4283 Valley Forge Pl
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CITY OF"EAGAN 1867$
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
7o be use tor r~WiIIIIIIIIII Est. Value Date JAp'31 19 91
Site ~ VBW a e
L$t ~TS Bloc= SeclSub. OFFICE USE ONLY
' P3fC21 NO. Occupancy - FEES
.man40m"i:' ' Zoning _ "40
W Name _ (ActuaQ Const _ Bldg. Permit
o Address (AUowable) - 9
Surchar e
City EACAN Phone # ot Stories _
Length Plan Review
=o Nflf119 _ Depth - SAC, City
ou ug Addresg. S.F.Total _
r SAC, MCWCC
City PhOf18 S.F. Footprints _
On Site Sewage _ Water Conn
Name
on site wen
~ W - weter Meter
z= AddreSS MWCC System
City Phone City Water _ Acct• Deposit
PRV Hequired _ S/YV Permit
I hereby acknowlege that I have read this application and state that the Booster Pump - g/yy Surcharge
inlormation is correct and ayree to comply with all applicable State of
Minnesota Statutes and Cit.of Eagan Ordinances. Treatmant PI
Signature of Permitee ~i- f01t1f APPROVAIS qoad Unit
A Building Permit is issued to: M• Pie""er - Park Ded.
on the express condition that all work shall be dane in accordance with all Council
applicable State ol Minnasota Statutes and City of Eagan Ordinances. gldg. pN, _ Copies
Building Olficial ~ Var1ence - TOTAL
. .
•~~a..a......_y~_ s,__ ..z - _ _ - . . _ .
PWmit No. PwmM Holdw Oate ToNphwN #
WATER •
SEYVER ,
PLUMBMIG 7 H.V.A.C.
ELECTRIC 38 0
k„QWU„ Daft ,,,P. commenu
Foo&Vs I
FowWation
Frart" -
Roolft
Ra+9h PIb9•
Ra+9A ~'166• •
FKeplace
Final Hlg.
Final PDg. /
Cons1. Meter Pb9• i^speck)r - No* Plumber
EngriPlen
elag. FinW 'E' i< L[J
Deck Ffg-
Detk Fmel
WeU
Pr. Diap.
CITY OF EAGAN
3830 Pilot Knob Rosd, P.O. Box 21•188, Epsn, MN 55121
PHONE: 454-8100
<UILDING rERMIT Rec.+pt #t
19
To w wed he Est. Volw Date . : ` 22
' . , Eroct ? ooa,pancy ,
Sita Addrea
Lot P ~ Blxk ` s.M I; : ~odel ? Zoning ~1
ParcN No /Sub. ~ Rsp~ir ? Type of Const. ~
.
Enlupe ? No. Storlss
Move ? l.enqth
I Name Damolhh ? Dapth 4 jj
Addrm Grede ? Sq. Ft.
City Phone ,2-`' _ 4 Install D
APMevab
a Name
Addrou /lsstssn'ronf Pe?mit 7 • io
~ City Phons Woter 3 Saw. Surchorpg C~
~ Polfu Plan ReviewU '
°f Name Fln S/1C . 0
z
~v Addrost Erq. Wafer Conn. d ~
~W City Phone Wonrwr Wafer Mefer.~..~i l'
Council Rood Unit 2
I hercby ocknowledQe thot I haw rood this oppNcotion ond stote fhot Bldp. Off. J i 21 / i 5 R cpT. P. 1 32,(} 0 I
the Information is carrecf or?d ogree fo comply wifh oll oppliCObl• A~ Total 049, 5 G +
STote of Minnewto Statutas and Cit~r of Eaqan Ordinoncss.
, • ~ . ; ~ - i ~ V sr. Dete
Sfpnatun of Pertnittea A Buildinq Permif is Issued to: ~i ~ ~ e~n ~~tlon thot
oll work sholl be done in oocordance wltFi all opplicoble State of Minneaota Statutat ond City of Eapon Or+dinonas.
