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2008 Zircon Lane CITY OF EAGAN 12104 ~ , 3830 Pil~ot Knob Rosd, P.O. Box 21-199, Ea9an, MN 55121 I'y ~ PHONE: 454-8100 BUILDING PERMIT Receipt M , To bousedlor R1s'PLACE WINDO*JgValue $5,400 Date JUNE 11 , 1g 66 Site Address 2008 Z IRCON LN Erect ? Occupancy Lot 8 Block 11 SeciSub. CEDAR CsROVIs' 1STRemodel ? Zoninfl Parcel No. Repair ? Type of Const Addition ? No.Stories ~ Na~ RUTH Z IERDON Move ? l_ength # E Demolish ? Depth Address o Int Impr. ? Sq. Ft Ciry Phone Inatall IX o Name HARVk:Y H. BRAUN CONST APProvals Fe" Address 3732 P I LOT KNOB RD Assessment Permit $56• 5 0 ~ City EAGAN Phone 454-3335 Water 8 Sew. Surcharge 3.00 t¢ Police Plan Review v= Name Fire SAC ~ a Address Eng. Water Conn. i~ City Phone Planner Water Meter Council Road Unit I hereby acknowledge that I have read this application and state thatthe Bldg. Off. 6 10 8~ Tr. PI. information is correct and agree to comply with all applicable State of Minnesota Statutes and Ciry of Eagan Ordin nces. APC Parks t' Var. Date Copie Signature oi Permiriee _ TOtel A Building Permit is issued to: H"V$Y H. BRAUN CONST on the express condiUon Uhat all work shall be done In accordance with all appl g" State of Minnesots Statutes and Clty of Eagan Ordinances. Building Officiat ~ P«mit Mo. Pwmw Mow« oaa rd.vhon» r Pkimbirto H.VJLC. ~ ai Sr 4 4 ~ ~ M.afttio, Do. InW ~ ~I Fooli 11 Foundedon FnmYq RoolYp ROUph PlbW RouYA Mlp. Imui. ~e Fb.+ Heo. . :~~€8 ~l • FkW ftg. swo. Fti.l cae. ooo. Dwek F1o. Dock Frnp. OMCi1b~ locdlon: WO11 r?. Wsp. I PERMIT # CITY OF EAGAN FEE dz) ~ MECHANICAL PERMIT RECEIPT 45!~-8100 S/C MINIMUM RESIDENTIAL FEE - $10.00 + =.SO TOTAL ) DATE ~ L MINIMUM COMMERCIAL FEE - $20.00 +=.50 1. Bldg. Type: RSs ~ Comm Inst 2. New Add Alter Repair . ~ / 3. Total Bid Price J4. Job Address c Lot Biock Sec 5. Owner 6. Contractor 1411 (Ma"'°) 1 i_jj (sv°eQ (cinr) RiP) 7. Contractor Phone # f•RESIDENTIAL HEATING - 01-100,000 BTU's - 524.00. Eech additional 50,000 BTU's or fractlon -$6.00 RESIDENTIAL COOLING - 01-24,000 BTU's - $12.00. Each additional 6,000 BTU's or fraction - $6.00 MODIFICATIONS/ALTERATIONS -$10.00 minimum fee , r } ~ HEATING VENTILATING HOT WATER STEAM AIR COND. -AIR PiPING PROCESSED PIPING AIR HAND. EQUIP. RtFRIG. RES. GAS PIPING OUTLETS - $1-50 TANKS: LP. UNDERGROUND OTHER COMM./IND. RATE - 1% OF TOTAL BID PRICE PLUS $.SO STATE 5URCHARGE FOR EACH $1,000 OF FEE. tor Approved Inspections: Date Rough Insp. Date Final Insp. CITY OF EAGAN Remarks* C~x' GL^yva% quisition AdditionSEl]8R GROVE #1 Lot R Bik 11 Parcel - 10 16700 080 11- Owner Street 2008 2]rootl L3Ae State ~an D1N 55122 ~ r. Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. c~ STREET RESTOR. GRADING SAN SEW TRUNK SEWERLATERAL 1972 1,304.00 52.16 25 WATERMAIN # WATER LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. gUILDING PER. ~ SAC PARK ' ~ INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: "t I `4 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 , . 1.~ SITE ADDRESS: APPLICANT: . [ Rr nN 1 ANh- ~ E t';,; l:;, t I' i ! , 1 PERMIT SUBTYPE: TYPE OF WORK: INSPECTION D• • DA ~ ~ 1 Permit No. PermR Holdsr Dati! Telaphone # I ELECTRIC , PLUMBING HVAC Inspection Mte Usp. Commenb I FOOTiNGS I FOUND I I FAAMING ROOFING ROUGH PLUMBING PLBCi , AIR TEST ROUGH HEATING GAS SVC I TEST I INSUL I t3YP BOARD • I ~ FIFiEPLACE • ' , , ~ FIREPIACE ' I AIR TEST I FiNAI PLBG - . . I C FINAL HTG 1 ORSAT TEST BLDG FINAL .J . BSMT R.I. - • . , BSMT FlNAL , . DECK FTG . DECK FlNAL ,i . i • ' ' f I P. . , ~ 7, PERMIT# ~1 U ~e;cl RECEIPTDATE: 2002 RESIDENTIAL i'LUM$INfi PEftMIT APPIICATION CI1'Y OF Ef1fiAN SSSO f1LOT KNOB RD gtkHAN, MN 55122 651-697-4675 Please complete for: single family dwellings, townhomes and condos when permits are required for each unit, /har.kflow oreventer for irnoation svstem_ _ 1 ZIERDEN, RUTH SITE ADDRESS: zooa ziRCON LaNe ~ - EAGAN, MN 55122 ~ OWNERNAME : (612)819-5451 ~ TELEPHONE#. ` J (AREA COOE) INSTALLER NAME: ~ O b I d Yv'1 ~ I IA.WtI~I ?l.c~ TELEPHONE # (D IZ' 22--7' 1-fd$3 STREETADDRESS: z°C~S C7Glr1P1GIGI ATVY,h"e. SOWV'Lt (AREA CODc) CITY: (vti~'JLS. STATE: M~ Zip: 551-4 0~ _ SEPTIC SYSTEM, newlrefurbished (requires two sets of plans and MPC license) $ 100.00 includes $40.00 County fee Note: Additional consultant fees may apply • MODIFICA710NIALTERATION TO EXISTING DWELLING UNIT, INCLUDING _ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00 _ Abandonment of septic system. _ Water tumaround - existing dwelling unit 5/8" meter if needed -$118) Other: _ RPZ: new installation/repaidrebuild $ 30.00 _ lawn irrigation system ReplacemenUadditional: _ water softener X water heater $ 15.00 State Surcharge $ 50 Totai $ I5.50 I hereby acknowledge that I have read Ihis application, stale that the in(ormation is correct, and agree to comply with a Iapplicz an ordinances. It is Ihe applicanYs responsi6ility to notify the property owner that the City o( Eagan assumes no liabiliry for any damages caused by the City during its normal operational and maintenance actiwhes to the facihhes construc[ed under this permil wilhin Cit pro ertytright-of-way/easemenL p C 7n^7 i ' ~ SIGNAfU OF PERMITTEE 1102 CITY OF EAGAN , . F 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 12104 • BUILDING PERMIT PHONE: 454-8100 aeceipt a ri 3 7o be used tor REPLACE WINDOiQ7a~.Value $ 5,4 00 Date JUNE 11 1986 SiteAddress 2008 ZIRCON LN Erect ? Occupancy Lot 8 Block 11 Sec/Sub. CEDAR GROVE 15T rtemodel ? 