4232 Valley Forge Pl
REACTIFV~D FOR DlMft CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 j3
PHOME: 454-8100
BUILDING PERMIT Receipt #
To be wed tor SF L)WG/CAR Est Value $62,000 Dete ` - ,19 " 6
S+te ~ Address 42~2 VALLF:Y F'ni?CE Erect Occupancy R3
Lot 1 h Block 1 Sec/Sub. tSnRTH LI&model ? Zoning
Parcel No. • Repair ? Type of Const v
Additlon ? No. Storias
~ Name «tii9 ElCii.~{,:i Move ? Length 95
z 183U8 ~1I1R?H Y i..AKE HLVD Demolish ? Depm d~
o Addreaa Int. Impr. ? Sq. Ft
I Ciry PRIQR Li4,one 432-2460 Instau ?
Z o Name 7n`;I-% A provaM FNs
I oQ Address Assessment Permit 31 31 ~
City Phone Water & Sew. Surcharge
~ Police Plan Review 159 . 50
. W~ Name A• i' • S. HOME DES IGN Fire gqC 575.00
Address Eng. Water Conn. 50 0. 00
i W city Phone Planner Water Meter 63 . 50
Council Road Unit 290.00
I hereby acknowledge that I have read this application and state that the Bldg. Off. 2?~~ 6 Tr. pl. 15 6. 0i
information is correct and agree to comply with all applicable State of
Minneaota Statutes and City of Eagan Ordinancea. APC ParkS
Signeture oi Permittee Var. Date Copies 9 4.U.~
Totai $ 2 ,0
A Bullding Permit is issued to; RSM IlOME.~'i on the expreas conditlon that
all work shell be done in accordance with all applicable State of Mlnnesota Statutes and Citxof Eagan Ordinances.
Building Oftlcial
~
• PNmN No. PwmN Mo1dN Wb TM*Aor» N
Plumbinp .
H.W.II+C. S ' -
Ebetrle
Solpnw
Impectlon Dift Insp. Commmft
y L~J
Fooqnps u
Foundelbn
Fnminq ~ J
Roollnq
Rouph Pibg.
Rouyh M10•
lrksul. ~(2$b
F~.~.
F" Mlp.
F{nal Plbq.
~ &dq. FNaI W ~
I CAri. Oec.
D@elc F1p. ~
Wek Frnq.
Wall )
P~. Dbp.
.
PERMIT # CITY OF EAGAN FEE
PLUMBING PERMIT Jv
RECEIPT # , SC ~ 454-8100 S/C
MINIMUM RESIDENTIAL FEE - $70.00 +5.50 TOTAL
DATE f y d G MIMIMUM COMMERCIAL FEE - $20.00 + $.50
1. Bldg. Type: Res Comm Inst 2. New Z Add Alter Repair
~3. Total Bid Price 4. Job Address
- # ,
Lotr~"-Bfock[. 8ec i"o~'~vic• • M~~+o~.~s 5. Owner
6. Contractor kA'. ,;,o< r't k'd f/"76 /.~J y! S?/,,.~,~.? Ad! o .5~+?i~Gc
(Name) r^ (Streeq (City) , (Zip)
7. Contractor Phone #
NO. FIXTURES NO. FIXTURES NO. FIXTURES
~ Water Closet - $3.00 ~ Laundry Tray - $3.00 -Well - $10.00 ~ Bath Tubs - $3.00 ~Floor Drains - $1.50 Private Disp Syst - $10.00
~ Lavatory - $3.00 ~ Water Heater - $1.50 __jRough Openings w/o
L5hower - $3.00 Whirlpool - $3.00 Fixtures - $1.50
_.L_.Kitchen Sink - $3.00 ! Gas Piping Outlets - $1.50
-Urinal/Bidet - $3.00 -Softener - $5.00
COMM./IND. RATE - 196 OF TOJAI BID PRICE PLUS $.50 STATERCHARGE FOR EACH $1,000 OF FEE.
9L-~ Signed: _ for
Approved Inspections: Date Rough Insp. Date Final Insp.
.
