4259 Valley Forge Pl
CITYOFEAGAN 1087)3
3830 Pilot Knob Road, P.O. Box 21-199, Epan, MN 55127
PHONE: 454-8100
eUILDINO PERMIT Receipt ~
To M w~ fer '1 t~1 : i; Esf. Volue E~~ r~';" ' Dote , I 9 R.
SiteAddren. VRi,IJ?Y FOltl : ! EreCt Oxupancy
Remodel ~ Zoning
Lot Block Sec/Sub. Repalr ? Type of Conrt.
Psrcel No. Addition ? No. Stories
Move ? Length ~
F. Name Demollsh ? Depth _
Addrass
Int Impr. ? Sq. Ft.
City V"Phone Install O
~
Name APpovob F.•t
~ Addrass Assesunent Permk > ' . i o
City Phone Water b Sew. Surcherpe ••uo:
~ Pollu Plan Rsview Z 5~} •5 0;
Name .l Fin SAC c :l,
GO Address Enp. water Conn .00 OCW Cicy Phone Plonnsr Water Mstsr •fi 0 ~
Countil ROad Unk
I hemby acknow0edys that I hove raod this opplicotion ond state fhat g[dg. Off. Tr. PL
fF~e information Is torrect and ogree to tomply with oll opplicAble APC Sfah of MinnesoM Statufes and City of En9an Ordinances. Pe~
Var. Date Coples
Sipnotum of Pemniftee 7ota1
A Butldlny Pe?mit Is iuued to: on the expross conditb+? ihoo
all wo?k shall be done in accordance with oll applicqble Stota of Minnesofo Statufes ond City of Eopon Ordiranus.
,
BuildinQ Officiol "
~ - - - -
,
PrrNo. hrmk IioWW Dea TehpAon~ ~
~urnwno Y 1.~~ ~ ~ ~ c cJ. `~l ~ 6 Y~ I - , - ,
H.vA.c.
e~~ 7 z(o 'O $
yY. ~
aaft..».
Irapfttion Dste Insp. OthN
FooNnps l
Footlnps 11
Foundetlon
Fnming
Roofiny
Rough Plbp.
~
RoWh ~ 6 : I-. L
InsuL
Flnplaa II
Flnal Ntp.
Flnal Plbp. r W4T.E12 Aj) c .CdL= .
Flnal
CWOcc. 3 ~ Co ~
W~~ Daaibe Location:
WNI I
S~w~r I~
Pr. Disp.
_ ~
~ . I . 1
Ruipt MECHANICALPERMIT PermitNo.
C1TY OF EAGAN
' F« I
Fi!/ in numberod tpacas ' S/C ~j
Type ar Prira /piWy Tot "
I
1. Data 2. Inataila,tion Cost ~
~
~
3. Job Addrest Lot 81k. Tract ~
4. Owner -
5. Contractor Phone
6. Address ,
7. City State " Zip
8. Building Type: Residential ~ Commercial 0 Institutional ?
9. Work Deacription: New ~ Add 13 Alter ? Repair ?
10. Describe Fuel TYPe
11. No. Fquipment BTU - M. Es. No. Eauiament CFM
Forced Air Air Handlinq:
Mf9•
Boilers Mech. Exhaust
Mfg. '
Unit Heater
Mfg• Other
Air Cond. ~
AAfp.
Gas. Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ardinances and codes governing this type of work.
Signed' for
Rou¢+ Final
Inapections: Date Insp. Date Inap.
This is your permit when numbered and approved.
Approved C1TY OF EAGAN 484-6100
_ i
~
PWMBING PERMIT Permit Na
Repipt
- CITY OF EAGAN
, Fes
fili in numbered spaces S/C
/J Type oi Prinf JegiWy Tot.
-=~e-
1. Date 2. Installation Cost
3. Job Address LotBlk. _4 Tract
4. Owner t ~
5. Contractor ~ Phone • - , r
6. Address ` • ` ~ '
7. City State Zip _
8. Building Type: Residential ~ Commercial O Institutional ?
9. Work Description: New El Add ? Alter ? Repair ?
10. Describe
11. No. Fixtures No. Fixtures
Water Closet Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
' Kitchen Sink
Urinal/Bidet Other
' Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby canify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rouqh final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454$100
CITY OF EAGAN Remarks
Addition NORTHI/IEW MEADOWS Lat 11 glk 4 Pefoei 99-52100-110-fy OAA Owner Street _ State EAGAN MN 55123
4259 VALLEY FORGE pj,4ZE
IOQJ
Improvement Date Amount Annual Years Payment Receipt Dete
STREET SURF. .(O 7.68 1 , 7 D/ be -76
STREET RESTOR.
GRADING
15.89 .79 20 O/ (0 7
' SAN SEW TRUNK 515 1$1 138.48 6.92 ZO / li . lO O/~v~ 74 SEWER LATERAL [9L 27$ z2 ~15 a O.,,Z D /~}d (p '7
? 22.28 i.+a +-.ft "Is 14 o ~ 7 4Q--.7-4k.
