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4167 Countryside DrOne or Two All Other CITY OF BUILDING DEPARTIIFa1T EXTERIOR E11VELOPE AVERAGE nUn C0RPUTATION (To be submitted with building permit application) Family Dwelling Contractor JE LINEAL FEET OF N N EXPOSED WALL e -T:V')4:. tt4e15r OPAQUE WALL CONSTRUCTION: nUn Value x Area nun t r'/1.3 x sq. -FT. 119(10.90 ,.U)(A) nun • c 11P x sq. FT. tp“?, _ '' �(U) (A) nun x SQ. FT. (U)(A) x' SQ. FT. - U) (AJ HUH x SQ. FT. - (U)(A) HUH x SQ. FT. - (U) -(A) Detail ¶ A W reference from attached sheets WINDOWS: Hake & Type • 11 11 11 Owner Fk17.7 ,,(l :Site Address Lei ` , t, c jc Z 2ec tit, Jt :eek% 4 7Th t Date Phone ft. above grade = Z9 JCA P 411) TOTAL EXPOSED WALL AREA SQ. FT. HU' Value x Area nun , i(.�1 x sq. FT. 2. nun x Sq. FT. - HUH x sq. FT. nUn x SQ. FT. D00RS: nUn Value x Area (take & Type 1::>t:-k:)E?4- It 11 n n 11 n TOTAL (U)(A) VALUES • nun TOTALS • x Sq. FT. x SQ. FT. x SQ. FT. ,. x Sq. FT. x5 .p lq 15 sq. FT. AVERAGE nUn DIVIDED BY TOTAL WALL AREA .Xii3(4,74111111, AVERAGE "U";i 15 or. l -.115 for 1&2 fa ROOF/CEILING:f TOTAL AREAS 47i(u)(A) (U)(A) (U)(A) (U)(A) dwellings. Detail reference nUn /074 x Sq. FT. I from • nUn x Sq. FT.` attached sheets. nUn x SQ. FT._ Describe openings nUn x SQ. FT.� in roof. nUn x sq. PT. TOTAL (U)(A) VALUES DIVIDED BY 2r511-541 TOTAL ROOF/CEILING_AREA I'14. AVERAGE,I'U'I.025 for,.ventilated roofs. (U)(A) (U)(A) (U)(A) (U)(A) (U)(A) =23111/ (U)(A) (U)(A) (U)(A) (U)(A) (U)(A) 1-1 X71 59 a4 Request Dat �/ 1 Ito Fire No. Rou. -i Inspection ❑ No jLI Ready Now El Will Notify Inspector When Ready? I X.licensed contractor 0 owner hereby request inspection of above electrical work at: Job Addr ss (Street, Box or Route No.) (jz4 —/1g 4z. Section No. Township Name or No. Occupant (PRINT) /i1/ /CE Sfy Power Supplier Electrical Co tractor (Company Name) City Range No. County Phone No. (Address /L,'%2 e.£C 7 '/G Mailing Address (Contractor or Owner Making Installation) (Contractor's License No. / 1f: .5699 f a txmiJ1 37-42 .? Authorized Signature (Contractor/Owner Making Installation) MINNESOTA STATE BOARD TRICITY Griggs -Midway B oom S-173 1821 Uni Ave., St. Paul, MN 55104 P (612) 642-0800 czTL of r./96/9 1 'Phone UNumbeerr THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IF ENCLOSED. 7//5/i/ REQUEST FOR ELECTRICAL INSPECTION ► See instructions for completing this form on back of yellow copy. H 71959 'X" Below Work Covered by This Request New Add- (Rep. " Type of Building tv Home Appliances Wired Duplex Range Apt. Building Water Heater EB -00001-08 r /Oa?a2/5 Equipment Wired Temporary Service Comm./Industrial Farm Dryer Furnace Electric Heating Other (Specify) Other (specify) I/ Air Conditioner Compute Inspection Fee Below: Other Contractor's Remarks: Swimming Pool Transformers Signs Fee Service Entrance Size Fee 0 to 200 Amps I Irrigation Booms lI Special Inspection !Other Fee Alarm/Communication I, the Electrical Inspector, hereby certify that the above inspection has been made. OFFICE USE ONLY This request void. 18 months from Above 200 Amps Inspector's Use Only: Fee 1TOTAk. b Circuits/Feeders 0 to 100 Amps Above 100 THIS INSTALLATION MAY BE ORD COMPLETED WITHIN 18 MONTHS. Rough -in Final Amps ED DISCONNECTED IF NOT Date (8. la4ruit.) Date 7c/ '4 f -IST" qi 0.4 XC alZaZ 2-T+ z-) . I v,,,. ;, LO 6,e)2.7x(42--t-.4tat 210+ UP) 12-00, OS 01)L14"7- i3 -So ...,.... r$?), F1 =- //(I,2_— Jlt'iPot'O ?j2XZ€ .f., R.O,5Xc Z2-1, 2-zfx4S-7- Zzi ' 151" 2. Zo)& ,ca= (`XZ- V37,o u/ 1-/74:-/.= 10z., = Z.10 Ps_32E- //4 WN.c,.z&?roger kVA jl ,z- 11 w 244flo �,o 552►a 407/4 z; J 5 888Z5 a ��9 44� �� el, Re Request Date ! s ' / contractor ❑ owner hereby Fire No. request 'oil. -in Inspection Re, red? ` Yes D No —' ❑Ready Now Will Notify Inspector When Ready? Ilicensed inspection of above electrical work at: Job Address (Street, Box or Route No.) 4 i bi . _Qo LavVr9 5vcte der. City `ct rU Section No. Township Name or No. Range No. Cou ' alt, VOA - Occupant (PRINT Phone nXj-015 ([) Power SupplierAddress ..------T --� Electrical Contractor (Company Name) �i4-'�ol�-Jhers Fleck* kc, Contractor's License No. Ci 3(,37 Mailing Address (HHo �ractorr. Owner Making Ins • n) � m O ^ � 1� ad_ .