4264 Valley Forge Pl
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-189, Esgan, MN 55121
PHON E: 1548100 ~
eUILDING ~ERMIT Rece+a # -
To, w siN/ hr Esf. Volue 1 r, ft r Dare
Erect ~ Occupancy r.
SiteA4ddrep
4ot I_L Bixk Sec/Su6. i9(IRTAV7 N i4 ' 1:JaCf.~Remodel Zoning
Repair ? Type of Const.
Psrcel No. Addftion ? No. Storia
Move ? Langth - f
s Narime ;
~ Damolish ? papth n ~
Addras~ Int Impr. ? 5q. Ft.
City " Phone -~2- 893 4 Inatall O
Avrrov•h i••s ;
Neme - ~
A~~ Assessment Permit ~ ~ 0
City p~~e Woter & Sew. Surcharge 1-, Q'
Poliu Plan Revlew ~ - I 5 [1;
Ile W Name Fin SAC 001,
vx Addrea E?p. - Water Conn. i ri 00:
~W City Phone Plonnwr Water Meter -F? ~ Q Ci
Council Aoad UNt o ~ Q Q;
I heeeby atknowlydpe that 1 how read thls opplicotion ond stots thot gldg. Off. 6,1 f fi ~i Tr. PI. 00
tM iniormafion Is corrcct ond oqree to comply with all applicobl* qPC Parke
Smte of Minrwsoto Statutas ond C iry of Eo9on Ordinar~us. ,
~ Var. Dats C~i~ ,
Siqnotun of Pennitta Total 5(~
A 9ulldinq Pennlt Is isswd ta r`A.r.L; - on eh0 expris caditian thoi 1
adl work :1w11 be dorn in aco0rdonuJwith oll opplimble Stotr of Minnesoro Stotutes ond City o} Eapon Ordinonaea. i
8uildinp Officiol
~ Pamit No. PKmk HokMr Dsa ToIoahons s
Plumbifq lu
H.'V.A.C. 5 ~
Ebetrie
Sottww
Irapaetion DafA Imp. Othw
Footlngsl f
Foottnps li
Foundition
Fnining
RooHnp
ROUqh Plbp. .7 -
Rou9h Hty.
Insui. ~
Finplace
Final Hty. 7
Final Plbq.
Flnal 7
c.wocc. l~
Water Dfteribe Loeatlon:
WNI
Sswsr
Pr. Dlap.
R"aipt MECHANICAL PERMIT PKmit No.
CITY OF EACAN '
' Fw
fill in numbentd Waces $/C
7YPe ar Pr/nt MyibJy Tot . .
1. Date 2, Installation Cost
3. Job Addrass Lot Bik. 1'ract
4. Ownar i
5. Cor+tractor Phone
6. Address
7. Gh State i- 2ip ~
f
8. Building Typa: Residential 6p Commercial ? Inttitutional 0 ~
1
9. Work Desciption: New Q Add ? Alter 0 Repair 13 I
{
10. Dacribs • Fuel Type ~
11. No• Equopffmnt 8TU - M. Ea. No• Eauioment CFM
Foroed Air Air Handiing:
Mfp.
Boi len
Mach. Exhaust
Mfg.
Unit Fleater
Mfg' Other
Alr Cond.
Mfp.
Gas, Pipiny Outlets
1
12. I heroby certify that the sbove inforrtwtion is true and oorroct, and I aqree to
oomply with all ordinancas and oodes governiny this typs of work.
S'iyned :
for
Ra+ph f IMI
Inspections: Dste tnsp. pste Insp.
This is your permit whan numbered and approved.
Approvad CITY OF EAGAN 454,gipp
f ~
l .