WATERMAIN 'gql 1984 70.67 4.71 1$ ~ R-V /G 6 7& / -.2
49-
WATER LATERAL 1981 18.65 .Z4' -'95 tvIS IA ~z~ -ju
WATER AREA S 1981 13$.4$ 6.92 20 (r •f 6 O 166 -y
2 1982 29.52 0-1 1-. 4,6 20 a~• 70 #,9-0 / 6 G y,S'
STORM SEW TRK 1984 392 . 32 761649-.Q3 -74 R 10 /6 G 4
STORM SEW LAT
DRAINAGE I 1984 33 . 9 7 3T40~ 10 . p p/ ~
CURB & GUTTER
SIDEWALK
STREET LIGHT
F .
BUILDING PER,
SAC
25-00
PARK
INSPECTION RECORD ~
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number: '
Eagan, Minnesota 55122-1897 Date Issued: ~ - ~ ~ ' ' •
(612) 681-4675
SITE ADDRESS: 1 f, 1. 1,,1 , APPLICANT:
.'M 1 FY F(tF?fil f,i r;i t I , MI IiI, iII I Iqtil " .f 1~ I
Idi+i' 1 iI'.fI I f! f+ll 111 tN.J'. 1e.o 1. I
PERMIT SUBTYPE: TYPE OF WORK: a
t; r t'n tR
INSPECTION • rA
~ ~
1
Psrmlt No. PormR Holder Dabs Tilephorn # i
ELECTRIC ~I
I
PLUMBING
HVAC
InspacUon Dib Insp. h Commmnts
FOOTtNGS
FOUNO
FRAMING
ROOFING
ROUGH
PLUMBING
F'l8G
AIR TEST
ROU('H
HEATING
GAS SVC
1'EST
INSUL
GYPBOARD
FlREPLACE
FlREPLACE ~
AIR TEST
FINAL PLBCi
FlNAL FfT'G
ORSAT I
TEST
BIDG FINAL I
BSART R.I.
BSMT FINAL
DECK FT(3
DEqC FlNAL
I
I
J
CITY OF EAGAN WpTU SERVICE PERNIIT
' 3830 Pilot Knob Rosd
i P. d' Box 21199 PERMIT NO.:
EsWn. MN 5,9121 . • - DIITE:' - • - ~ - _ ~ ~ ~
z°'^i^D fVa. of Uniti: .
Owrwr,
Addnu:
i Add,.m 42! ,^JoVl '~a
~h
i
bws
' Plumber. • s ;~lec. ~8' ] - ~ 1 l-, ~
~ Mmw No.: ~ 36 l ..16 0 r,,........l.,., r-~....,.._. 500. 0 Jtxt:
.
Siu: z " Aooount Deposit: • P
Reoder No.: ~~/1'J SI 9 c! Permlt Fes: P
i 1sMM Hown* ri1b ty CNp of sopm 5urcharge; • P
Mi,c. Chorpm 1 32. i10o;:
ToTOi: 63 -
' Doh PoM: -
of Irqp.: Insp.: ~
T D Z 5 8 5`
CITY OF EAQAN SEWN SmVm PEmff
3830 Pilot Knob Rosd
P. O. 9ox 21189 PERMIT NO.:
Epan, MN 55121 p,,TE:
Zani 1 ~
No. of Unlts: A
Owrnr. ~,uY'x Odk ~}1 i t;i .
Ilddross:
Shr Addnss: 4259 Val I eY F3z`q-- L I.t 114 i--, ,<~x~r • -
Plunber. '
I owm h«.Nr wkh er. aer .r ie@" Conn.djon CJ,ap.; 4 2 5. D O;x:
~NAOM. AOC01N'It Depait, S` ~i ~ s
Pome FYf:
8 $Yf'Cf~pfa: ` -
Y MhC. dIC/Q!{;
Dotr of Irop.: Total:
; Dotr PWd:
CITY OF EAGAN nf ° 10 8 5 3
3830 Pilot Knob Road, P.O. Bo: 21•199, Eagan, MN 55121
PHONE: 4548100 J
BUILDING ~ J/~
PERMIT ReceiPr #
Te M uwd fer SF DWG/GAR Est. Value $62,000 pate AUGUST 22 1985
Site Addreu ' 4259 VALLEY FORGE Erect ~ Occupancy
11 4 NORTHVIEW MEADSRemodet ? 2oning
Lot Block Sec/Sub. Repair ? Type of Const. V
Vercello. Addition ? No. Stories
SURR OAK BLDRS INC Move ? Lenyth 38
Nme Demolish ? Depth 46
z Address 11461 GOLDENROD ST Inl lmPC ? Sq Ft
~ Crcy COON RAPIDSphone 757-8157 instau ?