2oning Parcel No. Repair ? Type of ConsL Addition ? No. Stories RUTH ZIERDON n4ove ? Length z Name AME Demolish ? Depth o Address Int.lmpr. ? Sq Ft. Ciry Phone Install IN o Name HARVEY H. BRAUN CONST ApProvals Feea nddress 3732 PILOT KNOB RD Assessment Permit $56.50 ~ Clry EAGAN phone 454-3335 Water&Sew. Surcharge 3.00 ~ Q Police Plan Review F w Name Fire SAC _z ~ z Address Eng. Water Conn. a w Ciry Phone Planner Water Meter Council Road Unit IherebyacknowledgethaUhavereadthisapplicationandstatethatihe Bld9 Qff. 6/10/86 Tr.PI. mformation is correct and agree ro comply with all applicable State ot Minnesota StaWtes and Ciry, ol Eagan Ortli ance5s APC Parks Signature ot Permittee~' Var. Date Copies 59 - Total A Building Permit is issued to: HARVEY H. BRAUN CONST on the express condition that all work shall be done in accordance with all le Stat ot Mi nes a Statutes and Ciry of Eagan Ordinances. Building Ofticial VS CITY of EAGAN N4 - 3325 BUILDING PERMIT ~py'~ 3795 Pilof Knob Road Ownee -~••."~~~J...... ~ £agan, Miaaesofa 55122 Addsesc (Present) ..~........:7^...... 454-8100 % BuSlder ........:CR~I ~ ~ ~ Dsle o'_ 2 y Addrese DESCAIPTION 5torias To Be Ucad For Fson! Deplh Height Eai. Coa! Pexmi! Fsel Aemulu .3 J ~ a • ~ LOCATION /7- od Streel, Road or olher Desariplion ot Loaalion I Lot I Bloek Addilion or Trae! 'Ihis permii does not aulhorize the use of sireefa, roeda, alleys or sidewalks nor doee it give the owner or his a9en! the right !o ereaie any situafion which is a nuisance or whieh presenfs a ha:ard !0 the healih, safetp, eonvsnienes and geaeral melfaxe fo anyone in the communitp. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WOAK IS IN PROGRE58. This ie So eerlifp, fhal....... 21 .------------------has permisaion !o areet a.._...._,~.`.`..:.`.~.`.:"J~..~...~,.................. _upoe the above described premise subje t!o ihe provisions of all applicable Ozdinanaes for fhe eiiy of Eagan ................2.4 . Per Mayor 41-15 Hutldinp Impscios ~ EAGAIV TOWNISHIP M 390 BUIieDIiVC', PERMIT Ownex ~ ~~~C_G/2.4~......' ~ E84an Township / - " - Address (Pleseni`.`~'~- Town Hall Buildes Address . Daie - ( DESCAIPTION Slories To Be Used For FsonS Depih Heighi Esi. Cosf Permi! Fee Remarks LOCATION Sireef, Road or her Descripiion of LocaYion I Lo! 83ock Addifion or_Traaf / , This permit dces not auihorise f/he use of sfreefs, roads, alleps or sidewalks nos does it give the owner or his agen! the righi fo creaie any sifualion which is a nuisance or whieh presenls a hezard !o the healih, safefy, convenience and genexal we7faxe !o anyone in the communitp. THIS PEAMIT MUSh~EPT Ct'Fi~THE P/~gEMILSE WHILE THE WOAK IS IN PROGAESS. This is !o eriify. S l.:-- .lP~:!: fir•'.~x~l~'IS~.~.:~?t~4!f~/`.---hasPermission !o ereci a._..~...~i. .-~.iFr~-~--J----.--.--------upon the above scribed pr~~ e s ' f!o !he pzovisior.s of the Building Ordinance for Eagan Tovins%p adopted April 11, 1955. Per ' - - Chairman of To Board Building Inspecior _ PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 028418 (612) 681-4675 Date Issued: 0 7/ 2 9/ 9 6 SITE ADDRESS: 2008 ZIRCON LANE LOT: 8 BLOCK: 11 CEDAR GROVE 1ST P.I.N.: 10-16700-080-11 DESCRIPTION: - (ROOFING) Building Permit Type STORM DAMAGE Building Work Type REPAIR Census Code ` 434 ALT. RESIDENTIAL . . REMARKS: FEE SUMMARY: CONTRACTOR: OWNER: - APPlicant - ZIERDEN RUTH 2008 2IRCON LN EAGAN MN 55122 (612)454-1316 I hereby acknowledge that I have read this application and state that the information 3s correct and a9ree to comply with all applicable State of Mn. Statutes and City of Eagan Ordinances. L &-~l APPLICANT/PE TEE SIGNATURE ISSUED . GN URE 194191996 BUILDING PERMIT APPLICATION55122 RESIDENTIAL ( ) 681-4675 New Canslrudion Reauircments Remodelhteoalr Reouirementa ? 3 repbtered eke auneys ? 2 copies ol plan ? 2 copies of plans (indude Deam d window sixes; poured Md. dealgn; ete ) ? 2 sile surveys (exlerior addkions 6 decks) ? 1 energy wlculation! ? 7 energy calculetions for heated additions ? 3 copbs of tree preserverion phn H bl platted afler 7/7/93 iequlred: _ Yes _ No DATE: CONSTRUCTION COST: DESCRIPTION OF WORK: STREET ADDRESS: Z~~ LOT ~ BLOCK SUBD./P.I.D. ~,Dr~ltri ~Xfilh'.I~A PROPERTY Name: z/~ R D Cl}~ A(1 ~ V7 PhOne OWNER IMIT Street Address- Z~ec d/g) /-/,qajE City: C- Py State: M /0 Zip• CoN7w?c7oR Company: Ap ' Phone Street Address: License City: State: Zip: ARCHITECTI Company: Phone ENGINEER Name: Registration #Street Address, City: State: Zip: Sewer 8 water {icensed plumber: . Penalty applies when address change and lot change are requested once pertnit is issued. I hereby acknowledge that I have read this application and state that the info ation is correct and agree to comply with ail appliqble State of Minnesota Statutes and City of Eagan Ordinances. ~ Signature of Applicant: , OFFICE USE ONLY CeRificates of Survey Received _ Yes No Tree Preservation Plan Received Yes No 1986 BOILDIN~HlQT APPLICATIOH - CITY OF E9GAN HOTE: ALL CABTRACIOES MOST BE LICE9SED WITH THE CITY OF EAGAN SIAGLE FAFIILY DAEI.LINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MOLTIPLE