4850 Sheffield LaneCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
\,b35,
vac vl..vG vI CIL/14IN IIIK
For Use
Permit #: \p'e'r
Permit Fee: -4 \ 35�
Date Received:
St
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
,�f
Date: ' / Site Address: � i p_Il x / pi
Tenant:
Suite #:
RESIDENT / OWNER
Name: CVO b , 7Ch,d L - t,'t^oo Phone: 6s/- 9/'• (46---5-
P 6 -5--
Address
Address / City / Zip: qi5-0 c0 47Q 1el
iL,(,Q)d
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: G '7r L/h/ 1 ,
�' Ct Q� fj r
/(, SC
1 ,
Construction Cost:(2,, v� ,C� Multi -Family Building: (Yes / NoX )
CONTRACTOR
Name: C1(.&C47r
) /szip 'JG -- .1�✓) J )C„ License #: / / z/c9
Address: "7 74 Qc&YI , City: �,4j;G , j )
State: /�}') Zip: S:67/2/2, Phone: 4'5 / ' 99V- - &c&s`-
Contact: l. -(d/ 0'(:// Y) Email:
COMPLETE
In the last 12 months, has
_ _Yes No If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be,pubhcyinformation 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.orci
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.
rig O/T
Applicant's Printed Name
- C.)1k)OCAA)
App icant's Signature
Page 1 of 2
CITY OF EAGAN SEWER SERVICE PERMIT
3850 Pil~ ':nob Road ~ ~c~~~
P. O. Box 27799 PERMIT NO.:
Eagan, MN 55121 D^~: fi-28r+^ ~ ~
r 1
Zoniny: -~l No. of Units:
OWf1lI: rl~~llef S~n
A~?E55: i
4850 S:~effielcl Ln, I1•~ ~2 HEittanv
Site Address: ~
Plumber: C~nz ~~n -
5-~~-~3 3F'?33 100. C~ n~:
1 eqrea to eomPy wMl~ 1M Glp ef [a~en Connection Chorpe: 4 2~. 0 0 T~c1 ~
OrdinasoM. Account Deposit: .
Permit Fee: 1~,~ n r d
$UrthOrye: ~ rl n ~l
c
gy NuSG. CharpQS:
Date of Irup.: Totol:
Insp.: Dote Poid: ,
i
,
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: ~
Eagan, MN 55121 D/~TE: , '
Zo~ing: `1 No. of Units:, 1 ,
Owner. `~'Ol le t SOZl
Address:
site ,~ddrcu:4850 Sheffielc~ Ln. L4 ~2 rrittanY th
Plumber. GBAZ RyFtTi -
Meter No.: Connection Charge: 4 5 0. 0 Q p~l
5ize: Acoount Deposit:
Reoder No.: Permit Fee: p
1~~~ h wmPl~? aifh Nie Citr of E~ya~ Surcharge: p ,
p~i~~, Misc. Char~es: 6 n•~ ~ P~ meter ~
TotoL•
gy Date Puid: ~
Date of Insp.: ~~P•~
, , cirr oF ~?~~?N
, ~7lS Pilot Kno6 Roo~ Eoyan, MN SS12! . L~
?HONEs ~S4-e1Q0
BUILDING PERMIT Receipt # ` % - ~
To b~ w~A for Sr i1WG/C~ Est. Value $113 , 000 Date ?`~y '.'.6 , 19~"e
Sits Address 4850 Sheftiel~ Lane Erect ~ Occuponcy i: - s
Lot_-4- Blxk_..~_ Sec/$ub. ~ritCanZ~ SZ11 /11ter 0 Zoninp
pa~~e~ # lU Y50G4 OG 0 Oi Repoir p Firo Zone '•"+~t
Enlarge ? Type of Const. Vn
W Nome _ To~le£san Builders . Inc . ~„e ? # Srories 2
~ 1655 1Jorwood 'Jrive Qemoi;sF, p Length 5~
Ci ~~3L;an 55122 pho~ 454-6873 Grade ? Depth 5U Sq. Ft.
°C Nome ~1~~r Approrals Fee¦
,o
o~ Address Assessment pe~i~ 465. SO
u~ Cit p~~ Water 8, Sew, Surchorpe 5~' • 5~
Police Plon check 232.75
GW Nome Firo SAC ~2~.00
~
Address Er~. Water Conn.4 5(?