°C SAME AvDrorals Feet
o Neme
=u Addresa Assessment permit 00
o
u~ cit~ Phone H'ater 8 Sew. Surcharge 31 . 00
Police Plan Raview 159.50
CW Neme CRADIT & ASSOC Fire SnC 525.00
`-z 63.00
x~ Address Enp. WaterConrL
~Z CitY MPLS phone Plonner WaterMeter 280•00
t"'
Council RoadUnit 132.00
I hereby ockrwwledge tfaf I have read this opplication and stote fhat Bldg. Off. $ 19/85 Tr. PI.
tho inlormation is correct and agree to camply with oll opplicoble APC
State o4 Minnewla Sta u e nd rty of Eogan Ordirances. Parks
Q var. Date Coples ~_50
$i nofure of Permittee
A Building Permil Is iss o: BURR OAK BLDRS INC Totel
on the exDrcss cordition thai
oll work :holl be done in occordonce wirh all oDDli e Stnte of qlnnew Slptutes ond City of Eoqan Ordinonces.
8ulldirp Oflldol
SEDGWICK HEATING & AIR CONDITIONING CO. r+eanNC JOBNO 5~~6
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(952) 881-9000 TEST RECORD
&4
AODRESS I "I+ 7 "~~'~7 1 v'~-VV ~L CITV
OCCUPANT OWNER IRDn1 - M?4R~f J p / V/ VCSJC~ ~l
SOLD BY INSTALLED BV 45~4 ±J-L/~l4:H::
MAKE Le' ' MODEL fApV3 (oCSd?lD
SERIAL NO. QWM-3 INPU7 ~bD2L, ,
THERMOSTAT N-Z ?'~v NTSIZE
VALVE D ~~f}yPEOFLINER C`~t,SS B
LIMIT ~~e• MAY 0 2 2007 LINER S2E
LIMIT SETTING FILTERS: SIZE 6k2>Ir NUMBER ~ZLkYL
FAN SETTING WIRING SW w?~ "1,
PILOT TVPE TEST TAG
IGNITION MODEI 4-:~i LIGHTING INST.
?
PILOTTIMING ~H~ A=
Cti ~ DATETESTED
PRESSURE PERCENT COz INPUTCFH PERCEN70z ks COMPANYTESTING
STACK TEMP. PERCENT CO ~ NAME OF TESTER •
FOqM2]5(REVll/89) FORMDISTRIBUTIONWHITECAPY.JOBFILE YELLOWCOPV - CITV
.
. ' ~
/C/53
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED ifITN THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCOLATIONS
T(o2,f7CJb. !2
To Be Used For: Snc;fle~~,.i, Valuation: y~sBO~ Date: $ ~
Site Address: OFFICE USE ONLY
iKFJowS
Lot: If Block ~ Sect/Sub /1(arErect x pecupancy (Z-Oj
Remodel Zoning (Z-I
Parcel ll Repair _ Type of Const 'SL
Addition I1 of Stories
Owner M,% ynctprMove _ Length 3s
Demolish Depth 4ln
Address Int.Impr, Sq Ft
n Install
City/Zip Code 1Nrr"jPzSlej2, Al h.
r
Phone APPROVALS FEES
Contractor b?kO Assessments Permit 3 lot.
Water/Sewer Surcharge 31
Address police Plan Review 159.S-°
1 Fire SAC E52-S.
City/Zip Code Engr Water Conn 150t~"
Planner Water Meter
Phone '74~T)- 5-'15 ~ Council Road Unit
J Bldg Off Treatment Pl 132.=
Arch,/Engr. ~ra~, .7'yl A-'60c, APC Parks
Variance Copies
Address A ?er TOTAL ,~200 y~ Cj L
City/Zip Code
-T
Phone I!
24x 3~: & 4 K 5 ¢ ~ a(
q~ y J 4 ` Z I co 0
~K
~l
-,~Q6
North
7~$~NOhwlsy No. 571
DUQUROAN I M
65 Naf o
. 'r ~ NUINYt1~IN~ I lpOM~. M~NMWI~ S~~J1 ~
.~~I~ ' I BWIIWYI .
I(~ sooin oino.. esaeaio
' lClvil. A/umciPul tl f.ncvunrnrnia! f'nxinrrnnK 12750 Rrvn Rmye B,rd
r~~ land5w~~n~mX'IunJYlunnmy.SuJl'nunx ~.Mimtfo4S5]JI
LJ
i , -
Cewii.°cco& Wqurv~V ror Alarlhtliow Agooc.
„ . . •Pi+'
.I I
_ YoRKYoww . PLACe . . - .
0.
S 8905 2 I I" E 120.00 Ai ~
ro
Z I ; .
m
Z o.
• - - Ao[ d QTiLiTY ' ~SEMEelT lo
, IO I .
pe 0
0
-4 I " M I • ~ '•ti: ,4.
rn
:r. 03
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:'t ~
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~t'm:nl~v~l ~ .If J
I m V ~ V1
5 ~ F{ 7i F F d 9.. f~-FF, Jio ,v~ 3O . • .
