4476 Clover Lane BCity of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4476 Clover Lane B
Lot: 7 Block: 2 Addition: Eden
PID:10- 22750- 070 -02
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:
Haley Comfort Systems
122 West 3rd St
Hastings MN 55033
(651) 437 -0338
Jeff Sammon
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Owner:
Ann Eliz Ly
4476 Clover Lane B
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
equirements should be directed to Mark Anderson, State Electrical Inspector,
$50.00 0801.4088
$0.50 9001.2195
$50.50
Issued By: Signature
Mechanical
EA078398
06/20/2007
ePermit
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
' CITY OF EAGAN r i`? c?. 1?
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT Re«ia #
Te w wad fe. 7
51te Address '
Lot Block Sec/S
Parcei No.
? Name
? Addre
City _
Name
4 Addre
Citv
Name
Erect U Occupancy
Remodel ? Zoninq
Repair ? Type of Const.
Addition ? No. Stwies
Move ? Length '
Demolish ? Depth .
Int Impr. ? Sq. Ft.
wpprwraw req
/lssessment Pertnit
Phone Woter S Sew. Surcharge -?' o?
Police Plan Review 50 i
Fin SAC ? -10
Enp. Water Conn. ?
Phone Plonner Water Meter
Council Road Unit ? 9 Q'
edpe thot I have reod this opplication ond stafe that gldg. Off. Tr. PI. o C)
is correcT ond ogree to tomply with oll opplicoble
,.,, c.......e. ....a r:... ,.s E
h? Sipnoturo of Permittes
A Bulldin9 Pe?nit is {ssued to:
Buildinp Offidol monces.
oll work shali be done in occordance
a9on Ord APC Parks
Var. pate Copies
" - - rotal
I?
- on the exprcss conditlon thot
oll epplicoble Stote of Minnesota Statutes ond Cify of Euqon Ordinances.
. . - - --- -- 7
PormR No. Pormit Holdw Dace Tslephona #
PlumWrq ?- ?
H.VA.C. J
Ebctrle j ??-
Soherw
Iropsetion Dete Insp. Othar
Footlnys I Li
Footings 11
Foundatlon &I?W
Frsming ? Cvrj
Rooling
Rouyh Plby.
Rough Htp.
Inaul.
Flnplece
Finel Htg. -3G -lk
rinei Pleg. -3y-?? ? JiM
SSRS•?
Finsl
COVOCC. %,-'44 Lf/
Water Dfteribe Location:
Well
Sewsr
Pr. Disp.
CITY OF EAGAN
Addicion E Pn
Owner
Lot 7 elk 2 Parcel #10 22750 070 02
street 44766Clover Lane State Eagan NIN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1982 504.7? 100.94 5
STREET RESTOR.
GRADING QqD 9a 2 4
SAN SEW TRUNK
# SEWER LATERAL 1896.46 179.29 5
WATERMAIN
* WATER LATERAL 1982
WATER AREA I
* SP.!'V C 8 1982
STORM 5EW TRK 1982 2 6. o0 1.20
i STORM SEW LAT 1982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER ONN.
BUILDING PER.
SAC • O
PARK
(TOWNHOUSE)
CITY OF EAGAN N° 11218
° '§$30 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
BUILDING PERMIT PHONE: 4548100 Receipt jk s ?)- 7 ?-
Te ba and fer 1 OF 4 PLEX Est. Volue $60,000 pote NOVEMBER 7 1985
SiteAddrau 4476B CLOVER LN
Lot 7 BIock 2 sec/Sub. EDEN ADDITIO
Parcel No.
EreCt 6J Occupancy nJ
Remodel ? 2oning PD
Repair ? Type of Conrt. V
Additlon ? No.Stories
Move ? Lengtn 44
Demolish ? Dep[h 24
Int Impr. ? Sq. Ft.
Instell ?
