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2012 Zircon Lane INSPECTION RECORD ~t it 1 4 li 1 lf ~ i CITY OF EAGAN PERMIT TYPE: 0 2R f, 14.; ~ 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55 1 22-1 897 ~ - . Date Issued: (612) 681-4675 L SITE ADDRESS: APPLICANT: ! Rr.ON t aMF i~:~~~! i~ • r,E [,I:r;i ~ ~ i,;,: ~~i.~~ 1. i f n l. i 1~ ~.l?N.i PER IT UBTYPF: TYPE OF WORK: ~ ~ , . - 1. 1 rni E.: INSPECTION DA • DA ~ I i ~ ~ ~ Permit No. Pertnit Holder Date Talephone #I ELECTRIC PLUMBING HVAC Inspaction Dats Msp. CommWnb FOOTINGS FWND FRAMING ROOFING / l.~ ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TE5T FINAI PLBG FlNAL HTG ORSAT TEST BLDG FINAL BSMT R.I. I BSMT FINAL 1 DECK FfG I DECK FlNAL ~ CITY OF EAGAN Remarks * Cedar Grove Acquisition Addition CEDAR GRQVE #1 Lot 7 plk 11 Parcel20 167Q4 970 11 Owner ~ i F Or~hL: ')•C Street 2012 Zircon Lane Eagan, MN 55122 SletE 1 Improvement Oete Amount Annual Years Payment Receipt Date STREET SURF, s STREET RESTOR. GRADING 5AN SEW TRUNK * SEWER LATERAL 1972 1,304.00 rj2.l6 2t'j WATERMAIN WATEA LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. ~ BUILDING PER. SAC (A PARK ~ oeb Mwa he.Mb. Plumbing Mechonicol INSPECTIONS I D TE INSP. Rouqh-In Firql Footings L Dote Insp. Dote Irup. Foundction Plumbing Frame/ins. Mechanicol Finol ~57-x Remorks: crrir oF EAGAN 3795 P11ot Kneb Rood Eoyen, MN 55123 N0- 6601 PHONEs 434-t100 BUILDING PERMIT Receiat # _ - To M aed fer Est. Volue Date , 19 Site Mdrcss -n Eroct Occuponcy Lot Block Sec/Sub. /?Iter [3 Zonirg Parcel Repcir Q Fire Zone ~ # Enlorpe ? Type of Const. W Nome Move p # Stories ~ Addrcss Demolish C] Front ft. G Phone Grode ? Depth ft. ~ Nam ApProrals iNs St, Addnm , Assessrt+ent Permit ~ Ci • Phone Water & Sew. Surcharye Police Plan check Narr+e Firo 5AC ~0 Erq• Water Conn. ~ W a phorw Plonner Water AAeter Council Road Unit I hereby ocknowledpe thot I hmro reod this opplicotion ond stote thot Bidg. Off. the informotlon is co?recf and apree to comply wtth all applicable APC Total $tate of Minnesoto Stctutes and City of Eoqan Ordinonces. Sipnoturo of Pem+ittea A Buildinp Pertmit is issuad to: on the expross rnndition that ' all work shall be doru in accordance wtth all opplicoble State of Minnesoto Stotutes and Gty of Eagon Ordinances. Building Officiol CITY OF EAGAN ` 3795 Pilat Knob Road Eagen, MN 55722 N2 6601 PHONE: 454-8100 , BUILDING PERMIT APPLICATION Receipt # ~`~l ~ ~1 To ba uaed for 3 SEIISON PORQI Est. Value 2,000 pate 4-14 19 81 Site Address 2012 Zircon Lil Erect Occupancy R3 Lot 070 Block 11 Sec/Sub. Cedar CrOVe 1 Alter ? Zoning Rl Porcel .fk 16700 070 11 Repair ? Fire Zone N~ Enlarge ? Type of Const. V s Nome C,aom2 (7riSwOld Move ? # Srories Z Addreu Demolish ? Front 12 ft. 9 55122 Ci Phone Grade ? Depth 12 ft. ,X Name Lyle Johnson AODrovala Fees zi;- 1338 Jers Ave S ~a Addre~ _ Assessment Permit 9.00 F 5L• lAw-s clY' Water 8 Sew. Surcharge 1.00 Cit PFrone F Police Plan check Fw Name Fire SAC ~ZAddress Eng. Water Conn. aw Ci Phone Plonner Water Meter • Council Road Unit I hereby acknowledge that I have read this application and state that gldg. Off. the information is correct and agree t comply with oll applicoble APC Totol 1~.0~ State of Minnesota