Suildinp Officid
. PWmit No. Pwmk Holdw Daft TNo hono ~t
w°"bing 5 5!
H.v.w.c. 5 b I `46
El P1 1P
softww
Inspection Daq Insp. OthM
Footin¢ 31ZA'K- ~rn r' PI~1 ~twvcr ~Uwsfd O~
Foundstion
Fnminy
ROOflng
Rough Plbo.
Rough HV
Inwlation ~ .
Fiml Plhy,
Final HVAC
f
Final
Crt/Oos.
Ws»r Demibo L o~:
YIINI
So "r
Pr. Dhp.
R"WPt ' MECHANICAL PERMIT Pwmk No.
CITY OF EAGAN
, FN
Flll in numbsrod appaca • S/C
Typs ar Prini AwIdIY Tot
1. Date 2. Inspllation Cost
3. Job Address z ~+r , t i Lot Bik. ' Traet
4.Owner
5. Conusctor . ~ ~ . . . ' Phone
8. Address 7. C'ity 'k;t 1 State Zip ~
T
8. Building Type: Residential E3 Commercial O Institutional ?
9. Work Desaiption: New 13 Add ? Alter D Repair ?
10. Descxibe Fuel Type '
11. No• Equjprmni BTU - M. Es. No. Ecuioment CFM
Foraed Air - Air Handlinp:
Mfg.
Boilers INech. Exhsust
Mfg.
Unit Heater ~
Mfg. Other
Air Cond. ~
Mf9•
Gst, Pipiny Outlets
12. 1 he?eby csrtify that the above information is true and correct, and I syree to
wmply with all ordinanoes and codes governiny this typa of work.
Signod' for
Rouqh F inal
Irupections: Date Insp. Dste Insp.
This is your permit when numbered and approved.
Approved CITY OF EAQAN 46"100
Receipt ~PLUMBING PERMIT. • Permit No. -
CITY OF EAGAN
Fee
~ Fi!l in numbened spaces S/C =
Type or Print legibJy Tot. .
T
1. Date ` 2. Installation Cost
3. JobAddress~ Lot Bik. ' 7ract •'.~~~-c
4. Owner '
5. Contractor Phone z~ / ~
6. Address
7. City State Zip
8. Building Type: Residential ? Commercial O Institutional ?
9. Work Description: New ? Add ? Alter O Repair ?
10. Describe
11. No. Fixtures No. Fixtures
Water Closet Cesspool/Drainfield
Bath tubs _ $eptic Tank
Lavatory $ofiner
Shower ' Well
Kitchen Sink
Urinal/Bidet Other
~ Laundry Tray
i Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify 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 , A
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
' Addition NORTHVIEW MEADOWS Lot 17 Rik 4 Parcel 10-52100-170-fw
Owner Street 4283 VALLEY FORGE PLACB State EAGAN 1wW 55123
Improvement Date Amaunt Rnnual Years Payment Receipt Date
STREET SURF. 19$4 'JG.7$ `f.6T ~rf!- 10
STFiEET RESTOR.
GRADING
SEWER LAT 1981 15.89 .79 20
SAN SEW TRUNK 1981 138.48 6.92 20 103.88 C01068 •-2
'I
SEWER LATERAL TR 1984 27$.22 18 .34 ~$:3515 238.54 (;Qlo
468
SEWER LAT y 1981 22.28 1.48 -29is 14.88
"
WATERMAIN 1984 70.67 4.71 is 61.2
WATER LATERAL 609 19$1 1$.65 -94 -M IS
12.45
WATER AREA 19$1 138.4$ 6.92 20
103.88
WATER LAT 1982 29.52 147 1-.49 20 -
STORM 5EW TRK 1984 392.32 78, +05 2 Q 11
STORM SEW LAT .
