4265 Sandstone DrDate:
City of Ea�an
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: /� f/ d
Permit Fee:
Date Received:
Staff:
o�
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:
Unit #:
RESIDENT /
OWNER
Name: A NS . Lt C. Phone: 6-f z- 2_9 Q ty 990
Address / City / Zip: k--(2, 6 o INI d b AN.
Applicant is: K Owner Contractor
TYPE OF WORK
Description of work: A Ai eg r e,s lkj it 11 01
Construction Cost: 1 Z., 0 0 Multi -Family Building: (Yes / No )
CONTRACTOR
Company: Contact:
Address: City:
State: Zip: Phone:
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes 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:
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 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x AbduRa)1 Mort A(JO
Applicant's Printed Name
Applicant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Fireplace
X, Single Family Garage
Multi Deck
01 of Plex Lower Level
Accessory Building
WORK TYPES
New
Addition
Interior Improvement
Move Building
Alteration Fire Repair
Replace Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100%)
Census Code
# of Units
# of Buildings
Type of Construction
REQUIRED INSPECTIONS
Footings (New Building)
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In _Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
/ !' 1 L—
Siding
Reroof
Windows
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Egress Window _ Water Damage
*Demolition of entire building give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final I No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: Footings Air/Gas Tests Final
Siding: Stucco Lath Stone Lath Brick
Windows
Retaining Wall: Footings Backfill Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
1N SYLC,'1'lUN KEUUK1)
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
~E7'dgan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLICANT:
• ~ i , i . ~ ' ~3'. 1 ~ I ° ~ .
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION D. • .
F
J
L
Permft Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING ~~ayy
ROUGH
PIUMBING
PLBG
AIR TEST
FOUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIFiEPLACE - - - - -
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER FLUSH
MAINS
CONDUCTIVIIY
7EST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks ACqtiiS3.t10I1, CAdAY' Grove
Addition Cedar Grove #2 Lot 8 Blk 2 Parcel 10 16701 080 02
Qwner l r':i., r.! • ~li%! 11 1 Z,i 4 f fi~ Street 4265 Sandstane Dr. State Eag2?1T N 551 2P
~Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 8 1 1
STREET RESTOR.
GRADING
SAN SEW TRUNK
~ SEWER LATERAL 1972 1
WATERMAIN
# WATER LATERAI. 1972
WATER AREA
STORM 5EW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
. . . . . . . . v . _ ...°'f:, 1F., p.~. .
- . p. . ' . - . .
CITY OF EAGAN ~ t o' oo
3830 Pilot Ftnob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING RERMIT Receipt #~r 1 t,
To be used for REWpEL Est. Value Oq,300 Date JtFLY 20 , 19 ~
Site Add ss 4265 S~DS~~ pR
Lot ~ Block Sec/Sub. OFFICE USE ONLY
Parcel No. occupancy - FeES
SXLL HI1IlAidl zoning - 31.00
¢ Name (Actual) Const - Bldg. Permit
o Address TONE DR (Allowable) - ~.pp
Surcharge
City AA Phone 456-9380 # of Stories -
Length _ Plan Review
~ R GONBTRiICTIOFi
Zo Name ~AVE NW Devtn - saG ciiy
ou Q Address S.F. Total - SAC, MCWCC
~ City WASECA Ph0112 507) $35"83 S.F. Footprints -
On Site Sewage _ Water Conn
~
W W Name On Site Well - Water Me1er
x
MWCC S stem -
Addre5s y Acct. Deposit
<W City Phone caywacer -
PRV Fequired _ SAN Permit
I hereby acknowtege that I have read this application and state that the Booster Pump - 5/w Surcharge
information is correct and agree to comply with all applicable State of
Minnesota Slatutes and Ci ol Eagan Dr¢enance Treatmenl PI
- ' - G~~ APPROVALS
~ignatura of Permitee Road Unit
A 8uilding Permit is issued to: M R CQiYSTRUCTION Planner - Park Ded,
on Ihe express condition that all work shall be done in accordance with all Council
applica6le Slate of Minnesota Statutes and Gity ol Eagan prdinancas. g~. Off. _ Copies
32.W
Building Official y' •Variance - TOTAL
Permit No. Permit Holder Oats Telephone #
WATER
SEWER
PLUM&G
H.V.A.C.
ELECTRIC
Inspecilon Date Insp. Comments
Footings I
foundation '
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Freplace
Fnal Htg.