Rraipt PLUMBING PERMtT Pwmit No.~ -
CiTY OF EAGAN
, . FN
Fill in numbend spaces S/C
Type or Print lepibly Tot'
1. Date 2. Installation Cost i~' l'
3. Job Address ~4 - L ! 1 4; r Lot "k Blk. ~ Tract - ' .1 ~
4. Owner C -1 c.' " ~ 1J
5. Contrador l~- H . Phone
6. Address L i l. C: < i~ L•
7. City _ T , . i State + + Zip
8. Building Type: Residential Commercial ? Institutional O
9. Work Uescription: New E] Add ? Alter O Repair O ~
10. Describe j
~
~
11. No. Fixtures No. Fixtures ~
Water Closet Cesspool/Orainfield
~ Bath tubs Septic Tank
Lavatory Softner
_L Shower Well
I Kitchen Sink ~
Urinal/Bidet Other
; Laundry Tray ~
Floor Drains ~
Drinkiny Ftn. ~
Slop Sink ~
~ Gas Piping Outlets ~
1
~
12. I hereby certify that the above information is true and correct, and I agree to ~
comply with all ordinances and s ovcrning this type of work, i
Siyned : iL ~ ,.lcs ~ ~ l = for
Rough F inal ~I
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EA(;AN 4644100
CITY OF EAGAN Remarks
Addition NORTHVIEW A+IEAI?OWS I.ot il Rik 5 Percel 10-52100-110-05
Owner Street 4264 VALLEY FORGE PLACS State EAGAN MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1984 76.75 '7;L-" 10 61.41 L'010 2$ -2
STREET RESTOR. 1
GRADING '
SEWER LAT 1981 15.89 .79 20 11-94 C01052 7-29- 5
SAN 5EW TRUNK 5 1981 138.48' 6.92 20 103. C01052 7-29- 5
SEWER LATERAL TRK~ 1984 27$.22 18-54 ~$~J~ 15 2 Ci~l~ 2 -2 -
SEWER LAT 1981 22.28 1 48 26 IS 1.$$ " "
WATERMAIN 1984 70.67 4.71 1$ 61.25
t~ WATER LATERAL 19$1 1$.6$ 1.24 r~ -20 LS 12.45
WATER AREA 19$1 138.48 6.92 ZO 10 1 t IWATER LAT ; 1982 29.52 1.4-r I-r48 20 22.1 -
STORM SEW TRK 1984 392.32 76,46 49-.-H 1452 . 0 "
STORM 5EW LAT
DRAINAGE 1984 33.97 3-34 2.1 " "
CURB & GUTTER '
SIDEWALK
STREET LIGHT
Road Uni
WATER CONN. 500.00 of 9UILDING PER. tt sAC 525.00
PARK
~ /lq:~1:O9FA:~~ ~!~_l~~~Sllasa:ia ~ Os~.ss:~:~~ ~lfJ~:~yi~~ s!l~~s~i•c
F O R C I T Y U S E O N L Y
PEBMIT - ISSUED
pnr.5: $ ~~.57U crc.,~~ nr~~trm (=`iCT_.:;:D° S'vRCFi: P.C,7)
S D (J WATER PEi2i`tIT (IiICLUDE SURCF!ARGE)
S WATER METE°/COPPEBHORN/OUTSIDE REAuER
S R',aTER T.-`,? (I„CLi.iDE COa?OR.yT=0.7 5'?'C?)
$ SE:•iE3 mpn
$ accoovT DEDoszT -
$ ~S.d-CJ ACCOliNT DEDOSl`?' - j•jhmrR
$ SOO. G~ WHC
$ SAC
$ TRliVK ~dAT°p ASJESSi`::::T
$ TRliNS SEi~ER ASSESS_•?E?iT
$ LaTE°AL BEtIE:'IT/TRU`iK SE-v:E:
$ LATERr?L BEP?EFIT/TBU.7-K SdATER
$ OTFiER
$ TOTAL
vU
$ A~10[i:7T PAID/RECEI2T '
DOES UTILITI CONNECTION REQUIRE EXCAVATZON IN PUBLIC RIGiIT OF WAY?
YES IF YES, THEN A"'PERMIT FOR 540RK WZTHIN
P_U,BLIC ROAD[dAY" MUST BE ISSUED BY THE
c~6I6-_ENGZNEERID]G DZVISION_ LZST AS A CONDI-
TION.
SUIIJECT TO TIIE FOLL0I.9IDIG COAIDITIONS:
APPROVED BY:
TITLE:
DAT°: (J'~
mm aa="a wk-+wwwlW:w w" wa2t~w~~~~~~W*ms~ar+w.aMcM Madoww=
.