Approvals Faes
W I Name GOOD VALUE HOMES INC
? Address 1460 93RD LN NE
City BLAINE phone 780-5510
,? Name SAME
Address Assessment Permit $ 313.00
? City Phone Wa1er $$ew. Surcharge 30.00
Polica PlenReview 156.50
Fw Neme Flre SAC 525.00
?,-? Address Enp. WaterConn. 500•00
?w City Phone Plonner WeterMeter 63.00
Countll Road Unit 280.00
1 here6y acknowledge tFwf I have reod fhis aODlicotion and state tFwf Bldg. Off. 11 4$rJ Tr. PI. 132.00
the inlormation is wrrect and agree to wmply wrth oll opplicable
Stats of Minnewta Statute n
d Ciry of Eogan Or inonces. AP?
Parks
0 Vaa Date Copies
Siqnafure of Pertnittes 1, 9 9. 50
h Building Dermi lss to: GOOD VALUE AOMES INC on tha ea?
xprcss condieion Ihat
oll work sholl in eccordonee with oll
opDlicqble Stofe o newfu Statutes and City of Eoqon Ordirwnces.
BuildirqOificial ?O.
! X?L c--i
? .:
• 3830 Pili
dU1LDfNG PERMIT
To M rwd ier
Site A ddreas
Lot Block Sec/Sut
Parcel No.
W Name
; Address '
b Cky Phone
z? Name
?? Addreu
1- City Phone
tat
W
Name
i? Addresa
1 her+eby atknowledga thot I hove read
the inlormotion is correct ond ogree
Stats of Minnesoto Statutes and Ciry
Sipnofure of Permittes
N Building Pe?mit is iuusd to:
all work shall be done in occordonce w
Bufldinq Officiol
CITY OF EAGAN
Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
Li7
U
$60,000 Dote
Erect ?
j ; Remodel ?
Repe{r ?
AddRion ?
Move ?
Demolish ?
Int Impr. ?
Occupancy
Zoning
Type of Conat.
No. Stories
Length
Depth
Sq. Ft.
/lssessment Pertnit - ?'i Q ;
Woter & Sew. Surcharge )0
?
, Police Plan Review " 0
Firo SAC ' ri I
Enp. J
Water Conn. ' o
Plonner Water Meter 4
Council Roed Unit
plication ond state tfiot Bldg. Off. Tr. PL
ply with all applicable
on Ordinances. '4PC ParkB
Var. Date Copies
Total `
on t he exprcss conditlon thoi {
appliwble Stote of Minnesoto Statutes ond City of Eapon Ordinonces. ?
i" 11218
ReceiPt #
Pwmk No. Pwmit Holder Dats Tslsphone Jk
???ing a g g
H.VA.c. f I- 8 a o
ENctric
Sottarnr
Impsction Date I Other
Footlnps I 1G p 0
Footings II
Foundatlon I
Framinp C!
Roofin9
!,?-
t
ROUQh Plby. '-? LG
Rough Htg.
Insul.
Firoplace
Final Htp.
Flnal Plbg.
Flnal
c.rvocc. s;
Water Dftcribs Location:
Wall
8ewsr
Pr. Dlsp.
?s------ ! - T- IN?PECTIOl? RECORD
CITY OF EAGAN PERIUIIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(851) 681-4675
! r; SITE ADDRESS:
. , - ; i?VEit t ANI
! PERMIT SUBTYPE:
f
tit+ttti iW,
4'3`;N
L?I /NHi9t)
r'v -1 4' f " W 'f APPLICANT:
r V31 r„C9 :
TYPE OF WORK:
lil':Z;170Ti'1 f.frN
I ;?i?Vt: ; i 1M 1 (
f;s- P A ri,
ftFF'i 14[;I
li)IPJi,
?
Permit Ho{der DBte Telephone #
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUNO
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
FiEATIIVG
GAS SVC
TEST
INSUL
GYP 80ARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METEF
IRRIGATION
METER
FLUSH
MAf NS
coNOUCTivirr
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
Receipt PLUMBING PERMIT Permit No.
" CITY OF EAGAN FN
FiII in numbered spaces S/C
•' ? Type or Prin[ legibly Tot. .
