4540 Scott Tr CITY OR EqGAN SEWER SERVICE pE~~T
3795 Pilot Kno6 Road
Eagon, MN 551Z~ PF~IT N~.:
Zoning; DATE:
Owner: No, of Units:
Address:
Site Address:
Plum(~r;
1 e9ree to eoe~P1Y with fhe Cify of Eagae Connectfon Churge:
Ordfeonces,
Account Deposit:
Pennit Fee:
By Surchorge:
~are of Insp.: Misc. CF?orges:
Insp.; Toto1;
Date Poid:
CITY OF EAGAN WATER SERVICE PERMIT
3795 P~lot Knob Rood PERMIT NO.:
Eagon, MN 53122 DATE:
Zoning: No. of Units:
Owner.
, Address:
Site Address:
Plumber.
Meter No.: Connection Charge:
Size• Account Deposit:
Reader No.: Permit Fee:
1 agree to eomply witt+ the City of Eegan Surchorge:
ardinanees. Misc. Charges:
Total:
gy Date Poid:
Dote of Insp.: Insp.:
l CITY OF EAGAN 7~
' 3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
Tobeusedfor ~~F-`~~~ Est.Value Date ,19
Site Address r~~ OFFICE USE ONLY
Lot Block I Sec/Sub.'-t•~ ~~-~Fr j;L OnSiteSewage Occupancy
MWCC System Zoning
Parcel No. on Site wall (Actual)Const
~ Name L..N ~ " ' [..:Y BLCn Citywater (AUowable)
z Address ' S`~` PRV Required # ot Stories
p Cjty i'. A vAi. Pho~e S~"S'~4' 2~1.~- j 1•' 2 ~oster PumP Length
Depth
, p Name ~l` i' .AL t.: S.F. Total
o ~ Address Footp~int S.F.
U~ City ~°'~~~'~C . Phone S~~b--41.1U
APPROVALS FEES
~ W Engr./Assess. Permit ~
Name
~ W Planner Surcharge '
= Z Address
~ Z Cit Phone Council Plan Review
qW y
Bldg. Off. SAC, City
I hereby acknowledge that I have read this application and state that the Varfance SAC, MWCC
in(ormetion is carrect 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: ~Y Treatment P1
on the express condition that a~l work shall be done in accordance wlth all Parks
applicable State of Minnesota Statutes and City of Eagan Ordinances.
6uilding Official TOTAL
Permit No. Permit Holdsr Dat~ Tslephone ~t
Plumbing
H.V.A.C.
Electric
Softener
Inspection Dste 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.. '
WeU
Pr. Disp.
.
CITY OF EAGAN
3795 Pllot Knob Rood Eagnn, MN 55124 N~ 6 2 6~J
• PHONE: 454-8100
BUILDING PERMIT ReceiPt # _
To b~ nted for Est. Vulue Dote , 19
Site Address Erect ~7' Occuponcy
Lot Block Set/Sub. , ' ''r ~ Alter ? Zoning -
pa~~ # Repair ? Fire Zone
Enlarge ? Type of Const.
aWe Name Move ? # Stories
3 q~~~ Demolish Q Front ft.
t~ Grode ? Depth ft.
Ci Phone
°C Name Approvuls Fees
o ,
u~ _ Assessmerrt Permit
~ CI Phone Water & Sew. Surchurge
Police Picn check
~W Na^'~ Fire SAC
Address Eny. Water Conn.
<W G Phone Planner Water Meter
Council Road Unit
I hereby ocknowledye that I have read this opplication and state that Bldg. Off.
the infonnntion is torrect and ogree to compiy with oll applicable APC Total
Stote of Minnesota Stotutes ond City of Eagan Ordinances.
Signature of Permittee
A Building Permit is iuued to: - ' on the express condition thot
oll work sholl be done in accordance with cll opplicable Stcte of Minnesota Stotutes and City of Eagon Ordinonces.