CITY OF EAGAN N~ 10320
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 551T7
BUILDING PERMIT PHONE:454-8100 Receiot # / ~
Te M uiod !a SF DWG/GAR Est. Value $70,000 Date JUNE 3 jy 85
Sitej.ddrest 4264 VALLEY FORGE Erect 6a Occupancy R3
NORTHVIEW MEADSRemodel ? Zoning R1
lot 1 L Btock 5 Sec/Sub.
Parcel No. Repair ? Type of Const.
Addition ? No. Stories
Move ? Length 50
Nerrme GRAND OAKS Demolish ? Oepth 4$
= Address 1$$1 SUNRI$E CT Int.lmpr. ? Sq.Ft.
~ City BAGAN Phone 452-8934 Install ?
$AMF Approrala Feas
o Name .Q~
=u Asussment Permit
o qddress
u~ City Phone Woterd5ew. Surcharge 35.0(
Police Plan Review 171.5(
U. Neme Fire SAC 525.0(
Address Erp. waterConn 500.0(
< "'City Phone Vlonner WaterMetar 63.0(
Council Road Unit 2$ 0. 0 C
I hercby ackrwwledga thot I hove read this epplicohon ond stote that eid9. ox. 6/3 $5 7r. PI. 132.0(
fhe inlormotion is corrett ond ogree to comply with oll applicable .
Sfate of Minnewro Stotut ond City of Eoqan Ordinonces. APC Parks
{ Var. Date Gopies
SipnMUre of PermiMee~ Total $ 2. 04 9. 5~
A Building Cermif Is iuued to~ GRAN ~ OAK$~Z-
on tha ezp'esa conditlon thoi
oll work sholl be dorro in ac rdance wifh all opplimbti rjate of Min esota afutes and City oi Eopon Ordinuncea
, Buildirq OfFlcial 4-1' 4040)n
L- /
1'l. -7 S 2--72lp
RESIDENTIAL
BUILDING PERMIT APPLICATION
~ CITY OP EAGAN
3830 PILaT KNOB RD, EACAN MN 55122
651-681-4675
New Conslruchon Reauiramenta RBmodellReoair ReQUirements
• 7;egisterea site surveys showing sq of lot, sq tt. of house, and all mofed areas • 2 cooies of plan
(20°6 maximum lot coverage allowed) . 1 set ol Energy Calculations for hea[ed addihcns
• 2 copies of plan showug beam 3 window srzes; poured lound aesign, etcl . t vre survey `or zztenor adddions S decks
• 15et of Energy Calculauons . Ind¢ate d home served by sephc system for addiftns
• 7 copies of Tree?reservaticn Plan rf lot platted after 711193
. Rim Jorst DelaA OpUOns selection sheet (blCgs wtlh 3 or tess units)
DATE VALUATION 0 A ZS ~ 00
SITEADDRESS yZ~q UqI(¢.r F^s.e_ I'/. MULTI-fAMILYBLDG _Y /r N
TYPE OF WORK &~rcLe~ fIREPIACE(S) _ 0_ 1_ 2
APPLICANT
STREETADDRESS 56y_7 d4Qiii t4ch_• CITY STATEM ZIP SO
TELEPHONE # (oSl-q39-4432-0 CELL PHONE # fAX # ~5!- 351- ?_C~S ~
PROPERTY OWNER :j;,rr[ TELEPHONE #~SI - qSy-Jo7Tf
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MIVN!~F:SOT.A R[iLF.S 7670 C:ATHGORY 1 N(IVV'GSO"f:A RCLlis 7672
(d submission type) . Residenhal Ventilation Cate9ory 1 Worksheet Submitted . New cnergy Code Workshee[ Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone ft'
Plumbing systcm includes: _ Water Softencr Iawn Sprinkler Pce: 590.60
Water Hcater No. of R.I. Baths
No. of Baths
Mechanical Contractor: Phone #
NIccli>uiical scstcm include_~: _ :Air Condfuonmg Fcr. S70.00
r---
Hc1l Rccovci}'Scstcm ~ f117 f2 ~
LI IS
Sewer/Water Contractor. 'uUon~~j' 0 4 z~~? U
u
---------~~v
I hereby acknowledge ihat I have read this appiication, state that the information-is corree3, and- gree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature ofApplfcant~~
~
OFFICE USE OtiLY
Certificates of Survey Receroed _ Tree Preservation Plan Receroed _ Not Required _
Updated 4102
OFFICE USE ONLY
? 01 Foundation O 07 OS-plex ? 73 16-plex O 20 Pooi ? 30 Accessory Bldg
? 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.(1-sea.) ? 33 Ext. Alt- SF
? 04 02-plex ? 70 OS-plex ? 18 Oeck ? 23 Parch (screened) i7 36 Wulti
? OS 03-plex ? 11 70-plex O 79 Lower Level ? 24 Storm Damage
? 06 04-plex O 12 72-plex Plbg_Y or _ N ? 25 titiscellaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? da Siding
? 32 Addition ? 36 Move 81dg. O 42 Oemolish (Foundation) ?45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System Census Code Zoning City Water '
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
, REQUIRED INSPECTIONS
_ 'Footines(new bldg) _ FinaVC 0.