~
S 09° 52' 11" E 120. oo'
; .
. . . . . . . . . . . . - -
:,r~~~,
:
;:i; • ~ , . i'' ~;I:,..
Y~'
.:1 .
V.
' , ' ~'~j`i
k ~'~C 30
Lvr sc.ocg
A1o,e7w,~~1,:"w l4,6aOoW,0,
,~~'a~,~ ~'OU~~Y, ~i~vVE;orq .
Approved for Morthview Associates at per Architectural Control Couittee by
~ •
~
1 herebt cartify that thii wrroy. Olan er repart ras.prePared br as or rnder ey dif-at wpsrvisioo
and that 1as a duly`NopittvN land Surreyor uader tM Lws of tb• Staj$ of [eaqott.
~ Dated tliii ~46y of Or
GsrY p. N rrls, Aeglstars/ Lu1 irrvelor
Me. 10943
? Q
`i ,.i 3794947 . . k~
L7L'Q$ a OSwcbtDfl. II1C. ~
:l'~.;f';j' . ~ t M e 4eNr n~ mW., nim. ~ W u 1J
e A ~t. 'e tlY
'li~,. .crcn!bCturaldatAprar6ol0u1nL~ ne~4 , . '
,
EXTe-AZOR EtNGLOPE AVERAGE pi1" CCL'dPOTATION
owsm PIJLa Voe ~3 03 OG• r j
li
SITG ADDRESS DATZ MA~~ f i I9p7~ • ;
' COHTItACTOR PA f~-R Dr'iL PJtJIL-UC.R`7 ' PfiQHE
Datarmine iaoricing 'square footngo of eaoh '
1. Total axposed wnll AP813.....b4.ft. xA='~''~
2. Total roof/coiling arou.,.. sq.ft. x~~rs`}
3. Total f].oor/cant, area>,..... n4•ft• z~_ 'i
';r . ~
;
~
Q Total exposed wall area abovo floor 151 ~I. o
' I19,
• i
' 8• TO'f81:w8ll windOL1 8T'08.......eo....... D
' ~ ~
17. Total door LiPOA...eeeee. e.e.e.... e........ao• ~
c. Total slidin3 glass door aroa.o...a.....o....
d. Total fireplaca cJall aroa.........aeseo..o.ae q
e, Total wall frm]ng eroa (average 10%),,..avoo >>d ;
fe Total not G1311 IIPO3 LtJ074 flOOPeoeaoo.a. os-ae ~
. . ~
~f.raiC7 }
f: ge Total rim j01.9~. 8P01oo..e......o.e...ae..... t
Lp ~
' Total exposed foundation area
tl• Total foum3u'tioza orindrna aT90soeee~•eeee~eoeoe ;
,i. 1, Total not foun3atlon area abovo grade ~
k' llatercdne "II" value of each wall segment
~A'
x4i; a. R arQn G7 i
bo x "Ua
, y b v
a, D, 7C aU~° a i
de X roIIn c
. . e e g „Q"
P. y`~0 7C apn
ge x °II"
~ ho x eaQn z
7C nUn
i
4. Totab
;r If item #4 is the same as, or less than item f1, you have met
4J
the intent oP S13C 6006(o)2.
<,fo~
,
.
. . - . : ~C:' : i . _
i~?,~e~~ tA t.'. . . . . ,.J . . c.~. t 'ti: ~.e.aR's......~...u..AI: _<.VC . r~'~~
i': ~~:~,,,~°`r'cI`~ <--E=i~-ma,{`.~ •
, F,t~..y.~~•
Total exposed roof/ceiling arou
, ,
Total ekylight uras
Total rocf/coiling f1•r<ning arers (avor. (>10516"o/c),
(.062y914"o/c)...
le Total not insulut@CI roof/cailing area................. e ~ .
~I
Dotermino "U" value far each roof/ceiling sagment
u~a =
J. X
ko Gr /rJ x ::U" -'.v
~
1^_~.~G, ~j g Uv -c~:
5 . •e..e..eeeoe.ao..eeaas~aeaaseseesa~eooee~~~~~sa~• TOta1
If total of $5 is tho same as, or less than #29 you have mot the '
intent of S3C 6006(c)i,
Tetal ezposod floor/cant. aroa ,
m. Total floor/cant. frraming area (uvorrage .10%)
o~ fl• ToCaI r.et insulL•ed £loor/CSRte 81°06ooeoaoeoeeeeeeesoeoo . :
z~ , t
IIetercatne "U" valve for sach floor/cant. segment
1~-
jA p~
a X
~ 11 B
n. x
,
• P
x: 6. ...•.....11•...,•0...•...e0...•..•.O..•.•.•..... Total
1
If total of 1~6 is the an.Yne as, or less than ¢39 you hmvo met tha ?