Building dfficiol
~
Psn~M # Oet~ hw~ P~rwMh~
Plumbing - /(o - ~
Mecj~anical a / /L -ol - d
°.Ee r~ ~ ~c 7 /t - t G - f C ,,~_,c.~
INSPECTIONS DATE ~NSP• Rouph-In Finol
FOOtings ~-/y-~ Date Irqp. Dote Inap.
Foundotion Plumbfng G~~
Frome/ins. J r Mechonical
Final $
Remorks:
s
. cir~r oF ~?c~?N
^ ' " 3795 Pilot Knob ReaJ
No. ~gen, Minnasora SS12Z INSPECTOR NOTIFICATION
Phe~e: 454-8~00 REQUIRED BY LAW
~~~~fi•~~~'~ PERMIT FOR ALL INSPECTIONS
Date: - Receipt No.:
Single I
~ : ~ , ~ , ; r Residential
Site Address:
Lot ' Biock 1 Sub/Sec. T Multi Res., Comm./Ind. I
Name j~4l~ :^.21 I?~ . . .
New/Alter./Repair
; Address ('•-~1 T~d Cost of Instollction
O
~'P;. ; ,..i12'-i.~~ ' !1?
City - Phone: Permit Fee
Name `'`t "=e].ter I~eati.,:-
~ $urcharge
~ Address ~A~'G ~ VB .
0
V .
Ciry ' Phone: Totul
This Permit is issued on the express condition that oll work shall be done in accordance with all applicable State of
Minnesota Stntutes and City of Eagan Ordinonces.
Building Official
. . . cirr oF ~?~~N
' 3745 Pilot Knob Road
' Eayaw, Min~awta s51?,2 INSPECTOR NOTIFICATION
No. Pl~on~: 464-8100 R E Q U I R E D B Y LAW
PERMiT FOR ALL INSPECTIONS
Date: Receipt No.:
~ , Single I
Site Address: Residential
Lot Block Sub/Sec. ~~'`'r Cla ~ M„ir~ Res., Comm./Ind. I
Name ~ C ~.i;' . w - : '
New/Alter./Repair
~ Address 77E;~) '~il.`_r''c
Cost of Installotion
_^li;"1.['. ' ~
City - Phone: ' - Permit Fee
Name ' ~.LE i 1? Ttl~'~1:'.
~ Surtharge
~ Address ~ ~ ~a-i},ci2-~ x 'J .
~ •
City ` " Phone: Totcl
This Permit is issued on the express condition thot oll work sholl be done in accordance with all applicable Stcte of
~ Minnesoto Stotutes ond City of Eagan Ordinances.
Building Offitiol
. . ~ ~
.r,h,. - r i`~+- oy ~"~0"ms'1 r~ ~ ,
~ ~ ~ ~t ~1i9? i~? ~ ~_.:~~~f l~~ ? _ ~
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~ w, ~
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4.h ~ttp ~of c~agan In
,
'r~~~ ~
~P}~tti~mpttl ~f l~Utl~tttg JttS~JPrlimt ,
~G'~ ~
F Tbis Gaaficutt itautd ~urtuant to tht ra~ttfrtmtrttt of Srction 306 of thr U~iiform Building
~ k l
; ~
r' Code cati
f7ing that at the time o f usua~r~u thi.c nructure wa.c in cmn pliance with tbe various V, ~
' f~"~ ' in const~uction os ust. For tix f
ollouring: 'r
~~,L ,i ordinarucs of tix Cu7 ngulat:ng bruld g 1~
~
,
~ ~ ~ ~
~ r~Y+ 5285 :
! ~I ~n~'C~; H1es. Pemri~ No.
