4769 White Oak Ct
r.'~,;,~,.~r,Y~,~:,F..z• •
~ cIrr oF,EAc,At+ SEWER SERVICE PERMIT ~
$830 PUot K-`bb Road ;~ERMIT NO.: 9433
P.O. Beic 21199 12-17-86
Eagan, MN 551~211 DATE: I
Zoning: No. of Untts: ~
I
Owner. Ozmun-Pedersoii ~
Address: ~ ~~~e Oak Court I17 B2 Oak Cliff 4th ~
, Site Address: ~
' Plumber. Peine Plum ~
~I u ~Iltie~S 100.00pd ;
' I agroe !o comPlY wfth apnwq~U" C8{~ ~e~n~~arge: 4 7 5 nnn~l
i ordinances. ' ~Et~PH0~1E - ELEC~ou eposit:
REQUtRED A~`ha rge:S()Ta
~ By nnisc. cnarges:
, Oate of Insp.-
~ Date Paid:
Insp.:
~ cInr oF EAGAN WATER SERVICE PERMIT
seso Pilot r~aoe Roaa 8282
~ P.O: -=x 21199 PERMIT NO.: 47 66
Espan, MN SSRi DATE:
2oning: No. of Unib:
Owner: dzmun-Pederson ,
Address: 769 White Oa Court B Oa t ,
Site Addess:
Plumber. Peine Plumb3n.g ;
3 7(~ l0 6 cnarga; p
Meter No.:
Size: ~.,~.f~c ° !G ~~posit: . ,
aeader No.: p ,
.50pd
I agroe to comPly vrHh tho CIttfME . E~~fB • 'p TP
Ordlnancss. Misc. Char es: ,
- REQUIRE-~I~RY ~ ~W b3.50nd meter ~
By Date Pafd:
Date of Insp.: ~nsp~ '
a-~ ~ F-7
_ - -
~
I
-i 9, Eagan, MN 55121 N A 12 935
3830 PAot Knob R d! P.O. BoExA2G~
PHONE: 454-8100
BUILDING PERMIT Receipt M
Tobeusedfor SF DWG/GAR Estvalue $128,000 Date DECEMBER 3 ,1986
Site Atldress 4769 WHITE OAK CT Erect 14 occupancy R3 '
Lot-1? &ock 2 Sec/Sub. OAK CLIFF 4TH Remodel 0 Zoning Rl
Percel No. Repair ? Type of Const ~
Addi6on ? No. Stories
,g Name OZMUN-PSDERSON INC Move 0 Lengm 6'
15136 GALAXIE AVE Demolish ? Depm
o Address Int Impr. ? Sq. F+
Ciry A.V. Phone 431-5000 Install ?
o Name SAMF. ApprO°als Fe"
00~ Address Assessment Permit 503.00
City Phone Water & Sew. Surcharge 64.00
Police Plan Review 251.50
1~a W Name Fire SAC 575.00
= o Address Eng. Water Conn. 500.00
0
il Ciry Phone Planner Water Meter 63.50
Council Road Unit 290.00
I hereby acknowledge that I have read this application and state thatthe Bldg. Off. 11 2 6/8 Tr. PI. 156.00
information is correct and agrge ioyompi ith all applicable State of
Minnesota Statutes and City oT Epqan Or itrl ces. APC ParkS
Var. Date Co ieg
Signature ot Permittee - - ~-f= ~'~~1.. -~'J.%4•~- p
Total
A Building Permit is issued to: OZMUN-$ • UERSON on tlhe express conditlon that
all work shall be done in accordance with alt applica/bl State oi Mlnneso~ta7Statutes end City of Eagan Ordinances.
Bullding Official ~ ` - - 4~ - -
b-
1
PanMl Na Pwmit Holdw DaM T04pbonN •
~
~
PkpA*0
N.Y.A.G
Electric
Soltedl.ir
ln"m,Wn Da. InW. Cam,,.M.
fto*w i w~Q.
Fooaqa n
Found~tloe
Fr.minp
noarw
pwOpft
Rouo Hq.
Irrul.
Fkepl-e
FkW Mo. ' - i
FMW P&W
sidp. Fbnal '
c.?L o«. a u~B
Mek Fty.
Mck Frnq.
Ylfdl
Pr. DMp.