~intont of SBC 6006("c)3, '
LL
AI.TL3tNATL BUIIAING ENVELOPE DESIGN
~I
" To utilize the total envolapo system method9 the nalues estmblishod I
by the sum of items ~41 '~5 and '~`b shall ~ be greater than the sum
of iter3s #1, 02 and'$3o
2• 15,~,`1 3.
J I n
(~~iOL
Y 7~
Ya S> O•
i~.~. Proparod by •
D8te
5:;
.
Y.~ .
r-. .
,
~.i ~A{.
~ ~V
' 1..':..! . .r 9
?UD Int. Air e69 '1HiII ZNS. blAI.L Int: Gir e68
S.R. & SIDINO 1/2^ S.R. ,45 v/ 3Ro & SIDIPdG 1/20 S.R. ,45
. ,
(,.bb Ci p Ins.
19v {
25/32^ Bild. 2,06 ~ 25/320 Bild. 2.06
Jiding tU~ V gJf.1ing I1O I T
,4.'•, . ii, X
I~f 6 ~ Ext.s L!12' el'f ~ E7'.to I,lI' .17 k
u . Tottsl "'R" _ Totnl nRn = Q--~?
.
' l/g = aQn _ , OG1~ 1/R = "lJ°" _ •04'~j `1;
r:
L
~
,
- -
~y THRU R7M Int. Air .68 I THP.O CONC' HIRCS Int. Air o68 f
i
: JOIaT Ins.
C.B. (12 n) I•Z~5 -
;
Opt, Styro. Opt. Ins. "7,c-~ ~
~ i i /2,1 Wood 1,II9 ~
Exto lt11' .17 ~
,
.
ra 25/32" Bildo 2,06 e. opt. S.R.
_ . ~
II; I v~~ (c~ G, ~a S~e
L3:t. Air ,17 , Totnl "R" _ r;
Opt. Srick ~ 1/R"um _ ,I1
, I s
; Total pRn = 24 ofl ~
` 1 /R = "A" _
I. ~
:
THRU riLGs II'lte ~'ai3' • a61 ' THRQ CiLG• ZIlte AiT e01
MDMraR S.R. nvscrLnTaox S.R. cig. Memb. Ins. ( q,?D,o '
;
U'S. st111 air
n
li
Still Air ..61 ~ Total "R"
;
Total 'R" = 4'I I" J 1/g c v0" o ,(7`li •
I j'•
1/R _ ieIIp = ,D~--
t
e
a;
i . .
' i..
PERMIT C.12o~70~~
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, Minnesota 55122-1897 Permit Number: 0 2 6 2 5 6
(612) 681-4675 Date Issued: 0 8/ 18 / 9 5
SITE ADDRESS:
4259 VALLEY FORGE PL
LOT: 11 BIOCK: 4
NORTHVIEW MEADOWS
P.I.N.: 10-52100-110-04
DESCRIPTION:
Building Permit Type FIREPLACE
Building Work Type REPAIR
REMARKS:
FEE SUMMARY:
Base Fee $25.00
Surcharge $.50
Total Fee $25.50
CONTRACTOR: - Applicant - ST. LIC. OWNER:
VALLEY METRO CHIMNEY SPEC 14601233 00003810 KOLTUN JANIS
P 0 BOX 240295 4259 VAILEY FORGE PL
APPLE VALLEY MN 55124 EA6AN MN
(612) 460-1233 (612)452-2449
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State ofi Mn.
Statutes and City of Eagan Ordinances.
/e/ (l_.P u~
APPLICANT/PERMITEE SIGNA7URE ISSUE Y: SIGNATURE
_ CITY OF EAGAN ~ S Sj
3830 PILOT KNOB RD - 55122
1995 FIREPLACE PERMIT APPLICATION
681-4675
DATE:
DESCRIPTION OF WORK: _ INSTALL N.lp( FIREPLACE: _ WOOD BURNING _ GAS
_ INSTALL GAS LOG ONLY IN EXISTING FIREPLACE
_ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
OTHER: /LEPiR12JAJL 14 0 5ordRy ~LI~jDl~t:4/.AMRbvD CLAy
- F~L uEr~LF,S #l~OStA~..L~Nb "V~lv7'lniDX S7q)NLP'.53.Ft~ L~,v1~/6
AREA TO BE INSTALLED IN: SYSTSWI (u.t-• LS7eD 9AD02"O
STREETADDRESS: 42SY ALLEv)6'y2te,PLAr.E
LOT ~ BLOCK ~ SUBD./P.I.D. AbL'0~
APPLICANT: (circle one only) OWNER CONTRACTOR
I hereby acknowledge that I have read this appiication and state that the information is correct and agree to
comply with ail appticable State of Minnesota Statutes and City of Eagan Ordinances.
da~,-ropi 14RRIAN~,l605 Phone#: 452 -244`I
PROPERTY Name:
OWNER
Signature:
Street Address- VAL'L'~ k646E PGACI",
City: State: M^J Zip:
FIREPLACE Company: ALL~yfV'~1'2D('}liMAPC'`l SF~L, phone#: -460-1233
INSTALLER
Signature: klil-m
J
Street Address: P D, 6ax 240295 License 3B1D 3~3~I
City: f)PPI.r.Vfl LLEY State: M0 Zip. S5{Z4
GAS LINE Company: Phone
INSTALLER
Name:
Signature:
Street Address-
City: State: Zip:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 14 Fireplace
WORK TYPE
0 31 New o 33 Atterations
? 32 Addition o 34 Repair
GENERAL INFORMATION
Census Code.