DWELLINGS - RFSIDENTIAL 9Et7T6L Q9ITS FOR SALS ONITS ZNCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQItVEY - CHECB iiITH HLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COl4lERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, i SET OF SPECIFICATZONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: Valuation: 13~ Date: Site Address ,06 a~ Zi,P~Qai/ OFFICE DSE ONLY Lot 0 Block Erect _ Oceupancy Remodel Zoning Parcel/Sub YLj/ Repair _ Type of Const -7 Addition # of Stories Owner 2U~f.J~ G-/ e/ danj Move _ Length Demolish Depth Address ~~n V ~f ,Pe,~,,~/ LA~ Znt.Impr. _ Sq Ft Install City/Zip Code r.a.jqN~ m.t,. ~ Phone APPROVAIS FEFS Contractor q?,ti/ ClOJT Assessments Permit 5/o. - Water/Sewer Surcharge 3. Address ~A;.dL6 Police Plan Review Fire SAC City/Zip Code 1'91AI, Engr Water Conn r Planner Water Meter Phone ~(oILl ~1~~333C • Council Road Unit T-' Bldg Off -1O reatment Pl Arch./Engr. APC Parks Variance Copies Address 1Y1iAI. 59 , S Li~EssE ZS. City/Zip Code J Phone U NOTE: ADDBESSES FOR CORNER LOTS - CONTRACTOR/HOHEOiiNER liOST DESIGN9iS WHICH ADDRESS IS DESIRED. BO CHAAGES WILL BE ALLOiIED ONCE BOILDING PERMIT IS ISSOED. J MASTER CARD LOCATION Z~ Reo n 20o F- ll - C-r1' / OWNER Z i erde n ~ STRUCTURE AND ~A X LAND USED AS ~ .'J` L CAAA~ry,~ Issued To Permit No. Issued Contractor Owner BUILDING t1~.J PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Ifems (Initial) Date Remarks Distance From Well FOOTING ~ , r 74 SEPTIC FOUNDATION CESSPOOL FRAMING ~ TILE FIELD FT. FINAL ELECTRICAL DEPTH HEATING OF WELL GAS INSTALIATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER Violations Nofed on Back COMMENTS. F~~- 2007RESIDENTIAL BUILDING rEitmrr a,prLicnTtox City Ot Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 NeM Construdm Reauiremenh RemoEeVRaoeir Reauiremenh 3 reghlered sNe euneys ehoxirg aq. IL of Id, sq. R ol houee; end dp roofed arem 2 apies of qan slqwing loatinps, beama, jdsb Qedof S,u1w_Y _,N (20%maxYnumbtcoverageaAaxed) lsetdEneigyCeldAnBaafaheatedad3tlan 80MReppt _Y _p + sad+Revon nawosea wakre b ro ee vleced m aywrnea sa isiie wnrey ror aaaieons a axxs rreo aree DIeakecu Y_N 4 apim of pan showing Deam 6 xiiWow sizes: Doured lound desgn, eoe. A06tian • iMvete Honake se0tie sYSlem TieeP0Rqr4d!e?, . _ Y_N 1~IOtEicergyCalaAabms OtreHe9§ptl~9yDt9m' _y.Jp 3 oopies d Tree Praervatlm Plan if Id pWCed afler 771513 Rim Jdst Delai Optime sekctlm sheet (buildrgs wiU 3 a lesa units) Mnnegesm mechercrsl venwetion lorm Plans are considered ublic information unless ou state the are trade secret and the reason. Date / / ~~70A, n ' CoostructionCost ~ I Lt Site Address :tooFs 2im-6~ LNEA~=,Aoj SS i:)-a, unwsce a Description of Work 1F-lih g. O~-~- P-v-:>& 11-V (_lPc,~-F, ROO Y Multi-Family Bldg _ Vx N Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner R1.&~ {Z& 'r-0 Telephooe#(6Sl ) 9 Sy ~ 131 ~e ContreMor 5;r0K-YY. C-zlAq2S). Addras ~g'74o PtA[tSotN R&. Sk-'kr- 4 City_ W0c),S1nLie~,. Stete ~u. Zip .5S12S Telep6one#(loSl) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Cotle Category - Minnesota Rules 7670 Cate¢orv i _ Minnesota Rules 7672 (J submisslon type) • ReslOentlal Ventllallon Category 7 Wakaheet . New Energy Code Waksheet SudMtted SuDmitled ' • Energy Envelope Calatatlons Submlttetl In the last 12 monihs, has the City of Eagan issued a permif for a simiiar ptan based on a master planZ _ Y _ N If yes, date and address of masler plan: Licensed Plumber Telephone ) Mechanical Coniractor _ Telephone # ( ~ Sewer/WoterContractor _ 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 pertnit, 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 teview and approval of plans. Applicant's Printed Name Applicant's Signature ~ City 0~ Eapn December 17, 2008 Mike Maguire Mayor Paul Bakken Mrs. Ruth A. Zierden Cyndee Fields 2008 Zircon Lane Gary Hansen Eagan, MN 55121 Meg Tilley Council Members Re: Deferment of Special Assessments-Project 953 Parcel Number 10-16700-080-11 Thomas Hedges City Administrator Dear Mrs. Zierden: In official action of the Eagan City Council at its regular meeting held on December 16, 2008 the City Council approved the enclosed assessment • agreement for your parcel, 10-16700-080-11. We will process the necessary paperwork to Dakota County so your subsequent tax statements will reflect the deferment. Municipal Center . 3830 Pilot Knob Road The deferment will remain in effect as long as the required eligibility conditions Eagan, MN 55122-1810 are met. Interest on the original assessment of $553.61 will accrue at 8.0% per 651.675.5000 phone annum from the date of adoption, which was December 1, 2008. I have enclosed 651.675.5012 fax a copy of the appropriate section of the Eagan City Code that ouUines those 651.454.8535 TDD conditions. I ask that you keep the City informed of the occurrence of any of the events that would trigger the deferred assessments to become due and payable per the agreement. Maintenance Facility Please call me at 651-675-5016 or Accountant Ryan Stevens, at 651- 675-5032, 3501 Coachman Point if you have any questions about the deferment or anything eise related to this Eagan, MN 55122 action. 651.675.5300 phone ~ 651.675.5360 fex Sincerely, 651.454.8535 TDD 4u~•axr~.,,~.