,
c=
' PERMIT # ~
MECNANICAL PERMIT RECEIPT # aC) -2 -7
CITY OF EAGAN
3830 PILOT KNOB ROAD, EACiAN, MN 55121 OATE
CONTRACT PRICE PHONE 454-8100
Site Addr 4 gLp6. TYpE WORK DE8CRIPTION
Lot~ Block Sec/Su '
Res. X New ~
m Name Burnsville Ht . 5 A/C Mult Add-on
- Address P.O. $Ox 1634 epa
-51 c City BurnBVille Phone 894-0005 ' R ir
Name RSM Homea FEES
c Address ' U er 145th St Ct RES. HVAC 0-100 M BTU - $24.00
~ C~, Apple Ve11ey phone 432-2440 ADDITtONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
TYPE OF WORK ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
Forced Air M BTU 02 COMM/IND FEE - 196 OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
UnR Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
Vent CFM (ADD 550 S/C IF PERMIT PRICE GOES
~
. Gas Piping Ouilets Ik BEYOND $1,000.00)
' Other
c ST~ ~
FEE $/C, ~50 SIGNATURE ERMITTEE
uJ
. TOTAL -
FOR CtTY OF EAGAN
CITY OF EAGAN Remarks -
Additfon NORTWIEW MEADOWS Lot 26 Blk 2 Parcel 10-52100-260-02
Owner Street 4232 VALLEY FORGE PI,ACE Scate EAGAN NIIV 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1984 76.7S -7_6-1 ~•~.(7'~ 10
STREET RESTOR.
GRADING
SEWER LAT 198 .79
' SAN SEW TRUNK -rj'Fj 1981 138.48 6.92 20 --773727- SEWER LATERAL TRK 1984 (8,S4
7 1981 22.28 1.+8 -1-.-1+ -H15 •
WATERMAIN 1984 70.67 4.71 15
WATER LATERAL 571 1981 18.65 .24 r9-3' 2-0-15
WATER ARER 57 1981 138.48 6.92 20
3 1982 29.52 141 20
STORM SEW TRK 50 1984 392. 32 46 31 -3Ms
STORM SEW LAT
'81 1984 33.97 3-40 - 10
DRAINAGE CURB 8i GUTTER '
SIDEWALK
STREET UGHT
WATER CONN.
BUILDING PER.
SAC '
PARK
~
I CITY OF•EAGAN WATER SERVICE PERMIT ~
~ 3830 Pilot Knob Rwd
~ P. O. Box 21199 PERMIT NO.: ' J
Eapan, MN 55121 DATE: - - zor1v: IR 1 No. of Untts: '
p,,,,rwr_ RS" :Ioraes
/1ddnm
51h /lddips: 4232 Valle For e L25 R.^ . ~r ,,,,io;a "~~:,c•:
Plumb+r. ' I.2'-es ide Plur;bin , -
Meftr No.: 4 d 0 0. 0; t:.;'
Slse: " oc Depodt: 15 i 1i,'
I MO.: 01+pr'
I Mm *o wM.OF Mo 1v .`.0 p'.i
1 t) ( ± 'i
FQ~1Il~EOrM~ ~
81' Dob Pbid:
~ Dah of Irap.: lnap,;
~ 6-~~-
i CITY OF EAGAN snm Savxl PERM
f 3830 Pilot Knob Rwd
' P. Q. Box 21189 PERMIT NO.: .
; Espan. MN 55121 p„+TE:
Zonlnp: F' 7 ,
( No. of Units:
Owrrr: 717-'t Howes
Mdross:
i 5t» Addresc 4232 Vatle For e T,?.r- ?5' •4OrCti2Vi.°V '`e•a:?o~,5
~umber
622331
' 1 oc.oopa
b...m* wM~ Iro dh, oi 5".. con,,.ctbr, CJ,,w; 7--0`11r'
i Odl~wa~. Ac°°iint DopwMo - ~ 5-t~oi~._._
Prnnlt FN: - ~
l B Sy/dpw. S Il r, . 2
Y Mim OIO
Dor~ of Imp.: Totol: ~
InW" Datr Piald:
CITY OF EAGAN N 0 11700
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE:454-8100
Receipt#
7obeusedlor SF DWG/GAR Est.Value $62,000 pa1e_AP$IL 1 19 $6
Site Address 4232 VALLEY FORGE Erect LT y Occupancy R3
Lot 26 Biock 2 SeciSub. NORTHVIEW Pemodel El Zoning
Parcel No. Repair ? Type of Const V
Addition ? No. Stories
w Name RSM HOMES Move ? Length 45
~ 18308 MURPHY LAKE BLVD Demolish ? Depth dc
3o Address Int.lmpr. ? Sq.Ft
Ciry PRIOR L{ihone 432-2440 Install ?