_~1(l
~ W C~ p~e Planner Water Meter 6li . 00
Councll Rood Unit ZSU.O~
I hereby acknowledye that I have read this application ond state thot g~~,
the informotion is correct ond ogree to comply with oll applicable $2039 _
State of Minnesota Storutes ond City of Eogon Ordinances. APC Totol
Sipnature of Pertnittes
1'oll~_f son Buildera , Inc .
A Building Pertnit Is issued to: on ths exprcss COndition thnt
oll work sholl be done in occordonce with oll oppliwble State of K!Iin~esoto $tatutes ond City of Eayan Ordinonces.
r-.,__------°--
Bufldinp Officiol
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing ~ f~ (p'27 3
H.V.A.C. ~ ~ ~t e ~C ~ l
w.u
Water
Disp.
S~wer
Electric W0 Z q ~ EC ~ 5-~.-.~3 t
weg~ z~ l G-z4~8'3 -
Inspection Date Insp. - Other
Fooei~~c -ao-~3 b
Foundation ~
Froming
Rouph Plbg. ~
Rouph HVAC ~
i""'i't'°" 3J 3
Flnal Plbq. -77- !.J
Final HVAC . - -
Final
W~~ D~sixibe Location:
YVell •
S~war ~
Pr. Dhp.
,
1
Receipt : ' ~-1 n ~ PLUMBINt~; PERMIT Permit No. ~ ~ / %
CITY QF EAGAN . , - _
, Fes - ;
~ FiII in numbered spacea S/C _
Type or Prrnt legib/y . . ~•:T~
1. Date 2. Installation Cost -
J ;
3. Job Address Lot ~t Blk. c=? Tract
_ ~
4. Owner
6. Contractor ~ _ - r j Phone ~
6. Address -
7. City - State ~I Zip ' '
8. Building Type: Residential ~ Commercia~ ? Institutional ~
9. Work Description: New ~ Add ? Alter ? Repair D
10. Describe
11. No, Fixtures No. Fixtures
~ Water Closet Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
i Shower Well
Kitchen Sink
Urina?/8idet 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.
Signed: for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
~ f
Receipt . i MECHANI~AL PERMIT Permit No..~ ~ ~
CITY ~F EAGAN
- Fea
~ Fill in numbered spaces S/C ~
Type or Print legib/y ,
Tot
1. Date ~ 2. Installation Cost
3. Job Address Lot ~/y/ ABIk. Z Tract ,
T ~T
~
/ ^
4. Owner - -s-.~.-•- ~
5. Contractor -c Phone 7 - ' % ~ %
Jl~
6, Address S % % '~t'^t--~ 'u"`'
7. City Statei7~ Zip ~ 5 ~
8. Building Type: Residential ~ Commercial ~ Institutional ?
9. Work Description: New ~ Add ? Alter O Repair ?
10. Describe Fuel Type ~ Yf.~'.-~..-~-s„!
11. No. ~7uipment 8TU - M. Ea. No. Equipment CFM
Forced Air ~ ' . ~
Air Handling:
Mfg.
Boilers Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other
Air Cond.
Mfg,
! Gas, Piping Outlets
12. I hereby certify that the above infarmation is true and correct, and I agree to
comply with all ordinances and coc~es governing this type of work.
Signed : ~ for
Rougn Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RCC6IVED ~
FROM
AMOUNT $ ~
~
~ OpL4AR4
~oo
~ CASH ? CNECK
FoR
FUNG COOE AIAOUNT
Thank You
BY
wn~te-Pavers caev
~ " Yellow-Posting CoPY
Pink-File Copy
CITY OF EAGAN Remarks ;
Addition BRITTARY 5'1'H ADDN Lot ~ Rlk 2 Parcel
Owner Street ~8~~ `~~I~~ State ~4~ ~ ~5122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR,
GRADING
SAN SEW TRUNK 1976 133. 57 8.90 15
# SEWERLATERAL 1 82 1 0~. 38~.1
WATERMAIN
* WATER LATERAL 1
WATER AREA 1$Q 0.6 6~.1
STORM SEW TRK ~ 1, 2 9 ~9• 3j~ 5
~ STORM SEW LAT 1~2 S
CURB & GUTTER ~
SIDEWAI.K
STREET LIGHT
~ . - -
WATER CONN. 45a. ° "
BUI~DING PER. 80']~j
SAC 525.0~ ~
PAR K
ThiS request vaiE ~~~/8 ~ / ~ ~
18 months Irom /
1
~ 2 517-~ ~ ~ ~~-u,~.t.~ . ~'i~
RequeM DatB Fire No. FouPh-in Ins'ec[ion
Required? ~ Y ~ReadY Nuw ~ W~II Notify. InsPec-
July 14~ 1987 ?Yes ~~]No Whe~ Reaav
~ Licensed Electncal Contracmr 1 hareby reqaest insvaction of ahove
? Owner elacvical work ins~alled at:
Svee[ Adtlress, Box or Rovte No. Ciry
4850 Sheffield Lane Eagan
ecLOn o Townshf0 Name or No. Range No. County
Dakota
OcwGan~ (PflINT) Phone No.