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract ,
4. Owner
5. Contractor ' Phone
6. Address '
7. City State 2ip
8. Building Type: Residential ? Commercial ? Institutional El
9. Work Description: New O Add ? Alter ? Repair O
I 10. Describe
1 11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
l.avatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
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
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN WATER SERVICE PERMtT
3830 Pilot Knob Rosd
P, O: Box 21198 PERMIT NO.: _
Eagen, MN 551.1 ? DNTE:
? ?' . p
Zanirg: _
,U=, •olU2 No. of Untts:
OwrNr:
Mdnra: ,1µ, ; aver a,?. .., . ._ ,.iLen .tic: ,n.
Slh Mdnss: , .
Plunber.
? p;!
11Aet?r No.: 3 4 ction Charqe: ,
?..,.
Siu: ' ` R Oeposlt: ? : ; . , , i
Itpder No.: a In '?'0 "itlt4eS
?s---?-;T-.-,?----
?rJiw?woM. ? ? ! p•.: r1eter
_ncni iiRrcD
CITY OF EAGAN
3830 Pilot Knob Road
P. A. Box 2ry 199
Eagan, MN 55121
?fo
Zoninp: ,,.....i ?r. ee oe.vh wMb ir. Ckr of lag..
DATE: No. of Units: CITY OF EAGAN WATER SERVICE PERMR
SEWER SERVKE PERMIT
pERMIT NO.: ,
3830 Piloi Knab Rwd `
P. O. Box Z1199 ' PERMIT NO.:
Eagan, MN 551? D/?TE:
Zonirp;. No. of Untts: _
?Mr: O 8 ue
Addr+ess:
, over
ne . n.
Sih Address: Nz e n ..; m.,
nlor
P1
.
u
.
?
fon CFw?ps:
AAe/sr No.
?
- •
y
. .
i S
' •
` pr?IiCS-powt:
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=
i
RN ?
`?fltjC. -~ x+
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I
, mmply 'W .? fle
u
t?
! °`a""'°"'
EQUIR ED B`T",c?"?°`. I32.00pd TY
R 63.oopa met
g Doto Poid:
Dote of Insp.:
? Insp.:
ft - PI1 wbb !M CRY of aMn
By
Dote of Insp.:
Insp.:
2m
30 Pilot Knob Rosd
0. Box 21199
yan, MN 55721
/ccouM Deposit:
Pennit fw:
Surdhorps: .-
Misc. CF+orpes:
Totol: _
DoM Poid: -
Surcharps:
By Misc. Choros:
Oote of Insp.: Total:
Irop.: Doft Po1d:
Thre requesl void
18 imnths from
o 096154 L?
Rr.que+t DzW
?? Fre. No. PouP 1?? '??sper,tinn
fie? retl?
Vps E] NO ?
Heatly Nuw Will No?ify Inspec-
lor When ReadY
LJ ucensea tlrctncal ConVactor I I hereby requxsl inspection ot above
? Owner electncal work mstalled at
Street Addr sx, Bon or Roule o. .
L CnY ?p
2
ec Name or No. Range No. County
?-
Or,cupant IP I Phone No.
Fnwer SuppLEr Addre55
Elec
b
iy
I Contractor ICOmpeny Na Con[racmr's
L
icense No.
/
/
,
X' -
7
? / O C
Mailung AdJiess (Convar,tor or Owncr Makmg Instailabonl -
pA) OF/allx_-'
!+uthor¢ed 9A re IContracrodOwner Makmd IntitailaLOnl Phune Number
MIryNESOTA ST{(y( 90ANO OF ELECTRICITY
Griggs-Midwey Bldg. - Raom N-791
1821 University Ave., St. P.W. MN 56104
Phane (812) 297-2111 .
THIS INSPECTION pEpUEST WILL NOT
BE ACCEPTEO 9Y THE STATE BOAHD
UNLESS PROPEH INSPECTION FEE IS
ENCLOSEO
REQUEST FOR ELECTRICAL INSPECTION % ee-oonoi-oa
' Sea mstmctiuns for complebng chis lorm on back of '?
n= (? /1 p? A? p val low coov.