- • - - _ . . . . . ..r . . . _ . - _ . ,
PERMIT # - % --G
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 454-8100
Site Address 4. " k. I _ gLpG, TMpE WORK DESCRIPTION
Lot7 Block ' Sec/Sub Res New
Mult Add-on
m Name .
Address Comm. Repair
9 - er .
c City ' Phone
a FEES .
Name RES. HVAC 0-100 M BTU - 524.00
c Address ADDITIONAL 50 M BTU - 6.00
p City Phone - (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 196 OF CONTRACT FEE
Forced Air M BTU _ APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLJES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent CFM STATE SURCHARGE PER PERMIT - .50
PERMIT PRICE GOES
BEYND $1/000)
Gas Piping Outlets #
Other
FEE
3/C: • ~ SIGNATURE OF PERMITTEE
TOTAL• { (I - 2^ `
FOR: CITY OF EAGAN
• • • PERMIT If ~d l~ ~
PLUMBING PERMIT RECEIPT p C''
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: _/Z9,Zg 7
CONTRACT PRICE: PHONE: 454-8100
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Black ~ Sec/Sub Res. - New
~ , Mult. Add-on
Name " Comm. Repair
Other
~ Address -
c Ciry Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
- NO. FIXTURES T L ,
'Water Closet - $3.00
Name =Bath Tubs - $3.00 • ~-,n
Lavatory - $3.00 k
p Ciy d Phone Shower -$3.00 ;
~ - Ki!chen Sink - $3.00
j FEE5 UrinalJBidet - $3.00
I COMM/IND FEE - 1% OF CONTRACT FEE Laundry Tray -$3.00
APT BLDGS - COMM RATE APPLIES Floor Drains -$1.50
' TOWNHOUSE & CONDO - RES. RATE APPLIES ,TWater Heater -$1.50
, MINIMUM - RESIDENTIAL FEE - $12.Q0 Whirlpool - $3.00 ~I MINIMUM - COMM/IND FEE -$20.00 Gas Piping Outlets -$1.50 STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIT)
(ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00
BEYOND $1,000.00) Well - S10.00
Private Disp. - $10.00
• Rough Openings - $1.50
SIGNATURE OF PERMITTEE FEE: C
STATE S/C: • S U
FOR: CITY OF EAGAN GRAND TOTAL• ~ U• 5 v
~ INSPECTIQN RECORD i
/CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued: .
(651) 681-4675
SITE ADDRESS:' ' APPLICANT: ~
i ~';t 1 I i r?Af" i T . ~ ~
PERMIT SUBTYPE: TYPE OF WORK: I'
INSPECTION . .A
I
~
~ J I
I
Permit Holdsr WM Tslsphons 1 I
WA EER I
PLUMBING I
HVAC ~
Mmpwtbn Dats bnp. Comrtents I
FOOTINCiS I
FOUND I
I
FRAMING . I
ROOFING I
ROUGH I
PLUM81NCi I
PLBG I
AIR TEST
ROUGH I
HEAT7NG I
GAS SVC I
TEST
INSUL I
I
C3YP BOARD I
FIREPLACE I
FIREPLACE I
AIR TEST I
FINAL PLB(i I
FINAL HTG I
I
ORSAT I
TEST
BLDG FINAL I
DOMESTIC I
MEfER I
IRRIGATION I
METER
FLUSH I
MAINS I
CONDUCTIVITY
7EST
HVDROSTATIC
TEST I
BSMT R.I.
BSMT FINAL
I
DECK FTG I
DECK FINAL I
I
~
.~.M
, (Str#i#irate u# Orruparcry
j- of (Eagan
appartmrnt uf luildiag jwtrtiatt
This Certificate issued pursuant to the requirentenls of Secdon 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construciion or use. For the following:
ux aaanrion SE M/GAR Hid;. Pornut No. ; 29 35
O-t;
a-r .n,a ~ ~a ~ R I rya cOM
owo« of e~o GEM-PEMRSM 1ZJC Add. 15136 GAtAVY, AVE. A.F.
