4290 Sandstone Dr
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: APPLICANT:
. . i<<{ , , PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION . DA
~ ~
PermR Holder Date Telephone #
SEWER/
WATER
PLUMBING
HVAC
inspectlon Date Insp. Commerrta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
QYP BOARU
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTQ
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
coriDucnvrrv
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAI
DECK FTG
DECK FINAL
CITY OF EAGAN Remarks Cedar GT'OV6 ACqU1.Slt14ri
Addition Cedar Grove #2 Lot 23 Rik 1 parcel 10 16701 230 01
Owner 4~-4a =JStreet 4290 Sandstane Dr. State Eagan, r~r 55122
Improvement Date Amount Annual Years Paymeni Receipt Date
STREETSURF. g8j 1985 1266.95 8 4 1 1266.95 C009910 11-14-84
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL (Q 1972 1304.00 Z 1 2 Paid
WATERMAIN
* WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. ~
BUILDING PER,
SAC
PAR K
.WL016'~ 2005 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construdion Reauirements RemodeVReoair Reauirements Office Use Oniv
3 registered site surveys shawing sq. fl. ot lot, sq. ft. of house; and ~II mofed areas 2 apies oF plan Cerl of Survey Recd _ Y_ N
(20%maximum lot croverage alimved) 1 setof Energy Celculatians forheated additions Tree Pres Plen Recd _Y _ N,
2 coples of plan showing beam 8 window s¢es; poured found design, etc. 1 site survey for addiGons 8 decks Tree Pres Required _Y _N
i set of Energy Calculations Addifion-irMicateHonsdesep6csysfem On-stteSepticSystem _ Y _N
3 copies of Tree P25ervation Plan'rf lot platted after 711193
Rim Joist De1211 Options selection sheet (buildings with 3 or less unit.s)
Date CO l Cj'7 Construction Cost 1 0~• oo
Site Address W o2 q O S a n O S'F'GVx e- ~r . UnidSte #
Description of Work 2/~ ~lat i yl~~ ~ W~ r 1 c vS
Multi-Family Bldg _ Y-9 N Fireplace(s) _ 0_ 1 _ 2
Property Owner ~ 4" c` 'Tc i d'5on Telephone #((p 5~) ~ 5 Y- v a 7 3
Contractor fS2> 1ts- /-Y-wA -er `c
Address City
State ^ I ' \JlJ Zip S~ ~Telep6one # ( Si ) G ~J 7 ~ -S S ~O
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rutes 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category , Residenlial VenGlation Category 1 Worksheet • New Energy Code Worksheet
(q submissionfype) Submitted Submitted
• Energy Envelope Calculations Submitted
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 Telephone #
Sewer/WaterContractor Telephone#( )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
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 w' d
approval of plans. 1~FIE @~ QT m ~,~JUL g r 2005
Applicant's Printed Name Applicant's Signature 1
ey
OFFICE USE ONLY
Sub Types
? 01 Foundation O 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
O 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - MuRi
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Eut. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck O 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• 0 43 Reroof ? 46 Windows/Doors
? 34 Replacemenl "Demolitlon (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 (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ A'u/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ W indows
_ 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
I . PERMIT
ItI`f? OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 033951
(651) 681-4675 Date Issued: 11 ( 0 9/ 9 H
SITE ADDRESS:
4290 SRPIDSTONE DR
LOT: 23 BLOCK: 1
CEDAR GROVF #2
P.I.N.: 10-16701-2341-01 ,
DESCRIPTION:
REROQF
Bulldinq.Permit Type S70RM DAMRGE
~3'uilding Wark Type REPAIR
,tensus Code 434 ALT. RESIDENTTAL
, Y
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_A . . _ . ` REMARKS:
FEE SUMMARY:
CONTRACTOR: - ApPlicant - sT. Lic. OWNER:
MIDWESl' SIDING & ROOFING 13281343 20010277 KLTEST BRUNFLL
II 18979 GLAOSTONE CiLVD 4290 SANOSTONI°_ DR
I MAPLE GROVE MN 55311 EAGHN MN 55122
~ (612) 328-134-1 (651)
i I hereby acknowledge that T have read this appl3cation and state that the
information is correct and agree Y.o comply with all applicable State oY Mn.
StaL'utes and City of Eaqan Ordinances.
~ -
1iSB
-
APPUCANT/PERMITEE SIGNATURE UED BY: SIGN T=~ U~
! 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
~
3830 PII.OT KNO; RD - 55122
O
New Conshuetion Reauiremants RemodeVRenair Reauiraments
? 3 registered site surveys • 2 eopies of plan
? 2 copies of plans (inGude beam S window sizes; poured fnG. design; atc.) ? 2 site surveys (erzterior addkions & decks)
? 1 energy calwlations ? 1 energy calculations far heated addkians
• 3 eopiea of tree preservation plan if lot plattad after 7/1193 required: _ Yes _ No G UU
DATE: CONSTRUCTION COST; y`J Od -
DESCRIPTION OF WORK: Y~OB `i ric,/ ~ 0,r "i ?a r"7 Q
STREETADDRESS: la~?d _So+naS~av~ ~ ~r- _
LOT: BLOCK: ~ SUBD./P.I.D.
Name: &'I'l{/ r Phone N:
PROPERTY 1.ut First
owrrEx Street Address:~ d~0 s,1in/51a,2a ID~`•
City EA?:(= v~ State: Zip:
~
Company: M1 r-5 1 J~ Z~p1,,Z £XUD Vury. Phone J o~ J 3 T~
CONTRACTOR /1 ¢
Street Address: License # CM6 ~ o a~>
City 1714 ~2 )t g/'o`/.A State: /,`X/ Zip: Jr~J7~
ARCHITECT/
ENGINEER Company: Phone
Name: Registration
Sffeet Address:
ciry State: Zip:
5ewer 8 water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this appliqtion and state that the information is cortect and agree to com ly with all appiicabl
State of Minnesota Statutes and City of Eagan Ordinances. '
~
Signature of Applicant:
OFFICE USE ONLY I I
Certificates of Survey Received _ Yes _ No NN- 21998
Tree Preservation Plan Received _ Yes _ No _ Not Requir d
~ t
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Mufti Repair/Rem. ? 17 Swim Pool
? 03 SF Addition O OS 8-plex ? 73 Garage/Accessory ? 20 Pubiic Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscelianeous
? 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. MClWS 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 Buiiding 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. e
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
~ ~ ~ P
M 1.061
BIJ9LD1NC; PERF+91T
r - Ownex _._4.~-~__.xrc.o.`.r~`.^~/1
_.~.'._`..'!i------ . . Eagan Township
p ~
' Addresl (presenf) .~_..~C..£C..°4 Town Hall
' Builder,
' . . /t7~ / G~3
~ Address . . ' . Daie
, .
DESCRIPTION
Siories To BeUsed Fos Fron! Depih Height Esi. Cosf 'Permii Fee Remarks
I - LOCATION
SfreeS, Road or ofher Descri n of Loaati
on Lo! Bloek Addiiion or Traci 9-7
This permit does not aufhorize the use of sfreeis, roads, alleysor sidewalks nor daes it give the owner or his egeni!he rigkit io creafe any sifuation which is a nuisence or which presenls a haaard fo ihe heallh, safely, convenience and
generali welfare fo anyone in the communify. ~ THIS PiERMIT MUST BE KEP~T,, O THE PREMISE WHILE THE WORK I5 IN PROGRESS. ~ ;.Thia is So eerlify, ShaS._.~.....7~.:--_.:....~L. has permission !o erecl a. ~EL,---. .~---.s. y upon
t - ' ~~~ia.
theabovo described premise subject So the provisions of the Suilding Ordinanee for Eagan 1` wnship adopfe&' April 11.
, . 1955.' ~ ! /pn?,,/_•/1 .