DRAINAGE 1984 33.97 3-=910 2,1 "
CURB & GUTTER '
SIDEWALK
STREET LIGHT
Ro
WATER CONN. • 11 500.00 SUILDING PER,
t~ n
sAC 525.00 ?r
PARK
i
~
~
r CITY GF EAGAN WAM SERVICE PERMIT
I 3830 Pilot Knob Road F~91
P. O. Box 21199 PERMIT NO.:
~ 2sgan, qfiN 55121 DATE:
`Zoning; R 1 No. of UMrx 1
rrand Oa
~ Nddrom
Sft /lddna: 42831-~ ~--k'p~~g, I.17 ~~'dynr~l~vieca ve r1o~,s
urr~r .1u r r lb~
. No.: .3y9 Conn*&6 aaro.: _ 5oo.o0 pa
size: p„ .iED__, AccoiA WAwt: 15.00 pu
Rso&r No.: .0 !z L- x/O S/ Permk Fea: 10.00 121_
' ~ Mw h w.Py W" Nw qep oi Eope Surchorpr .50 ~i2-i_
Orrl.weM. Misc. p+orp.s: 132. 00 d
\ Totol: - 63 _o0 nj r
BY Dob Poid:
Dote of In:p.: Inq.:
CITY OF EAGAN
3830 pilot Knob Rwd . SEWER SERVICE PERAAIT
P. O. Box 21189 PERMIT NO.: 7280
Eapn, MN 551~1 pATE; 4-17-SS
Zon1ng' No. of Unib: 1
pwner Crancl Oaks
Addren:
Str. Addi,em . Valle For e LI7 B4 '7orthview 'i
Plumber.
-2 ~ 50308
~ M" t~ "M* we& tM Cily oi sq"¦ corwa:"wparge; 425.00 pd
Orll.-sa.. Aeooue+t psposit: _ 15. 00 pd
PMernit FN: - 10. OQ pd
B S~,Khoro.: .50 nd
Y Misc. Owr~a;
Dote of Irop.: ToMI:
Insp" Dote
PiaW:
I
I
I
i
CITY OF EAGAN N~ ~$6~S
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8700
BUILDING PERMIT Receipt ~ e , %dw
To be used for „BASEMENT FINISH Est. Value $1, 500 Date .TAN 31 , 7g~L
Site Add~ ss ~.$3 VALLEY-= FOR(:R'
Lot 17~ Block 4SeGSubNORTHVIEW MEADOWS OFFlCEUSEONLY
PdfCBI N0. Occupancy - FEES
2oning
w Name 13ARK & pF$By TF_S('I~Mjp_ (ACtuaqConst - Bldg Permn 35,U0
; Addre55 4283. VALLEY .FORGE jAllowable) _
° City EAGAN Phone 452-2146 x of Srories _ Surcna~ge 1.~n
lengih _ Plan Review
io Name HI-PObNT .CONSTRUCTION DeOth - SAC, City
oa Address 796~ SUNSET ?R S.F Total
U~ City EAGAN Phone 688-2747, S F. Fwtpnnts _ SAC, MCWCC
On Sna Sewage _ Water Conn
r
ow Name on siawen
Fw - Water Meler
~3 AddlBSS MWCC System _
aw City Phone Ci1y Water _ /+ccl. Deposit
PFV Reqwred _ S/W Permil
I hereby acknowlege that I have read Ihis apphcation and state that ihe Boosier Pump - SIW Surcnarge
intormauon is wrrect and agree to compty with all applicable State of
Mmnesota Statules antl Cia Ordmances. Trealment PI
SignaWre of Permite~ APPROVALS Road Unrt
A 8uilding Permit is issued to. HI-POINT-CONSTRUCTION Pianner - park Ded.
on the ezpress condihon thal all work shall be done in accordance with all Counal
applicable State ol Minnesota Statutes and ICiytyyo~f Eagan Ordinances. gldg, pff, - CoOies
BuiltlingOlhCial -J1~~_~ad 1 1~~~ Vanance - TOTAL 36.00
• CITY OF EAGAN y° 9 9 8 6
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-5700 `~>o
BUILDING PERMIT 2eceivt #
Te 6e, awd fer SF DWG/GAR Est. Volue_+570• 000 Date MARCH 22 , 1985
SiteAddrese 4283 VALLEYFORGE Erect ER Occupancy R3
Lot_j, 17 Block 4 Sec/Sub. NORTHVIEW MEAD04`model ? Zoning RI
Parcel No Repair ? Type of Const. ~F
.