�(1C Q kc%/ 6j Authorized '.nature 4tor/Qwn-odd aking Installation) / • Phone Number 1/502-3QQb MINNESOI A-BFATE BOARD OF ELECTRIC! Griggs -Midway Bldg. — Room S-173 1821 University Ave., St. Paul, MN 55104 1 Phone (612) 642-0800 THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. ��/ REQUEST FOR ELECTRICAL INSPECTION J 5 7 ^ 8 3 ► See instructions for competing tri.^ -term on back of yellow copy. QJ r�'X" Below Work Covered by This Request EB -00001-08 LOC.9 New Add Rep. _ Type of Building AppliancesWired EquipmentWired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other (specify) Contractor's Remarks: e�- Ctn, Bt tsevnnT ut [, f n � -�'^L.ry '7 Compute Inspection Fee Below: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps $ 0 to 100 Amps a -- Transformers Above 200 Amps Above 100 Amps Signs Inspector's Use Only: Y° ° w THIS INSTALLATION MAY BE ORDERED DISCONNECTED COMPLETED WITHIN 18 MONTT TOTAL 301Sa Irrigation Booms Special Inspection IF NOT Alarm/Communication Other Fee I, the Electrical Inspector, hereby certify that the above inspection has been made. Rough -in 1 f 7 (;� Date /? se rc� (� " L Final • /; '��(} 2 .r, _ p`a}e: r) 079 f OFFICE USE ONLY This request void 18 months from , - ,.ULera►11110g NJ" values at hoof, Wall, Rim. and Oono. Block IJ . Ob (1• b•• • IlooF/CSEILIIlQ 1.) Interior Air Film 2.) 5/8" 0yp. Bd. 3.) Insulation 11. ) 5.) Exterior Air Film (STILL) 1/11= , 021 • • 1. . SILIRAIN 0.61 .56 44.o, .61 iOTAL til). 7g WALL 1l VALU 6.) Interior Air Filni 0.68 7.) 1" ay1'. Bd. .45 8.) Insulation Mod 9.) P�uitu--141 Z.n��- 10.) 11nsonite siding .67 11.) Exterior Air Film .17 ' HUn e, 1/Il TOTAL, (It)z 23.0/ RIR (S) VALU} 12.) Interior Air Film 0.68 13.) Insulation 19,o0 14.) 2" Fir Aim Joist • ' 1.88 15.) Kv it,T-'u r' 2, 04 . • 16.) Masonite siding 7 17.) Exterior Air Film .17 111111 a 1/Aa ,0/'D TOTAL FOU11DATI011 / (I1) VALUE 18.) . Interior Air Film' 0.68 19.) 20.) g-,/ 91k/PfEi • !!. cv 21.) 1211 Oonoreto Block 1.28 22.) 23.) Exterior Air Film .t7 nun a 1/Aa ,070 TOTAL (A) )3.12J 9�1g3 -, ri IooFszV Request Date / I April 2 2, 1991 Fire No. 4 h -in In pection Yesd? ❑ No 0 Ready Now liWill Notify Inspector When Ready? 1 "licensed contractor 0 owner hereby request inspection of above electrical work at: Job Address (Street, Box or Route No.) 4167 Countryside Dr. City Eagan Section No. Township Name or No. Range No. County Dakota Occupant (PRINT) Joe Miller Homes Phone No. 431-2001 Power Supplier Dakota Electric Address 4300 220th St. S. W. Farm t A n M 1's 1 n$ ° Electrical Contractor (Company Name) Midland Electric Conttr cit License No. 041610 Mailing Address (Contractor or Owner Making Installation) 7630 145th St. W. Apple Valley,MN 55124 Authonz d Signature (Contr r er Making Installation) 1X//11�I/1 .1 %1vi 1 L,J_€J l Phone Number - +32-6688 MINNESOTA ST Griggs -Midway 1821 University Phone (612) 64 • ARD OF ELECTRIe1TY — Room S-173 St. Paul, MN 55104 1/...(7/, REQUEST FOR ELECTRICAL INSPECTION ► See instructions for completing this form on back of yellow copy. 'X" Below Work Covered by This Request 39183 THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. New Add Rep. Type of Building Appliances Wired Equipment Wired xHome Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other (Specify) Comm./Industrial Furnace Farm Air Conditioner Other (specify) Cont actor's Remarks: Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 1 0 to 200 Amps /5 /g/o to 100 Amps Transformers Above 200 Amps Akin e 100 Amps Signs Inspector's Use Only:�� THIS INSTALLATION MAY ORDERED COMPLETED WITHIN 18 M HS. � (J TOTAL ?5<, 5e3 Irrigation Booms Special Inspection IF NOT Alarm/Communication DISCONNECTED Other Fee I, he Electrical Inspector, hereby certify that the above inspection has been made. Rough -in f Date I Final t t �+ OFFICE USE ONLY Cit This request void. 18 months from 954870 COUNTRY HOLLOW SECOND ADDITION PRESSURE REDUCING VALVE AGREEMENT This agreement, made and entered into the 5 day of l -f -f, c-gZ , 1990, by and between the CITY OF EAGAN, a municipality of the State of Minnesota, (hereinafter