U j j 1 1 I Y ?-X'* Se/ow Work Coveredbv Thi.c RP.,??r.<? iN 1, I t-
j j
Atl ilAmg Appliancea WveO Eqwpmenl I Wi dredl o
H
e
Range
Teinporary Service
), Water Heater Liqhtiny Fixtures
K
m? Dryer
El
ecin
t:
H
ea
m
l Bldg. Fumace Sflo
Unl
o
ad
E:r
ldq. Air Condrtioner Bulk Milk Tank
mrr oe(.i rv
?iy pum,
O?hcr
'Jq lUUt B lnS nacfinn Foa gF# Eiji e tt Fee Fxnders/Suhfaedera N Fee Grcwts
0 to 30 Am s 0
tn 30 Am>s
?y 31 to 700 Antps 31 to 100 pm
Above 100_qm s Amps
Above
100
Irrigavon Booms _
.
Partial-'Other
R¢poarks SUeaal Inspection
rO
TOTAL
R
•
? ? FEE/
1 f"L ?
ough-in DM,e ?
I
thy Elxcvicei?
? iIy/ ,
Inspecbr, hereby
Fnal ce
td
h
? p ?
-
?1eq' ? r
y t
at ihe abova
oris0ecfmn has been
mada. .
City of Eap
3830 Pllot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax:(651)675-5694
------------------
? ?o?_om? u5a I
j Pertntt5V`7??
? Pertnit Fee:
I
? Date Received: ? j
I Statf: I
i
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: '`6 Z 1 5ite Address: ?/4 ?? 4 ql 7 6 C bjPf L lJ
Tenent:
5uke 8:
RESIDENT / OWNER Name: ? t43.. jbk*\f 01@?fS 0 .Cv??4hone:
Address / City / Zip:
Applicant is: _ Owner ? Contractor
TYPE OF WORK Description of work: KE r?a T"
Construction Cast:L?f700 ? Multi-Family Building: (Yes ?/ No ?
CONTRACTOR Name: _? )_kboIS 40mP Tani/,2FJpin License#: 2046113'7
Address:11b4 C•y(/ 11r, 5+. Lo.
City: i af I-N,?? State: MN Zip: aS02v
8D,4,1 ??b6Q?3
P
?W-34/23
erson:
Contact
Phone:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv t Minnesota Rules 7672
Energy Code . Residential Vendlation Categwy 1 Worksheet • New Enargy Code Worksheet
Category Submitted Submitted
(4 sllbmission typ9) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan Issued a pertnlt for a similar plan based an a master plan?
Yes _NO If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanlcal Condactor: Phorre:
Sewer 6 Water Contractor: Phone:
NOTE: Plans and supporting documents that you submR are consldered to be yub!!c informaNon. Portions of
the lntormatloo may be classl/led as non-pu61(c N you provlde specltlc reasons thaf woWd permit the CRy to
conclude that the are frade secrets.
I hereby acknowledge Ihat this information is compiete and accurete; that the work vriil be in wnformance with the ordinances and codes of the Ciry o(
Eagan; that I understand ihis is not a permit, but only an application for a permit, and work is not to start without a pertnR; that Ue work mll be in
accordance with the approved plan in the case of work xfiich requires a review and approval of plans.
z KOr??''1T x . ?
Applicant's PriMed Name AppllcanPs Signature
Page 1 of 3
2/84
CITY OF EAGAN
APPLICATION FOR PERMIT
SE:•lER AND/OR WATER CONNECTIODi
(PLEASE PRiHi)
1) P??OP='?t?'?' ACDP.?.SS: g ? ?
(IocBlock/Su:aivisicn or Tax ?arcel I.D. Nur.er)
I i DaT':; 0° C2IGuAL ?.?.'1i ?SJI.l+.Cr:
..':::1.N:/!:.'?oPO-= LS: ? R-1 Si:GL'-. :?%+SLY
? R-2 DU?= ('?':'J II.?I.S7
. ? R-3 'IC7.t1?Hnr„*cg (mcro, + nIITS) ( W. ITS)
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2) A =Wi=_iP (PLEaSE PR1fiiJ
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sT.= , zIP: ?c n w, r? ? ra Z???N ?d 73
Ph=:
j) F7;`: (PLEAst Pflltii) FOR CSTY (1SE OYLY
PLUH9F S-CIC:YSEc
Active
CIi?, ST?. ?-, ZI°; Q Esp' ed
Pl-.C%Z= M??r.