_ Footings(deck) _ FinaV?fo C.O.
_ Foonngs (addition) _ Plumbmg
Foundation HVAC
Drain Tile Other
Roof _ Ice R: \Vater _ Final _ Pool _ Ftgs _?,idGas Tzsts _ Finaf
_ Framing _ Siding Smcco _ Stonz
_ Firzpface _ R L _ Air Test _ Final _ Windows (nzN%/replacement)
Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S8W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
license Search
Copies
Other
Total
d /V ~ ~f / ~i • a
o 29.
yyl-6
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATZONS
To Be Used For: Valuation: Date:
--T--
Site Address: v OFFICE USE ONLY
Lot: Block ~ Sect/Sub _ ,Atc.l Erect X Occupancy ~-3
Remodel Zoning Q-1
Parcel II Repair Type of Const $
/ q.. n n ~.,.d,t,..,, Enlarge _ It of Stories
Owner Move Length 50
Demolish Depth 4-8_
Address Grade Sq Ft
City/Zip Code
Phone APPROVALS
Contractor A_,n,~o (3a44,d Assessments Permit 2~4V!
Water/Sewer Surcharge 35'°O
Address Police Plan Review 1"l l.`-''°
Fire SAC 5215,°O
City/Zip Code Engr Water Conn oo. V
Planner Water Meter (0 3.°'
Phone Council Road Unit
?.~50.
Bldg Off 3 ks
Arch./Engr. APC Treatment Pl
Address Variance TOTAL 5 o
City/Zip Code
Phone #
1 .
(
•
J I.DR~IEYOR9S C IERTIFICA.TE`! GRAND OAKS DEVELOPMENT C0.
_ VZ7b
30 ,
M 1 /l -1- ( r' 1 "7- .
~ LI ic~ , Lf. •
120.00 N89052'11"W --30.00 ' 48.00
10
~ 22. 3 0 I i~'it0 OSEb'c~ 0 0 O 25.67 -L0~5 l.
LL I a.GAR. l l1!
^.'.n:~`:
W „OR EWAY`"~_ . .
' 22.0 O D l ~ . O ,
~ ~ t(-nj\°~ 0! Ra p • .
$\o
I ~p ' ~ a o x a~ e~ 0 0. ,
Op
O I ~N .a wW ~ ~ O .
00'
io ~ I P
I tp s
N
N i h
W !e o ' - 30.00 - - 48.00 - - •
J a, 120.00 N 890 52'1 t" W~~~
~ ..i
30
. . .
DENOTES PROPOSED SURFACE DRAINAGE
O DEN6TES IRON MONUMENT SET SCALE: 1 INCH = 30, FEET
• DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR = 9 79.4 FEET
.X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST F100R = 9 76•5 FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK = 9 74.7 FEET
I HEREB9CERTIFY TO GRAND OAKS DEVELOPMENT.CO. THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
lot 11, Block 5, IJORTNVIEl7 MEADOt9S, according to the recorded plat
thereof, Dakota County, Piin:-esoLa.
AND OF THE LOCATION OF A PROPOSED BUILDING. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS.
OR ENCROACHMENTS, IF ANY, THEREON. AS SURVEYED BY ME, OR UNDER MY DIRECT SUPERVISION,
THIS DAY OF , 198 .
PROP05ED ELEVATIONS lJE2E TAKEti SIGNED:. JAM R HILL, INC.
FROM THE DEVELOPp1ENT PLAN FOR
NORTHUIEIJ 11EADOWS BY SUBURBAN
ENGINEERING, INC. LAST DATED
9-29-83. BY:
HAROLD C.,-PETERSON, LAND SURVEYOR
h1INNESOTA LICENSE N0. 12294
PROJECT N0. BOAK / PA(iE JAMES. R. HILL, . INC. '
85578 • ' ` ,
Pianners / Engfneers / Surveyors •
FILE NO. , . • . . .K.-;3 •
8200, Huenbold! Avonus South -;P
FOLDER : . sloomtngton;iwri:~ 55431;,.812-8e4-3029
` :
, 'EXTERIOR ENVFLOF'E AVEFAGE 'U' COMPUTATION
GkAND CIAI::S DEVELUFMENT COMFANY
MODEL D AREA U U x AREA
REQUIFtED
1. TOTlaL WALL AREA 180C> X. i 1 198
2. TOTAL ROOF AREA 1196 X.026 31.096
ACHIEVED
flFEA U U X AFtEA
A. WINDOW AREA 186.66 .5 93.33
B. DOOk AREA 39.8 .077 7,.0646
C. SLIDE GLASS AREA 13.44 .48 6.4512
D. FIRF_F•LACE AREA 0 i>
E. WALL FRAME AREA 1847 .041 7.38
F. NET WALL AREA 1164.1 .049 57.0409
0. RIM JOIST AREA 119.52 .0436 5.211072
H. FOUND WINDOW AREA U D U
1. FOUND AFOVE GRADE 96.48 .135 13.0248
TOTAL WALL AREA 1800 1E35.5026
J. Sr;YLITE U U C)
K. k00F FRAME 119.6 .C)32 =.8272
L. NET ROOf- AFtEA 1076.4 .025 26.91
4. TOTAL ROOF AREA 1196 30.7372
SUM 1 . +2, 229.096
SUM 3.+4. 216.2398
~
z/aa
p-m.
CITY OF EAGl,N
APPLICATION FOR PERDIIT
SELdER aND/OR L4ATER CONNECTI0.1
(PLEdSE P9IHT)
1) PP.OPERIY ACDRESS: ~12 67 L-( UA IL1 7- d Y 9 F F q G 4 y/
r_Fr=,L DESCtI°TIC:I: ~j 1,64 P ar!
(Iot/31ock/Sutiaivlsicn or Tax Parcei I.D. Nin;er)
u ru~-7:c, sr :cMTR:., eaT cF oRIcl :AL =UzLer:c
F.°'~....,. ~ iSE. ~ a~.iv,T
~ R-1 Si.iG',~:. _ Y
? R-2 GUPI.EZ. (?Tr;O UNITS )
R-3 ZC;v-l\aIGY;SE (THFtE;" + Ti'NITS) ( [JVImc)
? R-4 r1DAR'IS"TM'`T/CJiII)CiIN IU.°S ( [NZTS)
? C(~^-+1,1E.RCLAi.,JRL.'TAI?,/OFFICE
. ? LNDL'STP,IAL
? INSTI2LTIONI'.L/GGVE.R~~TML~'rV'P
2) F~PPLIC_`:P (PLEASE PRL4iJ
rrWE: ~ 1^ ~ n al Q a~ S :
ADDRESS:
crrY, srATE, ziP: 9 4 n J~'I h r~ 1~~
-PHONE: GI _
) pLU,.IBco ((PaLIAtSEGPRIIit) fOR CITY IISE ONLY
NAiySE: -
ADoREss: l0 (D G~_e eQ vi p PlUH6 N~ActiveCITY, STATE. ZIP: l0 t' ~ O Yl xp' ed
" La~ ecord
PHODIE: pL1J,98ER LICENSE ci~
~
3ft Ipltlal
4) OCCUPAn]'j`/('J,•T]ER NFlitE: (PLEASEPR1N!)
+ •
ADDRESS:
CITY, STATE, ZIP:
PHONC:
5) INDIC,'i'E WHICii PEPhLiT IS BEZtG RDQ[1ESTID;
9 CCZNECTZON TO CSTY SETi1ER
~ CC:]=IGN TO CITI SJATER
? C7I'['G..'4 (PLFrISE DESCc,IBE)
6) LNDIG,;:: C:E:
? PLEASE F?OLD A,PPROVID PERLIIT FOR PICi:-UP BY ONE OF ABOVE
~°T..Fi1SE ti*'LiL APPR(T,^ED PIIZNLIT 'I17 1, 2. P, 4 11FQ'JE
, - - ~ (Circle one) ~
` 7) SICZ'v11L:~E: Dr1TE:
cirY oF EnaaN WATER SERVICE PERMIT .
' ?830 °11,Ge Koob Road 6 2 " 3
P. O. Box 27199 PERMIT NO.: . 61185
, Eapn, MN 55121 DATE: - -
Zanirg. R1 1
I pN,r„~; Grand Oaks Dev ~ u~~ ;
I llddratt:
' S1ti Add as 4264 Valley T'orge I'lace L11 B5 Northview Mesdotas,
Va 1 Iev P 11~
MNer No.: 5~10. RQ pd ~
PLL
I Stu:3~~~~~ _ i
Acoount Depoait:
No.: Peni,it Fe.: 10. 00 pd i
~~w e..yy wMb Ir. Ctti of r~ . 50 p d
~Cha?pes: - 132.00 pd
i k. Tota1: 63.00 Rd Tn?rPr
~ Poid:
~ Insp.: Insp.:
6/!~/S S
CITY Of EAGAN UWER SaVa PEmR
' 3830 Pilot Knob Road
P. U. Box 21199 PERMIT NO.:
Eaqan. MN 55121 DATE:
. Zonirg: ~I No. of Units: ~
Ownwr. Graud 4aks Dev
Address:
Sta Addross; _ 4264 Va.2.2ev Fc,rike I'I;ce L12 E5 'iorts;view
Plumber. P V T' -
r, .
s ~ ! ' r 7
± ; . . PiT-
I or" t+ OWN1r wlh !v phr ot i"" Canrwetion t?weq: 425.00 pd
O"di"""m /1ooo,w,t pepait; 15. JO :
PrnNt FM: ;1Y_
Surcharge'
By Mlsc. Chorpes;
DoM oF Insp.: Totol:
I"sp" DaM Pald:
Use BLUE or BLACK Ink
. " I For Office UselIrr~~ 1
i1V~h$
~j Permit
Cityo of EaEd I Permit Fee: 4 • I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: 5 ( 3 1
Phone: (651) 675-5675 1 1
Fax: (651) 675-5694 1 Staff: I
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: m I d Place- Unit
Name: eLr~ Pe I e ("s C) (I Phone: (0 _ y5 7y
Resident/
Owner Address / City / Zip: -a (oq Valley Fo- fge P I ac t
Applicant is: Owner Contractor
I Type Of Work Description of work: I 2-0 ( 0
i~
Construction Cost: S~On ° Multi-Family Building: (Yes No
Company: Contact:
Contractor I Address: City:
State: Zip: Phone:
11 License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
T C) 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.aopherstateonecall.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 Building Code must be completed within 180
days of permit issuance.
X_ e-y- petecson x
Applicant's rinted Name Applicant's g ature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE Q Cn
SUB TYPES I~ API
- Foundation _ Fireplace _ Porch (3-Season) _ Sfdrm Damage
- Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
- Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex Lower Level _ Pool Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation yob Occupancy MCES System
Plan Review Code Edition AOO? SAC Units
(25%_ 100% J/) Zoning ;Do City Water
Census Code u3y Stories Booster Pump
# of Units / Square Feet ,L YG PRV
# of Buildings > Length /.Z Fire Sprinklers
Type of Construction Width ,gyp
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
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES /b e 3fo~
Base Fee /8 3
Surcharge
Plan Review 7-_-
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies '7 @
TOTAL
Page 2 of 3
7
Y URVEYOR'S' dERTIFICATE ' GRAND OAKS DEVELOPMENT CO. ~ -
#-`276
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120.00 N 89 0 52' 11 "w
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120.00 N 89° 52,11" W
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.30 MED
DATE:
,..-1 NS DIVI a10N . '
DENOTES PROPOSED SURFACE DRAINAGE
4 DENOTES IRON MONUMENT SET SCALE: 1 INCH = 313. FEET
0 DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR = 9 79.4 FEET
.X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR - `T 7(•S FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - nj 7`1.7 FEET
I HEREBY CERTIFY TO GRAND OAKS DEVELOPMENT.CO. THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 11, Block 5, NORTHVIEW MEADOWS, according to•the recorded plat
thereof, Dakota County, Minnesota.