~- Gene VanOverbeke www.ciryofeagan.com Director of Administrative Services cc: Ryan Stevens, Accountant I Linda Fink, Accountant II The Lone Oak Tree Enclosure The symbol of strength and growih in our community. APPLICATIOTt AND AU7HORIZATION FOR DELAYED PAYMENT OF TAX ON SPECIAL ASSESSTENTS FOR SENIOR CITIZENS' HOMESTEAD . LAWS 1974. CHAPTER 206 STATE OF MINNESOTA) COUNTY OF DAKOTA ) . v1 •DATE30'~00g' . T0: Coimty Auditor, Dakota County, Minnesota - I, the undersigned, declare umder penalties of erjury: That I reside at~pp9 z; r~?p~ j~~ll'p ,~Q,qQ-+n ,/Vf n~ That I am not less than 65 years of age and that'the dat of m birth is~4 ' 0_ That I am the owner of the property legally deseribed as: L o ~jI o c;k ~l , l_'~dc~r ~rov2 _T , , Property Identification No.lD -l6*700- O$D=11 That my interest in the ownership of the above property was aquired on 8-~7 - Sq . and is as follows: . ' . ' 1. Sole ownership (Enter Yes, i£ applicable) 2. Joint tenancy, held ivith 3. 01HER undivided interest (Specify) That on January 2, or June 1, I owned and occupied the above vroperty as my homestead and such occupancy began on'i r~~ h D- That the installments for improvements on the 5PECIAL ASSESSMENTS duly adopted in ordin- ance by the _ j- OF~E O,.q0. y1 AS OF which have been allocated against~ t e subject prope y wduld create imdue personal hard- ship on my behalf and I respectfully reqnest that payment be delayed and that such'in- stallments be so defened for the years to SIGNED: fl ( P ~ , I~JI.bL-~VIJ ' . 01. 'ER SPOUSE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - . ~ - . . I, MAM%'&_ Clerk of the ~ OF `0..q.0..~• IN ht~& Co ty, State of Minnesota, do ereb certify'that th application of above named, has been dvly reviewed an3 that " in ac=erdance with e minutes of official record in s d ehambe s was duly 1 APPROVED ~ BENEEB as of c.t w..~ax • i~o ~ . That in accordance xith approval granted, the SPECIAL.ASSESSMENTS listed belox on the , affiants subject property levied for annual collection in the amounts and for the years shoxn be so deferred with i.nterest at the annual rate shown imtil such time as it is deemed the applicant no longer qualifies or the propeity loses its eligibility. ASSESSMENT D/P N0. ' TOTAL AMOUNT 1`EARS INTEREST RA7'E SY q S 3 103137 ~553.~ I 5 LS) 9o o~o . DATED~ C erk Agenda Information Memo December 16, 2008 Eagan City Council Meeting H. APPROVE SENIOR CITIZEN SPECIAL ASSESSMENT DEFERMENT APPLICATION - PARCEL 10-16700-080-11 (PROJECT 963 CEDAR GROVE 1sr & 2NO ADDITIONS-STREET OVERLAY AND UTILITY IMPROVMENTS) ACTION TO BE CONSIDERED: To approve an application for a senior citizen deferment of special assessments. FACTS: • Section 2.75 of the Eagan City Code allows for the deferment of speciai assessments for senior citizens, if certain conditions are met. • The City has received a request for a deferment from the property owner at 2008 Zircon Lane. • The assessment was levied for street improvements related to project 953. • Interest on the original assessment of $553.61 will accrue at 8.0% per annum from the date of adoption, which was December 1, 2008. • Staff has reviewed the application and determined that the eligibility requirements are met. ATTACHMENTS: • Enclosed without page number is a copy of the application for deferment. 76& , Rep°" Naa'e: City of Eagan Printed: 1211 U2008 Assessmen[ Search Page: 1 Special Assessments Search Prooertv ID LA Block Addition Addition NamelLeeal 10-16700-080-11 8 11 10 16700 Cedar Grove Is[ 8 11 Prooertv Addresc Pronertv Status Special Flaes 2008 P&I Cert: 2008 Zircon Lane Active 1 2 3 4 5 6 7 8 9]0 $0.00 Ea¢an, MN 55122 N N N N N N N N N N SA Nbr Descriotion Year Term $gg Total Curr Pri n Pavoff Status 100166 SW WATLAT 1971 25 8.0000 $1,304.00 $0.00 $0.00 Closed 100885 ST342 1984 15 10.5000 $1,266.95 $0.00 $0.00 Closed 103737 ST 953-Cedar Grwe lst 2009 5 6.0000 $553.61 $0.00 $553.61 Levied Summary of Levied: 1 $553.61 $0.00 $553.61 Summary of Deferred: 50.00 $0.00 ~ Summary of Closed: I IQ "~a $2,570.95 PendingEstlma[e: ' $0.00 Fulure Estimate: E0.00 Hookup Fee Estima[e: $0.00 9DCq 1 y l~. 70 a.o (I 13o.t.5 i a a ~ Dakota County Real Estate Inquiry Page 1 of 1 Dakota County Real Estate Inquiry Data Updated 11123I2008. Need Help? What's New? Legend Map navigation Real.Estate Parcels dv~nl Selact optlon and click on map: El ParOms 13 w~e °".ow~.~sn~ ~Zoomin 0 ZoomOut CPan 0 Identify q Show Full County Map Big Map Rww.easemern ? oedomee anrtr @ Tax Parcels 0 Market Value [3 75 g ¦ 0 Recent Sales 75 0 YearBuilt 0 AirPhoto Torrens Refresh Map Choose ONE aearch method, enter ~ aiteda, end dlUc Go or hit enter key. 5 5 ~ Go ~ House Q' ~R ~ . ~ PIN: , Go CoPY~neM1e-soua.-oika, ac ~ . -0 I Details Tax Stub Statement Plat Comp Sales Neighborhood Birds Eye Photo I PIN: 10-16700-080-11 2008 Est. Value (Paable 200~; $202,900 Owner: RUTH A ZIERDEN 2007 Taxable Value (Payable 2008Y $207,800 Address: 2008 ZIRCON LN Pa~able 2008 Tax:_ $1,959.88 C_it. EAGAN, MN 55122 Total Acreaoe: 0.21 Year Built: 1960 PLEASE READ DISCLAIMER This applicalion was developed by the Dakate CauMy Otfice o(GIS in cooperation with Assessirw Services and the Prooertv Taxation 8 Records Depar4nents ~u ry~ Gidc on the Dakota County Lopo above to retum to the hortre page http:!