Statu d ity f 'an Ordinunces. Signature of Permittee A Building Permit is issued to: LYle JOY1T150T3 on the express condition thot ull work shnll be done in accordance i halIC opp/liwbleyStat~` Minne f'o Statutes and City of Eogan Ordinances. Building Offlcial O( CITY OF EAGAN Include 2 sets of plans, ~ 1 site plan w/elevations & BUILDING PERNffT APPLICATION 1 set of energy calculations. s/ J '1b Be Used For l~ _~~Pe~e.uNi - al tion a o~. O QG nate Site Pddress: oFFI(E USE oNLY Lot 070 slocx p sec./sub. Erect ~ occugancy Parcel 6 Alter zoning Repair Fire Zone Owner: - Enlar4e _ ZYAe of Const. G Nbve # Stories Pddress: DeJrolish Front ft. City/Zip Code: Grade Depth ft. PhOne # : „ APPFiDVAIS FEES Contractor: ~ r Assessments Permit 90 jaa Address: Water/Sewer Surcharge j Police Plan Check City/2ip Code:,. ;%iGuan7 5 ire SAC Phone 'J-ys- 55 kI7 Eng • Water Conn. - Planner. Water Meter ps.ch /Eng : Council Road Unit Bldg. Off. Pddress: ppC City/Zip Caie: Phone # : WTpS, 4v ~ Q CITY OF EAC?N 3795 Pilot Knob Road Eagan, Minnesota 55122 PERt'ffT NO.: 661 The City of Eagan hereby grants to r+rvwiaP Pitw & Hra cb. of 2912 Aloomington. Mols. 55407 Geozge Griswold a Permit for: (Owner) uir.hard otremba ircon Lait at 2043 Cor=1 Lnne , Pursuant to application dated 4/15/75 Fee Paid: cln pn dated this _21__day of _Alpril r 19 75 1.00 ($5.50 ea, Building Inspector Mechanical Permits: Bid Total: ` EAGAN TOWNSHIP BUILDING PERMIT N•° 2508 1 , Owner ~~`'4"`•'-T-~`"~ Eagan Townahip Address (Preseni) ..1.-:?---------^-~ Town Hell Huilder ................Q cr q. ~'7.1 @ Dele Addrese DESCRIPTION SSOrias To He Used For Froa! Dapfh Heigh2 Enl. Cos! PormIf Fee Aemarks I~- I LOCATION Streel. Roed or oiher Descripfion oi Loeation I Lo! Black Add[iion or Trae! 7 8-C-4a--.- i This pesmif does not aulhorise the use of sireels, roads, alleys os sidawalks nor doea if give the owner ot his agen! the righ! !o creafe anp sifuefion which is a nuisence os which presenls a hasard !o the healih, eflfefy, aonvenience and general welfare !o anyone ia the communify. . THIS PERMIT MUST BE }K,EPT ON THE PREMISE WHILE THE WOAK IS 2N PROGRESS. This is fo aerlify, lhai...l.S!.........~W ................hea permission !o ereci a................ _upon the above described premise subjec! !o the provisiona of the Building Ordinenee for EagaA Townehip adoplad April 11, 1955. ~ ....................J!-:....1.`.. Par ~1~~•~~•->-~~-' " Chairman of Tnwn Board Building Inspecior ~ r 3 EQ?GAN TOWNSHIP x2 379 n BUILDING PERMlT (yr/'~' " , Ownex~~_?~4~.h~~._..-- . Eagan Township L Addrass (Pxesen ......PJ . . . . ......._....:!~C/~. Town Hall Builder ......--.-f F`~'GGt-:-----...........--------------"-----....--- .l?.._......~, ..v.~ Addsess Date - DESCRIPTION Siories To Be Used For Froni Depih FIeigh! Esi. Cosi Permi2 Fee Remaxks r ~DDD~ LOCATION Streel, Aoa or oiher Desari Sion of Locafion I Loi Slock Addition or Trac! 1 1- / I ' This permii does not aufhoxize the use of sireels, roads, alleps or sidewalks nor does if give the owner or his ageni the righ!!o areate anp siiuation which is a nuisance or whieh presen2s a hazard fo the healih, safelp, convenienee and general welfare fo anqone in the communiip. , THIS P£AMIT MUST B/~` g/P-T, O/J~'jj~ THE SE WHILE THE WORK IS IN PRO E S. ' This is fo c'fy, ihaf.C~Y~'I?