called the City), and the Owner and Developer identified herein. The terms "Developer" and "Owner" as used herein refer to: PROGRESS LAND COMPANY, INC. whose address is 14300 Nicollet Court, Suite 235, Burnsville, Minnesota 55337. WHEREAS, the Developer has applied to the city for approval of the plat or subdivision known as COUNTRY HOLLOW SECOND ADDITION, located within the City; and WHEREAS, the Owner and Developer agree to notify the proposed potential buyers of all lots within COUNTRY HOLLOW SECOND ADDITION that Lots 1-4, Block 1, Lots 1-17, Block 2 and Lots 1-10, Block 3 are in a high water pressure zone and a pressure reducing valve shall be installed in each home below the elevation of 875 feet. All costs shall be the responsibility of the Buyer and shall be installed to prevent damage due to high water pressure. NOW, THEREFORE, the City, Owner and Developer agree as follows: 1. Recording. This agreement shall be recorded with the Dakota County Recorder so as to provide notice to the owners of Lots 1-4, Block 1, Lots 1-17, Block 2, and Lots 1-10, Block 3. The Owner shall provide and execute any and all documents necessary to implement the recording of this agreement, 2. Notice. The recording of this document shall constitute notice to all owners and future owners of property in the COUNTRY HOLLOW SECOND ADDITION subdivision that Lots 1-4, Block 1, Lots 1-17, Block 2, and Lots 1-10, Block 3 are in a high water pressure zone and that a pressure reducing valve shall be installed in each home below the elevation of 875 feet. All costs shall be the responsibility of the Buyer and shall be installed to prevent the damage due to high water pressure. 3. Validity. If any portion, section, subsection, sentence, clause, paragraph or phrase of this agreement is for any reason held to be invalid, such decision shall not affect the validity of the remaining portion of this Contract. 4. Binding Agreement. The parties mutually recognize and agree that all terms and conditions of this recordable agreement shall run with the land herein described and shall be binding upon the heirs, successors, administrators and assigns of the owners and developers referenced in this Contract. IN WITNESS WHEREOF, we have hereunto set our hands. CITY OF E;�N (Date: OWNER AND DEVELOPER: PROGRESS LAND COMPANY, INC. mas A. Its: Mayor Attest . J. VanOverbeke Its: erk By: L )th9 YV , , .rsefirt„,f A) Its: PSt0.1 By: Its* STATE OF MINNESOTA ) ss. COUNTY OF DAKOTA ) On this v2/ S% day of 6G/6/4'•G aTi, 1990, before me a Notary Public within and for said County/ personally appeared THOMAS A. EGAN and E. J. VanOVERBEKE to me personally known, who being each by me duly sworn, each did say that they are respectively the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing instrument, and that the seal affixed on behalf of said municipality by authority of its City Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of said municipality. t •Hirttc!tc: etttN*imttSH _ F.' .S„A 640 STATE OF MINNESOTA ) ss. COUNTY OF I' t . <'� ) Notary i!,ublic On this - day of 1-1Lkvk Si Public within _ and for said appeared personall -they er' , 1990, before me a Notary County, personally f r l:C(C.+to me own, who being -each by me duly sworn, ea.o/a- did say that re3pcctivcly` the of the corporation named foregoing instrument, in the signed an Board of free act and and that said instrument 5ea1ct on behalf of said corpora ion by authority of Directors and said rrr 5 i CIC24- acknowledged said instrument to be deed of the corporation. C i .ii C.t. 6% 1-CrOc. it Notary Pubic was its the APPROVED AS TO FORM: 411 City Attorney ,'ated: /# APPROVED AS TO CONTENT: Public Wor4s Department Dated: A. 6 19r° THIS INSTRUMENT WAS DRAFTED BY: SEVERSON, WILCOX & SHELDON, P.A. 600 Midway National Bank Bldg. 7300 West 147th Street Apple Valley, MN 55124 (612) 432-3136 MGD oG -59 i/ g(5 -S1 PLUMBING (RESIDENTIAL) Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit Date / f / 0 # Site Address q I in 0_ . -ti �3U3VLP A. - Unit Property Owner AViArrYpk..1.1 Telephone # 01) Lo fx 0–ti---) 5o Contractor NAD \ l \` a t 1 A Nv "5e--_ Address ` '--1-- 05ft-ITA 0 C e, 