SAC Code
REMARKS: Chimney/flue must be inspected before concealing.
FEES
Pertnit Fee
Surcharge
Other
Copies
Total:
I Zblo 2000 BUILDING PERMIT APPLICATION (RESIDENTIA )
CITY OF EAGAN
3830 PILOT NNOB RD - 55122
651-681-4875
New CoruhucHon Reaulremenh ~ 1-6 Remodel/Reoalr Reaulremenh
> 3 reqlatered sIfe wrveys thowMO fq. % ot bf, sq. N. of hane 2 coPlen ol plan
and g0 roofeC areas (20% rtwxlmum Iot coveraae albwetl) 1 eat ol eneryy calcWaHOns (a treatsd additlons
> 2 coples of plans (ahow beam & wlntlow slzes; poured fnd. deslyn: etc.) 1 sife wney for exleAOr admNOns # Uecka
> 1 set of eneryy cdculafloru
> J coples W hee preservaHOn plan If lot platletl after 7/1/93
DATE: CO rl*
DESCRIPTION Of WORK:
STREETADDRESS:
LOT: BLOCK: ? RSUBD. P.I. . S: VTIO
LVt)rlhv;PVV Anendovr(c
Name: A Az Lf\,-~ Phone o „~/,,~~'68 iL2U
PROPERTY Wst First
OWNER Sheef Address: f/ q ZlT~-~ ~~C1 Cp
City Z~g_/i~o Stafe: 4Y1 t-,/ Zip:
Company: SELA ROOFING & REMODELING, INC. phone q: ~ v U y
4100 (area code)
COMRACTOR ST. LOUIS PARK~ N 55416 S~ Sa'3/
Sheet Address: ~ 00001009 License a F~tp.
City State: 2ip:
ARCHITECT/
ENGINEER Company: Name:
Telephone ( )
Sheet Address: Reglshaflon tY:
City State: Zip:
Sewer/water licensed plumber (if Installina sewer/waterPhone L
I hereby acknowledye fhat I have read this applicaNon, state fhat Me (Mortnation one 7onda ree to eomply with aU applicable State
of Minnesota Statutes and CMy of Eapan Ordinances.
Signature of Applicant: ~ OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes _.No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation ? 07 OSplex ? 13 16-plex O 21 Porch (3-sea.) ? 31 Ext. Att - Mutti
? 02 SF Dwelling ? 08 06-plex ? 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. AR - SF
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened) ? 36 MuRi
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 11 10-plex Plbg _Vor_N O 25 Miscellaneous
? 06 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory Bidg.
WORK TYPE
? 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
? 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
• Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code # of Stories sq. ft.
No. of Gnits Length sq. ft.
No. of Buiidings Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. City Water
Zoning sq. ft. Booster Pump
PRV
Fire Sprinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $
Surcharge
Ptan Review
License
MC/ES SAC
City 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 i~• • u n
4Em •71• • • • •bi a • • iwwo) • 7~~ 1 11 71 • • :
•
CITY OF EAGAN
APPLICATION FOR PERMIT SEWER ADID/OR WATII2 CONNECPION
(Please Pr1nt)
1) PROPERTY ADDRFSS: ~ /l / c
T.FY;AT DFSCRiPTIori: ~ w'~' b~c
(Lot Block Subdivision or Tax Parcel I.D. Number)
IF EXISTING STRI;CT[.'RE, DATE OF ORIGINAI, B[JILDING PFS2N1iT ISSUANCE:
(Mbnth Year)
PRESENT ZONING/PROPOSID L'SE: R-1 SINGLE FAMILY .
R-2 DOPLEX (T%vo Units)
R-3 'IOWDIHOL'SE (Three + Units) ( Units)
R-4 APARTMENP/CODIDOMINICM ( Dnits)
COMME2CIAL/RETAIL/OFFICE
IPIDLSTRIAL
INSTI'IL TIONAL/GOVE.RAAIENT
2) ~ / ~-I
NAME: J h .5 G/l !f !S /17 Y e
~
ADDRESS: S``~ /!5'7 TTh Ak, c N: w.Uw d/lA
CITY, STATE, ZIP: P9; r N 3 5-34 3
PHONE: i'-5- 3 -3 :2c~
3) i: [ f For City Cse
N~ : 4-,&-? ~ f S/! C uPlumbers License
ADDitESS: 33 S`~ Th Fi-c y~w ~tive
CITY, STATE, ZIP: '09a, a/! NN S C~ 30 3 ?~i / ired
PHONE : rJ.~'3 37 C G LICENSE # pp 3?O„^ I ~ ft Reorc
f
Sta f Initial
i
~ • i~•
4)
NAME: Qv/Z~ da.f' ~u;~L7crrc <6
rwDxFSS: 111173 ~o4C.N AeQ W.