/gis.co.dakota.mn.us/scripts/esrimap.dll?Name=webql &Lefr496622.241 &Bottom=99791.2181 11/24/2008 City 0f Eapn November 25, 2008 c1 `~~5 13 I b Mike Maguire (j J ` MAYOR Paul Bakken Ms. Ruth A Zierden 2008 Zircon Lane Cyndee Fields Eagan, MN 55122 Meg Tilley COUNCIL MEMBERS Re: Defennent of Special Assessments-Project 953 Parcel Number 10-16700-080-11 Thomas Hedges ion Dear Ms. Zierden: Cm AoMiNxrnn Per our conversation of yesterday morning, please find enGosed an application for a senior citizen deferment of special assessments. I have also enclosed a copy of City Code section 2.75 which explains the parameters by which the application will be considered by the City Council. MIINICIPAL CEMER If you would like to pursue a deferment in this manner, please return to me the 3830 Pilot Knob Road compieted application along with a copy of your most recent federal income tax Eagan, MN 55122-1810 return which wili be used to determine eligibility. Please also note the other 651.675.5000 phone conditions inciuded in the Code section inGuding the requirement to apply for the 651.675.5012 rax deferment not later than 90 days after the assessment is adopted by the Council. 651.454.8535TDD However, if the completed form can be retumed to me during the week of December 1, I will be able to place it on the City Council Agenda for the December 16, 2008 meeting. MAINTENANCE FACILRY I can be reached at 651-675-5016, if you have questions or if you would like to 3501 Coachman Point discus this process in more detail. Eagan, MN 55122 651.675.5300 phone Sincerely, 651.675.5360 tax 651.454.8535 TDD L E. J. VanOverbeke www.cltyofeagan.com Director of Administrative Services cc: Director of Public Works Colbert (w/o enclosures) Accountant Stevens (w(o enclosures) Enclosures THE LONE OAK TREE The symbol of strength and growth in our community. ADMINISTRATION AND GENERAI. GOVERNMENT § 2.75 eatension thereof such other and further conditions and restrictione as the council may deem proper to pmtect the city's interests, nor shall anything contained in this section limit any right or power possessed by the <aty over existing franclrises. (Code 1983, § 2.72, eff. 1-1-83) State law reference-Municipal franchieea, Minn. Stat. 300.03, 300.04. Sea 2.73. Absentee ballot counting board. The council hereby authorizes an absentee ballot counting boazd and further authorizes the election judges of such board to receive, examine, and validate abaentee ballota. The further duties of such boazd shall be those pmvided by statute. (Code 1983, § 2.73, eff. 1-1-83) Sec. 2.74. Special assessment policy. The council may, by resolution, adopt, from time to time amend, or repeal a special assessment policy. (Code 1983, $ 2.74, eff. 1-1-83) Sea 2.75. Deferment of special assessments. ~ Subd. 1. The counal may defer the payment of any special assessment on homestead ~t A property owned by a person who is 65 years of age or older or who ia retired by virtue of 40 permanent and total disability, and the city clerk-treasurer ie hereby authorized to record the deferment of special assesemente where the following conditiona aze met: O jf~- A. The applicant must apply for the deferment not later than 90 days after the 30 assessment is adopted by the council. ~l\ .~~~AA ~B. The applicant must be 65 yeara of age or older or retired by virtue of permanent and total disability. ~ C. The applicant must be the owner of the pmperty. @,C D. The applicant must occupy the pmperty as his principal place of residence. El The average annual payxnent for all assessmenta levied against the subject property ,okP. exceeds one percent of the adjusted gross income of the applicant as evidenced by the ~ 5 5 3•~O\ ~ applicant's most recent federal income tax return. The average annual payment of an S assessment shall be the total cost of the assessment divided by the number of years over which it is spread. Subd 2. The deferment ehall be granted for as long a period of time as the hardship effists and the conditione as aforementioned have been met. However, it shall be the duty of the applicant to notify the city clerk-treasurer of any change in his status that would affect eligibility for deferment. . Smbd 3. The entire amount of deferred special assessments shall be due within 60 days after losa of eligibility by the applicant. If the special assessment is not paid within 60 days, the city clerk-treasurer'shall add thereto interest at eight percent per annum from the due CD2:19 § 2.75 EAGAN CODE date through December 21 of the following year, and the total amount of principal and interest shall be certified to the county auditor for collection with tasea the following year. Should the applicant plead and prove, to the satisfaction of the council, that full repayment of the deferred special assessment would cause the applicant particular undue financial hardahip, the council may order that the applicant pay within 60 days a sum equal to the number of inetalimenta of deferred special assesaments outatanding and unpaid to date, including principal and interest, with the balance thereafter paid according to the terms and conditions of the original special assessment. Subd 4. The option to defer the payment of speaal assessmente shall terminate and all amounts accumulated plus applicable interest shall become