Richard Martin 452-0921
Power Sup0lier A~idress
Electrical Cnntracmr IComDany Namel Cnnvacmr's License No.
Corrigan Electric Company 03954R 8
Mailing Address (Contractor or Owner Makine Instailation~
P.O. Box 475, Rosemount, MN 55068
Aut r-zed Signature ( mractor Owner Makiny Ins[allatinnl Phone Number
, ~ 423-1131
MINNESOTA STATE BOA F ELECTRICIiY THIS INSPECTION REQUEST WILL NOT
Grigpa•Mitlwey Bldg. - Itoom N-791 BE ACCEPTED BY THE STATE BOAFD
1821 Univarsitv Ava., St. Peul, MN 55704 UNLESS PPOPER INSPECTION FEE IS
P~one 1612J 642-0800 ENCLOSED.
~J/j~-~~? REQUEST FOR ELECTRICAL INSPECTION e~s7-oao/ot.-osG
, See instructionaYOr como~bting this torm on 6ock ot vallow copV~ /-~`W~ /
7 7 'X" Below Wo~k Cove~ed by 7hrs Request
Fdtl Nep. ~ TVPe oi BuilAing AOP~~011C03 WireO Equipmenl WireA
g Home Range Temporary Service
Duplex Water Heater Ligh[iny Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldg. Furnace Silo Unloader
Industrial BIAg. g Air Conditioner Bulk Milk Tank
Farm ther peci y ther ISp~ar,ify)
t e yeufy ther Oth¢r
ompute Inspectlon fee Below
p Fee ServiceEMrencaSize H Fea Fexders/Svbleeders p Fne Circuits
U to 200 qm s 0 to 30 Am s 1 0 30 Am
Ahove 20D qmps~ 31 to 100 Amps 31 to 100 Am s
Swimming Pool Above 100_Am s Above 100_Am s
Transiormers Irrigation Boorc~s Partial.'Other Fee
Signs Special Inspection S TOTAL EE
Aemarks 1~. rj~ .-~l~
C •Cl~•
Bough-in Da1e I, the EI v-
Inspector, heraby
cer~ify the~ the above
Final ~ paction has bean
~ ae.
mb request roiU 1B montM imm
This reQUest voidS-L~ 6a ~ B cC~-C~~ 5~ ~ s~(~ z.
18 monlhs imm ~
~1073943 G~~~~
Fequest Date/ y~ Fire No. R~oqgh-Bi~n7 nspection ~Ready Now ~ Will Natif¢ Inspec-
~ /(p O~ ?~es ?No [or When fleatly
Licensed Electrical Convacmr I hereby requeaf inspection ot above •
Owner electricel work instelled et:
Siraec AdQre~BO~R~te No. City /
ro ~ ~
trcL-e~ ~Ct,VL ~ ~
ectron o. Township ame or o. ange No. Counry ,
Occup~ (PRINT) Phona No.
I~L.Ce~
Power 5 V ier Adtlress
r~!-Ke.9~o7-
Elect~n
Contractor IC~om-~pany ~Namel Conrractor's License No.