=o Name SAME APprovale Feee
~ a Adtlress Assessment Permit ' 0
a
• ciry pnone Water & Sew. Surcharge
..Q Police PlanReview 159.50
Fw rvame A.P.S. HOME DESIGN Fire SAC 575.00
~a nddress Eng. WaterConn. 500.00
a W Ciry Phone Planner Water Meter 63. 50
Council Road Unit 290.00
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe Bidy.oe.3/27/86 Tr.PI. 156.00
informahon is correct and agree t0.comply with all applicable State of
Minnesota Statutes antl Ciry of E§gan Ordin ce APC Parks
Signature of Permittee /-c- Var. Date Copies
Total $2.094.00
A Building Permit is issued to: RSI-i i' ES on the express condihon that
all work shell be done in accordance with all applicable State o274
nesota Stat tes an Qlpr'ol Eagan Ordinances.
Building Official -..S
MECHANICAL (RESIDENTIAL)
Permit Application 3b•S~
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Pleasc complete for. Single Family Dwellings
Townhomes and Condos when permi[s are required for each unit
Date q / 36 / -O 5 "
Site Address ~ l~L Unit #
~
PropertyOwner Telephoneik(0( ) 5~ 583~
31~"
Contractor 1 ? ( h I
Street Address ~D rpn~/ ~ ~ City
State /V Zip Telephone # 3
The Applicant is _ Owner ~ Contractor _ Other
Add;on, modifica[ion or al[eration to existing dwelling uni[ $ 30.00
~ furnace replacement I--, ~'Cf Yl~ ~.J ~76
air exchanger
air conditioner
other
State Surcharge $ 50
Total ~ ,..~Y~~ ~
I f~~~~T
~ OCT 0 2 2003 11 I hereby apply for a Residential Mechanical Permit and acknowledge [hat the iniormation is complete and accurate; that the work will
be in conformance with die ordinances and codes of [he City of Eagan and wi h~t~e Mechamca] Codes; [hat I understand [his is not a
permit, bu[ only an applica[ion for a permit, and work is no[ ro start withou[ e[hat the work wil J in accordance with the
approved plan in the case of work which requires a review and approval of plans.
N S
Applicant's Printed Name App icant's Signature
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Pleasc completc for. commcrcial/industrial buildings
multi-family buildings when separate pertnits are not required (or each dwelling unit
Date
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Froperly Owner Telephone ( )
Contractor
Street Address Ci[y
State Zip Telephone # ( )
The Applicant is _ Owner _ Contractor _ Other
Work Type
Newconstruclion UndergroundTank _Install _Remove
Interior Improvement Cail for inspection during installationlremoval of tank
Processed Piping
Nature of Work:
Permit Fee 550.50 Alinrmnm Pee (include5 Slaie Surcharge)
ContractValue $ x .01% = S PermitFee
• Ifpemtit fee is $1,000 or less, add $.50 ~ $ State Surcharge
If perntit fee is over 51,000, add $.50 per
$1,000 Pernvt Fee
3 Total Fee
I hereby apply for a Commercial Mechanical Pemvt and acknowledge that the information is complete and accurate; [ha[ the work
will be in conformance wi[h the ordinances and codes of the City of Eagan and with the Mechanical Codes, that 1 understand this is
no[ a perntit, bu[ oiily an application for a permi[, and work is not to start wi[hou[ a permit that the work will be in accordance with
[he approved plan in the case of work which requires a review and approval of plans.
Apphcan4s Printed Name ApplicanPs Signature
Approved By: , Inspector Date:
h 3,7 5
2q53 RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
q 3830 PILOT KNOB RD, EAGAN MN 55122
851-681-4675
New Conetructlon Heaulrements RemotleVReoair Peaulrementa
• 3 registered stle surveys showing sq. it. of lot, sq. ft, of house; and all roofetl areas • 2 copies ot plan
(20% maximum btcoveiagealbwetl) • 1 set of Energy Calculatlonsfor heated atldihons
. 2 wpies ol plan sliowing heam 8 wlndow sizes; poured found design, etc.) • 1 site survey tor etterbr aadAions 8 decks
• 1 set of Energy Calculatbns • Intlicate B home servetl 6y sepLC sys[em tor atltlilions
• 3 wpies ol Trea Preservatbn Plan tl bt plettea alter 711/93
• Him,bist Detail Options selechon stieet (bltlgsw0h 3 or less untts)
DATE ~ I /Z IO Z VALUATION q &C ~ vC)
SITE ADDRESS 14 2 3 Z ()aI (e~~_ ~c v~ MULTI-FAMILY BLDG _ Y _ N
NPE OF WORK_ FIREPLACE(S) _ 0_ 1_ 2
APPUCANT Wew4a.rWJ@.,fC~ CnnSa-ri/cr~iMv.