due upon the occurrence of any one of the following: ' A. The death of the owner when there is no spouse who is eligible for deferment. B. The sale, transfer or subdivision of all or any part of the property. C. Loss of homestead status on the property. D. Determination by the council for any reason that there would be no hardship to require immediate or partial payment. (Code 1983, § 2.75, eff. 1-1-83) State law reference--Senior citizens or retired and disabled persons hardship special assessment deferral, Minn. Stat. § 435.193. Sec. 2.76. Partial prepayment of special assessments. Subd 1. Scope. Partial prepayment af assessmenta in connection with any assessments adopted by the council and certified to the county auditor for collection may be made at any time. . Subd 2. Paymeat. The owner of any property so asaesaed may, within 30 days of adoption of the assessment mll by the council, prepay any or all of his assessment to the city. No interest will be chazged on any portion of the assessment paid within said 30 days. The remaining unpaid balance of the assessment shall be spread at the same rate of interest and for the same term of yeaxs as the original assessment. (Code 1983, § 2.76, eff. 1-1-83) Sea 2.77. Emergency preparedness plan. The coundl may, by resolution, adopt, from time to time amend, or repeal an emergency preparednese plan for the rrty. (Code 1983, § 2.77, eff. 1-1-83) Sea 2.78. Building nnmbers. Subd. 1. Bnilding numbers required. The owner or occupant of any building fronting upon any atreet or avenue ehall place and maintain on the front thereof the proper building number assigned by the city. CD220 . ~t\~~N ~•J~J~~-°~~~ DeparMmt af Ne Tmawry - INemal Rovenue Sorrice ~ Form 1040 U.S. Individual Income Tax Return 2007 IRSUSeOn- DOmiwma«etapemtlxsspam. For 1he ar lan 7- Dec 31, 2007, a olher lax E2f beginNng , 2007, entlin . 20 OMB No.1545-00]4 Label YO1Pfbv rema MI laslname Yoursoclalaecurltynwmber (5BB1nb10^O".) Ruth A Zierden U50 IhB Ha1oirrit retwn.sWuse'etkslname MI Lastiarte Sppusa'saocWl se[urfrynivnber IRS label. Otherwise, Ho,,,o acl~ (nu„vier oM eo-aeq. n ~ nnna e P.O. eo., see ~e,.cuo~~. naen~m ~o You must enter your please print ortype. 2008 Zircon Ln socialsecuriry Ciry, mvm or pmt otfice. II yvu luve a(caeign M~ecs, see InsWdbm. Stae t vv mae ~ num6er(s) above. ~ PresideMial Ea an hIIJ 55122-2804 ctargnyaurwcwrduM ~ . Election Campalgn , Check here A yau, or your spouse if filugjoimly, wam $3 ro go to Ihis funO (see insuuctions). You ~ Spouse Filing Status I Sirgle 4 L-j Head of household (with yualifyirg person).(See 2 Mamed filingjounly (even if oNy mie hatl income) inshuctions.) If the qualifying person is a child but nat your dependenl, enter this child's Chedc only 3 Mamed filing separately Emer spouse's SSN above & full name here ? one box. name here. ? 5 n Qualirying witlow(er) wdh depentlerrc child (see iriswaiars) Exemptions 6a rli Yourself. If someone can claim you as a deperWent, do not check box 6a. ~¢r, e a"e . 1 b S ouse . No. W cniNrm (2) DependenPs (3) DependenYs (4) ;r oo ee.no: c Dependenffi: social sewnry reladonship q~m~r 0 lw°° number royou 1°~«`" . . 1 Firsl name Last name W aedO • aa "O~ I"~) Ilva wIN Y. aue m aivwu or retion Iaesnetrsl . . If more than on e~c notnede four dependents, ~ see instructions. nee ninfne«. on Iirce d Total number of exem tion5 daimed ,eow 1 . 7 Wages, saWries, tips, etc. Attach Form(s) W-2 . . . . . . . . . . . . . . . . . . . . . . . . . 7 Income 8 a Ta"ble interesl. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . 8 a 56 . b Tax-exempt interest. Do not include on line 8a 8 b. Anach Form(s) 9 a Ordinary dividends. Attach Schedule B if required . . . . . . . . . . . . . . . . . . . . . . . 9a W2 here Nw b QuafifieC tlivi0entl5(see iirsVS) . . . . . . . . . . . . . . . . . . . 9 b aVazh Fmms 1111213 aM 1099-R 70 7axade reNnds, credqs, or ofisels W sUle and local ukofre laxes (see insuuclipr) . . 10 if tax was rithheN. 11 Alimony received . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 If you did na 12 Business income or (loss). Attarh Schedule C or C-EZ . . . . . . . . . . . . . . . . . . . . . 12 get a W-4 13 Capilal gam or (bss) /+n Sch D if reqdJf rrol reqtl, ck here . . . . . . . . . . . . . . . ? El 13 see inunufions. 14 Other gains or (losses). Attach Fo" 4797 . . . . . . . . . . . . . . . . . . . . . . . . . 74 15a IRA distributions . . . . . . . 15a bTaxable artaunt (see instrs) . . 15b 16a Pensions and annuities 16a b Tazable amount (see inshs) 16 b 17 Rental real estate, royalUes, partnerships, S mrporeoons, Wsts, etc. Attach Schedule E . . . . 17 Emlose, bul do 78 Fartn income w (loss). Attach Schedule F . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 nd anxh, any 19 Unemployment compensatlon . . . . . . . . . . . . . . . . . . . . . . . . . . . ~~a~50' 20aSotialsecurilyhenefus...... I 20al 11,700.IbTaxableamount(seeinstrs).. 20b 0. om 1090.V. 21 01her mcome 21 22 Add the amounLS in the far riht column for lines 7 ihmu h 27. This is our total Income. 22 56. 23 Edurator expenses (see instrucaons) . . . . . . . . . . . . 23 AdjUSted 24 CenainbusinLssexpensesofreservisis,peiforming ana~s,andfee-basis GroSS govenunem ol(icials. Anadi Fortn 2706 ar 2106-EZ . . . . . . . . . . . 