=-q~li ~f~2°'-r_....has permission !o ereci a- uPOn the abo describe ubjeci !o the pzovisions of the Huilding Ordinance for agan To ship adopfed April 11. . . . . .5"~ Per .--------...-------...........----"-----------.--.-.-4 P a~rma Town Board Suildin Ins ecior EAGAN TOWNSHIP No 580 DING PERMIT . Ownex . . ~ Eagan Township . Address ( resen!) ~c v.... . ~ Builde - - Town Hall ..1' . ~ ~ v Address - - - Dale.. . DESCRIPTION Sfories To Be Used Fos Fronf Depih HeighS Esf. CosS Permi! Fee Remarks ea W ~I LOCATION Sireef, Road or ofher Deseripiion of Localion I Lof Elock Addition or Traci ~a/ , ~ I ~ _ This permii does n aufhorize the use of sireels, roads, alleys or sidewalks nor does it give 1he owner or his agenf the righlto creafe, y sifuatioa which is e nvisanee or which presenis e hazard fo the healih, sefefy, convenience and general welfare !o anyone in the eommunily. THIS PEAMIT MUST KE/py T~ OA T MISE WHIL£ THE WOAK IS IN PROGAESS. This is fo ceriifY. !hal~r:f!~.Y..-~4.-.~..~,.- has permission ! ereM . . ._1....... . ...__upon the above desczibed pre ise subjecf i e provisions of She Building Or in or Eagan- w s ip-a opied April 11, ` 1955. _ . . . . . Pe . Cheirman of Town Board ~ Huild'~ g'.. peeior PERMIT CITY OF EAGAN BUILDZNG 3830 Pilot Knob Road PERMIT TYPE: 028693 Eagan, Minnesota 55122-1897 Permit Number: 0 8/ 2 7/ 9 6 (612) 681-4675 Date Issued: SITEADDRESS: 2e12 ZIRCON LANE LOT: 7 BLOCK: 11 CEDAR 6ROVE 1ST P.I.N.: 10-16700-070-11 DESCRIPTION: REROOF Building Permit Type STORM DAMAGE ,'Building-Work Type REPAIR . Census Code ~ 434 ALT. RESIDENTIAL ~ . , , . REMARKS: FEE SUMMARY: App~tudnt CONTRACTOR: 0MMI-0 GEORGE 2012 ZIRCON LANE EAGAN MN (612)454-6083 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 Mn. Statutes and City of Eagan Ordinances. L J APPLICANT/PERMITEE SIGNA7URE ISSUE . SIGNATURE ~ CITY OF EAGAN 93 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Canslruction Reqpirements RemodeVReoair Reauirements ? 3 registered s@e surveys ? 2 copies o( plan ? 2 copies oi plans (include beam 8 window sizes; poured fnd, design; elc.) ? 2 site surveys (exterior additions 8 decks) ? 7 energy calculations ? 1 energy calcufations for heated additions ? 3 wpies ot tree preservation plan if lot platled afler 711193 required: _ Yes _ No e~, Q DATE: TRUCTION COST: DESCRIPTION OF WORK: J P STREET ADDRESS: C o`V LOT 7 BLOCK SUBD./P.I.D. ~s i.rio ~~~~r e l/`/v~? G~1~ PROPERTY Name: r P ~ Phone J 3 OWNER Street Address:_~G~~ 'Y '4 City: ir/ State: A/-'e/ Zip: ~z- CONTRACTOR Company: Phone Street Address: License #City: State: Zip: ARCHITECTJ Company: Phone ENGINEER Name: Registration Street Address City: State: Zip: Sewer 8 water Iicensed plumber: Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comp all appiicable State of Minnesota Statutes and Ciry of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY REC~2~, ~VED Certificates of Survey Received _ Yes _ No AUG 26 IppS Tree Preservation Plan Received Yes No ' MASTER CARD • LOCATION OWNER G STRUCTURE AND 4-1 LAh1D USED AS issued To Permit No. issued Coniractor Owner BUILDING PWMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL H EATI NG GAS INSTALLING SANITARY SEWER OTHER OTHER • Approved Items (Initial) Date Remarks Distance From Wetl FGOTING -~EPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD FT FINAL ELECTRICAL DEP7H HEA7ING OF WELL GAS WSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD \ PIUMBING WELL SANITARY SEWER +J--b~--~-f- • Violations Noted on Back COMMENTS: . 1 City of Eapn ~0$3 Mike Maguire December 10, 2008 MAVOR Paul Bakken Mr. George V. Griswold , 2012 Zircon Lane Cyndee Fields Eagan, MN 55122 Meg Tilley COIINCIL MEMBERS Re: Deferment of Special Assessments-Project 953 Parcel Number 10-16700-070-11 Thomas Hedges Cm AoeaiNisrnnroa Dear Mr. Griswold: In response to your letter received December 9, 2008, 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 wiil be considered by the Ciry Council. MUNICIPAL CENfER If you would like to pursue a deferment in this manner, please return to me the 3830 Pilot Knob Road completed application along with a copy of your most recent federal income tax Eagan, MN 55122-1810 return which will be used to determine eligibility. Please also note the other 651.675.5000 phone conditions included in the Code section including the requirement to apply for the 651.675.5012 tax deferment not later than 90 days after the assessment is adopted by the Council. 651.454.8535 TDD Please return the completed form to me as soon as possible so I can place it on a City Council Agenda for approval and take the necessary steps to have Dakota County issue a correct tax statement for taxes payable in 2009. MAIMENANCE 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, 651.675.5360fax 651.454.8535TDD , l -_J_ Vep.Q~erbeke www.ci+yoreeyan.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. ' Repart Name: Printed: 12/15/2008 Asse~a~ts~ch City ofEagan Page: I Special Assessments 5earch Prooer[v ID Lgl BIQLk Additio° Addition NamelLeeal 10-16700-070-11 7 11 1016700 Cedar Grwe lst 7 11 Prooertv Address Prooerlv Statas Special FIaQs 200g P&I Cer[: 2012 Zircon Lane Active 1 2 3 4 5 6 7 8 9 10 $0.00 EaRan, MN 55122 N N N N N N N N N N SA Nbr Descrintion Year Term B= Total Curr Pri° Pavnft Status 100166 SW WATLAT 1971 25 8.0000 $1,304.00 $0.00 $0.00 Closed 100885 ST342 1984 15 10.5000 S1,266.95 $0.00 $0.00 Prepaid 103737 ST 953-Cedaz Grove lst 2009 5 6.0000 $553.61 $0.00 $553.61 Levied Suuunary of Levied: $553.61 $0.00 $553.61 Siunmary of Deferred: S0.00 $0.00 Snuunary of Closed: $2,570.95 ' PendingEstima[e: \ $0.00 ~ FutureEsbmate: $O.OD \G~ A Hookup Fee Estimate: ~d f ' $0.00 \a ~ ~ \ . ao lo 13~, 2~t [a`1.o1 L2 o 01 ~ ac~ ~ Dakota County Real Estate Inquiry Page 1 of 1 Dakota County Real Estate Inquiry DaW Updeted 12142008. Need Helo? What's New? Legend A~i Map navigation Real,Estate Parcels Selact option and click on map: o Pa«eis OO Zoom In OZoom Out O Pan O Identify q~°~e on,Ownership ShoW Full County Map Big Map L7RnN.Easemem ? Oedicated RNU ~ @Tax Parcels 0 Market Value 5 g . O Recent Sales 0 YearBuilt L 0 AirPhoto 0 Torrens ~ ~ Refresh Map ~ ~ . ~ . . . _ . , Choose ONE search meMod, enfer aiteda, erM dick Go or hft enter key. 5 a 5 ~ , a - - ° - - - - House Go _OR ~ ' e u _ ° ~ - - - Go ,PIN:, Copyrigh't p 11108, Daaa Comrcyr °Details Tax Stub Statement Plat Comp Sales Neighborhood Birds Eye Photo PIN: 10-16700-070-11 2008 Est Value (Pavable 2009)_ $195,500 Owner, GEORGE V& CAROL E GRISWOLD 2007 Taxable Value lPavable 2008~ $200,200 Address: 2012 ZIRCON LN Payable 2008 Tax $1,674.58 City_ EAGAN, MN 55122 Total Acreaae: 0.21 Year Built: 1959 PLEASE READ OISCL4IMER This epplicaUOn was developed by the Dakota CouMy Office of GIS ui cooperetion with Assessirw Services and ihe Property Taxation & Rewrds Departments v Vi p c o u rv Click on the Dakota CouMy Logo above to retum to the homa page htip://gis.co. dakota.mn.us/scripts/esrimap.dll?Name--webq 1 &Left=496622.241 &Bottom=99791.2181 12/10/2008 • ' I %0A LO+ APPLICATIOTt AND AUTHORIZATION FOR DELAYED PAYMENT OF TAX ' ON SPECIAL ASSESSMENTS FOR SENIOR CITIZENS' HOMESTEAD ~\~~l?" ~\5 A$ LA4VS 1974, CHAP7'ER 206 STATE OF MINNESOTA) COUNTY OF DAKOTA ) . . DATE . ~o;7 ~,J - ,C UU 15 T0: County Auditor. Dakota County, Minnesota - - I. the undersigned, declare imder penalties~ }f perjury: That I reside at U/,2 z/J~ C o N / ~"V.. .6:-14'( ~c>A AU, /v That I am not less than 65 years of age and that the date o£ my bi th is Z- 2 That I am the owaer of the property legally d scribed as: Prope=ty Identification No./O--/,~7r7o--07c~~// That my interest in the ownership of the above property was aquired on . and is as follows: ' 1. Sole ownership (Enter Yes, if agglicable~ 2. Joint tenancy, held 'with CRRoi . 3. OTkER undivided interest (Speci£y) That on January 2, or June 1, I owned and occupied the above property as my homestead and such occupancy began on_ 'Ihat the installmen s for improvements on the 5PECIAL ASS SSMENT5 duly ado ted in ordin- ance by the ~ ~ ' OF AS OF ~~G which have been allo ated against, the subject property would create undue personal hard- ship on my behalf and I respectfully,reque t that payment be delayed and that such in- stallmen, he so defei9redfor the"qears to IJ~ SIGHED: Ok7r'ER POUSE - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - I, , Clerk of the OF IN County, State of Minnesota, do hereby certi£y'that the application of above named,, has been duly reviewed and that ' in ac=erdance with the minutes of official record in said chambers was duly : - APPROVED or DENIED as of That in accordance with approval granted, the SPECIAL.ASSESSTlENTS listed below on the , affiants subject property levied for anmial collection in the amounts and for the years shown be so deferred with interest at the annual rate shown imtil such time as it is deemed the applicant no longer qualifies or the property loses its eligibility. ASSESSMENT D/P N0. ' TOTAL AMOUNT 1`EARS IN7'EREST RA7'E DATED Clerk or Authorized Deputy C ~ ~ 7\ Oa(NlflrnaN9(iMaTr4aauurv-IntalnalRUVdnua9arvlca 2007 Farm1R.pg V~0~ 1~.~. Individual Incom~ Tax Return irtS ucaor,i- Aaneiwni@nr§ww inini§§AQe, Label Ypur Ilrsl nama anA Initlal l.net nnmd OM6 Na, 1945 4494 tSec inalruallons.l Yaui soalal gaeudiy nwn4er G84L' o V GP19WOlf1 U90 I II v'alou'91um, ~POUSa'9 IIY91 wm11 Bn9 InIIIAI L6bt nWU9 IRS la4el, oin,•~,~,P Carnl E Criswold niensu p~inl Iapme atlCra5§ (nunibar and xlinaq, If yoii hnve e P.O. gpe, 9ed ~n9bucbAns. Aparimaot na, ar lypq, A Y911 OlU9i uf114f A 2012 Zircan Lane ypurSSN(s)n49ve Giiy, iown u' peai oibta. ity4W nnvo n mrmgu Vadiaas, aue inaouceona. ~~an: 21P coaa Ch88kIFlg o b4x q61qw will f::a ati MN 59122°2909 ne4chungayour PrasidunUal tnx Ar rafund ElecUon Gam al n ~ Ch9ck haro If ou or aur s ouse if tilin oinU , want $9 to o to this fund sop IFlatruetlens " You S auae Piling 1 Sinpl4 4 Head o( houQahaltl (wilh qualifylnq paraon), (Sao inalructians.) StatUs 2 X Mnrried (Ilmg jointly (evan ih only ano had mcama) If ifia qunhfyinq penon is p clnld but npt ypur dogendanl, 3 Maniad iihnp sopornlely. Enlar spousg's SSN nhave nnA ontar this 6hi1L1's nama haro ll` cm~~ ~~iv lull nanm horq ~ 5 Qurillfylnp wi9tdw(er) wilh Siqp§ndonl Chilsl sne inslrueuons) - ExemptiOrlS 6a X Yourself. It semegno ann claini you as a dopandnnl, do not ahack 4ox Go cialcNilU pn 4aanACb ~ d X S PL15a . , . . Da edanCx (8)9apendenPs (4) Jif nn,e~~wnaaian e 9epundonts: (2) n sociarsoaurlly rulntlenahlp qcn~iayieA 4 11wsa (7) Flrst nnmo I.ast nama nun~ber la you ehiid ~nx wnh veu ~ Ilinare Ihon alx • Ald nPl depontlenls, IIvA with see inslnsliPnS, ~IUa 6o u~ m° ,epaiatlAn(sae innlnIellpn§) . _ - - - ~ 09p9nQBnis QII a6 P9o 411t4f$d 2bPYB . AGA nu~nhers dfofalnumberpfexemAtipnsclaimod.................... .......anilnasadove~` 2 Income 7 Wagos,salarlas, tlAS,etc.AitachFarm(s)W-2 7 3 611. - - Attaeh Form(s) 8 a Taxobla IntorosL Attsch Schodulo I if raquirod . . . . . . . . . . . 81) W-2 here. Also - - - - attach Farm(s) b Tax•oaempl intcrust. Do not inalude an lino &n Bb 1099•R I( tax 8a Qrdinnry r1lvldancJs, AUraeh Schadule 1 if raquireA . . 90 waswithhald, bQualdiAddwidencJS(sooinshuctians) 9p 10 Qayrtnigaindistnbutions(seainstruehons) lU - - 11aIRAdistribuflons 17p 11bTaxable nrnount11b 19,400. 12a Panslona und onnullias 12u 92bTaxablo nmount 12b 1, 649~ 13 Unamplnymunt cpmpansshpn cind Alaslco Narmansnl T ir you dm oroi Fund ctlvlcJends 19 9ela W~2. sow Inslruclipns. 14a SObiAl 56Cllflty en0m9a,don banoflls 14u 21,296. 146T€ixuble emount,,.... 14H 1,652. ao not atlacn, a"Y a,Y'"e"t 15 Add lines 7 thr9uglj 146 (for right column) This Is yaur loial Incoine ' 95 26y347. Adjusted 16 Eduaataraxpansas (seoinstructians) 16 gross 17 IRAdaduction(saelnstructlons) 17 incorrl4 18 Studont loan intaresl doductlan (sea Irrslruclions) 18 79 Tuillon eind loes deduction. Atlach Farm 8917 . . . . . . . . . . . . . . . 19 20 Add lines 16 thraugh 19. Thase tare your total adJustmonfs . . . .0. . . . . . . . . . . . . . . . . . . 20 21 Sublract linq 20 frpm line 16, fhts is Your udJustad gross IncOmv R 21 264 397 . BAA For Disclosuro, prlvuoy Act, and Pnporwork Reducdon Act Notlco, saa Instrustlone, Ferm 1040A (2007) ~ IYFPIAI)12 II1I4107 ~ t ~ Z?~~P Form toqOA (?007) Georae v& Carol E Griswold Pfl .ME Tax, 22 Enter tha amount trom line 21 (ecljusted gross income) 22 26, 307 . credits, and 23a ChaoN X Yau were bam balare Jnnuery 2,1943, ehnd Total boxao paymentS it: X Spoueo wns horn 6ePore Junuary 2, 1943, ~ Blind chacked 23a 2 . 29b ? 9Eendard b sfe~olnstru tionsoand chaakpheaeely and your spouso ilemizas deductions, Deduetion for-- ~ 24 Enteryourstandarddoduatlon(seeleftmargln) 24 _ 12( 900. • Reqplo whp 25 Sublract Ilne 24 from Ilna 22. If Ihiq 24 Is more than Ilna 22, antor .Q. . . . . . . . . . . . . . . . . 28 1 3t 597 . checkad any 26 If line 22 Is $117,300 or loss, multiply $3,400 by iha tott+l numbar of axemptians clAimed bax an linq . 29a or 23b or on line 6d. If line 22 ie avar $117,300, sea lha Insiructlons 26 6t Q Q Q- who cen be 27 SubUact line 26 from line 25. If line 26 is mqra than linr 25, entor -p-, TMiS is your alaimed as a taxablo Incomo " 27 6, 707. dependent, e 28 Tax, Including niiy aIternatlve minimum tnx instrucuans. (sae insiruclions) 28 673, • All athars; Single or pg prsdlt for child and dapendenl cars expenses. Marriedfilin9 AltachSahodula2 29 separAisly, $5,350 30 Cradit for lhe alderly or Ihq disobled. Atlach ScMOCiule 3... 30 31 EducalwncreAits.AltashFarm8B63 31 L _ Marned filing intly pr 32 Chlld tax credit (see inshuCAons). ualifying Attach Form 5901 if roquirad . . . . . 32 widow(er). 33 Rehremqnt savinQs contnbutians cradit. Attach Form 8890 33 $10,700 34 Add Imes 29 thraugh 33. Thesa are your totul crodits . . . . . . . . . . . . . . . . . . . 34 Head of 35 Suhtract line 34 from Ilne 28. I} line 34 is mare Ihan lino 26, anter ~0. . . . 95 67 Household, . , , . . " g7,85D 86 Advanse eamed incoma credit pLiyments from Form(s) W-2, qox 9 . . . . . . . . . . . . . . . . . . . 96 37 Addlines35and36.Thisisyourtotaltax 37 673. 38 6edaral ineama tax withheid from Farms W•2 and 1099 36 39 2007 astlmaled tnx pnymants and amount rappiied fr9m Ifyouhave ~ 2006relum 38 1,200. a quallry allach ing QOnEarnodincomocredit(EIC).. . 400 Child~ . , . . . Schedule @IG, ~ bNonteixtible combat pay aleotion. 40b 41 Additional chlld tax eredlL Altach Form 8812 . A1 42 Add hnas 38 39 AOa nnd 41 These r,ro yaur total DAymonta . . ~ 42 1; 29 9. Refutld 43 If line 42 is mara lhan line 37, 5ubtrael line 37 from line 42, aa 527. This is the amount ypu overpald 44n Amount ef line 43 you want rofundod to you. It Form 8888 Is attached, chack hare 44 527. Direct doppsit7 ~ bRPUting 9ee instruchons num6er XXXXXXXXX ' c T a; Chaaklip ~ Savings and fill in 44b, 44c, und 44d ar ~ d Aecounl Form 8888, number . , , . , . , . XXXXXXXXXxXXXXXXX 45 Amount ot Ilne 43 you wrant applled to your 2008 esllmaRed tux 45 Amount you owe 46 see~nstrueuoo~wo. Subtract line 42 from line 37. For detAils on heW t8 pny~ ~46 - - 47 Estimnled tox enalt seo inslruclions . . . . . . . . . . . . . . 47 Third party pa you wanl la ellow nnothar porson to discuss this rolurn wilh tho IRS (saa Instrucfians)7 Yos, Ccsmpletg tlla following, X Na designee Psr:4n9l pesiynwn s Pheno r~qn) nama na. lll' nump~ iAwniiliqal(P IN " SI n ' Undul panalllp6 O( Rdr4iry, I dBClnra IhBI I hpvu Braminaa IhiS mtum BnQ AC60mpenying SChBdul9e antl 9ltlBm5n15, dn9 10 Iha 4ab1 9f mp knpwladg4 dntl pe64i, Iney 9 are Irual aarrect antl ascurntaly lixl nll 9mounla anG sources af incOma I raaervoq dunng Ih91ax year, paclanalian ol 9opar§r (gther IhaB Iita taxpayer) is pased oA all here informalton ol wlnch tha preparer hao any knuwlndpa. Youi siynuiura Pata Yaur escupnlian fJaynme pnqno num4er lomt return? Seeinstruchony. ' ~n1 Retircd 653- 454-6083 Keep a copy cAnusab alpnnture. II n I Int ralum,\E~~ n. Pala Speuse'€ astu@atloa ior your records. R~ tired PrePdrar's 4aIB y+heqk d poperePs 55N ar PTIN signniare ~ 02/12/2008 am~ Paid