STREETADDRESS S(«/1/IP41or'daI Q(/e- CITY 4L31L,)o.~STATEk(A) ZIP '~~Qcd
TELEPHONE # IoS( -`f39-432o CELL PHONE # FAX q/<1- 2056
PROPERNOWNER Le~Pr TEIEPHONE#( SI-,IS2-5g37
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RliLES 7672
(4 submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calcuiations Submitted
Plumbing Contracfor: Phone #
^
Plumbing sys[em includes: Water Softener _ Iawn Spi'inkler Fee: $90.00
Water Heater _ No. of R.I. Baths
_ No. of Ba[hs
Mechanlcal Conhactor: Phone N
Mechanical system includes: Air Conditioning Fee: $70.00
Heat Recovery System
Sewer/Water Conhactor: Phone #
I hereby acknowtedge that I have read this application, state that ihe information is correct, and agree to comply
with all appllcable State of Minnesota Statutes and City of Eagan Ordinances.
_N'i Signafure of Applicant
b k- ~L~
-----------------------------------°---------------,.e._°----------------------.._..__.___.
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex ? 13 16plex ? 20 Pool ? 30 Accessory Bldg
q 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck O 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
O 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
O 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) p 45 Fire Repair
? 33 Alteration ? 37 Demolish(Bldg)' ? 43 Reroof ? 46 WlndowslDoors
O 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC1ES System
Census Code Zoning City Water
SAC Units Stories Baoster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) ` FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
^ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AidGas Tests _ Final
, Framing _ Siding Stucco Scone
_ Fireplace _ R.I. _ Air Test -Final _ Windows (new/replacement)
Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Ciry SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
70D
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED YITH THE CZTY OF EAGAN
MonG~- f~
C014MERCIAL SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIF'CATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS' -
$2,000 LANDSCAPE BOND
To Be Used For: S.F.47W67/6,4~ Valuation• G2,0C0 Date: ~ L?
Site Address ¢232 f~~ OFFICE USE ONLY
Lot 46 Hlock LErect x Occupancy R.3
i~ Remodel • Zoning ~•I
Parcel/Sub /1/040p~i) Aa/,j~,~S . Repair , Type of Const "Q
Addition 0 of Stories
Owner RSM HOMES, INC. Move , Length S
Demolish Depth 4(D
Address 18308 Murphy Lake $1vd. Int.Impr. 1 Sq Ft
Install
City/2ip Code Prior Lake, hIIV 55372
Phone 432-2440 APPROVALS FEES
Contractor Same Assessments Permit 31 .
Water/SeWer ~ Surcharge I.
Address Police ~ Plan Review ISR.x'
Fire SAC 5iS,
City/Zip Code Engr Water Conn S~o.
Planner Water Meter L'3,s°
Phone Council Road Unit 2tic7.
Bldg Of~Treatment Pl 1 5(0.
Arch,/Engr. _ A.P.S. Home Design ppC parks
Variance Copies
Address TOTAL
City/Zip Code ,
Phone p
~ .
ROSE ak 37 9 73
~
PNGINEERING iIIXStliTiN6 E3{31HEfAS. . N I
PLAHHEAS and CAHD SIJAVEYOl1S
COMPANY, INt.