~ v,.cwor~m pD f.~
~ ' wo ~ V Fin Zoeu~ 3 _ z~~s u~~M ~.i
i o~wr.d.r'ha~ 'hwc~u~n
~ ~ 7760 Mitchell Rd,Eden Prai-rz
2achanan Hares Y.nc„aa~ ~ '
o~`• ~~e~` 4540 Scott Tr L6 , Bl ~ Cedar Clif f 3 .
k-i ~
~
~Y ~r~ tlalt: 2~1J-UZ 7~ ~~~~t,~~~
~ k i Buildi~ip(gdal i: ~
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~ ~ rarr • wwwcuws ruu
. - , - - - - - :
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, ' - ~ - ~ .:rr.o,w s n.
p~-e, ~s~ ~ . _ _
CASH RECEIPT
,
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE ~ g
wece~vco f ~
FROM
AMOUNT $ I
3 DOLLARS
~oe
? CASH ? CHEGK
FDR (n I C V ~
- _ ~
FUND COOE qMDUNT
Thank You
BY J
~
UVhite-Payers Copy
Yellow-Postinp Copy
Pink-File Capy
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: ' ~ ~ ~ ~ ~ ~ ~
3830 Pilot Knob Road Permit Number: • ~ 4+
Eagan, Minnesota 55122-1897 Date Issued: ~ ~
(612) 681-4675
. 1 l~ i . 5t<. ,
SITE ADDRESS: E„~ F APPLICANT:
- t~ i~..~
, ,
PERMIT SUBTYPE: TYPE OF WORK:
~
, , . . . ,
. .
~ ~
~ ~
Permit Holder Date Telephone #
PLUMBING
H VAC
Inspection Date Insp. Commenta
FOOTINGS
FOUND
FRAMING
R~OFING i ~~Q J/~.j'
6 - `~W
ROUGH
PLUMBING
PLBG
AIR TEST
R~UGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METEP
FLUSH
MAINS
coNOUCrivirv
TEST
HYDROSTATIC j
TEST I
BSMT R.I. I
I
BSMT FINAL I
DECK FTG I
I
DECK FINAL I
~
CITY OF EAGAN Remarks
Addition Cedar Cliff Third Addn ~ot ~ eik 1 Parcel 060
Owner " Street 4540 SCOtt TY'ail Stace Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1982 1496.30 299.26 5 1496.30 C007211 9-2-81
STREET RESTOR.
GRADING 1982 718.58 143.72 5 718.58 C007211 9-2-81
SAN SEW TRUNK f ~ 42.19 A009933 2/24/81
~1f'aEWER LATERAL 19$2 rj ~S C~d]211 g-2-$].
WATERMAIN
~iIVATER LATERAL 19$2 S
WATERAREA 50.58 A009933 2 24 81
* Service Stubs 1982 5
STORM SEW TRK . q~~1?~ y{, 342. 24 A009933 2/24/81
~6TORM SEW LAT 19$2 S
CURB & GUTTER
SIDEWALK
STREET LIGHT
Rd. UNIT 185.00 21345 8/14/80
WATER CONN. 305. 00 21345 8/14/80
~UILDING PER,
SAC
PARK
~ aa
This request void Pj ,3 ~i ~ ~
18 months from / ~ ~
Date of this Request O Fire No. ~ J O~~
I, as ~ Licensed Electrical Contract r OOwner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. S~SyD C/,~'/~i~l.olh.A.cy (,ytyG~
Section Township Range County
1Vhich is occupied by ~ g~pr/~p,~
(Name of Occupan[)
Is a roughin inspection required on this ~ob? No ? Yes ~ Ready Now ? Will Cal] ?
Power Supplier Ap~y~/j~ ~~,C ~ Address
t~~~X111 e 39~~~
Electncal Contractor .s ~~LA-~~u' ~ Contractor's License No. _
Company Name)
Mailing Address ~ SS
' (Electri I Contractor or ne~ Making Thls Initallatlon)
Authorized Signature Phone No~6G-~~~l9
(E ectrlcal Con ractar or owner Maki g This Installatlon)
~,Q~~`~~ ~o~~ This inspection request will not 6e aceepted 6y the
~7,) e~ State Board unless proper inspeetion fee is enclosed.
mmneso[a state noam ot t~actncity /
Griggs Midway Bldg. - Room N791 EB-000o1-02
^,I University Ave., St. Paul, Minn. 55704 - Phone 297-2177 v~.7
.;H~.~ELOW WORK COVE EDTBY'THIS RQ EST,ON ~ V T 9 0 7 8 '
Type of Budding New Add. Rep. Check Appliancea Wved For Check Fquipment Wieed Foc ~
Home ? Range ? Tempoiary Waing ?