Fnal Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
Engr.lPlan
Bldg. Final 4 G - c 'r
Decic Fi9. ~l H / P ~ L</4
Dedc Final < IeZ -
Well
Pr. Disp.
~ CITYQFEAGAN
~ 3830 Pflot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
To be used for `Est. Value 1~Date ,19
Site Address OFFICE USE ONLY
Lot Block ` Sec/Sub. On Site Sewege accupancy
MWCC Syatem Zoning
Parcel No. On Site Well (Actual) Const
e Name City water (Allowable)
W PRV Requlred # of Stories
3 Address
p Booster Pump Length
City Phone Depth
, o Name S.F.Total
o ~ Address Footprint S.F.
d
U~ City Phone APPROVALS FEES
Engr./Assess. Permit
yU W Name
~ g Address Planner Surcharge
`W City Phone Council Plan Review
Bldg. Off. SAC, Ciry
I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC
information is correct and agree to comply with all applicabte State of Water Conn.
Minnesota 5tatutes and City of Eagan Ordinances. Water Meter
Signature of Permittee
Road Unit
A Building Permit is issued to: Treatment P1
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. Parks
Building Official_ TOTAL '
Permit No. PermR Holdar Date Telsphone ~t
Plumbing
H.V.A.C.
Electric
Softener
Inspaction Data Insp. Comments
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
L ~ C . G • ~ ,~j
This request void l 7
18 moniiis from
00447
Date ~of ~t Request Fire No. S 1
I, as Y7Licensed Electncal Contractor OOwner, do hereby request inspection of the above electri-
cal wiring ins[alled at:
Street Address or Route No.
Section Township Range County,[r~~t~s
Which is occupied by
(Nama of OcCUDant)
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will CaA§~-_
Power Supplier Address
- y .~,~~6~
Electrical Contracto~~/'t>Ga ~ontractor's License No.
s Addre ~ ~'d.
Mailin W-17
~~m(Elye tric tr ctor or O n Making Thls Installatlon) Authorized Signature ~fJ~~z Phone No~.~i~s~-
- (Electrlcal Contnctof or Owner M ng Thls InstallBtlOn) /
~~~Q~ j ~ rJ` This iiupectian request will not be acceptad 6y the
~ State Baard unless proper inspeetion fee is enclosed.
• c.:am o- uBC[l1CR
Griggs Midway Bldg. - Room N791 ng EH-00001-02
~ 1821 University Ave.. St. Paul, Minn. 55104 - Ptwne 297-2111
!$EQUEST FOR ELECTRICAL INSPECTION ~ I
CHECY BELOW WORK COVERED BY THIS REQUEST S100447
Type o( Building New Add. JR111111ep. Gheck Appliances Wved For Check Equi pment Wired Fm
Home ? ge Temporary W'ving ?
Duplex er Heater ? Lighting Fixtuies ?
APt. Bld8. ec ? Electric Heating ?
Commercial Bldg. ace ? Silo Unloader ?
]ndus[rial Bldg. ??Conditioner ? Bulk Milk Tank ?
Farm List
Othec ~ ~ isOthers~
) Eiere 7
COMPUTE INSPECTION FEE BELOW
Selvice Envance Size: # Fee Fceders&Subfeeders: x C"ucuits: # Fee
0 to 100 Am s. 0 to 30 A s to 30 Am eres
101 to 200 Amps. ~ 31 to 100 ' s.] to 100, m eres
Above 200_Amps, Above 100 u.~Amp~; • Above 100 Am s.
Transformers RemoteCon ICi . Panialorotherfee
S' ns S ecial Ins ection Minimum tee $
Remazks
TOTAL F Q .
I, the Electrical Inspector, hereby cer ' at e ifispection has been e.
(Rough-in)
(Final) Date
.-A% Date
This request void
18 months from
~
~ HM .
IY° ].061
BL91LD9Nrm PERM1T
~ -:Ownex C~
~ . .
+ ~ Eagan Township
' Addres4 (PresenS) ~~r~'1~ Town Hall
I
Builder~ V >
Addres . . . . Date .