PLUYBER LICEVSE # ?/,4l?? /y/C? af
Recard
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g) cX'Z,?PS?/C(•.?:E2 r?cns? rnin??
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ACCRESS: Lo /3?f(E /vCS
cri^r, sr;::::, zIP: ? f Rl NE J? Jv S"SF3 5%
5) IIdDIC:.Tr. ::'[-IICH PEF:•IIT IS SEP:G RFQLiESTLp:
IZI CC..'.IEC:IC:1 ZO CITY SEYER
?[. CC:::,=IGN 'IC) CZTY hTATER
? al-L'.M (PL.ZA-CE D..SC.'RZBE)
6)
• ? PI.: `SE f?OID APPP,OVID PER.mIT Farcle ?-L?i BY C:IE OF AFiCV?
? °T-EiSc :•T'r12L APP?20VE? PFF:•1IT 3, 4 ABOVE
one) '
DATE• !
ll4lo
OR?l c1?lY feJS ? Y? R??a?c:?.? a t P+t rs aFr a+.? _ s I?s i?a :a a?e ra ?tl?ff r-ss? fw f? t?s:?a
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C 2 T Y U S E O N L Y
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LYATCR DER:1TT ?• ? \
(T?..C?;;L..:. SU..C::F,RGL/
hA'=SR i`1ETER/COPFE:?OrZ;;/CUTS=0? RE;,DER
WA:ER TAP (ZNC:.UL`-^. CORPORnT?0N STOP)
S=:IER Ta?
AC.^_Ou?:T D=:POSIT - i•i;i^'?i
WAC
SAC
TBC?iR WAT°R AS2ES...._...
TRi:.i{ SE:]cR
i?....?.,.. :..? ' ?
LAiE:.=.L BLNLC:T/="';K C-'.:-?
LA':?RAL BE\EFIT/'?':;v::K '=?-_?
?JATER TREAT?fENT PIaL`:T SCRCF?aRGE
OTHER:
TC i =.L
A??cU?:T DalD;•R??z:- _ n LS2.t?'S
DCES UTI:,Z:Y CD;7:IEC;ZON REQUZP.E EXCAVATION I,7 PUE:,IC RIGHT OF WAY?
L Y: S IF YES. THE:: H"PER:IIT FOR :•70:.K SQIT??I:I
PUBLIC ROAD:vAY" ,1UST BE ISSGEZ BY TEE
O NO ET7GI:IEERZNG DIVISZON. LZST i,S A CONDI-
TION.
SCBjECT TO THE FOLLOWINIG CONDITIC^:5:
APPROVED SY:
TI':LE: ? .
DAT°_:
? MeW M Wi+w40 VcW Ol?w?.?
• ? '\ , ?
?
1985 BUILDING PERHIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTR6C?ORS MUST BE LICENSED YITH THE CITY OF EAGAN
C0141ERCZAL
SINGLE FAMILY DiiEL[.INGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS'
$2,000 LANDSCAPE BOND
I vF 4 ?oDpctJ
To Be Used For: N '' Valuation: Afm=
Site Address a?z(?6??
Lot _2 Block
Parcel/Sub ;Lsa++V
Owner >2!4 ?4'L,e
Address lW?r, -r'-?'1?L,j F-
City/Zip Code l2/A.iv x ?+t n> STr?3 54
Phone W-0 sr/o
Contractor
Addres
City/Z
Phone
Arch,/
Addres
City/Z
Phone
Date: ld ?D "
-r
OFFICE USE ONLY
Erect Occupancy V•3
Remodel Zoning
Repair _ Type of Const
Addition U of Stories
Move ? Length q
Demolish Depth 714-
Int.Impr.
? Sq Ft
Install
- - -------- - ---- -
APPROVALS FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Ffre SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Offd.4.gS? Treatment Pl
APC Parks
Variance Copies
TOTAL
C- T(q_ 10 30-?5
I
44q 6
Troy Haskins
Eden Homeowner's Association
PO Box 22195
Eagan, MN 55122
City of Eagan
Building Permits Department
March 21, 1999
To Whom It May Concern:
Ann Ly of 4476B Clover Lane has the approval of the Board of Directors of the Eden
Homeowners Association to extend her deck per the plan submitteci to us.