161-k City --RuniThim State A \. Zip 5) h I Lti Telephone #(n) ?X..Q ` Q Lo 1 The Applicant is Owner l`` Contractor Other Septic System New Refurbished Submit 2 sets of plans and MPC license $ 100.00 _ _ Includes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Including Adding fixtures to lower levels or room additions, excluding water softener and water heater — Abandonment of septic system — Water turnaround (+ 5/8" meter if needed - $121.00) Other: $ 50.00 RPZ new installation repair rebuild )3 30.00 $ 15.00 — Lawn irrigation system T 037i Water softener — Water heater VL 'replacement — additional By State Surcharge $ 50 Total $ /5, J I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; 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. Applicant's Printed Name Applicant's Sign b51-bS1-4b75 Please complete for: single family dwellings, townhomes and condos when permits are required for each unit, backflow preventer for irrigation system SITE ADDRESS: COLS OWNER NAME:: 1V\ s INSTALLER NAME: p-i.--1/0•AL) - O 1/OVt STREET ADDRESS: i CITY: TELEPHONE #: LD 51 ci'; V7 3 co (AREA CODE) J TELEPHONE #: L t c ?col-- �t (AREA CODE) STATE: IML) ZIP: 5 (—I` — SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) includes $40.00 County fee Note: Additional consultant fees may apply $ 100.00 • MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING: water heaters. $ 50.00 Adding fixtures to lower levels or room additions, excluding water softeners and Abandonment of septic system. Water turnaround - existing dwelling unit (+ 5/8" meter if needed - $118) Other: RPZ: new installation/repair/rebuild X. lawn irrigation system $ 30.00 Replacement/additional: water softener water heater $ 15.00 State Surcharge t $ .50 (P n qi I Total MAY 2 1 2002 LJ $ so'r I hereby acknowledge that I have read this application, state that the information is correct, and agree to c o ply with all applicable City of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan ass no for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit thin Ci roperty/righ -of-way/ as ment. PERMIT # ase complete for: E ADDRESS: fNER NAME: : ,TALLER NAME: BEET ADDRESS: Y: 2002 RESIDENTIAL PLUMBING P crrY OF EA 3$30 PILOT KNOB LAGAN, MN 5512 651-681-4675 single family dwellings, townhomes and condos wh backflow preventer for irrigation system DEMPSEY, MICHAEL 4167 COUNTRYSIDE DRIVE EAGAN, MN 55123 (651) 688-4329 NORBLOM PLUMBING CO. (612) 8274033 2905 GARFIELD AVE. so. s SEPTIC SYSTEM, new/refurbished (requires two sets of plans an includes $40.00 County fee Note: Additional consultant fees may apply MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, Adding fixtures to lower levels or room additions, excluding water so Abandonment of septic system. Water turnaround - existing dwelling unit (+ 5/8" meter if needed - $ Other: RPZ: new installation/repair/rebuild lawn irrigation system Replacement/additional: _ water softener water *Oa OttiZi 1410.18q014 ECAs:MS(M) 03.3VA (MASAOan. O� ilio 1) CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION 681-4675 SINGLE & MULTI -FAMILY COMMERCIAL 2 sets of plans, 3 registered site surveys, 1 copy of energy calcs. 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last working day of month in which request is made or lot change is requested once permit is issued. Date nig aC4-1 / 3 / 092_ 2_ Valuation of work f'0 Site Location: Tenant Name: ' 16i CoJN7)2ys i D6 ba - STREET STE # /1,c tt, J- 44 tvive -j. A- pskif LOT 5 BLOCK 2- SUBD. C a vni72 y tit) 4.(..01.../ , 2ND P.I.D. # Description of work: FrNrst1 £ 4s 14/7 The applicant i s : [3/Owner • Contractor • Other (Describe) Property Owner Name -1112 / / tG 4-0 t ,V6i7- Phone Li— 0 7.1"--‘ LAST FIRST Address `f(6,7 Cov„,-Y24/s /7 6- - STREET STE # City i' 1 -A.1 State t1'1 Zip MS'S<2-3 Contractor Company Phone Address License # City State Zip Architect/ Engineer Company Phone Name Registration # Address City State Zip Sewer & water licensed plumber sewer & water permits is two . Processing time for days once area has been approved. I hereby acknowledge correct and agree Eagan Ordinances. Signature of that to comply Applicant: I have