. Enlarge ? No. Stories
GRAND OAKS Move ? Lenqth 50
W Name • Demolish ? Depth
z Address 1881 SUNRISE CT Grade Sq.Ft.
~ City EAGAN phone 452-8934 Inscall
$ AM$ Approrab Fees
Z,O Name O
o~ Address Assessment Permit '
u~ City Phone Waler85ew. Surcharqe 35.00
Police Plan Review 171.50
Gw Name Fire SAC 525.00
Address Enp. Water Conn. S00 - 00
°LW City Phone Plonner WaferMefer F+-4 - n0
<
0 Council Road Unit gR n .n 0
I hereby ockmwledge that 1 hove reod lhis applimhon ond state thaf Bldg, Off. ~"j ~Ig~T _ P_ 132.0
~
the inlormation is correct and cgree fo comply with oll opp6cuble ~~-'`-Y--
Sfata of Minnesota Statutes ond Cityyy,,~ f Eogan Ordinonces. APC Totel $2 . p49 _ SO
/j~i~,L_. _ „f` Var. Date
Sipnoture of Pertnittee//// ~>m"
A Buildinq Permir is issued to: GRA OAkA EVELOPMENT CO yi rye azpren conditlan Ihat
oll work shall be done in accordance wit o aDV~~~ble tat o iwqewta Sratutes ond Ciry of Eopan Ordinonces.
Buildinq Officiol
-~6
5
CITY USE ONLY
PERMIT RECEIPT DATE:
2002 RESIDE1V'flAi. MECHANICAL PEfiMIT APPLICATION
CITY OF ERfiAN
S$SO PILOT KN08 RD
E,4fiAN MN 55122
651-681-4615
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: L- lq -00-\
SITEADDRESS: ~~~I~-~ I ~r •
OWNER NAME: TELEPHONE
INSTALLER NAME: ~ONE
Wohlers Southside Htg. & Air, Inc.
6950 W. 146'~ St., #106- -
STREET ADDRESS: Apple Valley, MN 55124
(952) 431-7099
CITY: ZIP:
Place a check mark next to the permit work type
~ Add-on, modification or alteration to existinq dwelling unit $ 30.00
• furnace replacement
• air exchanger
• air conditioner
• other
Nature of work: h!WCLC~ 0-1C.,
State Surchar e $ 50
Total
S[GNATUR OF ERMITTEE
i rn?
CITY USE ONLY
PERMIT RECEIPT DATE:
APPROVED BY: , INSPECTOR
2002 COMM£$CIAL MECfiA1VICAL P£ftMIT APPLICAT10N
CI1'Y O£ £AfiAN
3$30 PILOT KNOB RD
EAsAiv, auu 55122
651-6$1-4675
Please complete for: ali commerciaUindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
S[TE ADDRESS:
OWNER NAME: PHONE -
TENANTNANtE (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY: STATE: ZIP:
TELEPHONE
WORK TYPE: New construction Install U.G. Tank
_ Interior Improvement _ Remove U.G. Tank
_ Processed Piping
Specify Namre of Work:
Wlren instn/fing/removing underground tartk, call 651-681-4675 jor inspection by Fire Marskal and
P[umbing inspector.