All decks (including steps), not on the street side of the buildinga, are allowed to be built
out a maximum of twelve feet (12') from the building. All decks (including steps) aze
allowed to be taken to the end of the building (frant of unit), but no part ix allowed to
extend beyond the brick on the front of the unit.
If you have any questions ar concerns, please feel frce to contact me. Thank you for your
help.
Sincerely,
?
Troy Haskins
Maintenance Manager
Home; 651-687-0597
VM: 651-458-7010
LOTS 5,6,7,Ati/D 81 BLUGK 21 EDEN AVDITIOV,
, DAKOTA couNrY, MlNN65oTA /Il?vi.
1?rt 79
(,Qioio). pENOT65 EXISTlN6 66E?A7110N
(Qta.o) DEA/OTE'S PROPaSED ELEVAT/oN
/ND/CATES pIRECTIOti( oF SuRiACE DRA/NA6E
NORTH
sr-ALs : r" a30'
`IT-'?•S = F/NlSHED GARf?66 FloaF ELEVAT/oN
EY •
DATE
Ull I MPS DEPT.
,
920 '-:
a;jt ?l
ZZX"12
c)r.c-w,w=n&3
.?o • v?
s??,a•P?,vT
i ?
<_(J i-
'VF
7 Ter•bvi certify that thie im s true and corract t"epreeentation of a tract? !
? ` 1999 BUILDING
3S3 ?-1
`lew Cons[ructian Requiremen4s
PERMII` APPLICATION (RESIDENTIAL)
CITY'bF EAGAN ,
3830 PII.OT KNOB RD - 55122
(651) 681-4675
RemodeVReoair Reauirements
? 3 registered site surveys
0 2 copies of plans (inGude beam & window sizes; poured tnd. design; etc.)
0 1 energy calculations
? 3 copies ot tree preservation plan ff lot platted after 7N/93
required: _ Yes _ No
DATE: 4-'9"'Iq
DESCRIPTION OF WORK
? 2 Copies of plan
? 1 ske surveys (exterior additions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST. kt 4 oO
STREETADDRESS: 406 Cl0?Pir laYIZ
LOT: I BLOCK: SUBD./P.I.D. _??rh
gLfCI i 7] dY1
T'h?c: ho P ?'c bla-7qa8
f
Name: ? ?/ Phone #:
PRC)PERT1' Laz First
OWNER
Sheet Address:?? b f'? ?I ?(er I QV--'
City C?q a Yl State: (n A! Zip: ?-
Company: Phone #:
CONTRACTOR
Street Address: License # Exp.
Ciry State: Zip:
ARCHITECT/ ,
(
5;
ENGINEER Company: ? Phone #:
Name: Registration #:
Street Address:
City State: Zip:
Sewer 8 water licensed plumber (new construction only): Penalty applies when address
change and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
?
OF'FICE USE ONLY RECEIVED
Certificates of Survey Received _ Yes _ No APR 19 1999
Tree Preservation Plan Received _ Yes _ Nol _ Not Required BY'?
OFFICE USE ONLY
3UILDING PERMIT TYPE
-1 01 Foundation ? 06 Duplex
7 02 SF Dwelling ? 07 4-plex
-1 03 SF Addition ? 08 8-plex
1 04 SF Porch ? 09 12-plex
7 05 SF Misc. ? 10 = plex
NORFf TYPE
0 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace 0
A 15 Deck
? 36 Move
? 37 Demolition
GENERAL INFORfr9A7"ION
Const. (Actual) 5•n? Basement sq. ft.
(Allowable) Main level sq. ft.
UBC Occupancy Sq. fq.
Zoning f7•0 sq.ft.
? of Stories - sq. ft.
'Length - sq. ft.
Nidth - Footprint sq. ft.
4PPhTOVALS
°lanning Building ?? ? _ _l.(,/?
- CT
?
. ; ?.
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Census Code 43?
SAC Code v 1
Census Units f
Census Bldg D
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
iNater Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
L.