DESCRIPTION
3tones ~ To Be Used For ~ Fronl. Depih Heigh! Esf. Cost Permif Fee Remasks 0
- LOCATION - ~
~ Sireef, Road or other Descnphon of Locahon LoS Block Addition or Tract
17 .,/Gf - ;;~.tl- 3.' _24 ' .-3
-
. This permit does nof - auShorise- the use of sireels, roads, alleys or sidewalks nor does if give the owner or his agenf
, the rigkii !o cieaie any siiuafion which is a auisance ar which presenfs a hazard 30 the heallh, safely, convenieneC and
generali welfare !o anyone in the communi2y. - - ~THIS PERMIT MiTST SE KEPIT, Og/y THE PREMISE WHILE THE WORK IS IN PROGAE55.
~ This is'to cerSify: iha1...L? haspermission !o erecl e-~/.L? p~
t. ...........y7~...... upon
~ the ahove desaribed premise subjed So the provisions of-lhe Suilding Ordinanae for Eagan T wnship adopie@' April 11,
; .......i..:IdS.~-la~a.N~i1."---... Per ........-----(/+YLd'.^.~~`'. ...'P.~!:'`.fR
.p .
Chairman'of Tnwn Board . 0 Su_' in Inspector
~3.isf;~;:3';.•s4:i~~~czczcr,aac~n;ct~'axcr~r~r~~c,:~;a,~czc~cr.cz'~;u<ro;;~c
CITY OF EAGAN
CASHIER: S TERHIi+tAf_ NDa 782
iWTE: 06/22/98 TIM=: 14:ii:''c7
m~
KAME: CHRISTQ°HEF C SKA\SQ?t
3210 9003 4265 SANDSTONE 23.E10
2155 9001 4265 SANDSTQNE 0.50
Total Receipt Amoilnt: 21.50
CR033i40
USEF SL: NRNCY
ic:tY,cY,cY,:Y,cY,c$:x:>:ng~CY,;r;7,c~tYcrc%:S~t;~:cX•~;:ti;Sc~c~ r~c~SY~%>>:G~>.a.c>;.xc
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 3 2 2 9 2
(612) j81:4fr75 Date Issued: 0 6/ 19 / 9 8
SITE ADDRESS:
4265 SANDSTONE DR
LOT: 8 BLOCK: 2
CEDAR GROVE 2ND
P.I.N.: 10-16701-080-02
DESCRIPTION:
RESHINGLE
Btr3ltliit`_Permit Type SF (MISC.)
Building Work Type ALTERATION
f!`Census Code 434 ALT. RESIDENTIAL
~
_
( .
~.-~.t~-. = -
~
REMARKS:
FEE SUMMARY:
VALUATION $500
Base Fee $21.00
Surcharge $.50
Tatal Fee $21.50
CONTRACTOR: OWNER: - Applicant -
~ SKANSON CHRIS
4265 SANDSTONE DR
; EAGflN MN 55122
(612)452-2752
2 hereby acknowledge that I have read this appliaation snd state that the
_ information is correct and agree to camply with a11 applicabl.e S te of Mn.
StaCutes and City of Eagan Ord'inances.
,
PLICANT RMITEE SIGNATURE ISSUE B. AT
322a ~1 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
- ~ ` CITY OF EAGAN
3830 PILOT KNOB RD • 65122
681-4675
1
New Construction Reouirements RemodeUReoair Reauirements
? 3 registered sfte surveys ? 2 copies of plan
? 2 copies of plans (inGude beam 8 windav aizes; poured ind. design; etc.) ? 2 sRe eurveys (erzterior addkions & dedcs)
• 1 energy calwlations ? 1 errergy celculetions for heated addftions
? 3 wpies of tree presenation plen if lot platted a@er 717f93 '
required: _ es No
DATE: CONSTRUCTION COST;
DESCRIPTION OF WORK: i a(`n
STREET ADDRESS: Qr, ~
LOT: C BLOCK: SUBD./P.I.D.
Name: I~or~Sc?1 C6 r6% Phone
PROPERTY Lest First
OWNER
Street Address: s„ rl .t -P 0!