24 Income 25 Heatth savings account deduction. Attach Fortn 8889 25 26 Moving expenses. Attach Fo" 3903 . . . . . . . . . . . . . . 26 27 One-half of self-employment tarz. Attach Schedule SE 27 28 SeK-employed SEP, SIMPLE, and qualified plans 28 29 Self-enployed health rtisurarce demxrim (see uiswawns) 29 30 Penalty on eaAy withdrawal of savings . . . . . . . . . . . . 30 37 a Atimorry paid b Reripenfs SSN. . 31 a 32 IRA deducUan (see insWCtions) . . . . . . . . . . . . . . . . 32 33 Sludent loan interest dedudion (see instructions) 33 34 Tuition and tees deduction. Attach Fo" 8917 34 35 Domestic protlucrian activiues deduc6an. Anatli Farm 8903. 35 36 Add lires 23 -31 a aM 32 -35 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 37 Subtract line 36 Gom line 22. This is our ad usted ross income 37 56 . BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see Instrudlons. cvia0112 Ivam7 Fo" 1040 (2007) ' Form 1040 2007 Ruth A Zierden Pa e 2 TaX and 38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . . . . . . . 38 56. Credits 39a ~heck r1 B Spose was ban before Jnuary 2 1943, e 81id. che Ikd X?$ 39a 1 ~ SW ndard b If your spwse itemizes on a separate rHUm, a you were a dual-stams alien, see insus aiM ck here ? 39 b Deductlon 40 henuzed deduaiwis (fram StlicdWe A) a yau sYaMard deAuctim (see left marry'n) 40 7,881. for - 47 Subtract line 40 fmm line 38 . . . . . . . . . . . . . . . . . . 47 -7 , 82 5 . • PeoPle who . . . . . . . . . . . . . . . . checked any box 42 If line 38 is $117,300 or less, multiply $3,400 by the total number of exemptions on line 39a or daimed on line 6d. If line 36 is wer $117,300, see the insWctions 42 3,400. 39b or who can 43 Taxahle incwne. Suhtracl lim 42 from 6ne 11. be Gaimetl as a If line 12 is mme than 6rre 41, eruer -0 - . . . . . . . . . . . . . . . . . . . . . . . . 43 0. dependent, see qq Tax (see instrs). Check if any tax is from: a B Form(s) 8814 b~ Fortn 4972 instrUCtions. c Form(s) 8889 . . . . . . . . . . . . . . . 44 0. • All others: 45 qtternaUve minlmum Wx (see instructions). Attach Fortn 6257 . . . . . . . . . . . . . . . . 45 66 Add lines 44 aM 45 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 0. Single or Married filing separately, 47 Credn forchiltl and dependem care expenses. Atladi Farm 2441 47 $5,350 qg Credit for the elderly a the disabled. Attach Schedule R . . . . 48 Martied filing 49 Education credits. Attach Form 8863 . . . . . . . . . . . . . . 49 jointl~ or 50 Residentlal energy vedits. Attach Form 5695 50 ~ualdyi~g widow(er), 51 Foreign tax credit. Attach Fortn 1116 if required 51 $10,700 52 Child tav credrt (see uaWClions). AtlaU Form 89019 required 52 Head of 53 Retlrement savin s contributions credit Attach Fortn 8880 53 household, 54 CreOas from: a~Form 8396 b[ Fortn 8859 c[] Form 8839 . 54 $7,850 55 Olher credes: a~~ b Q aepi c? Form 55 56 Add lines 47 thmugh 55. These are your total credits . . . . . . . . . . . . . . . . . . . . . 56 57 Subtract line 56 fmm line 46. If line 56 is more than line 46, enter -0 - 57 0. 58 Setlempbymem tax. AnacA Schetlule SE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Other 59 Unrepohed sor~al 5epirily ard Medxare lax from: e? Form 4137 b? Form 8919. 59 Taxes 60 AdAilional laz on IRAs, oNer quafdieA retcemem plans, Mc. AMCh Form 5329 d requved 80 61 Advance eamed income aedit payments hom Form(s) W-2, box 9 . . . . . . . . . . . . . . . 61 62 Household employment tazes. Atlach Schedule H . . . . . . . . . . . . . . . . . . . . . . . 62 63 Add lines 57-62. This a tolal tu . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ? 63 0. Payments 64 Federal income tax withheld from Forms W-2 and 1099 64 If you have a 65 2007 estunated tax paymenls and amoum apptie0 hom 2006 reWm 65 qualifying 66a Eamed income credll (EIC) . . . . . . . . . . . . . . . . . . 66a child, attach b NontaxaMe wmbal pay elecaon 66b Schedule EIC. 67 Ezcess social securily an0 Ger 1 RRTA Iac wthheld (see instruclims) 67 68 Add'Rional child tax credit. Attach Form 8812 68 69 Miwrq paid xiN request fa eqenaon to fde (see nstructiorts) 69 70 Paymenls hom: aF] Form 2439 b[] Form 4136 cE] Fam 8885 70 71 Relimtlahle creAit lor pria year minvnum la: from Fdm 8807, line 27. 71 sa. es, sea. ar~e 67 mm~n 71. 72 Pea nnaa mno are yo„r to~z~ ? 72 Refund 73 If lirre 72 is mae Nan line 63, whuact fine 63 hom line 72. TNS is Ihe amounl ya overpaid 73 Direct deposit? 74a Amount of line 73 you want refunded to ou. If Fortn 8888 is attached, check here 74a Seeinstructions - bRoutlngnumber.....091000022 ~cT e: Chedcing ~Savings and fill in 74b, . d Account number 111927036934 74c, and 74d or Form 8888. 75 Amourrt die 73 you wam a ied tu 2008 estureted tai . 75 ATOU fft 76 Amount you me. Su6Van fure 72 from line 63. For details on how to pay, see mvructions ? TB 0. YOU Ow0 77 EsBmated tax pem[ty see inshudions . 