~i~t .C~ c~c£r~.C ~~/b o3 '
Mailine dress (CoMractor or Owner Makine Instailation~
S - ~!J ~~f~
Autho ' SiBnature (Contractor Owner Making Installationl Phon/e Numb~er~j
OU / f -
MINNESOTA STATE 80P.XO OF ELECTflICITY THIS INSPECTION 0.EQUE3T WILL NOT
Griags•MidwaY Bldg. - floom N-791 BE ACCEP7ED BY THE STATE BppqD
1827 UnivarsitV Ave., St Paul, MN 66104 UNLESS PNOPEN INSPECTION FEE IS
e~___ ~a~~~ ~e~ ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
' Sea inetructione for completing this form on beck oi yellow copy.
C"~ ~ !(J~,~
" X" ~elo~W ~~o%red by This Request ~J S~~D Z
AAtl flep. Type o~ Builtling APPlinntes Wired EQUipmentV/ired
Home Range Temporary Service
Duplez Watar Heater l.ightiny Fixtures
Apt. 8uildinc~ Dryer Electric Heatin
Commercial 81dg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Fafm Other vec~ v ther (Snecify)
t er Voc~ty t or Other
ompute lnspection Fee Below ~
p Fae ServiceEntrenceSlie b Fee Faetlare~Subleadera N Fo Circuits
0 to 200 qm s 0 to 30 Am s 0 to 30 Am s
Above 200 qmps 31 to 100 qmps 37 to 700 A
Swimming Pool A6ove 100-Am s Above 100_Am s
Transformers Irrigation Booms ~ Partial-'Other Fee ~
Signs Suecialinspection 5
Remarks i0 TO F
b.o
flouBh-in Dete ~ t ecvical
Insoectoq heraby '
certifv ~~at the abave
Final Date~s ^ inspee[ian has been
~ y mede.
iTla reeumt vole 18 montlo irom
This requesi voitl ~ Zq
fr3 Ly g a, pQ`~w'!~-~ h{~ Si ~ 3~7
16 months irom ~
~YG'8127~. ° ~9,so
Aeqvest Uate'~~ Fire No. Bau h-in InsPection ~~SPe,
rted7 ~Reatl Now~W~ll NotilY.
l.0 -83 ~e= ?No /'T tor When Raady
Licensed ElecVical ConVaclo~ I hereby requeslinspection otebove
Owner - electrical work inslalled at
Sveet Address, Box ar Route No. Citv
z~ ~ ,
ecLOn o. Towns~ip Name or No. Rangu No. County
1
OccupantlPRI(NT/) ~ Phone No.
~ 1 ( L I" .]c~ / /
Power Supplier Address
i
Elect ~cal Conhactor (Compeny Namel Contrector' Licinnse No._ /
~ LJ S~ ~
, ~ r
Mailine dress IConva r r Owner Makfna Instailationl
.5 ~ ti u.) ~
Authorized Signaiur c[or Owner kinB~ Installationl Phune Num /er
V/ u1~ lS~ ' l0 ~ ~
MINNESOTA STATE BDAND OF ELECTflICITY THIS INSPECTION NEQUEST WILL NOT
GrigBS-Midway Bldy. - Room N•791 gE ACCEPTED 9Y TME STATE BOAHD
l1NLESS PflOPEfl INSPECTION FEE IS
7821 University Ave., Sl. Peul, MN 55704 ENCLOSE~.
e._" ~a~oi oov»~?
REQUEST FOR ELECTRICAL INSPECTION EB-00007-Oq
w:
' Sae imiructions for completi~ this torm on beck ot Vellow copV~ ~
'"R~ Belo ~~or7c Co~ered by Thrs Request 3~D 7 0~ v~
Add Hep. Type o1 9uildina APO~ionc95 Wi~Bd Epuipmen~ Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electnc Hea[in
Commercial Bldg. Fumace Silo Unloader
Industrial Bidg. Air Conditionei Buik Milk Tunk
Farm e~ ~ er ISper.;ryl
t nr Succi y r Oth~r
ompute Inspection Fee Below
tl Fee ServicaEntrance5ize p Fee ieetlers~Subteaders # Fee Circuits
0 to 200 Am s 0 to 30 Am s 2 0 tn 30 Am s
Above 200 qm~s 31 to 100 Amps - 31 to 1U0 q y
Swimming Pool Above 100_Amps Abave 100_Am s
Transformer5 Irrigation Booms .,SIJ Pdrtial.'Other Fee
Signs SNecial Inspection g ph 7pT F
flemarks ~ 0 ~
y
Houeh-in . Dace_l~S
v~ w . ~~a ~a~
Inspactor, hereby
ertily the[ the above
final ~ " ~ection ~as been
de.