Fees: I% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstallation = minimum fee
Contract price: $ x I°/a (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Fee
TOTAL $
SIGNATURE OF PERMITTEE
Updated I/02
y ~ . . •
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONYRACTORS l9UST BE LICENSED NITH THE CITY OF EAGAN
~ a"~ ~ /•~~~i~ ~ 1CERTDFICATES S OF F PLANS
3 SURVEY
~ 1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: m}C) - Date:
Site Address: elz OFFICE USE ONLY
Lot: 1~ Block G Sect/Sub ~"'o4Jtiuu,dErect ~ OccupancY
Remodel Zoning Q-I
Parcel Repair Type of Const ~
Enlarge fl of Stories
Owner Move Length ~
3-7' /bh~ n ~ Demolish - Depth ~
Address (~P j ~'~t/2 Grade Sq Ft
City/Zip Code y~~~S 5 5 Y'U ~
Phone :772~/_ ~ Z 3 y APPROVALS
Contractor Assessments Permit 343. ~
Water/Sewer Surcharge
Address ~Ut-ii21,5~ Police Plan Review
Fire SAC 525,°=
City/Zip Code ~P, 6 t+, r Engr Water Conn 500,
3y / Planner Water Meter
Phone Council R ad Unit
Bldg Off3 y2 )Parks
Arch./Engr. APC Treatment P1
Variance 4 O
Address TOTAL
City/Zip Code
Phone If
S~t`~.r'!3VCYOR,S CERTIf'ICATE f.RAfrO ONKS DEVELOPrr_rir co.
:,z6s /
L
XgTe.e ~
ti 19
101.95 N 89°20'42"E..
s79.s7~' . 54.42 . -41.93 97113 m X976.9
8B0.18~~4.0 J v1970.S% 0 ~ TO 6RM'
r ~ ~ S~ • ~ ~ M.H. 0 INV.•988.Yb ,
~09 ~ .
`EO.~~ •0 0
26, oaj Pa0P~5..,?'' ~ 00r~91~y9 ~ .
P - pY,a \ V ~
p ~B9 0
\ O / Q.Qj , Z p'~ 1,q 2'L ~ N y - r O~~J 9q5}+ ~ ` .
~ ~ aC
~ V 6~° G- p PFi• - ~ i/ r
n! / Q W N~~~ 3g ~0
5 o
~ ~ ~ °_ZZgr~+'• ~ .
6
2
~ 58~ L _ \ / ~ .
~ ql g.
lb ~ j + 0 2~
~ / ~ ~2
" ~ ~P O i N
6~51 ~ r~
sewx ~
n. .
2 hgr S
rr, I ~ 36+.,
` t ^ ~ \
c7
~ J
~
\
DEtlf1TES PROPOSED SURfACE DRAiNAGE
O DEPlOTES iR(1P! P'(1NUh"ENT SET SCALE: 1 iNCll = 30 FEET
• DENOTES IRON P10PlUMEMT FOUtID PROPOSED GARAf,E fL00R = 978•o FEET
znon.o IlEf10TES EXISTING ELEVIITION PROPOSED LOWEST FI.OOR = 97 S.z P[ET
(000.0) (lE'IOTES PkOPOSED ELEVATION PROPOSED TOP OF f3LDCY. = 9-78_1- FEET
, 41F IIERFf3Y CFRTIfY TO GRAND CAKS DEVE! CPP:Ef!T CO. THAT TNIS IS A TRUE AP1D f,ORRECT
REPRF.SENTATIOP! OF !1 SURUEY OF TIIE (30lRIDARiES Of:
Lot 17, Fslock 4, NOGTHV?EW FEAD01iS, acccr~inn tc :he reccrded nlat thereof,
DakoLa C0',!i.'',;y, 1:i^neSOtd.
1T DOES NOT PURPORT TO SI10W iNPROVEt1ENTS OR ENCROl1CIIh1ENTS, iF ANY. AS SURVEYED [3Y
14E OR UNDFR MY DIRECT SIIPERVISION THIS IATIt f1AY OF P1ARC~F , 1985.
S1GtlED: JAMES R HILL, I"C.
REVISED 3-19-85 TO SHOW
RELOCATION OF A PROPOSED
HOUSE. BY;
HAROLD C. PETERSOIJ, LAt7D SURVEYOR
MINNESOTA LICENSE NUh1BER 12294
PROJECT 140. BOOK / PAGE JqMES R. 1-IILLY INC.
85497 105/39 planners / Engineers / Surveyors
FILE NO. 8200 Humboldt Avenu• Soulh .