% SAC
SAC Units
PE'RMIT
CITY OF EAGAN
3830,Pilot-Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
P.I.N.: LQ-22750-070-02
DESCRIPTION:
44763 CLOVER LRfdE
I.OT: 7 CtLOCK:
F.CiEN
PERMITTYPE: BujLDiNG
Permit Number: 034390
Date Issued: 01 / 0 5 J 9 9
r?. REPLACL SIDINO
BI+ildind'?ermit Type S'(ORM pAMAGE .
Puildinq WO-rk Type ftEPAIR
(t:ensus L'ode 43Q ALT. RES'LpENTIAL
_y
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i.._V".< ?A ._ `• ._,
REMARKS:
uNl'r BI.
FEE SUMMARY:
CONTRACTOR: - Hu? ? ? can 1' I I C OWNER:
(:US70M CONCEPTS CONST 18987290 20142417 l_'Y HNPJ
1.654m KENkICK LOOP/STE B 4476B CLOVER LANE
LFlKEV.[LLE MN 65044 EAGFlN MN 55122
(612) 898-7290 L hereby acknowledqe Ltiat .C have head this applic,ai.?on arid st,ite that the
+nlurmation is correct rna aqrac to complv with all appticable StaT.e nh Mn
St,atute?; and C1ty o7 F_at7an Ordineoaes.
?
APPLICANT/PERMITEE SIGNATURE
I
? ??/ z) -
? UED BY: SIGNA RE
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830P1 51) 8104?-55122 9?
! I
New Construction Reauirements
? 3 registered srte surveys
? 2 copies of plans (inGude 6eam & window sizes, poured fnd. design; etc.)
? t energy calculations
? 3 copies of hee preservation plan rf lol platted after 7!1193
required: _ Yes _ No
DATE' i- ? Jql
DESCRIPTION OF WORK:
RemodellRepair Requirements
? 2 copies of plan
? 1 site surveys (exterior addi6ons 8 decks)
? 1 energy calculations for heated adddions
CONSTRUCTION COST; ?? 7 S
STREETADDRESS: "Iy-7Lo I7 OO\/2r ?-z,c v
LOT: ? BLOCK: SUBD./PJ.D. #: Az---
vamc:_Lq !1 Vln A Pl?one #:
PROPERTY Fu"st 0'vVNl12
Strcet r\ddress:
City
St?ate:
Zip:
Coliipauy:_ C4-"'1-/VP'1 Phoue
- - ? --------
CO V'PRAC'1'OR
Street Address:??If-O_Z?24[???? _or ? ---- License #Z?L/?' L%?--Erp' -----
City --- ??------------ S[ate: --ET• ?{?------- ???' ?------
ARCHITECT/
ENGINEER Comptuly:-------------- ------------------------ Phone k: -------- - ---------
Regishntiou f#:
SLreet Address:--------- ---------------------
Cily ---------------------- ----- StaLc:,------- ------ Zip:
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to compiy with all appiicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes
Tree Preservation Plan Received _ Yes
No I
_ No _ Not Required? ? ??i ? ?
" ,, ? O,? 33 PavE 38
AOBE COHSUlTIHO EHOINEEIIS
p NGINEEt?ING PLpNNfAS and IAND 3UflVEY0115
COMPAN4, INC.
