- _
? air exchanger
air conditioner _New _Replacement ?Uu JAN 2 2
l
20Qq
np (?(?l
other VwL '? 1) ecs.? QCXCK, 't i0?_? lo ?i
_
State Surcharge $ .50
Total $ a,5
I hereby apply for a Residential MecUanical Permit and aclmowledge that the information is complete and accurate; that the work will
be in oonformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
pernvt, but only an application for a permit, and work is not to start without a pemut; that ffie work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
?I lC'A vli Pl TY' elP(il ? i1 1 O QX1,P y ir.. c--
Applicant's Printed Name ApplicanYs Sign?
2004 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please compiete for. commerciaUindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date0q
Site Str [ Addre ? p 1? I C Y?& Lzx ? Unit #
Tenan Na e(if ap licable {ef ` Previous T ant Name
Proper
y Ow er Telep one #(
l
i ? T I i
i ?/
1
I
4
r 1?
(.'Ollt!'eC?01' ?
}.,,?
1
rn i n ?'!I
UL(-
17 Q/ ?LX
i r
j _'-
Street Ad ess ?v City ? r ?
? {
I
Stat
i n Zip 5S Telephone # t ^?
Bond Expires:
,
The Applicant is Owner _ Contractor _ Other
Work Type
New Construction _ Underground Tank _ Install _Remove *"see below
Interior Improvement _ Install Piping _Processed _Gas
Nature of Work:
**When installing/removing underground tank, calf for inspectron by Fire Marshal and Plumbing lnspector
Perlnlt Fees: $70.50 Ondergound tank instailafionhemoval
$53.50.".fittimum !incLdes Stz[e Rurobargel
OC
ContractValue $ x 1% _ $ Permi[Fee
+ If uermit fee is $1,000 or less, add $.50 ? $ State Surcharge
If nermit fee is over $1,000, add $.50 for
every $1,000 aemut fee $ Total Fee
I hereby apply for a Commercial Mechanical Pemut and aclmowledge that the informarion is complete and accurate; that the work
will be in conformance with the ordinances and codes of the Ciry of Eagan and wi[h the Mechanical Codes; that I understand tlils is
not a pernilt, but only an applicarion 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 wluch requires a review and approval of plans.
ApplicanYs Printed Name ApplicanYs Signature
Approved By: , Inspector Date:
2004 RESIDENTIAL BUII.DING PERMIT APPLICATION
(p City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construcfion Reauirements RemodelfReoair Reauirements ?ce i
3 registered site surveys showing sq. ft. of bl, sq. (L of house; and II roofed areas 2 copies ot plan ?' ?,..,.1- ,
(20% maximum lot cove2ge allowed) 7 set of Energy Ca?ulations tor heated addNOns '^°m•?1
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey (or additions & decks TFee?Pf"eq"Wreed
1 setof Energy Calculations Add'Aion -indicate 8arsile sepfic system -rtsJ(e
3 wpies of Tree Preservation Plan if lot platled aftaz 711193
Rim Joist Depil Options selection sheet (bldgs with 3 or less unAs
Date Construction Cost
Site Address UniUSte #
Description of Work
? J,N er / c /
L-e? 1? ? ???? S`?
Multi-Family Bldg _ Y _ N Fireplace(s) _ 0 _ 1 _ 2
/
J, ;I
d 4- 5 p
f hone #( 4? 5 n ? r?l i-9yu
Tele
Property Owner
i J?: 6t
i. .rc, v
/ P
-l p
Contractor ?-/I en m C hV/'//r?' ( i C 1 J' /^ v t// U t/
Address C7 L/ / 5` ..f'JL" C? City ??' S v,?vt S c-; ' e
State hi/ ? Zip S J 10 L Telephone #(?S ? y 3 1` -?G? 1;4 y
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesob Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy COde Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(d submission type) Submitted Submitted
. Energy Envelope Calculations Submilted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Telephone # (
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
I hereby apply for a Residential Building Permit and acknowledge that the informarion is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
(? /,-/z -'- JZzv? //?Z'-
Applicant's Printed Name
Applicant's Signature
OFFICE USE ONLY
Sub Typea
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 Otof_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 33 Ext.Alt-SF
? 04 02-plex ? 10 OB-plex ? 18 Deck ? 23 Porch (screen/gazeho) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex PI6g_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New O 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 ? 46 Windows/Doors
? 34 Repiacement •Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
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) _ Final/C.O.
_ Footings (deck) _ Final/No C.O.
_ Footings (addifion) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas T ests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
?
?
DELMAFt H. SCHWAN2
1.AND 6URVE1tORS, INC.
14665sourHaoesRrrMI. wosrawuKr, rnInNssarn swee 651-nS.17M.
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De1W lANvwwNe Uearms No. 8l26
a•.? 3S@b?b°i.SE++Ci 6c69`w??LS'3 Jns'21?F ',Plb'1 ?NNMf-?S?:Ulti? 9b?1, E60Z-bl -S?0
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Construction
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DELMAR H. SCHWANZ
LANDSURVEVOR'3 4 ' I%!Ky
ReqisterW UnCef Lawf Of Th! Spte OI Mlnnefola
2978 - 146TH STREET W. - BOX M ROSEMOUNT, MINNESOTA 66086
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MINNESOTA REGIS
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA167860
Date Issued:03/31/2021
Permit Category:ePermit
Site Address: 4879 Richard Lane
Lot:12 Block: 1 Addition: Hillcrest
PID:10-32975-01-120
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.
*Roof permits issued between December and March will be inspected in the spring or when weather warms up.
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 -
David P Peterson
4879 Richard Ln
Saint Paul MN 55122--278
(612) 202-3694
Ashton Mcgee Restoration Group Llc
5555 W 78th St, Suite J
Minneapolis MN 55439
(952) 426-3736
Applicant/Permitee: Signature Issued By: Signature