?
Thle reaueet voi018 monlha ~rom
CITY OF EAGAN ~7 p
~795 PIIaR~Kno6 Read Eegan, MN SSI~ lrO O~~S
PHONEs 454-8100 I •
~11LDING PERMIT Receipt #
Te ba u~ad fe~ SF DWG/GBR Est. Value $113~000 pa~e May 26 ~q 83
S~ro Address 4850 Sheffield Lane Erect Occupanq R-3
Lot 4 Blatk 2 Sec/Sub. BYittany Sth Alter ? Zoning R-1
Pnrcel g 10 15004 040 02 Rapo~r ? F~re Zona NA
Enlarge ? Type of Const Vn
~c Name Tollefson Builders, Znc. lvlove ? # Srories 2
Z Address 1655 Norwood Drive pen,oi;sh ? Length SZ .
~ agan 55122 ~o~ 454-6873 G~vde ? Depth 50 Sq. Ft.-
p OWiler Avv~ovals Fees
o Name
~Address Assessment Permit •
~F Woter & Sew. Surchorge 56. 50
C~ Phone 232 . 7 5
Police Plon check
Gw Nnme Fire 5q~ 525.00
4~ Address Eng. Woter Conn.4~Q~~
~W pha~ Plonner WaterMeter 60.00
Cauncil Rood Unit 250.00
I hereby ackrwwledga that I have reod this opplication and stote that BId9• ~f.
the inlormation is correcf and ogree to comply with oll applicable APC Total $2039.75
Stote of Minnezom Statutea ond City of Eagon Ordi~onces.
Siqnoture of Permittea
Tol e son Bui ders, nc.
A 8uildfng Permit is Issued to: on tha ezpreas condition Ihm
all work sholi be done in accordance with cll appli Is1 ate inne:oto~tes ond Ciry of Ecgan Ordinances.
Building Officfol ~a~~L
CITY QF FAGAN Include 2 sets of plans,
~ M1~ ~ 1 site plan w/elevations &
BUILDING PEPMIT APPLICATION 1 set o£ energy calc.vlaticns.
-~-C~-r' ~ I .
4n He osea For C ` valuation //~ooo D~.,te 5~~19i _
Site Address ~ C~FICE USE ONLY
I,ot Block Sec./Sub. Vl W~ Erect J~- ~~S!
Parael lb 1~R2c7~ 0~0 C~~- Alter ~~'iirx7 t~
'I FEpair Fire Zone
Owner: F~1ar~Ie _ `LYL~e of CAnst.
Nbve # Stories '2~
1°~~58~ Dernlish Front ft.
~y~,/~yP Grade Depth d it.
Phone
APPROVAIS ~S,-
Contractnr: '~l ~P~VI ~f.l(r~~~` Assess~cients Pexmit
t4ater/Sewer Surrh~TM~e _56, .~1J
Hdclress: ~ 5~ ~(7ViA~ ~11f~ Polioe Plan c.~eclc ~.?i'
City/Zip Oode: ~~/~/I ~j Fire SPG 5'7 t. 00
Wates Conn- ~ a+~
Phor~e ~ ~~i~J~ ~~er ~ Water Meter ~~,o
, Council Fnad Unit 9 Sl~, ~J
.~~•/~5• ~ B1dg. Off.