read this application with .11 apslic•• State of // //i and state that the information is Minnesota Statutes and City of BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 02 Single Family ❑ 03 Two-family ❑ 04 Multi-fam. T.H. ❑ 05 Apt. Bldg. WORK TYPE ❑ 90 New ❑ 91 Addition ❑ 92 Alterations OFFICE USE ONLY ❑ 06 Garage/Accessory ❑ 07 Fireplace ❑ 08 Deck ❑ 09 Basement Finish ❑ 10 Swim Pool D 93 Remodel ❑ 94 Repair ❑ 95 Tenant Finish GENERAL INFORMATION Occupancy Zoning Const. (Actual) (Allowable) # of Stories Length Depth APPROVALS Planning Engineering REQUIRED INSPECTIONS ❑ Site ❑ Wallboard ❑ 11 Res. Add./Porch ❑ 12 Comm./Ind. New ❑ 13 Comm./Ind. Add ❑ 14 Comm./Ind. Rem. ❑ 15 Public Fac. ❑ 96 Move ❑ 97 Demolish ❑ 99 Undefined Basement sq. ft. 1st F1. sq. ft. 2nd Fl. sq. ft. Sq. Ft. total Footprint Sq. ft. On-site well On-site sewage • o. • ❑ 16 Agricultural ❑ 17 Building Move ❑ 18 Demolition ❑ 20 Miscellaneous MWCC System City Water PRV Required Booster Pump Fire Sprinkler Census Code SAC Code Building Y/-392 bs Assessments Variance ❑ Footing ❑ Final ® Framing ❑ Draintile 1-13 ❑ Insulation ❑ Fireplace Permit Fee Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Road Unit Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Total: SAC % SAC Units Valuation: .......SIDENTI ............................. CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 FOR CITY USE ONLY PERMIT # /c,2 igvlP O RECEIPT # /005/2 DATE: 3A1// 9/ PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION NEW CONST ADD ON REPAIR OWNER NAME: SITE ADDRESS: �1 LOT: BLOCK -, SUBD . �-ti Y> C' `� lt"O ( l l INSTALLER: �Q�61t'C \ \€ \. (� ADDRESS: ( A�' CITY: \\77C)`C M \ 'n ZIP: N5 Sc ��— PHONE #: FEES ADD-ON MINIMUM $15.00 HVAC 0-100 M BTU 24.00 ADDITIONAL 50 M BTU 6.00 GAS OUTLETS - MINIMUM 3.00 OF 1 PER PERMIT SUBTOTAL: STATE SURCHARGE: TOTAL: GNATURE OF PERMITTE co .50 LS 3UA PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS, APARTMENT BUILDINGS, AND MULTI -FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: OWNER NAME: SITE ADDRESS: LOT: BLOCK SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: CITY OF EAGAN FEES 1% OF CONTRACT FEE. STATE SURCHARGE = $.50 FOR EACH $1,000 OF PERMIT FEE. 25 PROCESSED PIPING = q��.00 $25.00 MINIMUM FEE. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL: $ (SIGNATURE) .................................. .................................. ..assxnsmv ................................. CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 yLVMOI FOR CITY USE ONLY PERMIT # /U b RECEIPT # 70/29/DATE: 5 /V PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION NEW CONST ADD ON REPAIR OWNER NAME: -10-e SITE ADDRESS: (�C t.��,�fi p�c;'�- LOT: BLOCK SUBD.,wZe.�-(eiv INSTALLER: ADDRESS: CITY: ZIP: TOM I ICSSIAN PLUMBING, INC. 121 REDWOOD DRIVE APPLE VALLEY, MPS 3124 PHONE #: SIGNATURE OF PERMITTEE COMPLETE THE FOLLOWING: NO. FIXTURES EA. ADD-ON MINIMUM / SHOWER - WATER CLOSET 2 BATH TUB ▪ LAVATORY KITCHEN SINK _L LAUNDRY TRAY HOT TUB/SPA / WATER HEATER FLOOR DRAIN TOTAL 15.00 3.00 _3-- 3.00 G�- 3.00 3.00 _LILL-- 3.00 3.00 3 3.00 3.00 3.00 3 GAS PIPING OUT / (MINIMUM - 1) 3.00 3 • ROUGH OPENINGS 1.50 HSv OTHER WATER SOFTENER 5.00 PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 SUBTOTAL $ ST. SURCHARGE TOTAL: $ COMMERC1 JpApkwAl PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND MULTI -FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. CONTRACT PRICE: OWNER NAME: SITE ADDRESS: LOT: BLOCK SUBD. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: CITY OF EAGAN FEES 1% OF CONTRACT FEE. STATE SURCHARGE = $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIMUM FEE. CONTRACT PRICE x 1% STATE SURCHARGE TOTAL: (SIGNATURE) SEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. Eagan, MN 55122-1897 DATE SITE ADDRESS 4167 COUNTRYSIDE' DR !