N
14 1000 EAST 146111 STREET, BURNSVILIE, MlNHESOTA 85337 PH 4432'3000
?CQ? I.D'CJC7'?p?20TC: LoTS 5,6,7AN0 8? BLUCK 21 EDE,V ADOIT/oN,
? DAKOrA CouNrY, MlNNESoTA
??to_a ) pENOTES EX15T/N6 E1EVAT10AJ
( 9La,o) pEA/OT65 PROP0560 ELEVAT/aN
- /NDICATES O/RECTIOti( oF Su2FACE ORA/NA6E
9Z3•5 = FiNiSHED GARN6E FlaoR E"[.EVATioN
NORTH
SCALe: I"= 30'
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I harsby certify that thia ie a true and corract rnpresentation of a tract of
land aa sho+m'and deecribed heraon.. Ae preparad by me on this 3eD day ot
(?'zaBF.P , 19 g5 . ' . laa. Xo.?;
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:49 #582 P.068/079
Use BLUE or BLACK Ink
For Office Use
j Permit M 1 I l j
City of Eap
Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: a 1 L3
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Dater Site Address: ~41' 4q_Hb,+'nV, Li q11190, UNeV WVlG Unit M
Name E CIO' NO, CumDOnN Phone:
Resident/
Owner. wner. ( Address / City/ Zip: ULM Utu V1 Sl ~I~~IXV r ~ irie, MN (~53fy
- T
Applicant is: Owner Contractor
Type of Work Description of work: lay Off 1-fi f
Construction Cost: IIlol loci, (N) Multi-Family Building: (Yes X / No-)
~ ontact: C lU~ ~i~~Qt~
ComPanY:c-t► ~ l~IUI~~t~+Yi On ll~l I
Address: 1 iq ~ e (h
Contractor 51 5 f~'-U~rS pI IQ~ UC city: Fw
State: Zip: PJ35 1 Phone:
License VC ,CJ15 Lead Certificate %'I7 2p9 wq --o
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
I 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
L Me information may be classified as non public if you, provide spa lp 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.gopherstateonecall.ora
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. n
Applicant's Printed Name Ap i nPs Signature
Page 1 of 3
From:ALLSTAR CONSTRUCTION 19529427464 02/10/2016 13:07 #301 P.021/022
City of £aan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6754694
Use BLUE or BLACK Ink
For Office Use
1300/3
Permit #:
Permit Fee:
Date Received:
Staff:
2016 RESIDENTIAL BUILDING PERMITllAPPLICATION n
Date:.?//d �/!o Site Address: VOW" Wi &JV87 - 4y Unit #: �l
Name: Ae.A 4164 t ifi — e-li&/`f 1 0fl
Resident/
Owner is Address / City / Zip:
Phone: ////,
J
Type of Work
Contractor
Applicant is: Owner ai Contractor
Description of work: /191-- /00 1nyiIs7P�°'t7nf/i8--(j�F.�4, ,vtCi+k�`
cJ
Construction Cost: /O,tOl/ ^ Multi -Family Building: (Yes /�/ No )
Company: All544itn giefi;71teelall cls Contact: J 1 nn A item'?
Address:Sl445 I tcs-tr;A I $?- so r -I t. /03 city: MAO- O- fi t, -;et
State: Zip: p 55359
Phone: '9 ' 6T Email: 4.7 74Gl.f/S- r..6
License #:.56 toCo 3S ® Lead Certificate #: itr. lk'% o2®91,9 V - d�
If the project is exempt from Iead certification, please explain why: 1.3u , r� /9es
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:
jSewer & Water Contractor: Phone:
Fire Suppression 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.orq
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 pemnit issued in accordance with the Minnesota State Buildin .0 plated within 180
days of permit issuance.
10411
Applicant's Printed Name
Applic nt's Signature
Page 1 of 3
%t:0®, 1 I I I
E AGA N
I� 1
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspectionsacityofeagan.com
--------------I
For Office Use ``�}, I
1 Building Permit #: 1 Le Z® 50
I I
S&W Permit #:
I
Permit Fee: I I - t V
I I
I I
Date Received: I
I I
I I
I Date Issued:
I---------------------'
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: �6q/Site Address:
Applicant is: ❑ Owner aContractor
Unit #:
Name: E- t/A �o0-Ae— d t,.l- S jags C-�, COt_4
Homeowner Address:&L j? AR Y147b 13 J 6 �,�(�I} Ae is Z city: �o Ct o- V�
Phone: Email:
Description of work: P, 2 Q C. J
Type of
Work Construction Cost 4(,q
Building
Contractor
Sewer &
Water
Contractor
Required for
new construction
Type of building: ❑ Single Family ❑ Townhome, of units Twin Home
Compan�636
Address Ll 2,P, ( . i �� W QRV
City: J�;66PY\ -Pv-GQ\-,r- l
State: Lip: 5 / T Phone>�tZ�17 Emailia/UIQ�C CSN�eo"`�Q°�`�i
License #: O Expiration Date:
Company:
Address:
State: Zip:
License #:
Phone:
Contact: _
City:
Email:
Date:
1 understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
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. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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.
Applicant's Printed Name A licant's Signature