8wdj.gAdd,,. 4769 M.LTE OAf' C CT. ,m,;ty L17, B2, OW CT.L~3' 45K
.
ate: F~'i. 2& 1987
~mng officw
PO5T IN A CONSPICUOUS PUCE
CITY OF EAGAN ~
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55,z, N- 12935
PHONE: 454-8100 /
BUILDING PERMIT Receipip ~O
7o be uaed for SF DWG/GAR Est. Value $128,000 Date DECEMBER 3 1986
StleAdtlress 4769 WHITE OAK CT Erect ~ OccuDancy R3
Lot 17 Block 2 Sec/Sub.OAK CLIFF 4TH Remodel ? Zoning Rl
Parcel No. Repair ? Type of Const. V
Adtlition ? No. Stories
w Name OZMUN-PEDERSON INC Move ? Length 66
z 15136 GALAXIE AVE Demolish ? Depth3~
o Address Int Impc ? Sq. Ft
ciry A•V• Phone 431-5000 Instau ?
o Name SAME Approvals Feee
¢
i
$Q Address Assessment Permit $ 503.00
~ Ciry Phone Water&Sew. Surcharge 64.00
Police Plan Review 251.50
_z Name Fire SAC 575.00
nddress Eng. WaterConn. 500.00
a w Ciry Phone Planner Water Meter 63 . 50
Council Road Unit 290.00
Iherebyacknowledqethatlha ereadthisapplicationandstatethatthe gldg.Off. 11/26/$ Tr. PI. 156.00
information is corred and r e to compl wrth all applicable State of
Minnesota Statutes antl 1 'r Oces. APC Parks
~41 Var. Date Copies
Signature of Permitte~ - Total G u)
A Building Permil is issued to. OZMON- DERSON on the express condition that
all work shall be done in accordance with all appl~J ica je~State of Min eso`S~tes and Ciry ol Eagan Ordinances.
Bmlding Ofticial
zl-
,
i'LUaTRI!vG (RESIDEiIMaL.) Pes tstff Applieution
City Of Eagan
3830 "';ior I{nnb Road, Eagan i1:u .S5122
Telephonc 9 651-675-5675 F3X'# 551-675-5674
Please complete for: Single Fanuly Dwellmgs
Townhomes and Condos whea pernuts xre requaed for each umt
Date / / OP- - - - 1
I JELWSKI, RALPH 'I
Site Address 4769 WHITE OAK COURT I Unit #
EAGAN, MN 55122 I
'I (651) 895-9182 ~
Property Owner i Telephone # ( )
J
Con[ractor NQOR13p1.~vn~ ~'16~k,3a~[~Y~i7 Wo
Address (V1Z)V6R'3i
_ City
~~a,
E}~:,o~~.S~
Sta[e ~~~MW-1P _ 1'~-,lephone # ( )
The Applicant is _ Owner ~ Cos:hactor _ Other _
Septic System New Refurbished Submit 2 sets of plans and h1PC license $ 100.00
Includes County fee, Additional consultant fess may api)ly.
Alteratious To Existing Dwelling Unif, lnc!uding $ 50.00
_ Adding fiMures to lower levels cr roorn addiuons, excluding water sortener and water heater
_ Abandonment of septic systam
_ Waterturnaround (+5l6"meter!':ieeded-$121.00)
Other:
_ RPZ _ new ins±allation repair _ rebuild g; 30.00
_ Lawn irrigation system
L; V
_ Water softener ~ R'ater heater OC r Y2003 $ 15.00
X replacemen; additiansl 8Y
State Surcharge $ 50
Total $
I hereby apply for a Residential Plumbing Ierr.ut avd acknowledge that the information is complete and accurate; that the work a-ill
be in conformance with the ordiiiancPS an,! : u.id< ;-_r the City of Eagan and with [he Plumbing Codes; that I understand this is not a
pemut, but only an application for a permr. and .voih is noi *.o start withour a per.nir, that the work will be in accordance wuh the
approved plan in the case of wotk which re:; ~x,es a review and approval of plaiis.
Applicant's Printed Name Ap/igfnYs Signature
~l
~s1986 BDILDING PERIiIT 6PPLICATION - CITY OF EAG9N
90TE: ALL CONTA9CfORS MOST HE LICENSED i1ITH THE CITY OF EAGAN
SI6GLE F91+IILY DiiELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MOLTIPLE DWELLINGS - RESIDENTIAL RENTAL TIBITS FOR SALS QNZTS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SORVEY - CHECB itITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMII7ERCZAt
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: SM Valuation: Date: n,,,,, 9s 19Q6
Site Address 4769 w;ta nak en,,,-t OFFICE DSE ONLY
Lot 17 Block Z Erect v/ Occupancy (G 3
Remodel Zoning P-•I
Parcel/Sub 0ak Cliff 4th Addition Repair _ Type of Const Y
Addition _ of Stories
Owner Ozmun-Pederson, INc. Move _ Length (ocv
Demolish _ Depth 3-7
Address 15136 Galaixe Ave Int.Impr. _ Sq Ft
Install _
City/Zip Code Apo1e Va11ey, MN 55124
Phone 431-5000 APPROV6LS FEES
Contractor p=in-pe7Prmn rnc-_ Assessments Permit 503.