j1d4~I'E'S5:
Clt}(~Zlj~ COC~i2: ~
Phone ~p,L 2 O'~ ~l ~`f `~a
~
~ ~ ~G ~ w~ ~ - i,J ~ -7 3 ~l ~ ~a - ~aab~~ ~~C S -14 Ff3 C.~ FJw~ ~
:&RSd F~!`]IT
'f EChOB ~ID
. ,"iN 55122
1._, 9 -5B fl-4675
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C: r-~; v~:-~ CJTTL.i LY?S-Qa1C~
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
~~'(1 3830 PILOT KNOB RD - 55122 CI~
l 657-681-4675
New Construetion ReaNremenfs Remodel/Reoah ReaulremeMs ~
)
? 3 registered sRe suneys showing sq. H. of lot, sq. lt. of house 2 copie~ of plan
and all rooled areas f20% maximum lot coveraae albwed) 1 set of energy cakulaflons (or healed adtlHlonf
D 2 coples of plans (show beam a window sKes; poured ind. design; etc.) 1 aXe survey lor extedor addiHona 3 decb '
D 1 seT of energy calculahons
D 3 copies ot hee preservafion plan H IW plaMed aRer 7/7/93 O~
DATE: ~ I I ~1 ~"1 7 CONSTRUCTION COST:
~
DESCRIPTION OF WORK: '
STREET ADDRESS: S~ ~ i~Q L
LOT: BLOCK: a SUBD./P.I.D. Y~~C~'A ~'L -~S~
Name: V ~~NP l~ ~v~"~ Phone ~J` r 7?,.~^ - ~ ~ )o
PROPERfl ws~ FIM
OWNER / /p'J~ ~l1~/ / ~ /
Street Address: `l
r~ Li ~ ~
City f.G ~f~'~ StaFe: Zip: S~/ ~
1
~ i' /,~ns~ ~~~n . 6I1- ~3r~
Company: 1~ w Phone
/ (area code)
CONTRACTOR ~ ~D J~?, ( ~j ~
Street Address: VL/~ d c. License N a ~~~a~~ Exp, l dU
Ci~Y ~OG''M-~~h ~ State: " Zip: S.S~~ U
ARCHITECT/
ENGINEER Company: Name:
Telephone area eode ( )
StreeY Address: Regishation 8:
Cryy State: Zip:
Sewer R wafer Ilcensed plumber (reaulred for new conshueHon oniv):
Penalty appltes when address change and lat change is requested once pe k Is Issued.
1 hereby acknowiedge ihaf I hwe read ihis appllcaNon, stale fhaf fhe IMo o h co , a d ree fo comply wMh ali apptfcabl
Sfate ol Minnesota SiaTUtes and Cfy of Eagan Ordinances.
Signature of Appllcant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? O6 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool O 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition O 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.' ? 41 Wood Stove ? 45 Fire Repair
? 34 Repair ? 38 Demolish (Interior) ? 42 Reroof
` Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main Ievel sq. ft. SAC Code
UBC Occupancy _ sq, ft. No. of Units
Zoning sq. ft. No. of Bldgs
# of Stories sq. ft. MC/ES System
Length sq. ft. City Water
Width Footprint sq. ft. Booster Pump
PRV
APPROVALS Fire Sprinklered
Planning Building Engineering Variance
Permit Fee ~~--~'-aS Valuation: $
Surcharge ~_C~C~
Plan Review
License
MC/ES SAC :
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit =
S/W Surcharge %
Treatment PL ;
Park Deci.
Trails Ded.
Other
Copies
Total: ~~~.25
SAC Units
% SAC
(,1"IY UJ~: U1VLY
LOT ~ BL 2' PERMIT ~ I
SUBD. I~J~~~clhN ~{E~ xECS~rr 1 a~y ~I ~
RECEIPT DATE: l ~j -d G~
2000 MECHANICAL PERMIT (RESIDENTIAL)
cixY-os Eacr~rr-
3830:-:PILOT` KlIOB RD .
.EA6AN A4~1 55122
q 651-681-6675
Date: ~ - f
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not ownerloccupied.
• HVAC: 0-] 00 M B T U $ 30.D0
ADDITIONAL 50 M BN - 6.00
• Gas outlets (minimum of one required Q$3.00 ea.)
State Surcharge .50
Total $
Complete this section onlv if you are remodeline, addin~ to, or repairins an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
_ New ~ Alteration _ Aepair _ Other
~ Furnace _ Au conditioning
_ Air exchanger _ Other
Fee $ 30.00
State Surcharge " .50
Total $ 30.50
Reminder: Call
for irtspections
sirEnnD~ss: U~50 SI'lefrfl~lc~ Lh .
owivsx Nn~: ~Qlrl G~ VO Sh ~ ~ ~ PHONE 1051 - ~I'rJZ-'~ 7"rJZ
t I,~I (AREA COD~ -7
INSTALLERNAME; UVU(JI~}~S ~b~~~~I~ PHONE#: (DIZ _ `y~I' IO~q
sz~xEEr nnnxFSS: lPq 5 0 1,~ • ~ ~I tt! 5~ I`~-e 1 dl.~p CODE)
CITY: V STATE: ZIP: 55 ~
~aR 1 o zooo /~,~P ~ c~1a2'~
SIGNATURE OF PERMITT'EE
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2ollefaon Builders Inc. ~ tiC~~ Or.1IG~9
~ ~ ^ ~ ~ 188-1
.