CITY, STATE, ZIP: dlOa ±,{s ni s s~/ 3 3
PHONE: 73'7 - ~/S7
5) i~ « •a~• • •
10 CONNECTION TO CITY SEWER R1 CONNDCTION 'Ib CITY WATII2
Q OTHEEt (Please Describe)
6) u • • i
~ PLEASE HOLD APPROVID PFT2MIT FOR PICK-UP BY ONE OF AEOVE
PI,EASE MAIL ARPROVID PERNLiT 'IC) 1, 2, 3, 4, ABOVE
(Circle one)
7) ~ /O S) J-
F 0 R C I T Y U S E O N L y y
PE2MIT ISSUED
rrr.s: $ SEWc.°. °ER]+.rT IINC,T.;DL .JUP.Ct';~RGGJ
$ ~
(L' WATEiZ PERPtrT (ITICiuDc Sii?CHArZG'a)
$ ~ ~ cG WrITER METER/COPPE4HORIV/OUTSIDE REe,DER
$ WATER TAP ( INCL[.'DE CORPORATION STOP )
$ SE;vER T.a?
/ S LO =r'~^,-••-•P ~r.c-._.
~ $ ~
l._:. 1_ - :
' $ /~uu ACCOUNT D.F,p(1SIT - Wr`,TE3
$ WAC
$ SP.C
$ TRU?1K WATER ASScSS:!E:iT
$ TRuNK SEYiER :ySSESSbLNiT
$ LATER;`,L BEi1EFIT/TRU`:K SEt:~R
$ LaTE;2t\L BEVEFIT/TRUNiC I•IATrR
$ WATER TREATMENT PLANT SURCHARGE
$ OTHER:
$ TOTAL
c ~
AMOL'NT PAID; QEC°IPT
DOES UTZLITY CONNECTION REQUIP.E EXC?.VATION IN PUBLIC RIGiiT OF WAy?
YES IF YES, THEN n"PERb]IT FOR :dORK WITHZN
PUBLIC ROADWAY" MUST BE ZSSUED BY THE
~ NO ENGINEERIrIG DIVISION. LIST AS A CONDI-
TION.
SGEJECT TO THE FOLLO:•7ING CONDITIONS:
~
APPROVED BY:
`
TI:LE: t ~
DAT°: //S /
\
: 612 822 5408
01/30/20
OS WE015:10 PAX $12 822 $608 A1'Q M6btOY plumbimq m001/001
. . : . C.'
of EakaIl
~ ,3,530 Pllot Knob Road ereC)'~ Q~rd~ I Pertnit Fee:
i ~
EdganMN55122 r / 1
DateReceived:
Plione: (651) 675-5675 (,:w - 4/.D8sl
Fax:-(651)675-5694 Lstarr:_7- -i
,~;.,,u.o- .
2008 RESIDENTIAL PLUMBING PERMIT.APPLICATION .
Date: Site Address: ' 5/
Tensnl; $uite
RESIDEMT'/'OWNER Name: Rcs-n 1- e-h Y'rjCS!^, Phon ~ 6Q1P- J Y70
1
Adtlress / City / Zip: tTeZc~/G ~qe T( Q(',~G
CONT,RqCTOR Name!"ie ii" Y -~7X V~~.K License#03 dOI / M
. ' Atldress: ~ 54 3 ~ S't' ~
iia.•.. Ciry:State:A4/V Zip:75~~
Phone.C9~ 93/ - 9~7~ Contact Person:
TYPE 4'FWORK _ New _ Replacemont, _ Repaif _ Rebuiltl _ Nbtlify Space _ Work in R.O.W.
' y ~Descrlptlonofwork: PERMI;riYPE RESlDENTIAL
Water Heater _ Water Softener
^-:i~:.,,• ; LawnlrrigaGOn AdtlPlumbingFixtures
RPZ / _ PVB) ~ Main _ Lower Level)
Septic System _ Water Turnaround
New
. _ . , _ Abendonment
RESIDEI11714L FEES:
$50.50 MiWmum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
. ;
$30.50 LBiv.fi Irfig82ioTt (includes $.50 State Surcharge)
$50.50 Atld: RJumbing Fixtures, Septic System Abandonment, Water Tumaround` (indudes $.50 State Surcharge)
'Wate(Turnaround (add S136.00 if a 5/8' meter is requlretl) .