Ciry rq state: zip: 'S 5 ! ~ c~--
Company: Phone
CONTRACTOR
Street Address: License #
City State: Zip:
ARCHITECT/
ENGINEER Company; !Y ' 7 Phone
Name: Registration
Sheet Address:
City State: Zip:
Sewer & water licensed plumber (new construction only): Penalty applies when address chang
and lot change is requested once pertnk is issued.
i hereby acknowledge that I have read this applicaGon and state that the information cortect and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Appliqnt:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT T1fPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4plex O 72 Multi RepaiNRem. ? 17 Swim Pool
? 03 SF Addition O 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Firepiace , O 21 Miscellaneous
? 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
? 31 New ? 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
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
S/W Permit
S/W 5urcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
°k SAC
SAC Units
, CITY OF EAGAN Np ~ 8 ~ 80
. 4 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-81D0
BUILDING PERMIT Receipt # /
To be used for 1tEMODEL Est. value $1, 300 Dale JULY 20 , ~g9~
Site Address 4265 SANDSTONE DR
8 2 CEDAR GROVE 2N0 OFFICE USE DNLV
Lot Black Sec/Sub.
P2fCEl NO. Occupancy - FEES
Zoning _
w Name BILL MADANI (ACiual) Const - Bldg. Permil 31. 00 .
~ Address 4265 SANDSTONE DR (Allowa6le~ - Surcharqe ~_nn
City EAGAN Phone 456-9380 soisiodes -
, Lenglh _ P~an Review
, o Name M R CONSTRUCTION Depth - SAC, Ciry
Address 421 14TH AVE NW s.F.TO~ai
c°~< ~ - SAC,MCWCC
~ CISy WASF.CA PhOnB (507) 83L~9 S.F.FOOtprints -
On Sile Sewage _ Water Conn
~
W w N8m8 On Si~e Well - Water Me~er
~ MWCCS stem
Address Y - Acct. oeposi~
aw City Phone c~rywaier -
PRV Required _ 5/W Parmit
I hereby acknowlege that I have read this application and state that the Booster Pump - g/yy Suroharge
information is correct and agree to comply with all applica6le State ol
Minnesota Statutas and C~ of Ea n Or ~ ance Treatmant PI
(~SignaWre of Permitee APPHOVALS qoad Unit
A Buildinq Pertnit is issued to: M R CONSTRUGTI ON Pianner - park Ded.
on the ezpress condition ihat a~l work shall be done in accortlance with all Council
applicable State ol Minnesota StaWtes and City of Eaga,an Ortlinances. Bltlg. Olf. _ Copies
~fl R~1 ~}l Yl Varianca - TOTAL 3Z.00
Building OHicial z ~f-j-h I--"~'
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE StIRVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF P$RMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE~ ADDRESSES FOR CORNER LDTS - CONTRACTOR/NOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWD DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LTCENSED PLUMBER.
~aWS
To Be Used For~~n0 de, Valuation: ~3 Date: l I~
X Site Address OFFICE USE ONLY
Lot ~ Block FEES
Occupancy
Zoning
Parcel/Sub Actual Const Bldg. Permit ~I• 0 Q
Allowable Surcharge d
~ Qianer # o£ stories Plan Review
Length SAC, City
Address ja~~o~ Depth SAC, MWCC
S.F. Total Water Conn
City/Zip Code Footprint S.F. Water Meter
Acct. Deposit
Phone 545 9.32-0 On site sewage_ S/W Permit
,p On site well S/W Surcharge
X Contractor MWCC System _ Treatment P1.
~ ^ /City water Road Unit
Address (~,cr2 , /~y.UV. PRV Park Ded.
Booster Pump Copies
City/Zip Code SUBTOTAL
APPROVALS Penalty
P h o n e 70 7 -.2- 3 S~ Z390 Planner _ TOTAL
Council
Arch./Engr. Bldg. Off.
Variance
Address
City/Zip Code
Phone #
. .
~
~
~
~
t ~
~
~
~
EAGAtV 'T'OWNSHIP N~ lsso
BUILDING PERMIT
Owuec Ea9an Township
'4--~-<__--- Town Hall
Address (presenf)
Huilder (1.[ -'-'-c /
Dale ~ l.314.I .
Address
DESCRIPTION
Siosias To Be Vsed For Fronf Depih Heighi Esf. CosS Permii Fee Remazks
~i
d2 z , 2
LOCATION
Sireei, Road or olhex Descripiion of Locafion _I Lo! Block ~ Addition or Traei
This permit does nof aulhorise the use of sizeels, roads, alleps os sidewalks nor does iY give the ownes or his agenf
the rig'a2 Yo ereaSe anq sifuaiioa which is a nuisance oz which presenis a hazard fo the health, safe2y, convenieace and
general welfare io aayone in the eommuniiy.
THIS PEAMIT MVST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
- .