AND OF THE LOCATION OF A PROPOSED BUILDING. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS.-
OR ENCROACHMENTS, IF ANY, THEREON. AS SURVEYED BY ME, OR UNDER MY DIRECT SUPERVISION,
THIS DAY OF 198 .
PROPOSED ELEVATIONS 14ERE TAKEN SIGNED:. JAM R HILL, INC.
FROM THE DEVELOPMENT PLAN FOR
NORTHVIEW MEADOWS BY SUBURBAN -
ENGINEERING, INC. LAST DATED
9-29-83. BY:
HAROLD C.,-PETERSON, LAND SURVEYOR
MINNESOTA LICENSE NO. 12294
PROJECT NO. BOOK /PARE JAMES R. HILL, INCO
85578
- Planners-/ Engineers' Surveyors
FILE NO.
+ j 8200. Hu iboidt iisnuo south-;:,
FOLDER
Biootnlngton;Mn.~ Ss~83i;: 612-88$-3009
1 ~ ,y d0os
12- Use BLUE or BLACK Ink
For Office Use 1
i t ~R Permit L1 I Permit Fee:
3830 PM Knob Road
Eagan i 0113-
Phone: MN 55122 Date Received:
Phone:(651)675-5675 I I
Fax: (651) 675-5694 1 Staff. - I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: s Site Address: D (P C 0(1(,e , Unit
i Name: Phone: 'sL -
Resident/ 7
Owner E Address / City / Zip:
Applicant is: Owner Contractor
(i , ~S.c1
Type of Work Description of work: 1°GIC -2
_ Construction Cost: (6 1 S~ 50 Multi-Family Building: (Yes No~
E Company-WaAhem - ,
C Ccrn+ U TnC Contact: 1 I w
l { Address: 5G q i
Contractor M4isn cyi d-1 19ye..~ City: s~
State: 1►IN Zip: SSQ~l Phone: 6051-099-913W0
.
!License #:a,P L4'4
Lead Certificate #:~7~ I y -
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
1-11
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:
j~a
NO
PP g
e information may be classified as non-public ouif submit are considered to be public information. Portions of
y you p easons that would permit the City to
conclude thatthey 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.oopherstateonecall oro
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 Building Code must be completed. within 180
days of permit issuance.
x
Applicant's Printed Name Ap is Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA129942
Date Issued:03/25/2015
Permit Category:ePermit
Site Address: 4264 Valley Forge Pl
Lot:11 Block: 5 Addition: Northview Meadows
PID:10-52100-05-110
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Teryl Peterson
4264 Valley Forge Pl
Eagan MN 55123
Weatherguard Construction
10860 60th St N
Stillwater MN 55082
(651) 439-4320
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA163110
Date Issued:08/17/2020
Permit Category:ePermit
Site Address: 4264 Valley Forge Pl
Lot:11 Block: 5 Addition: Northview Meadows
PID:10-52100-05-110
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation. When a weather barrier is installed or
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 -
Teryl Peterson
4264 Valley Forge Pl
Eagan MN 55123
(651) 454-9074
Weatherguard Construction Co. Inc.
10860 60th St N
Stillwater MN 55082
(651) 439-4320
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA173516
Date Issued:11/15/2021
Permit Category:ePermit
Site Address: 4264 Valley Forge Pl
Lot:11 Block: 5 Addition: Northview Meadows
PID:10-52100-05-110
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
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:
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 -
Teryl A Peterson
4264 Valley Forge
Eagan MN 55123--195
(651) 454-9074
Lofgren Heating & Air
5708 Upper 147th St W
Suite 106
Apple Valley MN 55124
(952) 431-5811
Applicant/Permitee: Signature Issued By: Signature