$100.50 S2ptic Sy518m New ($10.00 per as built) (includes Counry fee and $.50 State Surchange)
$90.50 FiCARepail' (replace bumed out'appliances, duclwork, etc.) (includes $.50 State Svrcharge)
" ' • TOTAL FEES $
I hereby acknpWletlpe fhat thm infortnalion is canplete and accurate; that ihe work will be in confOrcnanCe wHh the ordinance5 and codes ot the City of
Eagan; 1haC~l.~ypderslantl this is not a pertnii, but only an appllwtlon fa a permlt, a oAc is not to s[~lqfhout d permll; Nat Ihe work will be in
ac tl nc~ ~iRh"ikie apprplan In the case of work whlcb requlres a revlew antl a o M. x ~ X. ApplicanYsRrihted, Neme AppliCant's Slgnature
n
?FO$lOF.F CE: ~~~~iY.~•~t:~;;'i:i'`~!~,i?;,jyY'~i r~ i,""~'~,':?.~1ta "N~'',~ .
~~Y1F1ul b
~~,r ~F~. ~i'
.,TJ.`.~>%~:", y 1 Z~t'',~"~,tis,n"''~s7:'~A;" ~
,,..l~~~,•w~i1r'~a~
{ '
%R guiCeJ• L~ ~ng'~~' ull ~r~y/ ~~J ~1 z ~r, f.^7eg ~y .
[..:F:~.:~`,•Si..: r'.~~Y.'r.'rrC~u:Lt.el•~x,~l~uWffi~rns:~vij.i.m. °i::~r~?.G~S~14
H.m ?r. SiYSw.i. A i
•r.N~.~sc . , . . ~
- - - - - - - - - - - - - - - - -
I For Office Use
Permit
City of Ea ft~li I Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 Date Received: 1` 15
Phone: (651) 675-5675 I `
Fax: (651) 675-5694 Staff: 2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: L
Tenant: Suite
147 e- Y-t
RESIDENT/ OWNER Name: 2 -r\ G Phone: 9sa~n.ga5_ 31y S.'
Address/City/Zip: s9 _L e) rf'1_ 5 S1 2a
Applicant is: Owner Contractor
TYPE OF WORK Description of work: 54, e7
Construction Cost: I ' Multi-Family Building: (Yes / No Z3
CONTRACTOR Name: License
Address:
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
submission type) Energy Envelop Calcul ins Submitted
In the last 12 months, has the City Eagan iss ed a e t for a similar plan based on a master plan?
Yes _LNo if yes, date and ress of ma ter pl
Licensed Plumber: FPhone:
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.
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 wor of to start wo a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approv of plan
X I), X
Applica 's Printed Name Applican s ignature
Page 1 of 3
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4259 Valley Forge P1
Lot: 11 Block: 4 Addition: Northview Meadows
PID:10- 52100- 110 -04
Use:
Description:
Sub Type: e - Fumace & Air Conditioner
Work Type: Replacement
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical perm
952- 445 -2840.
Fee Summary:
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881 -7739
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
equirements should be directed to Mark Anderson, State Electrical Inspector,
$50.00 0801.4088
Owner:
Ronald G Peteson
4259 Valley Forge P1
Eagan MN 55123
$50.50
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$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
Mechanical
EA077385
04/19/2007
ePermit
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA115315
Date Issued:09/25/2013
Permit Category:ePermit
Site Address: 4259 Valley Forge Pl
Lot:11 Block: 4 Addition: Northview Meadows
PID:10-52100-04-110
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Audrey Flattum
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 -
Ronald G Peteson
4259 Valley Forge Pl
Eagan MN 55123
(651) 484-5470
Storm Guard Restoration
1355 Geneva Avenue North, Suite 201
Oakdale MN 55128
(651) 738-1698
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA130583
Date Issued:05/01/2015
Permit Category:ePermit
Site Address: 4259 Valley Forge Pl
Lot:11 Block: 4 Addition: Northview Meadows
PID:10-52100-04-110
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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 within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Ronald G Peteson
4259 Valley Forge Pl
Eagan MN 55123
(612) 209-7365
Wellington Home Improvement
3938 Meadowbrook Rd
St. Louis Park MN 55426
(952) 933-6300
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA157546
Date Issued:08/26/2019
Permit Category:ePermit
Site Address: 4259 Valley Forge Pl
Lot:11 Block: 4 Addition: Northview Meadows
PID:10-52100-04-110
Use:
Description:
Sub Type:Fireplace
Work Type:Gas Insert
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to
concealing.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 3,000.00
Fee Summary:BL - Base Fee $3K $88.50 0801.4085
Surcharge - Based on Valuation $3K $1.50 9001.2195
$90.00 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 -
Ronald G Peterson
4259 Valley Forge Pl
Eagan MN 55123
(612) 209-7365
The Fireplace Guys Llc
680 Hale Ave N #110
Oakdale MN 55128
(612) 326-1919
Applicant/Permitee: Signature Issued By: Signature