�11JJ// OFFICE USE ONLY TT� i 0 i PERMIT DATE '3/2'/°1 CHIP # C ( 6 METER # b £48 PERMIT # 1 1 f 7 METER SIZE e ") B.P. RECEIPT # ISSUE DATE " 3- B.P. RECEIPT DATE PRV BOOSTER PUMP LOT BLOCK SEC/SUB COUNTRY HoLLOW 7'TI APPLICANT- ADDRESS - CITY, STATE ZIP PHONE• PLUMBER: ADDRESS• CITY, STATE PHONE TOM HESSIAN PLUMBING 121. REDVOOD DR APP Ly Mt:' ZIP 55124 OWNER• ADDRESS• CITY, STATE "AR.aINGTON Jam:" ZIP 515O2f' PHONE 431-2001 JOSEPH M MILLER CONST INC 18133 CEDAR AVE S PERMIT REQUESTED SEWER WATER __ TAPS COMM/IND RESIDENTIAL NEW EXISTING Lawn Sprinkler Meters are to be Installed Ahead of Domestic Meters on Water Line. Credit WILL NOT be given for Deduct Meters. 1 AGREE TO COMPLY WITH CITY OF EAGAN ORDINANCES SIGNATURE WHEN METER ISS D PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. LJBL 02 SUBD . 0014.Aaritel 4.14:0,0- as CITY OF EAGAN PLUMBING PERMIT (612) 681-4675 RESIDENTIAL CITY USE ONLY RECEIPT # /D (c570 DATE �/�3/ — PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION NEW CONST ADD ON REPAIR OWNER NAME: 111 / J(' Oirn el SITE ADDRESS : 4i/6 /2 (.f Oti-i't. f v1 5/ (71 4/j11' INSTALLER : )1 �P/uyihjP / J ADDRESS: 6 LI (1 L'I((1J 6 4 %7/Le CITY: 5 I 1 )U'.i L ZIP: i'1 - (76 CJ PHONE # : ) b -4 64) SIGNATURE OF PERMITTEE NO. L COMPLETE THE FOLLOWING FIXTURES EA. T0AL REPAIR/ADD ON 15.00 SHOWER 3.00 WATER CLOSET 3.00 BATH TUB 3.00 LAVATORY 3.00 KITCHEN SINK 3.00 LAUNDRY TRAY 3.00 HOT TUB/SPA 3.00 WATER HEATER 3.00 FLOOR DRAIN 3.00 GAS PIPING OUT. (MINIMUM - 1) 3.00 ROUGH OPENINGS 1.50 OTHER WATER SOFTENER 5.00 PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 W. TURNAROUND 15.00 STATE SURCHARGE TOTAL: .50 /5.50 COMMERCIAL PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS. ALSO FOR MULTI -FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. WORK DESCRIPTION: OWNER NAME: SITE ADDRESS: TENANT NAME: SUITE #: INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: CITY OF EAGAN CONTRACT PRICE; 1% OF CONTRACT FEE. STATE SURCHARGE - $.50 FOR EACH $1,000 OF PERMIT FEE. $25.00 MINIMUM FEE. CONTRACT PRICE x 1% $ STATE SURCHARGE TOTAL: (SIGNATURE) NGLE FAMILY DWELLINGS SETS OF PLANS REGISTERED SITE SURVEYS SET OF ENERGY CALCULATIONS 1991 BUILDING PERMIT APPLI CITY OF EAGAN MULTIPLE DWELLINGS 2 SETS OF PLANS REGISTERED SITE SURVE (CHECK WITH BLDG. DEP 1 SET OF ENERGY # OF RENTAL UNIT # OF FOR SALE UN NALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BU OF MONTH IN WHICH REQUEST IS MADE LOT CHANGE IS REQUESTED ONCE PERM 1TE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MU DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DA PERMIT MUST SHOW A LICENSED PLUMBER. Be Used For: to Address c /1/4,7 auoirysiclF )r. Valuation: Block L. .rcel/SubeO tN'TRY 1.40tA 2 4i Ener /1(GPf' .f. V ' '( ip.q. k((67 dress %iJA7\i `ty/Zip Code . T 7Z3 �7‘ -07 r6 >?-7 G f�32 one ntractor dress ty/Zip Code one ch./Engr. dress ty/Zip Code one (Signa/re of actor) Occupancy Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F._ On site sewage_ On site well MWCC System City water PRV Booster Pump APPROVALS Planner Council Bldg. Off. Variance agrees that all wl applicable State of Minnesota Statutes and City of Ea, 19101c1IVATR FOR DECK -PLAN REVI M!CliARL- DEMPSEY'8688-4329(DAYS) trrtUiraIr of (!rrupaurq (Eitp of Cagan Erp rtittritt li# Btuitittg 3tnS.prrtiint This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the tune of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. Use Classification Occupancy Typc Owner of Building Building Address SF IMG/GAR R3/MI Zoning District RI Tyac«ar . MILLER c TSL?JY LON AE ddrar 18133 UAR AVE. S., FARMINGItts 4167 (WIR.YSILE DRIVE L c iv L5, B.2 , UNT_RY IntAW 2ND Bldg. Permit No. 18801 VN Balding Oficial Data: 6/14/91 POST IN A CONSPICUOUS PLACE CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT To be used for SF DW`/GAR Est. Value $141,000 Receipt # N® 18801 Date MAR 20 , 19 91 Site Address 4167 COUNTRYSIDE DR Lot 5 Block 2 Sec/Sub COUNTRY HOLLOW Parcel No 2ND cc w z 0 0 Name JOSEPH M MILLER CONSTRUCTION Address 18133 CEDAR AVE S City FARMINGTON Phone 431-2001 Q 0 z oQ UQ Name Address City Phone SAME UwE ww UU ¢z aw Name Address City Phone I hereby acknowlege that I information is correct and Minnesota Statutes and C Signature of Permitee have read this application and state that the ree to comply - II applicable State of f Eagap OrdinAnc A Building Permit is issued to• on the express condition that all wor shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official !1o4'11.Q,((LI EPH M MILLER CONST JO OFFICE USE ONLY Occupancy R-3 M-1 Zoning R-1 (Actual) Const V—N (Allowable) V—N # of Stories Length Depth S.F. Total S.F. Footprints On Site Sewage On Site Well MWCC System X City Water PRV Required Booster Pump 66' 26' APPROVALS Planner Council Bldg. Off. Variance X FEES Bldg. Permit 783.00 Surcharge Plan Review 509.00 SAC, City SAC,MCWCC 650.00 Water Conn 660.OQ Water Meter 90.00 Acct. Deposit 30.00 S/W Permit 30.00 S/W Surcharge . 50 Treatment PI 276.00 Road unit 370.00 Park Ded. Copies TOTAL 3,569..00 70.50 100.00 • 2-I X 2Ll 5'46 )4/ s- 86 yo �Sm-r . 2404,-41..= ! O'fl . X 14 is/2-6t3 I sT I/)<33 5 04 1_- 21.4t) 1=Lovir.► OSL1 014- ) (II Coo— Address: oo-" Address: 4167 COUNTRYSIDE DRIVE Lot 5 Blk 2 Sec/Sub COUNTRY HOLLOW 2ND ergs These items were/were not complete at the time of the final inspection. Date: 6/14/91 Yes No ". Tnspartnr: A' r 066 Final grade (6" from siding) Permanent steps - garage Permanent steps - main entry V Permanent driveway `,/ Permanent gas Sod/seeded grass V Trail/curb damage 1,-./1.6A-A--t-- -v_, Porch Porch ism Basement finish i. Deck GZ Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freezeotential exists. �1 P E RECYCLED PAPER White - City copy Yellow - Resident copy Pink - Contractor copy SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS 1991 BUILD N P I APPLICATION CITY OF EAGAN MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS - & STRUCTURAL PLANS (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. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - 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:,/%'LQ,d ZjL Valuation: Site Address 4 6 7� U riii L iii Lot 5 Block Parcel/Sub 6-1-L; Ale td- 2 - Owner Owner Address City/Zip Code Phone Contractor Address/ )11 1/47/1./214 /3.3Ci'i- ao, City/Zip Code Phone / 2_ ) Arch./Engr. Address City/Zip Code Phone # (Signature of Contractor) Date: 3 4 q1 / 1; 000 Occupancy 1Z-3 M'( OFFICE USE ONLY Zoning R-1 Actual Const V -N Allowable V -N # of stories Length C4 / Depth .2(, S.F. Total Footprint S.F. On site sewage On site well MWCC System City water PRV Booster Pump APPROVALS Planner Council Bldg. Off Variance FEES Bldg. Permit Surcharge Plan Review SAC, City SAC, MWCC Water Conn. Water Meter 793.00 170, SD /00 010 6,1) Acct. Deposit 30,00 S/w Permit 30,0J S/W Surcharge ,SV Treatment P1. 2.76„,00 3r)0+(,>® _ Road Unit v/ Park Ded. ie'' Trail Ded. Copies SUBTOTAL Penalty Lot Change TOTAL '1,211,q.00 agrees that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. - Permit No. Perm' Holder Date Telephone # WATER PLUMBING .,:;; H.V.A.C. ELECTRIC /82//'- �/ ck i. �! / p � //3 id--?2S- 92ov / dQ ,/9ot_ ,. , 5// 5232-(o ?Q -igo-, it 8 6 �jl IrrIO 6•[//t i '// �� `�j4�� p0 o� //O _ II`. , i„ 4.4,4 02/9, `¢%L Inspection Date Insp. Comments Footings 1 �p2IGY/ /-I9 Foundation Framing cQt V-2&' Y/ b s Q --5 7 /%1)kL , Roofing Rough Plbg. Y o7 -q+/ 44 Rough Htg. As/'7/ few,/ Fireplace //1.i1 ?/ s-", reit- Final Htg. /ci4(A/j Final Plbg. C� / - / f �a ^ 7' /f --7,o hi— Const. Const. Meter J Plbg. Inspector ify Plumber Engr.iPlan Bldg. Final G/lylQ/ 14.1 Deck Ftg.��41//1 Deck Final 74.3/4e al, / �,/Z O C4A / ef2 '/p oGO I Well / Pr. Disp. BUILDING PERMIT To be used for SI d =�� EAGAN 30 Pilot Knob Road, P O. Box 21-199, Eagan, MN 55121 PHONE:454-8100 rt - Receipt # Est. Value dr1,t Iti Date 20 y9 1 Site Aclress67 �it I Lot Block Sec/Sub. Parcel No. w z o' Name Address City Phone Name Address City Phone W a. Neale Address City Phone I, hereby acknowlege that I have read this application and state that the information is correct and agree to comply witli .all applicable State of Minnesota Statutes and City if Eagan Ordinance 1 Signature of Permitee f '4 't, a± JOSEPH 11 WILLSR CONST A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official Occupancy Zoning (Actual) Const (Allowable) # of Stories Length Depth S.F. Total S.F. Footprints On Site Sewage On Site Well MWCC System City Water PRV Required Booster Pump APPROVALS Planner Council Bldg. Off. Variance OFFICE USE ONLY 1 FEES Bldg. Permit Surcharge Plan Review SAC, City SAC, MCWCC 70.30 Water