~ f000 Li:T fSSL1 S7AE:?, 8L'A!!5'/1LL_°, YINH£_OLl ZCZ27 P!-! 4_Z'_pap
CerZZZ~'Z crzZe o~ 95zt~-~4e t~
~toCj ~_frrJ =,=Cr •
LOT 261 BLOCK 2~ NORTHV/EW MEADOW~~
DAK07-A CO[/NT7/J /7/NNESOT.Q
ORA/NAGE E 4i7-2 fTY
V~ EASEMENT ~ v /
973•S~ 5890 52'//"E
(9~2 95) > .z) 120.74
I q7S.2
; N i0 '3 0 975Z~ 4.5J~ \ i 5 W
0 7f~Q)GARAL i ~ 5 B, ai j
Q\p 9~4 h'ot~sE, [ ~Q 0W i (S~S. ; ~is /a~ ~~4 3 o?7(~64•z~
f7 3.7I i2o.~a (9a4•3)
SETBA
T L
CK L/NE
Dr~~
oR
(97e,r~ DENOTES EX/ST/NG EL6t/AT/ON
( y'7o,5) ZDENOTFS Pr40P05ED ELEVAT'iON
/NOlCATES D/RECT/O/V O/= SuRFACE Da2.4/NAGE
NURTH
SCALE: /"=30' -
F/N/5 ffE~ GA Rfj GE FL G70R
' ELEVL{T/ON = 915, 50
I heriby eartify that t5is is a t-:e and carr=ct raprraentitjoa of a trae: of
I:nd as ¦hovn'and described herzoa.. Aa prepared by me on this 24nl dty of
Hinn. ReE. No. /Z-ops-
_ *********#***********f3***#**t}#*** #
CITY OF EAGAN * :CnTT ~~El„~ °E' *
NOTE CONSTITUTE
* APPROVAL OF PkRMIT. ~
APPLICATION FOR PERMIT *
~
* INSPDCrION OF SEFM ADID/OR MM
* rnarnr.ramrONS WIIS. NOT HE SCAFD- *
SEWER AND/OR WATER CONNECTION » UI.ID DNrII, PII2NIIT AAS BEEN *
* APPRWID. *
+r *
* r
r *
**++*,tr+,tt,t*+~+*w*~*at,t+***,t*~tt+*f t
P ease Print
~ 1) PROPERTY ADDRESS: 4232 Valley Forge - Eagan
LEGAL DESCRIPTION: LOt 26 Blk 2- NVIEW MEADOWS -
. Lot Block Subdivision or Tax Parcel ID )
IF E7QSTING STRCCILRE, DATE OF ORIGINAL BI)ILDING PII2MIT ISSC`ANCE:
' PRFSEIIP 7ANING/PROPQSID LSE: (~n Year
~ CCD2hEE2CIAI./RE,TAIL/OFFICE ~ P.-1 SINGIE F_zMTI.Y
Q IAIDC`STRIAI, ~ R-2 DCPLEX (2+wo Units)
INSTI'IL'TIONAL/GOVERNM4,'NT ~ R-3 1OWDII10DSE (Three + Units) ( Units)
R-4 APARThENp/CONIDOMIDIIUM ( Units)
2) ~
tvAME: Lake Side Sewer and Water_, Inc.
. ADDaESS: 12469 Zinran Avenue
CITY, STATE, ZIP: Savaqe, Minnesota 55378
PHONE: 894-7600
3) ° 10 "For City Use .
NAME: Lake:.Side Sewer and Water, Inc. plumbers License:
AADRFSS: 12469 Zinran Avenue South Active
; CITY. STATE, ZIP: Savage, Minnesota 55378 Expired
Not recorded
PHONE: _ MASTER LICaISE# 002387M0
Initial
StaTf
4) • ~
NAME: RSM Homes, Inc.
ADDttFSS: 18308 Murphy Lake Boulvard CITY, STATE, ZIP: Prior Lake, Minnesota 55372
PHONE: 432-2440 .
5) i~ v~ r : ~ • oi • ~i
~ CONNE(.TZON TO CITY SEWFI2 ~ CpHNECrION 10 CITY WATII2 ~ p= .
6) ~ E3 PLEASE HOI,D APPROVED PMb1IT FCY2 PICK-UP BY ONE OF ABOVE - -
PLEASE MAIL APPROVID PERPIIT SU 1. 2,~ 4. ABOVE
(Circle one)
7) r r• u• ~
r".Tr.-
i ocTi~~7! T47'T'ti~a ~
•?l7 t74ng ~VY71 d! ~J17 ~ FrJi
1 I M./ Ha~ 1 1 1 71 .a -
.
- -
FOR -CITY USE ONLY ~PERMIT # ISSUED
~135 '7 Y/z 3/4
Pd w/Bldg. Permit FEES:
$ $ SEWER PERMIT (INCLODE SURCHARGE)
$ $ WATER PERMIT (INCLUDE SURCHARGE ) .
$ 1-3 ' S-ZJ $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ Z) ACCOUNT DEPOSIT - WATER
$ ~ C C ci t, $ WAC
$ 7; •f~7, $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT •
$ $ • LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER
$ IS-Z••G ~ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
S $ ~7 ~ G ZJ TOTAL
3 3 i: i 7,2- 7
RECEIPT # RECEIPT
DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE IS5UED BY THE ENGINEERING
~ NO DIVISION. LIST AS A CONDITION.