FO L D ER Bloominplon, Mn. 65431 612-884-3029
. . .
~ EXTERIOR ENVELOFE AVEFAGE 'U' COMPUTATION
GRAND OAk'S DEVELUFMENT COMFANY
MODEL Q AREA U U X AREA
REOUIFED
1. 'fOTAL WALL AREA 1800 X.il 148
2. TDTAL ROOF AREA 1196 X.0^<6 =1.096
ACHIEVED
AREA U U X AREA
A. WINDOW AREA 186.66 .5 93.33
0. DOOR AREA 39.8 .077 3.0646
C. SLIDE GLASS AftEA 13.44 .48 6.4512
D. FIFtEPLACE AFiEA 0 0 O
E. WALL FRAME AREA 18V .041 7.38
F. NET WALL AREA 1164.1 .049 57.0409
G. RIM JOIST AREA 119.52 .0436 5.213072
H. FOUND WINDOW AREA 0 U 6
1. FOUND APOVE GRADE 96.48 .135 13.0240
TOTAL• WALL AREA 1800 185. 59^b
J. SF..YLITE 0 0 0
K. ROOF FRAME 119.6 .0=2 3.B272
L. NET ROOF AREA 1076.4 .025 26.91
4. TOTAL ROOF AREA 1196 30.7372
SUM 1 . +2. 229.096
SUM 3,+4. 216.2398
L/7 gL CITY USE OMLY RECEIPT
~ 95
SUBD. DATE:
1995 PLUMBING PERMIT (RESIDENTIAL) 1137-
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 6814675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
FIXTURES EACH iVO. TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/S a 3.00 x =
a e earN te-~ ~ 3.00 x =
oor rai 3.00 x =
Gas Piping Outlet * minimum -1 3.00 x =
Rough Openings 1.50 x =
Water Softener 5.00 x =
Private Disposal " Dakota Cty. license 20.00 =
U.G. Sprinkler ' home under const. 3.00 =
Alterations * co existing 20.00
Water Turn Around 20.00
STATE SURCHARGE .50
TOTAL ~
SITE ADDRESS:_ tiCHM10 DEBRR ~
4283 uRLLEV FORr_,E PLRCE
OWNER NAME:EHGflti , 55123
~ H 452-7146 W 463-3288 MRRK
~
INSTALLER NAME:
Ou YE111~DOil~ 1ti8tALLERS
STREET ADDRESS: +rF#~..~~
MINMEAPOLIa. MN 5U00
CITY: STATE: ZIP:
PHONE { )
~ 1- z1- s5 -
OFFICE USE ONLY
L BL RECEIPT
SUBD. DATE:
7995 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for. • all commercial/industrial buildings.
P multi-family buildings when separate permits are p.ps required for each dwelling
unit.
DATE: CONTRACT PRICE:
WORK TYPE: _ NEW CONSTRUCTI[1N , ApD ON _ RFPAIR
DESCRIPTION OF WORK:
IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING:
WATER FLOW: GPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO.
FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OF METER ISSUANCE.
WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? YES NO.
IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT.
FEE: $25.00 minimum fee or 1% of contract price, whichever is greater. State surcharge of $.50 per
$1,000 of pg,pi fee due on all permits.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL
JI I C MVURCJJ.
TEPtANT NAME: STE. #
OWNER NAME.