~ JACKSON - ~ U EYORS
~
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' RLGIfT[R[D UND[R LAWt ~1~T[ a YII{M -
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o= Ir~n 3616 EAST 55th STREET, MINNEA OLIS, MN 5541J0~ 72734 ~N i
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SEDGWICK HEATING & AIR CONDITIONING CO.
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 • (952) 881 -7739
1 4? - SD 3r FtC,u) L>J
ADDRESS
OCCUPANT
SOLD BY
MAKE
SERIAL NO
FORM 235 (REV. 6/08)
39 9 /277 Z7'/ '
PR p % 2otu
FAN SETTING
PILOT TYPE i7 e-1 .74% '
IGNITION MODEL
PILOT TIMING
9
PRESSURE ( � PERCENT CO Y '
INPUT CFH ov PERCENT 02 7.0
STACK TEMP. / Z PERCENT CO
HEATING
TEST RECORD
CITY A
OWNER
INSTALLED BY
MODEL �+ r` 1-1 1, C0 1)
INPUT
THERMOSTAT I P 4 DO
VALVE
UMIT LINER SIZE
LIMIT SETTING FILTERS SIZE 0-0 >c 3{7 �/
NUMBER /
VENT SIZE
TYPE OF LINER "VC-
WIRINGtir
TEST TAG
LIGHTING INST.
DATE TESTED
COMPANY TESTING
NAME OF TESTER ^ Z Ae;
JOB NO 3 -b tq 53
FORM DISTRIBUTION: WHITE COPY - JOB FILE YELLOW COPY - CITY
Date:
Gity of Eagan
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 #:
Permit Fee:
Date Received:
Staff:
L
2016 RESIDENTIAL PLUMBING PERMIT APPLICATION
4/5//e
Site Address:
t 50 s►L4 Liz/d) La-huu
Tenant: Suite #:
Resident/Owner
Contractor
Type of Work
Permit Type
Name:
Lal - e14-uu
Phone:
Address / City / Zip: ' 50 _ 1� r l eQ. La -4w 1
Name:
tit5L-qq4-- (0855
/4t IV 55f as
ti(-Oct7 GOCe
License #:
Address: 3 440 7 l- e City: -A'
State:
v Zip: 5‘ -vat (p Phone: r (5- 81P-if10
Contact: T 1 M - r6ER Email: W. CL'W ` h el"
_ New Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
ansa W atm i
Lawn Irrigation ( RPZ / _ PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / Lower Level)
Water Turnaround
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround` (includes State Surcharge)
"Water Tumaround (add $280.00 if a 3/4" meter is required)
$115.00 Septic System New (includes County fee and State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Cali 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.
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.
dc IA 6C tuY‹..
Applicant's Printed Name
Applicant'ss 444())-TO
�gnature
FOR OFFICE USE
Reviewed By: Date:
Required Inspections: Under Ground Rough -In
Meter Related Items: Meter Size
Air Test
Gas Test Final
Radio Read Manometer Staff:
tise BLUE or BLACKC Ink
Cillof .„ , i
4,1I'' ,,,„ 1 7 71117 i Fort/dem Os.
Pennit /4__ 3 -7ICC
,, Penult Fee: 029 t
3830;Pilot.Knob'Road 1 g I {�1 t
Eagan MN 55122 4 Q 1 i
Phone:(651)675-5675 f Qy" k
buildinginspectionsCa�cityafeagan,cam t stair: t'
t, i,_
SI N I IA P" I APPUCA1104
Date: 8'9/2017 S Site Address: ihdt .
: Hans and Elizabeth Larsen :651-994-6855
Fhone
Residomi
owner Address/city/zip
4850 ie
Apprcantis: X Contractor
Remove and,rept deck
Dancatatort of work-
Type
Guns n , :(Yes / X )
:4':3k s'a: $.