Conn Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL IPr. Disp. W p IBldg. Final _ Const. Meter Final Plbg. Final Htg. Fireplace 1 Rough Htg._ Rough Plbg. I Framing 1 Foundation Footings I O 0 I CO Z m n jj1 c) Permit No. kh N -1k, r-4- -,. c'w FT - ` / 1 \ Permit Holder `l NO Q Plbg. Inspector Plumber 1 1 Nik > V Plb • Comments e '\4'h e y\,�,*�\L N't- (4 \ O Telephone # Parcel Files Cover Sheet Unique ID: 4020 4167 Countryside Dr 101827605002 City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675-5675 www.ci.eagan.mn.us PERMIT City of En Permit Type: Permit Number: Date Issued: Permit Category: Building EA076441 01/17/2007 ePermit Site Address: 4167 Countryside Dr Lot: 5 Block: 2 Addition: Country Hollow 2nd PID:10-18276-050-02 Use: Description: Sub Type: e-Windows/Doors Work Type: Windows/Doors-New/Replacement Description: House Census Code: 434 - Zoning: Square Feet: 0 Construction Type: Occupancy: Comments: If altering the opening size, a framing inspection is required. Smoke detec tors are required in all sleeping rooms prior to final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required Bat tery operated types are acceptable if the wall/ceiling finish (i.e. sheetroc k) has to be removed to install a smoke detector. Steve Holum 974 Arca de St. St. Paul, MN 55106 651-793-6110 bconstrl@aol.com Fee Summary: Valuation: 3,000.00 BL - Base Fee $3K Surcharge - Based on Valuation $3K $88.50 0801.4085 $1.50 9001.2195 Total: $90.00 Contractor: Benshoof Construction 974 Arcade St St Paul MN 55106 (651) 793-6110 - Applicant - Owner: Michael J Dempsey 4167 Countryside Dr Eagan MN 55123 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. Applicant/Permitee: Signature Issued By: Signature City of Eagan PERMIT City of Eaan Permit Type: Building Permit Number: EA136803 Date Issued: 06/01/2016 Permit Category: ePermit Site Address: 4167 Countryside Dr Lot: 5 Block: 2 Addition: Country Hollow 2nd PID: 10-18276-02-050 Use: Description: Sub Type: Siding Work Type: Replace Description: Census Code: 434 - Zoning: Square Feet: 0 Construction Type: Occupancy: 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. Fee Summary: Valuation: 4,000.00 BL - Base Fee $4K $103.25 Surcharge - Based on Valuation $4K $2.00 0801.4085 9001.2195 Total: $105.25 Contractor: Custom Remodelers 474 Apollo Dr Lino Lakes MN 55014 (651) 784-2646 - Applicant - Owner: Dennis Tste J Haugland Ii 4167 Countryside Dr Eagan MN 55123 (651) 261-9585 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. Applicant/Permitee: Signature Issued By: Signature City of Eagan PERMIT City of Eaan Permit Type: Building Permit Number: EA143897 Date Issued: 06/30/2017 Permit Category: ePermit Site Address: 4167 Countryside Dr Lot: 5 Block: 2 Addition: Country Hollow 2nd PID: 10-18276-02-050 Use: Description: Sub Type: Reroof & Windows/Doors Construction Type: Work Type: Replace Description: Census Code: 434 - Occupancy: Zoning: Square Feet: 0 Comments: Please print pictures of ice and water protection and leave on site. Windows/Doors: If altering the opening size, a framing inspection is required. Fee Summary: Valuation: 8,000.00 BL - Base Fee $8K $162.25 Surcharge - Based on Valuation $8K $4.00 0801.4085 9001.2195 Total: $166.25 Contractor: Minnesota Exteriors 8600 Jefferson Hwy Osseo MN 55369 (763) 391-5514 - Applicant - Owner: Dennis Tste J Haugland Ii 4167 Countryside Dr Eagan MN 55123 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. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA166894 Date Issued:02/10/2021 Permit Category:ePermit Site Address: 4167 Countryside Dr Lot:5 Block: 2 Addition: Country Hollow 2nd PID:10-18276-02-050 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Residential Additions, Alterations 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: 1,500.00 Fee Summary:BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 $63.25 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 - Dennis J Ii Tste Haugland 4167 Countryside Dr Eagan MN 55123 (651) 261-9585 Gladstone's Window & Door Store 2475 Maplewood Drive Suite 110 Maplewood MN 55109-0000 (651) 774-8455 Applicant/Permitee: Signature Issued By: Signature