SLBJECT TO THE FOLLOWING CbNDITIONS:
I '
APPROVED BY:
TITLE:
DATE: ~jL.3/4 ,h
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
~3 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Nevr Consirudion Reouiremenis RemodeVReoair Reouirements Once Use OnN _
3 regislered stte surveys showing sq. R of l04 sq. R of house; and all roofed areas 2 copies of plan Ced o( Survey Recd _Y _ N
(20%m)(mum lot coverage allowed) 1 set of Energy Calalalions for heated additbns 7ree Pres Plan Recd Y_N.
2 copies o( plan showing beam 8 window sizes; poured found design, etc. 7 site survey for additions & decks • ~Tree Pres Required _Y _N
lsetotEnergyCakulafions Addition - indicateilon-srtesepticsystem Oo-siteSeplicSystem__.=Y_ N
3 copies of Tree Preservatbn Plan if lol plaHed afler 711193
Rim Joist Defail Options selection sheet (bldgs wiN 3 or less unifs
Date _A( 40 4_ Construction Cost 201, 30 Y
Site Address 14 9L $ 2 L/ A I/ e J FO /Q' UniUSte #
r-
Description ot Wark '-~ty AC3n fS
Multi-Family Bldg _ YXN Fireplace(s) X 0 _ 1 _ 2
Property Owner 1( 1 1,A M 'r 4 I j 1i Telephone 4 6 L• ,ST Ly
Contractor TkC C o R P tJ e l4 (,s) Aol• jA le 17 I l
.
Address gZ0 1 r'r• ST City 6jOiT nfgMwlNt
S[ate uJ A. ZipjC02_tIll - Telephone #(Slr ) Cit • 300 s
0
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Ca[eeorv 1 Minneso[a Rules 7672
Energy COde Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously consiructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone )
Mechanical Contractor Telephone # D ~
Sewer/water Contractor Teiephone # R 16 2004
e
I hereby apply for a Residential Building Permit and acknowledge that the info an 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 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.
L ei v o 14AOOs VN X,l !4..
ApplicanYs Printed Name Applic s Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 Ot of _ plex O 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4•sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration O 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
? 34 RBplacem0nt 'Demolition (Entire Bldg) - Give PCA handout lo appliwnt
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaVC.O.
Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation _ HVAC
Draiu Tile Other
Roof _ Ice & Warer _ Fina] _ Pool _ Ftgs _ Air/Gas Tesu Final
_ Framing _ Siding _ Smcco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
TreaUnent Plant
License Search
Copies
Other
Total
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA163866
Date Issued:09/15/2020
Permit Category:ePermit
Site Address: 4232 Valley Forge Pl
Lot:26 Block: 2 Addition: Northview Meadows
PID:10-52100-02-260
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
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, Mark Anderson at (952)
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 -
James A Chytka
4232 Valley Forge Pl
Eagan MN 55122--195
(651) 276-8479
One Hour Heating & Air
11825 Point Douglas Rd S
Hastings MN 55033
(651) 437-4177
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA169641
Date Issued:06/03/2021
Permit Category:ePermit
Site Address: 4232 Valley Forge Pl
Lot:26 Block: 2 Addition: Northview Meadows
PID:10-52100-02-260
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Includes Skylight
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of
photos until the project passes a final inspection.
If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any
Valuation: 5,000.00
Fee Summary:BL - Base Fee $5K $118.00 0801.4085
Surcharge - Based on Valuation $5K $2.50 9001.2195
$120.50 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 -
James A & Belinda B Chytka
4232 Valley Forge Pl
Eagan MN 55123--195
(651) 248-7274
Verde Restorations
553 Robert Street South
St. Paul MN 55107
(651) 290-2222
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA178202
Date Issued:08/04/2022
Permit Category:ePermit
Site Address: 4232 Valley Forge Pl
Lot:26 Block: 2 Addition: Northview Meadows
PID:10-52100-02-260
Use:
Description:
Sub Type:Air Conditioner
Work Type:Replace
Description:
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
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 -
James A & Belinda B Chytka
4232 Valley Forge Pl
Eagan MN 55123--195
One Hour Heating & Air
15191 Boulder Ct
Rosemount MN 55068
(651) 437-4177
Applicant/Permitee: Signature Issued By: Signature