PSI Decks : Wade Tinwri
Conmany. Contact
Contractor Address' 35V ks* .i. g _LN: , ;Pty ! ►
AtilS1 55447 612-5.M-3811 wad. Vii,• . hi .. _ s ,-
: Promo anal:
BC636117
License it: Lead QwWtocaft If:
If the project is exempt from leadce _ i n expiate
/ v/G,i /N i*3 (4-'r
COMPLETE THIS AREA ONLY W CCMISTRUCTING A►:MEW BULTIR&G
In the last 12 months,has the City e1 Eagan issued a for a sharer plan based on a master plan?
Yes No IIyes,datearid.4 ole!s,s of inacter
licensed r Phone:
Mechanical actor:
ISewer&Water Contractor:
Suppression Contractor:
NOTE:Plans and supporting Dina y areed lla be pubic
_ x Parities=of Noe
infonnation may be ciassibed as nota you the City to coat:Mee that they
are trade secrets.
You may subscidae to receive an electronic notadcation horn die City of proposed onffinances by signing op for an ema8 madate on
the City'swebsalla at www.citvafeagan.com/subscribe.
Exterior work authorized by a budang pentad issued in accordance wet**idenesate Stade litidang Code mbe complebad within 114
days of permit
CALL SEPORE YOU at for GaAs tours before
you intend to dig to receive locates of ground . www.gooherstateonecait.orq
1!hereby actoowdedge that this infciiniation is conedete and ;that the work wa be in condowiance with the orchlances and codes of the City of
Eagan;that I:understand is not apevardt but onty an applocaden for a permit and wok is stet to start wdbout a ' that the work we be in
accordance with the approved pian in the case of work 101,CAY requires a review arm approval probes.
XWade;1 —'-a
Applicant's PrintedName net's lure
Paget of 3
, "j{ -s--0 S/iC Me /J Lc- {-F _
DO NOT . OW THIS LB4E / ,S- 3 7
SUB TYPES
Foundation Fireplace Porch(3-Season) Family)
Single Family ~ Garage iPorch(4-Season)n) Exterior Alteration(Multi)
Multi IC l _ himarameous
el of_Pkve Lower Level Pool — Accessory Stalling.
WORK P S
tO New _ Interior hirprovement SidingDemolish Building*
AthRtion Demolish kites**
_ _
Alteration - Fire Repair _ Windows — Demolish Foundation
Replace Repair Egress Wardens Water Dintifte
Retaining Wall give PCA handout to applicant
DESCRIPTION o,
Valuation G' ..- Occupancy Z) -/ IMESystem _
Plan Review Edition AD/,y SAC Units
(25%100% / Z /Z./ City Water ...,
Census Code 113 if Stories .---- Boaster Pcunp --
It of Units / Square Feet 6.7/ PRV
Si of Buildings I Length 14
Fire Stypression Required ---
Type of Construction 2,3 mail 34-1/1
REQUIRED W :.ECT ...
footings �'. .,1 Meter Time:
Footings j k) Final I C.O.Required
Footings - ) I No CM-Requked
.
Foundation Foundation Before Backlit! FIVAC Gas Service Test Gas Line Air Test
Roof: Ice&Water Final Pock_Footings Ak/Gas Tests __Final
If Framing 30 Minutes 1Hour n Tile
Fireplace: ,Rough In _�._Air Test Find `..�._Stucco Lath .4+,:_Stone Lath Brick—EF#S
Insulation Windows
Sheathing Retaining Wall: Footitgs—Backlit, Final
Sheetrock Radon Control
Fire Walls Fire Su _Romp In Final
Braced Wails Et"Control
Shower Pan Other:
Reviewed By: fit
RESOENTIAL -11 -.
Base , ?(: 7 ,,�. �'�, --G5
Surcharge
Plan Review 11,5-
MCES SAC
City SAC
Utility Connection Charge
&8 N Permit&Surcharge
Treatmerd Plant
Copies
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA152310
Date Issued:10/09/2018
Permit Category:ePermit
Site Address: 4850 Sheffield Lane
Lot:4 Block: 2 Addition: Brittany 5th
PID:10-15004-02-040
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.
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 -
Hans Larsen
4850 Sheffield Lane
Eagan MN 55122--277
(763) 203-2896
Wildwood Construction
4703 Bristol Blvd
Eagan MN 55123
(612) 369-1422
Applicant/Permitee: Signature Issued By: Signature