Duplex ~ Wa[er Neater ? Lighting Fixtuies ?
Apt. dldg. ? Drye~ ? Electric Heating ?
Commexcial Bldg. Fumace ? Silo Unloader ?
Industrial Bldg. ~ A'v Conditioner ? Bulk Milk Tank ~
pList pList
Farm ~ ? ~ perels~ Hehreers#
Other
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: # Fee Feedeis&Subfeeders: # Fee C¢cuits: # Fee
0 to 100 Am s. .S 0 to 30 Am eies 0 to 30 Am eres
101 to 200 Am s. 3l to 100 Amperes 31 to 100 Am etes
Above 200 Amps. Above 100 Amps. Above 100 Amps.
Transformers Remote Conhol Cire. Partial o~ other fee D
Signs S cial Ins ection Minimum Cee 55.00
Remarks TO'fAL FEE
I, the EI al ~ cerUfy that the a~oye insp ti h~s been made. GO
(Rough i~ D e ~ r /
(Final) ate G{~-
This request void , ~
18 months from
CITY OF EAGAN rf ~ O ~ 0
, 3830 Pflot Knob Road, P.O. Box 27-199, Eagan, MN 55121
~ PHONE: 454•8100 p i 1 I I~
BUIL~DING PERMIT ReceiPt# ~~"'t
Tobeusedtor DECK Est.Value $1,000 Date ~Y ZS ,1988
Site Address 4540 SCOTT TR OFFICE USE ONLY .
Lot 6 Block 1 Sec/Sub.CEDAR CLIFF 3RD OnSneSewage - occuvancy
MWCCSystem _ Zoning
Parcel No.
On Site Well - (Actuaq Const
a Name DOREEN & BRADLEY BECK Ciry Water _ (Allowable)
; Address 4540 SCOTT TR PRV Requiretl _ # of Stories
~ City EAGAN phone 456-9645 293-3192 Booster Pump _ Length
Depth
p Name RAY RHEAULT S.F.7otal
~ a Address ' Footprint S.F.
~ City HORACE Phone SSS-4109 APPROVALS FEES
~ a Engr.//+ssess. Permit 24.00
W Name .50
F i Planner Surcharge
i- Address
a W City Phone Council Pian Review
Bldg. OH. SAQ Ciry _
I hereby acknowletlge that I have read this application and state ihat ihe Variance SAC, MWCC _
information is covect and agree to compy~ with all applicable Slate of Water Conn.
Minnesota Statutes and City f gan Fi anc
Wa[er Meter
Signa[ure of Permittee _ _ Roatl Unit
A Building Permit is issued to: ~Y RHEAULT - Treatment Pi
on the ezpress contlition that all work shall be done in accordance with all
applicable Slate of Minnesota Statutes and City of Eagan Ordinances. Parks
1 -y~p TOTAL Z~+.SO
J1fA.
I 11 \l~
Builtling Otticial
CITY OF EAGAN
9795 Pilot Kno6 Road Eagen, MN 55722 NO
~ PHONE: 454-8100 , /S -
BUILDING PERMIT APPLICATION Rece~pt # r
To be uaed 1oe DWG/GAR Est. Va~ue 36~000 p~e 10-1Q ~q $0
Site Address ~+540 Scott Trail Erect ~ Occuponcy R3
Lot 6 Block 1 Sec/Sub. Cedar Cliff 3rd Alter ? Zoning PD
Pa~~~ # ~ Repair ? fire Zone 3-
Enlerge ? Type of Const. V
~ Name ZacYlman Homes InC. Move ? # Stories
Z Address 7760 Mitchell Rd. Demolish ? Front 4g _ r+.
~ Eden Prairie, ~„e 937-9520 Grode O ~epth 3b n.
Name ApP~ovals fees
0
o~ Address .4ssessnl~~t Permit 105.50
u~ Ci Phone Water & Sew. Surcharge 1g.00
Police Plan check 52.75
~w Name Fire SAC 525.00
~Z
Address Eng. Water Conn. 305.00
<w Gi Phone Planner Water Meter 60.00
Council Road Unit 1~5.00
I hereby ackrwwledge thot 1 have read thts application and state that g~dy, pff.
the information is correct and agree to comply with all applicoble 1 251.25
State of Minnewta Stotutes and Ciy of Eagan Ordinances. ~1PC Total ~
Signature of Pertnittee
A Building Permit is issued to: 7a~hII11~3ri HOID2S IriC. on the express condition tFwt
oll work shali be done in accordanc with ali ap~piicable State of Minne ta Statutes and Ciry of Eagan Ordinances.
~ Building Officiol C'~-Y-~~ ~
r . _ - ~
. . ~ ~~J
I^ CITl' OF EAGT~N Include Z sets of plans,
~1~~ 1 site plan w/elevations s
~ BUIIDING PERNIIT APPLICATION 1 set of energy calculations.
~J -
Zb se vsed For valuation ,3~, G'Q'O Daate G ~
Site Address: S OFFIC£ USE OIII.
Lot Block ~ Sec./Sub4~~~/,~. ~J,` ~~~~Y ~ 3
Parcel ~~~rU ZO11u'4 PD
Rep3ir Fire Zone g
F~laYge _ 'rype .of Const.
Qaner: t
Nbve # Stories
Addres • 7 , Dmr~lish Front y~ ft.
City/Zip Code: Grade Depth ft.
Pho~ ~~'~7 -C/
Sc~Q APPR7UAL5 Pg5
(:ontractor: Assessments Pesmit /a S~,~o
Address: Water/Sc~r Surcharge ~g.e O
Polioe Plan Check S2 . 7 S ~
Gity/Zip Code: Fire SAC S2s , D n
E~~q. Wates Conn. 3 oS c o
Phone Planner Water Meter
/od•o0
~~h ~g : Council ~ Rc~ad Unit ~ d~, o d
Bldg. Off.
Address: APC
City/Zip Code_
Phone # - ZU'I'AL / ~ a
o-
~ ~ ~ ~ . C, ~i ~<i
DAK SA
ZOPiING - NOTTFIGTION OF INTENT ~ ~9~^~
Foster Family Aomes ~Q~~'~
Daq . Care Homes ~~,~i~~~
i
~ro: c~ ~ c~ c Po~
" (Muaicipality or Political Sub-Division)
~ 7 ~ ~ -V ( ~.h 1" ~-YZG ~
(Street Address}
~~f~t'I !V 5~c ~~a
(~t9) (State) (Zip}
FROM: Dalcnta Caunty Social Services
357 9th avenue North
So. St. Paul, ~ 55075
APPLICANT: ~C C)~T CF h ct ~IG Pi r l J~ l~A> ~{`2 •
(Nae) .
~s~f0 Sc~-f-f- -I-f.
cst=~t~
~ F~~ ~3n ~Li SS f ~
(City) (State) (Zip)
Number of Naturai Children uader 18 ia home: 0 1~ 3 4 5''
(circ e number)
Number of Foster Children iacluded in licease:~1 2 3 4 5 6 7 '
~~circle number)
Number of Natural Preschool Cttildren in Home: 0 1 2O3 4 S
(circ3e rn3mber)
N~bar of Daq Care Ctiildrea included in license: 0 1~ 5 6 7 8 4 10
(circ e a~ber}
DATE OP YOTIrICATION: I~-'~ ~~Z
s~~~
, 7988 BUILDING PERMIT 9PPLICATION - CZTY OF EAGAN
.
SINGLE FAMILY DWELLINGS f ~ ~ ~ ~
INCLUDE 2 SETS OF PLANS~ 3 CERTIFICATES OF SURVEY~ t SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WFIICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL UNITS FOR SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.~ n
1 SET OF ENERGY CALCULATIONS ~
_ '1~ T a
COtM~RCIAL W 1C~
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
D ecK
To Be Used For: ~ i " Valuation ~ Date: ~
Site Address ~5~U SCO~ ~rr~i~ ~ OFFICE USE ONLY
/DOo
Lot ~ Block ~ On site sewage_ Oecupancy
~ i , M47CC system Zoning
Parcel/Sub C~Oq,li C~'~~~ ~i~l~~`h~1 On site well _ Actual Const
2f" p~ + City water Allowable
Owner ~~'~1/1 ~ L)Y'QdICU I"~0(~,(L PRV required _ lk of stories
6,....r~n ~}Booster Pump Length
Address ~j7~7` J ~1'n~i ~h eUX . Depth
r S.F. Total
City/Zip Code f~,iD~N,PI ~ ` \ Footprint S.F.
~J
Phone C) Cti~ a93 -3r9 pppROVALS FEES
247- o
Contractor ~~;LV 67A1' ~'r Engr/Assess Permit , Do
Planner Surcharge .S~
Address ~ ~(,LC~ Council Plan Review
1l - II Bldg. Off. ~~23 SAC~ City
CitylZip Code T~'t~V'C• C_F~ 5~`T7 Variance SAC, MF1CC
Water Conn
Phone ~j ~ Water Meter
Road Unit
Arch./Engr. Treatment P1
Parks
Address Copies
+ TOTAL ~Q ~571
City/Zip Code I _
Phone l~
I
.
• CI~LVIN H. HEDLUND 9608 6lrard Av~nu~ Sout~
Bloomfnqlon,Mien~wta 65431
~and Surveyor Clvil Enqin~~r • PDOn~:688-2080
sr~rve~vr~s G'ert~,
j"~cate
JOB N0.
SURVEY FOR~ 2achman.Homes
OESCRIBED A5~ Lot 6, ffiock 1, CEDAR CLIFF 3RD ADDITION, City of 8agan,
Dakota County, Minnesota and reserving easements of record.
~ _ qo2.4
!a6.2o 90~
r------ ~
~ ~
~
i ~
~ r
~ ~ 7op of Foundation = ,02.8
~ ~ ~ Baseme.fi F1oo~ ~ 899.fo
~ b~ra9e Floor 902.¢
~1 - - - - - - ~Z. y rN Prbpossd Eleva*iens ~
yo r, \22 \ I~ Ek~sfin9 Elevd};ons
1 ~ 25'8" D~~a/es Praina~je
~p~~ \PLIT '
~T~ K~ I GA R ~FoYe R nj ~ ~~~Q DenoFeS Lo+ Corn e r O
~ STAKES
µt 20 ~ ~
d°~ 1
i_;,-,- _ ~ ~ - - - - Z ~ ~
v ` ~J6 .
~ 9~' ~ ~ .I 1 'L
~i 1 _ _ _ _ ~ L- ~ ( C
L. . ~.1.
~ e Z
~ 5. 9 ,
/ 9D0•O $qq ~ `
0 Q
M n~ ~
~
SGOTT TRA?L
~ $99,.~
CERTIFICATE OF SURVEY
I ~ereby cerfify thot on ~D - 6- 8o I aurveyed the property described above and thot
the obave platis o correct representotion of sald aurvey.
~lc~L~-~ !'F • ~9`--~d~it.w~.a~
Calvin H. Hedlund~ Min~. Rea Na 5942
~ 66oa- a!~o ar
~ ~ ~ (°..ec~r~:-.. y~ d`
k Attechnant 2 P2-09131-01 i
F (~QUESTINC AGENCY: HINNESOTA DEPARTMEIiT OP.YUBLIC WELFARE I
~ Complete [hla form in triplicate (3). ~
Send origineil copy to: ~
Local Fire Depar[ment
(Tocm mue[ be on 11si approved HEQIIEST FOB FIHH IHSPHCTION ~
by State Eize Msrshal) . $Y L~~, g~gg DHPAETHENP
Send lat copy to:
Pamily Care Licensing Syeteos
Department of Public Uelfare (Hunicipality muat.be on State
Centennial Offlce Building • Fire Marehal.approved list.)
St.~yPaul. !Rd 55155
Keep 2nd copy in Requeating Agency's
file. Da[e: ~ ~
&equested by: _ ' ` Iiequeatied by: ;
(supervlsSng agency . (worker)_ '
City ~~C~~~ and County /t/~Q~~ ~
(in Which inspection is to be made) i
Applican['s Name /(~2~c- J'-'`zs'-~-"~~hr Pheae '7~~7` - 77 7 9
(~provider of~are) i ~
' Address ~7 ~~U `yP.A-f~~ ~.~r~ ~ _ City _ ~
(at vhich ins ection is Co be made) , j
Existing Use: , t~rr~ - :
~ .
~aa to be ~sed• (check) ~ronos~d IIset Ccheck one) ~
: ~ Hobile Home /L/ Besement F mily Day Care Home
~ - ~roup ramil,y pqq Car~ Nome ~
lst Floor
~ Apartment totel Nua,b-r Preschoolers Cared ?or..-••• 7-/v
2nd Floor ~~clude u<A+h° ahildz'rtt nct yet Sn lst •
/7 Duplex 8Y'~°~
~ /!iJ Single Ih+elling /_T Other rI Fami19 Foster Care Home -
- ~Group Family 2oster Cara Home
Total Wuiuber Children Under 18 Cared ! or
(Include ~~~'en Under 16) • .
- pge range O
Nuuber of persons involved _ 7-/f~
L ~ Days per zaeek /7'~ -
' Houzs to be used per day
Total staff on duty during occupancy .
. Yes, Numbe= _ No ~
~ Hentally retarded
^ ~ . Yee Number No
Physically Handicapped ,
Yes, Number No. ! %
~ Hentally I11 - /
I Yes, Nuober No •
Chemically Dependent
_ i
: ~ ~ • ~ _ z
Additional Comments: 7~3 o-a`^~ 2~'°` "~O~ i /
. m
~ -
~
: i....et flre deoarCment on: 3
PERMIT
CI~'Y Q.F EAGAN
383 PilotKnobRoad PERMITTYPE: euz~.osw~
Eagan, Minnesota 55122-1897 Permit Number: 0 3 3 014
(612) 681-4675 Date Issued: 0 8/ 2 6/ 9 8
SITE ADDRESS:
4540 SC077 TR
LOT: 6 BLOCK: 1
CEDAR CLIFF 3RD
P.I.N.: 10-16602-060-01
DESCRIPTION:
REROOF/STORM DAMAGE
Bu~s'1din~~EPermiC Type STORM DAMAGE
Building Work Type REPAIR
GensUS Cntle ^ 434 ALT. RESIDEN7IAL
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REMARKS:
FEE SUMMARY:
CONTRACTOR: OWNER: - applicant -
PAULUS MARK
4540 SCOTT TR
EAGAN MN 55122
(651)683-9110 g
I hereby acknowledge that I have read thzs application and stste that the
' inPormation is correct and agree to comply with all applicable State ofi Mn.
Statutes and C9ty tif Eagan Ord',inances.
~ ~
APPLICANT/PERMI7EE SIGNATURE ~ ISSUED BV: SIGNATUR~
, 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
' CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
3~a i y 6a~~~5 g ~ a~- qg'
New Construdion Reauirements RemodaVReoair Requirements ~
? 3 registered ske surveys ? 2 copies of plan
? 2 copies of plans (inGUde beam 8 window sizes; poured Tnd. design; etc.) ? 2 site survays (exterior additions 8 decks)
? 1 energy plalatlons • 1 energy ralculatlons for heateO atldkions
? 3 copies of Vee preservatlon plan if lot platted after 7/1/93 ~
required: _ Yes _ No
DATE: U-~S 90 CONSTRUCTION COST; `~~a
DESCRIPTION OF WORK: ~/PS f~o~~ ~LLGe ~`O ~^~'I Q~i~r2~~
STf3~
ADFr1" DRESS: `Z SG D ~C o// T/'Q i I n
LOT: BLOCK: SUBD.lP.I.D. ~Q c~1- 4.v` C X~.,k~ll ~r
Name: ~2~L~GLS 1+'Q~1"K Phone#: ~oD J~!</0
PROPERTY ~ F~t
OWNER J
StreetAddress:~~~0 T/'G~% /
City ~~Aq State: /~/V Zip: ??~a~
Company: Phone
CONTRACTOR
Street Address: License #
Ciry State: Zip:
ARCHITECT/
ENGINEER Company: Phone
Name: Registration
S~eet Address:
City State: Zip:
Sewer & water licensed plumber (new construction ony): . PenaHy applies when address chang
and lot change is requested once pertnit is issued.
I hereby acknowledge ihat I have read this application and state that the infortnaHon is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. ~~11
Signature of Applicant: ~v2~ 1iv ~.L,.~~
;ii;~~l~ `~~SU`J LS~-
OFFICE USE ONLY ~ ~ ~
Certificates of Survey Received _ Yes _ No
~
Tree Preservation Plan Received _ Yes _ No _ Not Requ!red
OFFICE U5E ONLY • ~
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex O 11 Apt./Lodging ? 16 Basement Finish
? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool
? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous
D 05 SF Misc. ? 10 = plex ? 15 Deck
WORK TYPE
0 31 New 0 33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MC/WS 5ystem
(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 Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
% SAC
SAC Units
411.
C!ty of Eapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit#: /D/tet 7 (�
Permit Fee: ,(,i
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date:
Site Address:
Name: a rn v1 K Voin
Address / City / Zip: 4 5 L* 0 5 Go l+ kie-o- `'
Applicant is: / Owner Contractor
Description of work:
Unit #:
Phone: 6V; a- - 4 (5-(0
Construction Cost: Multi -Family Building: (Yes / No
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)
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:
Mechanical Contractor:
Sewer & Water Contractor: Phone:
Phone:
Phone:
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.qopherstateonecall.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
Applicant's Printed Nae
NI 1/b NG m /-t T
x
Applicant's Signature
Page 1 of 3
411/11
City of Eaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
l �( /�
Permit #: �J a `"C - t
Permit Fee:
Date Received:
Staff: fJ 1<7
to6,
2-121 / act
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
i ..
Resi
Name: 'Nfkiv /DP C.or4 ✓\11 Phone:
Address / City / Zip: h SL -I0 5 ( c7 l . L
Applicant is: Owner X Contractor
Type of lr�C
Description of work: y c -) /:_ .;J
Construction Cost: 10700 Multi -Family Building: (Yes / No
)
tractor
Company: I Vh l (.6_, E.,c l C , ,2c7 Contac : � � j dc' -/-.
&1c ( ,Q Ci_— '+ S�f`LL[
Address: City: -. -
State: Zip 2 Phone: FSS (._`/j%-a(i Email: ',foe%, in 3TAC w_9&"
'c`11`‘
License #: (q(-4 c.2.. -i 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 BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
aN dans % porti - oco ,pu + infA ra lot1
tell formatr®. _ y be I ide s e m P rs• 'oulz� perm
chid at r trade
..
,
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; at 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- to Building Code mus • • • Mid -within 180
days of permit issuance.
x
Applicant's Printed Name
x
Applicant's
Page 1 of 3