This is io ceriifp, ihai.......... -"-'--'.........has permsssioa to ereci a . .
upoa
the above described premise subjee! !o the pzovisions ot the Building Ordiaance for E n Towns ip adopfed April 11,
1955.
Per
_ , .:......__"..:...'.'_K. ._Q_..._..._"'.....
Chairmad of Tnwn Board Suil~in InsPecior
„ •
8T' G!"~,vP -D.75 t, . "O . ~
. ~ .
;:J e~ _ _ f c - ~r•-.
-
~ F. C. JACKSt3N _~z~
~
LAND ii1RMlYOR
f+ . ~ ...a . •.~....~:...r. - -
1 Ri~1wT~REO 4N0[R LAWL OI tTAt= QF Y!lMf=W=A
r~ LtCW~iD EY ORDINl.MCS OF C1TY OI MiMN6AM0106
,i
~ 3614 EAfT 587N 5TR[ET PA. 4-4681
. ~
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. 'X~~N~• ~
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, 120
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~I ~ ~ ~ ' ,F~~•
kY
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7V ~ n
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t
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~ 120
1
z4
1 HLRiSY CEATIFY 7MAT Ttlt AiOYt 1! A TpU[ AIdD CO1MMfGT RAT OI? AWLIRMRY QW
.
t
mortgass Sv te'T
~
: ~
~
Lot 8,Bloak 2Oodar Oro" Na, E,
Ee.gtn `~b~rnulaip.L' akot?s Got~ttl?xicmsot,A?.
<
~
4t.h. Oot. 19~5 ~ J :
_ . , , _
A• •URVtYtD BY Mt ?M1B--.- owv w
~
F. C. Jemoo"• Mw1lwM*A
CITY OF EAGAN N! 14 617
„ ^ . 3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121
. PHONE:454-8100 O ~
BUILDING PERMIT Receipt# d
To be used for FIREPLACE INST. Est. Value $1, 000 Date ,19~
Site Address 4265 SANDSTONE DRIVE OFFICE USE ONLY
Lot 8 Block 2 Sec/SubCEDAR GROVE 2ND On Site 5ewage _ Occupancy
.
MWCCSystem _ Zoning
Parcel No. On Site well
- (Actual)Const
a Name BILL MADONI Ciry Water _ (anowable)
; 4265 SANDSTONE DRIVE PRV Required _ # of Stories
Address Booater Pump _ Length
° City EAGAN phone 688-0977 Depth
, o Name HEAT--GLO FIREPLACE S.F.TOtai
~Q Address 3850 W. HIGHWAY 13 FootprintS.F.
m Ciry BURNSVILLE phone 890-0758 pppppVALS FEES ~ ~nn
~ W Engr./ASSess. Permit ~=_vv_
W W Name
~ i Planner Surcharge .50
i- Address
aw City PhOn@ Council PlanReview
Bltlg. Off. SAC, City
I hereby acknowledge that I have read this application and state that the Variance SAC, M WCC
intormation ia correct and agree to comply with all applicable State of Water Conn.
Minnesota Statutes and City of Eagan Ordinances.
Water Meter
Signature of Permittee - Road Unit
A Building Permit is issued to:. _ ' Treatment P1
onlheexpressconditionthatallworkshallbedoneinacc*0m.rces. wdhall
applicable State of Minnesota Statutes antl Cityof EagaParks ~
/ TOTAL 24.50
BuildingOflicial y
r
~ L
1988 BUILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SGTS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESZGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS Ik OF UNITS
INCLUDE 2 SETS OF PLANS, CEHTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COtMIERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
/ CTI
To Be Used For: daluation: Date:
Site Address OFFICE USE ONLY
Lot ~ Block Z ~ On site sewage= Occupancy
~j MWCC system Zoning
Parcel/Sub jdfD!St On s3te well _ Actual Const
n City water Allowable
Owner ~ILL [/~zv1 PRV required _ It of stories
Booster Pump _ Length
Address ~7/o Depth
S.F. Total
City/Zip Code Footprint S.F.
Phone L(~d 7 7 APPROVALS FEES
Contractor ' I ~ Engr/Assess Permit
Planner Surcharge .ria
Address ~r> Council Plan Raview
Bldg. Off. SAC, City
City/Zip Code~iil~lil-~h~-2~ Variance SAC, MWCC
Water Conn
Phone Water Meter
Road Unit
Areh./Engr. Treatment P1
Parks
Address Copies ~
+ TOTAL
City/Zip Code I
Phone ll
As sz)
zoos RESIDENTIAL PLUMBING PeRmiT aPPLicaTioN
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
' Date 1 1
Site Street Address ~ z Unit #
Property Owner ~ Telephone # ((W)~9i~• /6.2f
7 Teleph
Contrector / one# (~-1~.~2~)~"3~ 2~'D
~-m ~iviJ l.(~iT~~' e P2
Address 1''4^•ffS~& City 1:;~/sLLP_ State)724)_ Zip~
The Applicant is: _ Owner iContractor _,Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Include$ Co0~nt~fee
Per as-built $ 10.00
Alterations to existing dwelling $ 50.00
Add plumbing fixtures. This fee includes instailation of a water softener and/or water
heater at the same time. !f you are installing only a water softener and/or water
heater, do not complete this section; move to the next section and check the
appliance(s) you are installing.
_Septic System Abandonment
WaterTurnaround (add $130.00 if a 5/8" meter is required) Other:
~ Water Softener _ Water Heater $ 15.00
new ~ replacement
Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
$ 50
State Surcharge
$
T$ /
I hereby apply for a Residential Plumbing 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 plumbing codes; that I
understand this is not a permit, but oniy an application for a permit, work is not to start without a permit and work will be jn
acco dance with the approved plan in the event a plan is required reviewed and approved.
~
p ticant's Printed Name Ap lic s
~----------------i
~ ~,•flH_'ice°;Cise
Pe
City of Ea~aIl j rmd #
I Permit Fee:
I
3830 Pilot Knob Road
Eagan MN 55122 ~ Date Received: ~ j
Phone: (651) 675-5675 i Stafr: i
~ i
Fax: (651) 675-5694
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: O,3 Site Address: i 1- 415- J a nci J~ on Ltbr
Tenant: Suite
RESIDENT I OWNER Name: 6 Phone:
Address / City / Zip:
Applicanl is: _ Owner ~ Contractor
TYPE OF WORK Description of work: /'S ~ R Br)
Construction Cost: nn Multi-Family Building: (Yes _ / No ~
z~9~t8~o
CONTRACTOR Name: ' ~ n~ 'j ~ License zb ,
Address: 1 D ddI WCV N
City: ~ State:~^^~ Zip: C S ~
Phone: ZZ. -1 aLNZ Contact Person: 5tCJZIe., V JJ~
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category t Worksheet • New Energy Code Worksheet
Category Submitted Su6mitted
(4 submission type) • Energy Envelope Calculations Submitted
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:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor. Phone:
`,"NOTE.Plans and supporting documen_ts ttiat you submIt aie considered to be public ~nformabon; Portions of :i
the mformatron may be dassrfied as non publ~c'~f you provede specirlc reasons that would permit 6the Ctty to
ts
~ 4` . . ~ , ° _ . __-concludethat iFie are trede secre
1 hereby acknowledge that this information is complete and accurate; that the work will be in conform ' t ord an d c des of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, work is no to s witho t a R; th he work will be in
accordance with the approved plan in the case of work which requi2s a review and a va f~ lans x
ApplicanYs Printed Name ApplicanYs Signature
Page 1 of 3
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41Pri
CityofEaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
MAY 202016
r
Use BLUE or BLACK Ink
For Office Use 1
Permit #: /_3670 0 1(
Permit Fee: _,`/ 7-. 6 0
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
eSl@trq
Owner
l
Name: 6A/S L$$ LLL Phone:
_
Address / City / Zip: Y21' S sal& I �i i/2/ ) f �i2 'f.��
Applicant is: Owner Contractor
.$
'�It>'1�C
�$
Description of work: r�J,^ ,S t%✓71(.}7 Eil �%d '` LI /7%(% ®t !� 71//061/99-7-4001 ilk
(Yes / Na)( )
Construction Cost: 500 Multi -Family Building:
*,r
Crttr C
£ `
Company: ^Mikc_(Lt)$6-4.;/(6/ d %) Cofl) Contact: 74:11 - C /
6-4
�If:) /<677{V (-k C -E /1 City: ArooId- /i7 4. ow
Address: S17/163–/'2
_ ��// C_
State: 41 Zip: rJ %l/l Phone: 6/ 2 2?6 3 Email: f& 0/J/?, 1W5 er(% i, /%69)7'
License #: iSGG 9 1/7 Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUDING
has the City of Eagan issued a permit for a similar plan based on a master
If yes, date and address of master plan:
Plan?
