4497 Clover Lane BCity 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:
Mechanical
EA079862
09/18/2007
ePermit
Site Address: 4497 Clover Lane B
Lot: 28 Block: 01 Addition: Eden
PID:10-22750-280-01
Use:
Description:
Sub Type: e - Fumace & Air Conditioner
Work Type: Replacement
Description: Fumace & Air Conditioner
Comments: Questions regarding electrical perm
952-445-2840.
equirements should be directed to Mark Anderson, State Electrical Inspector,
Fee Summary:
ME - Permit Fee (Replacements)
Surcharge -Fixed
$50.00 0801.4088
$0.50 9001.2195
Total:
$50.50
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881-7739
- Applicant -
Owner:
Doreen Y Collatt
4497 Clover Lane Unit B
Eagan MN 55122
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
Applicant/Permitee: Signature
Issued By: Signature
As,
4/I. City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
�
�7- �-( 2,
41
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #: /J
RESIDENT /,
OWNER "
Name: Phone:
Address / City / Zip: 14 LI Q 7 e �,, Le0"--0,f L a/kt --<.,
Applicant is: Owner Contractor
TYPE OF WORK
/ f�
t D k / / ie L{ ig-ea.4,-,
Description of work: lit i
Construction Cost: 47 Yod Multi -Family Building: (Yes / No )
CONTRACTOR
Company: OG//S by j -e _- Contact: e'/611-1
Address: R� 67-eite1- L-- ``i-L"'�---- City: -t. •.%`-✓
State: 44 ��1i'( Zip: s' 57 2- Phone: .j2 - 2 - / U 7 z_
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
/94.. '
, `Li- l ,Lem 7 tic(
In the last 12 months,
_Yes If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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.gopherstateonecall.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 permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
Ap icant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
/GS-7S7I
SUB TYPES
Foundation
Single Family
Multi
01 of _ Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%)
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In Air Test Final
Insulation
Sheathing
Sheetrock
Reviewed By:
M L
Siding
Reroof
Windows
Egress Window
q7- 3 C(Qse✓ L .
Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building — give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
yFinal / No C.O. Required
HVAC Gas Service Test Gas Line Air Test
Other:
Pool: _Footings _Air/Gas Tests
Siding: Stucco Lath _Stone Lath _
Windows
Retaining Wall: Footings Backfill
Radon Control
Erosion Control
, Building Inspector
Final
Brick
Final
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
CITY OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.:
Eagan, MN 55122 DATE:
Zohing:
— No. of Units:
Owner:
Address: _ — Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordina Misc. Charges: _
Total:
By Date Paid:
Date of Insp.: � --/(� Ins
p.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges: _
Date of Insp.: Total:
Insp.: Date Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:25 #582 P.002/079
Use BLUE or BLACK Ink
For Office Use
j Permit M , t
City of Eap I Permit Fee: 79 11°9/
3830 Pilot Knob Road
Eagan I I
Eagan MN 55122 ~ Date Received: ~ j
I I
Phone: (651) 675-5675
Fax: (651) 675-5694 i Staff: 06 1
- - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: q-5- 2013 Site Address: S Lm 5 y 1 unit
Name: CdtVl ftr7 C'0 • ~Vi( = Wm h~ Phone:
Resident/
Owner Address/City/zip: V439flitu We&t payk-W U , Edetl%Mitie , MN %-Nq
Applicant is: Owner -)LContractor
i Type Description of work--Tear off and re- roi~
of Work
Construction Cost: S OIS. OD Multi-Family Building: (Yes JC /No Company: A119INY [QnCJMCtDn W .rilLContact: JQC tact tfmd
Contractor Address: 5145 Indl TiAl S1 etf # 103T City: MCIDiL Nam
State: MN zip: 653,59 Phone: 952-941-74S79
a License BC10315'15 Lead Certificate NRT- 20910"4_0
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:aooherstateonecall.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. !
xJoe N-Qilsfegd x fly- ~
Applicant's Printed Name Applicant's Signature
Page 1 of 3
-------------i
i For Office Use
I Building Permit #:
i� i 0 I I
�0 �i I S&W Permit #:
EAGAN I Permit Fee:
Date Received: I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 1
(651) 675-5675 1 FAX: (651) 675-5694 I
I Date Issued: I
buildinginspections(a)cityofeagan.com 1---------------------,
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: W 7 /o4g2L2
Site Address: Unit #:
Applicant is: ❑ Owner aContractor
I 71Name:)_�
e d k_ A!9C S e, C" a-41 Cy
Homeowner
Address: �� pC e q `�1� q 5 City: �aQ O_`�
State:% Wip: 1>, Phone: Aoki-e' Email:
Q
Description of work: ►" 2 t:
Type of
Construction Cost
Work
Type of building: ❑ Single Family ❑ Townhome, of units Twin Home
-Ths ��L/L (fO,—�-ef
Compan r�A_�_,�-`p�/� Contact:
Building
Address: z-/3�� ( . i � j V-\A/ City:F-6ZF A
Contractor
State:% &4: �U `7/�/Phone6tZ-J,/
/ / b 62(0 2 ��
�!Q(�
License #: �� J Expiration Date:
Sewer &
Company: Contact:
Water
Contractor
Address: City:
Required for
State: Zip: Phone: Email:
new construction
rLicense #: - Expiration Date:-
! I 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. Z�
Applicant's Printed Name A licant's Signature