, Pe[ ......._..._...(/+K~.Ld."~!er~
. - . . ~....~'GLdlYC'r...........
Chairman of Tnwn Board < ui ing Inspeetor .
, ~ . /.Z . Q . . .
.
:
.
- . ~ -CITY of EAGAN N_-° 3558
UILDING PERMIT
Ownex Cl.(l.r......Q.~ ........~....S . 3795 PiloS Knob Road
o Eagan, Minnesota 55142
naaraw (a=e.on:) I.-Z& ...~_n. ..ST~r r? asa-aioo
suiiae:
.~...Z5
Addreu Dale
DESCRIPTION
Sforiae To Be Used Fos Fson! Deplh Heigh! Es2. Coo! armi! sa Aemsrks
sa g y 447tii4tn41 s Wo f evl
I'' 1"/' 57 da ,Ca Ts S- ea
LOCATION
Streel. Roed or other Desortpiion of Loealion I Lo! Bloek Addttion or Tsae!
4Z QD '1~ n o6s'ro nle I 2 3 7/ ~ eda r~rode
This permit doea aot aufhorize the use of slxeels, roads, alleys or sldewelks nor doea it give the oaaer os hfs egen!
the righ! !o ereale any siluafion whieh is e nutsanee os which presenls a hazard !o the health, sa4afp, eonveaiancs and
general wallare !a anyone in the commvaily.
TIiIS PEAMIT MUST BE $EPT O THE MIS£.~WHILE THE WORK IS IN PROGRESB.
This is !o aerriip. ~e:.z.rr.rnP. --I....... _.~.LF._~..------..has permiasioa !o xeet a ...r^...C.._..~'.~...P.........................._upoe
the above desaribed premise subjeeT So the provisions of all applicable ' ees fos !he C' of £agan.
........1 ._~'...1.. . Per~iC2..._..
MaYOr Hulldiay Inapectos
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MASTER CARD
LOCATION dr~~rPf 90 d3-
OWNER
STRUCTURE
IAND USED ASD /O x Z Z ~a fI ~df WY-%,
Issued 70
Permit No. Issued Contractor Ownar
BUILDING 36'S8 .4- 2$•2
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER I
OTHER I
Approved
Items (Initial) Date Remarks Disiance From Well
FOOTING SEPTIC
FOU N DATION CESSPOOL
FRAMiNG - ~ ~ TILE FIELD FT.
FINAL
ELECTRICAL DEPTH
HEATING OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONIY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPEC710N
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
~ NO EVIDENCE OF NON-COMPLIANCE ~ NON-COMPLIANCE. BUILDER DOES NOT
OBSERVED. INTEND TO COMPLY.
ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS. ? COMPLETION OF CERTAIN IMPROVEMENTS
WILI BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
a REIHSPECTION REQUtRED DATE OF REINSPECTION
REINSPECTION REVEALED
CE RTI FICATION - I certify that I have carefully inspected the above in which I have no interest present oi prospective, and that I have reported herein
atl significant conditions otserved 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 DATE
COMMENTS:
z~
Use BLUE or BLACK Ink
A A"
r - - - - - - - - - - - - - - - -
I For Office Use I
I / 790/
City of EaVR ; Permit#:_ I
J ~
I Permit Fee: 0J. Q2S I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: (Q3
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ! Site Address: 4'f v29o gam/ f!'!t° W ~ Unit
Name: u r ~`~D 1~:) Phone:
Resident/
OW ner Address / City / Zip: -2- 42
Applicant is: Owner Contractor
Type of Work Description of work:
Construction Cost:AZ~V Multi-Family Building: (Yes / No )
Company: e~d t° J 67 ~ 17 (0h Contact: 42574-"-7
~o~Ztr/
Contractor Address: C2/;;? 3 City:
State: /~??12 Zip: 3 7--2 Phone:
License 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:
i
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.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 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 5 101 /
ell"C' /_).1/_e,/
A
pplicant's Printed Name Applicant's Sture
g Page 1 of 3