INSTALLER:
ADDRESS:
CITY: n1 nute#Allla R;wST'4qrE' ZIP:
:.A31JAt?.NI~a~NMJV.~M?WOTM3V
PHONE ' ~~i~.~~~„«~=
^;a wht ,i1J09A3NNiMAPPUCANT
OFFICE USE ONLY
METER SIZE: " DATE: INSPECTOR:
CITY OF EAGAN FOR CITY USE ONLY
3830 PILOT KNOB ROAD
EAGAN, MN 55122 PERMIT #
PHONE: (612) 454-8100 RECEIPT # CGIf9~
PL~JI'1$XN~ 1'ERHT~' DATE :
ItESIAt371'TALt: PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLZNGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
WORK DESCRIPTION COMPLETE THE FOLLOWING:
N0. FIXTURES EA. TOTAL
NEW CONST ADD-ON MINIMUM 15.00 IS o0
ADD ON SHOWER 3.00
REPAIR WATER CIASET 3.00
BATH TUB 3.00
LAVATORY 3.00
OWNER NAME: KITCHEN SINK 3.00
IAUNSITE ADDRESS: ~3 FDY~'rC DRY TRAY 3.00
HOT TUB/SPA 3.00
d ~ WATER HEATER 3.00
LOT:~_ BLOCK ~ SUBD. /VO+~J~VIC[? ~QD~ _ FLOOA DRAIN 3.00
INSTALLER: S elF' GAS PIPING OUT.
_ (MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
ADDRESS: ~3 Fo~^se ~ ~ OTHER f,Jc7-j3p..-
CI~' ~ _ WATER SOFTENER 5.00
ZIP:; 5 S~~ 3 PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
PHONE - ~o
SUBTOTAL $ 0 0
ST. SURCHARGE .50
~~~[/~.~?/'T
i~ i
SIGNATURE OF PERMITTEE
TOTAL: S JO
CiiMMERCSAL/iNDiTSTRiAL:: PLEASE COMPLETE THIS PORTION FOR ALL COMMERC IAL/INDUS TRIAL BUILDINGS AND
MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACN
DWELLING UNIT.
CONTRACT PRICE: FEES
OWNER NAME: 18 OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
SITE ADDRESS: EACH $1,000 OF PERMIT FEE.
LOT: BLOCK _ SUBD. $25.00 MINIMUM FEE.
INSTALLER: CONTRACT PRICE x 18 $
ADDRESS: STATE SURCHARGE $
CITY: ZIP:
TOTAL: $
PHONE
(SIGNATURE)
FOR:
CITY OF EAGAN
!
1991 B NG P IT APPLICATION
SINGLE FAMILY DWELLINGS MUIIt L~ COMMERCIAL
2 SETS OF PIANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
OF RENTAL UNITS
OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: Q6&, Valuation: Date:
883 ~llty Fo~~
Site Address OFFICE USE ONLY
Lot 1'7 Block ~ FEES
Occupancy Bldg. Permit '
Zoning Surcharge Parcel/Sub Actual Const Plan Review
Allowable SAC, City
Owner # of stories SAC, MWCC
Length Water Conn.
Address yZ~j Depth Water Meter
S.F. Total Acct. Deposit
City/Zip Code 451--?6/Q/J Footprint S.F. S/w Permit
S/W Surcharge
Phone SZ-~ Z/ - On site sewage_ Treatment P1.
On site well Road Unit
Contractor ~ MWCC System _ Park Ded.
/ City water Trail Ded.
Address -St~n~~ PRV _ Copies
Booster Pump
City/Zip Code 6Lft ~5123 SIIBTOTAL
APPROVALS Penalty
Phone 7y7 Planner Lot Change
Council TOTAL
Arch./Engr. ~ Bldg. Off.
Variance
Address
City/Zip Code ~Phone #
agrees that all work shall be done in accordance with
'(Si ature of Contractor) ,
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
1
C' 2/84
~F,' CITY OF EAGaN
I ~ •
APPLICATION FOR PERP4IT
SESJER AND/OR WATER CO\NECTIODT
- (PLEASE PRIHi)
1) PP.OP= AL'DRUE-SS: L1 O VG P d
rcr=,L DF.SCRIPTIC`I: 1.04 n 115~6C lJ!"~//l~/el.iJ!///CKtN
(Lot/Blcck/Si;tcivision or Ta:t rarcel I.D_ idl.-.z~er)
j IF _.l; 5=-.UCMMEi Dtl-11-- OC DR-Cii i.AL
FJDFCLT z.•'1TF;/F.?OPOSz:) 40 R-1 S'~.'~;GL.: c`:•irrY . .