iaia F00095276 ' preparer's Fvm'swma - _ NIJ ASS9CIATES useonly to, youfs~isau m . ammvad), ~ 497 WAGNFIR ST FiN 91-1999971 e______na____.,,___~ Aa~rws;.NOa --___s__________ ZiNeoaa R9SEV7LI,E MN ne ne 651 994-1623 6DIAI3I2 i inn/m Form 1040A (2007) - RECEIrED - - DEC a 9 ?nnn EAGAN ENGINEERING DEPARTMENT John Qarder. On tho prupased Assessmont project N IOP953, my wifd and I will soe it as a very dli7icult Nardahip, We Rre both retired and ara in oue?Q 's and botN nm on a lat of inedicntian Aua to hean conditiens. Alsa ns overyAae else die utilitea hnve gono up , wa ere nuw living pny ciny Eo pny dny wlfh no monoy To sptva I The acomony has hit aur life anvinga vory hord, t hope you aen help me with chis iis9emment burdaii. Thnnk Yoti, Siijcercly , Georgc V. Griswold 2012 ZircAn Lane Gngun, Mii $5122 651454-6083 Novcmber 29. 2008 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - I For Office Use I I vI Permit City of EaAN a ; CC- Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Z Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: 64 I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: ,r 71r Phone: Resident/ Owner Address / City / Zip: ;;~Dx:p 2i~rc,~q i✓ Applicant is: Owner Contractor Type of Work Description of work: ~G1dG C~r~ ar Construction Cost: Multi-Family Building: (Yes / No ) Company:_ Z4aler, ~vS LGV;1✓v~ Contact: C/ 5 ~ Contractor Address:?~7 City: State: ! Zip: Phone: License 19C b3 b I I Lead Certificate - /0 9 5-- Z_ If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yes _No If yes, date and address of master plan: - Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that 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 B ing C must be corn ed within 180 days of p rmance. X /1" is X Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA121212 Date Issued:03/19/2014 Permit Category:ePermit Site Address: 2012 Zircon Lane Lot:7 Block: 11 Addition: Cedar Grove 1st PID:10-16700-11-070 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - George V Griswold 2012 Zircon Lane Eagan MN 55122 (651) 454-6083 Home Depot At Home Services 656 Mendelssohn Ave N Golden Valley MN 55427 (763) 542-8826 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA145271 Date Issued:08/31/2017 Permit Category:ePermit Site Address: 2012 Zircon Lane Lot:7 Block: 11 Addition: Cedar Grove 1st PID:10-16700-11-070 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - George V Griswold 2012 Zircon Lane Eagan MN 55122 Haley Comfort Systems 4320 Hwy 52 N West Frontage Rd Rochester MN 55901 (507) 281-0138 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA178914 Date Issued:09/09/2022 Permit Category:ePermit Site Address: 2012 Zircon Lane Lot:7 Block: 11 Addition: Cedar Grove 1st PID:10-16700-11-070 Use: Description: Sub Type:Furnace Work Type:Replace Description: Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 9001.2195 $60.00 Total: This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after started. 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 - George V & Carol E Griswold 2012 Zircon Ln Saint Paul MN 55122--280 (612) 356-0553 North State Mechanical 1444 14th Street W Hastings MN 55033 (612) 207-0345 Applicant/Permitee: Signature Issued By: Signature