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
N+DTL. submit are ® tiered fo be p • ,
the 1 ®v n y ® ie�d a o» public if you provide circ seasons a
concludeat theare trade re.• x
tion.0 4
s ®= it th Citi
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground itility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that 1 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 Printed Name
x
Applicant's Signature
Page 1 of 3
`7c 6S 4 2s7/26 DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation
�i )Single Family
{{ Multi
01 of _ Plex
WORK TYPES
New
Addition
'4 Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100% )
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
15191
Interior Improvement
Move Building
Fire Repair
Repair
Va
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Roof: Ice & Water Final
Framing 30 Minutes 1 Hour
Fireplace: Rough In Air Test
Insulation
Sheathing
Sheetrock
Fire Walls
Braced Walls
Shower Pan
Reviewed By:
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Final
Siding
Reroof
Windows
Egress Window
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Accessory Building
_ Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
yiiikV013
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Suppression Required
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Pool: Footings Air/Gas Tests Final
Drain Tile
Siding: _Stucco Lath Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill _ Final
Radon Control
Fire Suppression: _Rough In Final
Erosion Control
Other:
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
o-�
Page 2 of 3
4,1111'
CityofEaaii
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651 ) 675-5694
Use BLUE or BLACK In 4\LII
For Office Use
I.
Permit #:
7._-_- 71" >
Permit Fee: LSC " °i I�
Date Received:
C
Staff:
L
2016 RESIDENTIAL/PLUMBING PERMIT APPLICATION
Dale: �I z 7!)�/
) fc Site Address: 71;5- 5 /kv' Sra it,r 1-��•
Tenant.
•
Resident/Owner
r
/ C- k
Name: A- (tel/ h"e--g- A- 4,15.- I ` Phone: ms) Z - Z-90 -4/1'9 s�
Address / City / Zip:
ContractorAddress:
Name: - j E R TY �L a i' 13 ; p'I) c License#: 3/11 b 3C)C)
9 Zr 2_Z 7 f- 14110- City: r5 6 -1- (--
State: /1-1 Pi Zip: 5-50 cis" Phone: 76 7 .' 2 6 - 2 /8 S
Contact: k 2 `% Sk P -k- Email:
Type of Work
— New _ Replacement Repair Rebuild Modify Space Work in R.O.W.
— — — —
Description of work: r>i}-r&V'lel. r\ -- C 13rrl 7(t s .1- 0 0 tic:-
2=RESIDENTIAL
Permit Type
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation ( RPZ! PVB)
Add Plumbing Fixtures ( Main / Lower Level)
Septic System
_
Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
"Water Tumaround
$115.00 Septic System
Water Softener, or Water Heater and Softener
(includes State Surcharge)
Turnaround" (includes State Surcharge)
TOTAL FEES $
(includes State Surcharge)
Fixtures, Septic System Abandonment, Water
(add $280.00 if a 3/4" meter is required)
New (includes County fee and State Surcharge)
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 pJ9ns.
x
Applicant's Printed Name
x
Applicant's Signature
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: Under Ground Rough -In Air Test Gas Test Final
Meter Related Items: Meter Size
Radio Read Manometer Staff:
i. d
17ZZ l. -Z11 -£9L
Auedwo0 6ulgwnld AJegll d06: LO 96 6Z unr
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA140408
Date Issued:12/19/2016
Permit Category:ePermit
Site Address: 4265 Sandstone Dr
Lot:8 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-080
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
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 -
Answer Llc
211 Lake St W
Minneapolis MN 55408
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA140706
Date Issued:01/17/2017
Permit Category:ePermit
Site Address: 4265 Sandstone Dr
Lot:8 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Answer Llc
211 Lake St W
Minneapolis MN 55408
(608) 516-5566
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA149895
Date Issued:06/13/2018
Permit Category:ePermit
Site Address: 4265 Sandstone Dr
Lot:8 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Jacobson T Mcdade
4265 Sandstone Dr
Eagan MN 55122
Lofgren Heating & Air
5708 Upper 147th St W
Suite 106
Apple Valley MN 55124
(952) 431-5811
Applicant/Permitee: Signature Issued By: Signature