77 h pawn lo discuss tlus retum xvh ihe IRS (tee iMmxtions)1 Yes. Complete the following. X No Third Pa DD 1'ou rty ~^'am to aDow aroOer Desien°es P1pi0 . mmiOer~fPNjtlfi~aGw' Designee w . .SI UMer p¢relliea N W~INY. I Eetlare tliet I liaw a~aninetl tlu retun aM arm^Va^yi^B StleEWes aM sfatenienb, aM b Ne Oast d^H biowte09e enE 4]II Oelief. NeY ere hue. mrterl. an0 eompele. Deda2idi of GmW rer (oUier Man tazPeNar) n OaSeC an ell iMOmiation ol w1iIM Vreperer tm snY kno.NOtl9e. Here ,,a, . oam ra, Joint re[um7 °oapd°0n °aytimg phom, we1w seeinstructions. ? , xetired 651-4S4-131(0 Keepywpy Spane'svgnatuae.tlajoimreWm. both m~ agn Date Spwse'soavpalbn foryourrecords. ~ DMe Rapare/s SSN ar P11N Reparels Paid °gna°fe ? aeck aaaf-emu~ Preparer's F.sreme Self-Pre ared rs n UseOnly ~~nplEIN LP coEe Wq~y ~q, Form 1040(2007) Fowoiiz 1210em7 ' SCHEDULE n Itemized Deductions OMBNO 1505-0074 lFOrm 1040> 2007 paixir~ & y,a T~n ~ Attach to Form 1040. ~~l im~i a~ma sa~ ' See Instrudfons for Schedule A(Form 1040). seQUwm No. 07 NmKys) ~ on Frnm 1000 Your wcial iecuNly numOm Ruth A Zierden M~ical CauHon. Do not indude expenses reimbursed or paid by others. and DenWl 7 MedkalanAAemalexpenses(seeimwaions). . . . . . . . . . t 3,553. Ecpenses 2 EmeramaWfromFoim1040.lme38 . . . 2 56. 3 Muldply line 2 by 7.5% (.075) . . . . . . . . . . . . . . . . . . . . 3 4. 6 Subtract line 3 from line 1. If line 3 is more than line 1, enter -0 - . . . . . . . . . . . . . . . . . . 4 3,549. Taxes You 5 State and loral (check only one box): Paid a B lncome taxes, or ~ . . . . . . . . . . . . . . . . 5 209. b General sales taxes. 6 Real estate taxes (see insWctions) . . . . . . . . . . . . . . . . 8 1,690. (See 7 Personal property taxes . . . . . . . . . . . . . . . . . . . . . . 7 inshuc[ions.) 8 Olher faxes. List type and artaunt ~ 8 9 Addlines5Mrouh8 9 1,899. Interest 10 Home mtg interest arM points repotted w you on Form 1098 10 2,405. Vou Paid 11 Home mortgage in[erest not reported to you on Form 1098. IfpaiO to Ue person from whom you bought tlm home, see instructioM and show Ihal persai s reme, identifying numGer, arid address - 11 NMe. 12 Paims nrn reported co you on Form 7098. See inslrs fw spcl Ntes 12 3 Personai 13 Qualified mortgage insurance premiums (see instrucUOns) r14 interest 14 Invesfinent interest. Attach Form 4952 A re uired. is not Q deduc6ble. (Seektstrs.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Addlinesl0throu ht4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 2,405. GiRs to 18 Gifts by cash or check. If you made any gift of $250 or Charity more, sea ins[re . . . . . . . . . . . . . . . . . . . . . . . . . 16 323 . If you made 17 Other than by osh or check. If any gift of $250 or a gifl and more, see insWctions. You must attach Fortn 8283 if got a benefit or it, sae over $500 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 f insWCtions. 78 Cartyoverfromprioryear . . . . . . . . . . . . . . . . . . . . 18 19 Add lines 16 throu h 18 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .L.imited 19 28. Casualty and Theft Losses 20 Casual or Meft bss es . Attach Fortn 4684. Sce instructions. . . . . . . . . . . . . . . . . . . 20 21 Unreimbursed employee expenses - job travel, union dues, job education, etc. Attach Form 2106 or 2106EZ rf required. (See inshuctions.) ~ 21 . 22 Tax preparation fees . . . . . . . . . . . . . . . . . . . . . . . 22 (See 23 Other expenses - inveshnent, safe deposit box, etc. List instructions.) rype and amount ~ 23 24 Add lines 21 through 23 . . . . . . . . . . . . . . . . . . . . . . 24 25 Emer amouN han Fam 7040, lim 38 25 26 Multiply line 25 by 2% (.02) . . . . . . . . . . . . . . . . . . . . 26 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter-0-. . 27 Other 28 Other - from list in tlie insWctions. Ust type and amount - Miscellaneous Deductions 28 Total 29 Is Fortn 1040, line 38, over $156,400 (over $78,200 if Itemfzad martied filing separately)? Deductions ~ No. Your deduction is rrot limited. Add the amounts in the far right column for lines 4 through 28. Also, enter thi5 amount on Form 1040, line 40. yg 7, 881 . F] Yes. Your deduction may be limited. See inshvctions for the amount to enter. ~ 30 If ou Hep to kan¢e OeAucuom even Ihou are less W n ur slandard deduuion check here - BAA For Paperwork Reductlon AM Notlce, sea Form 1040 Instructions. Foinwoi 11107ro7 Schedule A(FOrtn 1040) 2007 ~ John GoNdep^ Nov.;t4, ;toas' ~ 4S5fs'EC3-n4 eifyFHTlneer (J2a-r Tmhn Corderj 1 avn c- cJI~ow t,v,{k LoW rn~am e /,~J}~ic~C is It~ai Iroad ~~-~~rern eh{. T wou l~ Ii I<e ~o ItnoLv r'f ~ would • ~Ua-< <f,/ f Or4L deferF-ylten4 on 'tke Stree4 rrnProvernerck5. - S l-h e C~ r e~ Y. _ a ao 8' Z ~ er d eh L.ah e • - - - - - - PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA125847 Date Issued:08/05/2014 Permit Category:ePermit Site Address: 2008 Zircon Lane Lot:8 Block: 11 Addition: Cedar Grove 1st PID:10-16700-11-080 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Brian Nerison 430 E. County Road D Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Ruth A Zierden 2008 Zircon Lane Eagan MN 55122 Kb Service Company 430 E. County Rd. D Little Canada MN 55117 (651) 748-4933 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA143904 Date Issued:07/03/2017 Permit Category:ePermit Site Address: 2008 Zircon Lane Lot:8 Block: 11 Addition: Cedar Grove 1st PID:10-16700-11-080 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. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). 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 - Ruth A Zierden 2008 Zircon Lane Eagan MN 55122 Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435-2442 Applicant/Permitee: Signature Issued By: Signature