Water/Sewer Surcharge cv
Address 15136 Galaxie Ave Police Plan Review 2 S 1.
Fire SAC S 7 S
City/Zip Code Apple Vallev, MN 5512 Engr Water Conn Soo,
Planner Water Meter (o3. -'!9
Phone 431-5000 Council Road Unit 290.
Bldg Off y Treatment Pl I S(o ,
Arch./Engr. APC Parks
Variance Copies
Address TOTAL Z403,
City/21p Code
Phone ll
HOTE: ADDRESSES FOR CORNER LOTS - CONTR9CTOR/HOMEOBHER MQST DESIGN9TE AHICH ADDRESS
IS DESIRED. NO CHANGES SiILL HE ALLOWED ONCE BOILDZNG PERMIT IS ISSQED.
~Z ~ 30 = c~o x ~ = 55~30
l 4- K Z l ~~`l 4 x Sa = I~l O S Z
Z~ K 23 - dE>3 x 12 ° 5-7 g&
Z73 x tz ' 37--7(0
1z x~z ~ 144 x iS = Z( coc->
12x(5 - l~oXB = 1440
32 x 30 =9 (,o k 44- _ `~-zz40
~Z-ICo4-4
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l'~
,
7
6 SZ 7-P(
p~
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- Gnc~A ti c
. FLOO~L aLL'Ii. -F3=0" I
, i 'rl=o:'
i
ASYIiA
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- g 5
~°~O
`~'V
,
' ~ . . . li\7'ERIDR ENVrI.OPE AVERAGE °U" CnMPUTA'fION
ner__DZkPILj IVAddress Phone~31~_506
gal Description of Froperty: I.ut~Block-i Addition d K GC-/r~ ~I'T~nate
te Address_` I % i 6A-),L G~TgZ
AVERACE LINEAL FEET OF
EXPOSED WALL AREA ABOVE GRADE
in level
Linea~f~dof Wall aUove grade 1 67- x height of wall - --1.~--,--~
l 2(0, 400 ~S
m joiet area J
Lineal ft. of rim x height of rim
lwer level ?a, S 4, S _ 92~ Zs
- z ~6. ca
Lineal f[. of framed wall above grade 3Z,ox height of wall
Ltneal ft.'of masonry wall above grade-Z /,0 x height above grade , ~6°
TOTAL wall area above grade including windows and doors
LNDOWS: Area x"U" value ,~7 X„U„ - (U) ske & type p~.Lf1 GLrI'~ pd7.ef3LE~C./1~~F•+~ft• Xliu.. _ (U)(,
ft sq. ft. 6 (U)
~ „ 7 3 s fr. ¢ X I:U' 5~ 7 4• 13 ¢ (u
~
o60 ~cm~sy. fc.q. `s x ~~u
X Ull Gsf cu> i
It ~nGD / G' .q sq. ft. ~ ~
Z4Go ~ . sq. ft.~X ~~U~~ . ~J 4R (U) (
Z~ 3-`I sq. ft. xelpullll 9 (U) i
sq. ft. 3357~ x U
sq. ft. x uU,tT_ Si
aq. ft. x Un (U)l
(U) ~
x 'iU"
sq. ft. xllul, (u) i
u u sq. Pt.`__X nun = (ti) ~
iIf sq. ft.~X liull (L) (
it sq. ft. _
X flUff (U) i
u n SQ. PC.~---X uUn (L') of sq. ft.~_ -
sq. ft.
Z Z, an
i00RS: Area x"u" value xliull 13 = s.79 (U)
lake & type 'JQCF ° ZZ.3~sq. ft.
Sq. fC. X
sq. ft.X f~ll
n u ~ sq. ft.`_ 0- D/ ,
1
)PAUUE WALL CONSTRUC ION; Area x"U" }~lue Sq . ft. x"U" 99, b (1!)
Y s ft. 51 D x~~U~~ , ORz= N)
Q• n n a Z( U)
letail refer m ~ 5 sy. fc. X„~,~ ZS,~ 8(U)
ance from `,~~J~~y Wf}(,(_ sq. ft.
nUn ~l!)
sttached sq. ft. X
;hee.te sq. ft.~___X „U„ (U)
sq. ft:~__..__
TOTAL Wall Area Including ~ TOTAL (U) (A) `f1,~! ~
Windowe b Doors
Z6,,~'~ nvc.
TU1'AL (U) IA) VAI.UES ZG~
UIVIpED BY 1'OTAL WALL AREA ~Z
AVERAf,E "U" MinJmum or less for 1 b 2'family dwellings
" Minimum . 2 or less for.all other bulldings
N(1TF.: ]f avr.rage "U" values ae calculated above do not meet the EnerRv Code requirements, the
"Alernate Envelope Design" as indicated on Page 5 may be used.
~ . ~ . . . . ,
R-Value ~
' • , FItAMING MEMBERS IN WALLS
Top View • .
YALL SECTIUNS Exterior _air_fi. Q.__....._.........-•- - . .1
7-_--•-
iUTE: Use 10;6
ot opuque Sidingr. 5rEUL WIP?7444
- J., 4~ Z
wall ureu , '
i'or lramin-~~ st,eathing •z5~32 Z_o 6
6.875
membaru
' sofC riood' J~ ~`L ^4-3$
at
• dr.y wall - - -r---- .45--
'Inter~ior~air film •68 „
TOTAL R= I Z. D SS
U ° 1/R . U-
-FRAMED WALL ~
` - •
Exterior sir,film .ll
~ SidinR 5 TeXZ rA PN l. 6-7-
Sheathing 2,j~3 2~ 'Z. O G
batt insulation ~ ~ ' ~ 9• ~
dry wall .45 !
Interior air film .68
D TOTAT R a Z 4_1 ~ S
U = 1/R U • OL~~
~ RIM. JOIPY .A
Exterior air film
~
i
Siding s Te-~L, wlFVl449
2.06
Sheathing ~ Z ?~~~j Z ' _ .
.
. 1.88
1L" 'soft wood
. • 3P.s.u7arie
.68
Irterior air film
. TOTAL R ~ Z S4'/
U° L/R ' , . u.° ~ I o 3 9
•
~ MASONRY WALL
17
Exterior air film .
~
, 12" concrete blocic '7
Inaulation H I- D' fL 1fl4 f D I" ~ ~O•'- •
. - .
~ .
~ Interior'air film •68
_
(2 ~ TUTAL N
. . . . ~l, 4'i, r . .
. , , ~ ~ . ,r~, , . . . , " , , %iti~ ~ ' . . •
. . , . ROOF CFILING
_Outside air film _,61
F~ - - Insulation
r~ Drywall .45
_ -
~
Interior air film. _ _61
TO'i'AL R
U=1/R U=_ rUZ
,
.61
Outside air film
Insulation
' ~ ' - - - - 35" Drywall .45 - ,
~ _ _ ~
. . _ Interior air film J. --.61 -
TOTAL R =
U = 1/R U =
Outside air film •17
~ SuilLup s'nnfinn - - --i33. .
Inaulation
rk 1 - -
Wood decking
~ i
Interior sir film .61
. ~ % - - -
~ ~ TOTAL R =
- -
U e 1/R U - - -
)F/CGILING: ~
PAL AREA: aq, ft.
:ail'reference x sq. ft: (U)(A)
)m above. x sq. ft. _ ~L)~A)
;crlbe openinga x sq. ft. _ ~U~~A~
roof "U" x sq. ft. _ (U) (A)
- nUn x sq. ft. _ (n)(A)
"Un x sq. ft. _ (L!) (A)
nUn x sq. ft. _ (U)(A)
TOTALS sq. ft. (U)
I'AL (U) (A) VALUES,
VIDED BY TOTAL ROOF/ ~ AVG. "U" ~
ILINC ,AREA,'
E1tA(:E "U" .OS for ventilated roofs ,
.10 Eor all other construction
i
fF.: ]f aver:+y,e "l:" vnlues as calculated a6ove do not meet the Engergy Code requirements, th
"Altcrna[e.Rnvelope Design" as indicated on Page 5 may be used.
(3)
;
~
, ~
~
CITY.OF EAGAN PERMIT
3 t 3 3 0 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 3 3 9 7 6
(651) 681-4675 Date Issued: i l/ 0 9/ 9 8
SITE ADDRESS:
4769 WHITF OAK CT
LOT: 17 BLOCK: 2
OAK CLIFF nTH
P.I.N.: 10-53553-170-02 DESCRIPTION:
GAS INSERT/GA3 LINE
Buildinq F,ermit Type FIREPLACE
Quildinq Work. Type HLTERATION
Census Code ~ 434 ALT. RFSIDEN7IAL
~
• ~ i
i.
REMARKS:
CHIMNEY/FLUE MUST BE INSPECTED BEFORE CONCEALING.
FEE SUMMARY:
Base Fee $50.00
Surcharge _ _-L-_60
Total Fee $50.50
CONTRACTOR: - Applicant - OWNER: •
CONTROLLED AIR 14606022 JELINSKI RALPH
'11210 EASTON AVE 4769 WHZTE OAK CT
FARMINGTON MN 55024 EAGAN MN 55122
(612) 460-6022 (651)895-9182
I hereby acknowledqe that I have read this application and state that the
i.nTormation ie correct and aqree tn comply with all apolicable State ot Ihn.
~ Statutes and C3ty ot Eaqan Ordinances. J
~a. E '-D 1~
APPLICANT/PERMITEE SIGNATURE SSUED BY. SIGNAT RE
3830 PILOT KNOB RD - 55122
1998 FIREPLACE PERMIT APPLICATION
681-4675
DATE: PERMIT FEE: $50.50
DESCRIPTION OF WORK: _ Consttuct new fireplace _ Alterations to existing
Install Eas insert oalv _ Install eas line onlv
Other
JOB ADDRESS:
LU'P: i~ BLOCK: ~ SCTBDtVISiONrP.[.ll. O
APPLICANT (circle one only): OWNER tTRAC;TOR
I hereby acknowledge that I have read this applicat on and state that the information is correct
and agree to comply with all applicable State f Minnesota Statutes and City of Eagan
Ordinances.
Name: Phone sqa
PROPERTY Lazt First
OWNER
Signature:
Street Address: `O C\
Ciry G--~~ State: Y Y l`V Zip: SS
Company: N Phone I ~OU-lfJ~~
FIREPLACE
INSTALLER Signature:
Street Ad : fiCeitse#
Ciry State: I ~ Zip: cJy-
Company: Phone
GAS LINE
INSTALLER Signature:
Street Address: a =-,I~
~ ~i ~ ~
Nov - s r998
I I ~ ~
,
III'1
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 14 Fireplace
WORK TYPE
? 31 New 8' 33 Alterations
? 32 Addition 0 34 Repair
GENERAL INFORMATION
Census Code. 434
SAC Code 01
REMARKS
Chimney/flue must be inspected before concealing.
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL~ fg~ . a 5
CITY OF EACAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Consh~cflon Reauiremenfs Remodel/Reoalr Reaulremenfs 7C
D 3 reglstered sBe suneys showing sq. N, of 101, sq. M. of howe 2 copies of plan
and QII roofed areas (207, maximum lot coveraae allowed) 1 fet of energy calculaflons for heafed addHlons
D 2 coples ot plans (show beam a window sizer, poured fnd. design; etc.) 1 sMe survey for exterior addkions 3 decks
? 7 sef o} energy calculations
D 3 copies of hee preservatlon plan M lot platled aMer 7/7193
DATE: CONSTRUCTION COST:
DESCRIPTION OP WORK: O
STREET ADDRESS: I C~ DG-~ C.
LOT: -X I 7BLOCK: Z SUBD./P.I.D. (~-l~•/V ~ fI tName:_ U6nc,ili PhoneM: b5I ~ 6`T,5 - -/Ie"i
PROPERTY Last Flrs~ t
OWNER StreetAddress: `-120 (10hIIe lJa.KJ C+•
City I: 0 QQL.f) State: Zip: 6ri I aL~
ComPanY: ~UIIT WUC.C. i alan 0CD Phone#k: -Tfp 557~ ~ 7C)
(area code)
CONTRACTOR
Sheet Address: I ~I DJD /9c~i~Gl /?V-p- N Lieense # , 3g9 9 Exp. ~
City [11rY1~ State: ffiI'1 Zip: SJC~7
ARCHITECT/
ENGINEER Company: Name:
Telephone orea code
Street Address: RegistraHon M:
City State: Zip:
Sewer S water licensed plumber (reautred for new conshucfion onlvl:
PenalFy applies when address change and lot change Is requested once permfl Is Issued.
I hereby acknowledge that I have read this applicatton, sfate that the Informatton is cortect and agree fo comply wifh all appllcabl
State of Minnesota Statutes and Cify of Eagan Ordinances. (
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No IJ- 2 3
Tree Preservation Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace 0 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4sea.
? 03 1 0`_ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level O 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging 0 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration 0 37 Demolish Bidg.' ? 41 Wood Stove 0 45 Fire Repair
u34 Repair ^u 3o DvrnoGsii -,iiiterior} u 42 naroul
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level 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
Fire Sprinklered
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Plan Review
License
MC/ES SAC
Ciry SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded. ~
Trails Ded.
Other '
Copies
Total:
SAC Units
% SAC
****#*#*********#*****i*******f#i**~
` C I T Y O F~ E A A f~ PAYPiFTI' OF FFE AT TIME OF ;
_ „ APPLICATIoN DoFS Nar oorSizTUTE ;
*t APPROVAL OF PERHIIT. *
~ APPLICATION FOR PERMIT * *
INSPF7LTION oF SEDM ADID/OR FIATII2
y*, TM1LSfA7.TATTONS WILI. NOT BE SQIm- *
SEWER AND/OR WATER CONNECTION UNM PERMIT BAS BEM *
w
APPROVID. ~
* a
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r *
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. ***t**:*+*~*r*t*:*,r+~,r*,e***r~+**t:~:
cf'~ g P ease Print )
1) PROPERTY ADDRESS:
LEGAL DESCRIPTION: J- yep<
(Lo~Block Subdivision or Tax Parcel ID#)
IF EXZ62'ING SIRCCIL'RE, DATE OF ORIGZNAL BIIILDIIVG PFRMIT ISSL'ANCE: '
~ T
PRFSEP7P ZONING/PROPOSID C'SE: (bbn Year
~ COi%Y"JERCIAL/RETAII,/OFFICE R-1 SINGLE FAMILY '
.y.._
F7 IDIDCTSTRIAL Q R-2 Q[;PLEX (ZtVo C'nits)
n INSTI'I[;TIONAL/GO~T ~ R-3 7DWDIIIOTISE (Three + Units) ( L~nits)
. R-4 APARTm=/CODIDOMINI[.7m ( Units )
2) ~
NAME__
ADDRF.SS:1DS'O.i F-4
CITY. STATE, ZIP:.v«- CiadK,
PHOi~: ~S%~'9f~U
3) • u For City Lse .
NAME: '
Pliunbers License:
ADDRFSS: Vo .s' /Y Fa rm'mN ESActivecpired
CITY, STATE, ZIP:rNot recorded
PHONE:_ ~e(vs MASTER LI(ENSE# BD-2-io - ~ns:2 Sta Initial
4) ~•r.N•:.~lT~~.,1' ,~T~=19
ry
NAD'lE: ~J2~nun v~8't:~GltS't.~ e.
. ADDRFSS: /S/.7 6 4Y~ ' - .
CITY. STATE, ZIP:/0 Pr4 Il? s S~/-2 S/
PHONE: 5-00 0 -
•5) ~ v ~ d: ~ • ou, • o~ U:1.tiuo-i
~ CONNECfION TO CITY SEWf:Ei CpNNIDCTION ZO CITY WATER a pTHEEt .
6) ~ PLEASE HOLD APPROVFD PERMIT FOR PICK-OP BY ONE OF ABOVE
~ PLF1iSE MAIL APPRWID PERMiT 2O 1, 2, ~ 4. ABC7VE .
• (Circ one)
7) r r u• -
, • 7: ~ Y: Y01: MY ' 7 • •J i.: ~ r •~r 7a io-• ~ r c.~• • iu . . a...~ . r •
i. a~r I:n ~ ~::r •:I•,N]~ 1 1 i' a: ~o ~a cr ~ n .
. u.
_ . " . FOR CITY USE ONLY
PERMZT # ISSCED
Pd w/Bldg. Permit FEES:
$ $ /O'Sa SEWER PERMIT (INCLUDE SC'RCHARGE)
$ $ /0 -S^0 WATER PERMIT (INCLODE SC'RCHARGE)
$ $ WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLi:•DE CORPORATION STOP)
- $ $ SESVER TAP
$ $ ~S 0-t ACCOUNT DEPOSIT - SEWER
$ $ ACCOC'NT DEPOSIT - WATER
$ ~DO • U D $ WAC
$ .5 7S' cD $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRC'NK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ 'oo $ WATER TREATMENT PLANT SLRCHARGE
$ $ ' QTHER:
$ I~' I`7 $ J I0 U TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PC7BLIC RIGHT OF WAY?
Q YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SLBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: c-f~~~q/
TITLE: .
v J~
DATE : /2- Z ~ 7 Z
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4769 White Oak Ct
Lot: 17 Block: 2 Addition: Oak Cliff 4th
PID:10- 53553- 170 -02
Use:
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: Replacement
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical perm
952- 445 -2840.
Fee Summary:
Contractor:
Controlled Air
21210 Eaton Ave
Farmington MN 55024
(651) 460 -6022 X253
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
$50.50
Owner:
Ralph P Jelinski
4769 White Oak Ct
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Mechanical
EA079925
09/20/2007
ePermit
equirements should be directed to Mark Anderson, State Electrical Inspector,
$50.00 0801.4088
$0.50 9001.2195
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Date:
cityofaftali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use C`, /1
b
Permit#: 1 379 l
Permit Fee: 1 72 . 3
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMIT APPLICATION
Type of Work
LAI
.A
Site Address: [ i W Unit #:
Name: VVt'? Y J j ( Phone:
Address / City / Zip: All &q Wyi IV, , 0 at CO tM'4;
Applicant is: Owner ContractorF_D
Description of work: IMO IO YiN�VV ( 1 ut 4 W h c{ I C l a, "S -et rig
14,(/1kUO
Construction Cost.
J
Multi -Family Building: (Yes / No)
Company: E`e (Gti ()fi Contact: El 12 at O t tiA
Address: 41 OD aLaCk011d j� VVI City: vl • O AL rot, Y K
State_Zip: Phoneg2G 1S1 L-Umaii:�,k)ess-PJ<ic'VYIWt1IT.W
License #: WO V t O Lead Certificate #: OM -0034— 2
If the project is exempt from lead certification, please explain why:
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:
Phone:
Phone:
Sewer & Water Contractor:
Fire Suppression Contractor:
supporting documents that you submit are considered to be` public information Portions„ of
NOTE: Plans and
the information may be classified as non p bl
t mu! permit
conclude that they are tradesecrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.org
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 Sty ildCod ust be completed within 180
days of permit issuance.
•
x ooiutotfin �12SS
Applicant's Printed Name
x
Applica
Page 1 of 3
2
V1/1/ii
/37”q
DO NOT WRITE BELOW THIS LINE
SUB TYPES /7(? 60k; 1.f, Oajc C `
Foundation_ Fireplace _ Porch (3 -Season) Exterior Alteration (Single Family)
Single Family_ Garage _ Porch (4 -Season) _ Exterior Alteration (Multi)
Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous
01 of _ Plex _Lower Level _Pool Accessory Building
WORK TYPES
New _ Interior Improvement
Addition _ Move Building
_ Alteration _ Fire Repair
Replace_ Repair
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25% 100%
Census Code {{
# of Units
# of Buildings
Type of Construction
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Siding Demolish Building*
Reroof _ Demolish Interior
Windows Demolish Foundation
Egress Window _ Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City ater
Booster Pump
PRV
Fire Suppression Required
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:,
(`• Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Roof: _Ice & Water _Final Pool: _Footings Air/Gas Tests _Final
Framing Drain Tile
Fireplace: _Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall: _ Footings _ Backfill _ Final
Sheetrock Radon Control
Fire Walls Fire Suppression: _Rough In _Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
51,70y6/
Page 2 of 3
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PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA153548
Date Issued:12/31/2018
Permit Category:ePermit
Site Address: 4769 White Oak Ct
Lot:17 Block: 2 Addition: Oak Cliff 4th
PID:10-53553-02-170
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 -
Ralph Tste P Jelinski
4769 White Oak Ct
Eagan MN 55122
(651) 895-9182
River Valley Rpz Llc
1623 210th St E
Farmington MN 55204
(515) 210-2094
Applicant/Permitee: Signature Issued By: Signature