? R~2 DLJ'rT.;:: (7:'7 L~:ITS)
. 13 :2-3 7.Cit~~-:rv1cE (`I'f'_°. + C~IITS) ! UiI2'=5) .
? a-a UtiiTS)
? cc~,~~cr-,i,~:.:T?o~_ T~~
? ~:ncs~.L i
p LVSTI=ICMz\i,/G,"V=.•TE~:P
2) t+P?'-.--'=T (PLEASE PRf~ii)
C~ (5 ct k:~
cri^r, s:aTE:, zza: ~ GS ovr Yh rJ ~S= /,a,.?
PHoNE:
3) PU„TLa (PLE.lsE PR1''ki) FOR CITY USE OVIY
N'1`E: r~)6 rn h I,
PL~JM ERS LIC:HSE:
~DC:2ES5: ~ ~e7U Active
CITY~ ST.~ic, ZI?: ~ ~ Expired
PHO~: ~ Not of Recard
~ J PLII.MBER LICENSE H c:~Q 4J
arr tia
4J OcC[J?n,iy'I'/c!•;~,]m NAhSE (PLEASE PRIJT)
:
ADDRESS: 04,
CIT'!. ST;TE, ZIP:
PFiO`IE:
5} INplCATE WHICFi PERi•LLT IS BEING RFX)UESTLD:
~ CZ,"':.TIFCPION 'ICJ CITY SES^lER
~ CU:.I'ICV Tp CITY j•7ATE:?
? di[{F'R (PI.G'1SE DF ,CRIIIE)
6) I"i:DIG,.:. C::c: .
? PM7%-cE f?OID APP ,P(iVID PER.%+ST FOR PIC:-L'? BY Q:IE OF r1EC,UE
~ PI.ESc :•*AIL APP?20VED PEF'IST TJ 1, 2. P. 4 ABOVE
(Circle one)
7) src7~T.R: : DATE: IS
Aal_iqAFJO:f~ i Li l~:Ofu !~l ?e ~:a sia ~ s f~~a~:~ ~~t !l~.~~yFi ~ s Is s it~ia~ FOR C I T Y U S E ON;,Y
P°_.°.MIT ?SSUED
$ 1TT ~T~ICL.;DL ~UP.~^=;.~GG~
$ 5 O w2.TE7 PER11tT_?T (Ii:CLL1.7L SUPC::ARCiL~
$ G~'•~---e WATER METEP./COPPEpHORN/OUTSioV REnGER
$ WATER TnP (ZNCLUDE COR?ORATZOi1 STOP)
$ SE;:ES T.,?
$ =Cc''i:"i 7_'C.cl: - a=..c?
$ ACCOuNT D.F.POSIT - WAT°_.^-,
W~,C
S IAC
$ T??U_dK WATER ASSESSi^E:iT
$ TRui:K SEi'iER nSSESJ.1=:,jT
$ LAT :RAL BtciGt IT/T.T?UNR
$ L:,Tc.R'r,L BENc.FIT/TRUNK WATER
$ OT :ER _
S TOTaL
$ ~03. p.tilOli`:T PAIDjREC°i?T R JrtJ 9~!7
DOcS UTILZTY COVNECTION REQUIP.E EXC:-.VATZOi] IA7 PU6LZC RIGriT OF SQAY?
C YES ZF YES, THEi! n"PEBh]ZT FOR :dORS WIT?iIN
PUBLIC ROnD47AY" MUST BE ISS[iED BY TY.E
i NO ENGI:IEERIP:G DIVISION. LIST AS A CONDI-
TION.
SCiB.7ECT_ TO TEir. FOLLO:•7IDIG CODIDITZOP?S: '
APPROVED BY:
TZ.LE: DATE:
!"
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA158093
Date Issued:09/25/2019
Permit Category:ePermit
Site Address: 4283 Valley Forge Pl
Lot:17 Block: 4 Addition: Northview Meadows
PID:10-52100-04-170
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Bradford A Weber
4283 Valley Forge Pl
Eagan MN 55121
(651) 468-8068
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature