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4158 Countryside Dr72(7I 2007 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements - 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas (20% maximum lot coverage allowed) 1 Soils Report if proposed building is to be placed on disturbed soil 2 copies of plan showing beam & window sizes; poured found design, etc. 1 set of Energy Calculations 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form Remodel/Repair Requirements 2 copies of plan showing footings, beams, joists 1 set of Energy Calculations for heated additions 1 site survey for additions & decks Addition - indicate if on-site septic system AN 17 /3Q,00 L�- SFr, Office Use Ott Cert iit$u Soils Ref'' Tree Pres Plan R Tree Pres Required On-site Septic System; Date 0 1 / 14- / 61 Construction 0 r Cost Site Address 4 1 e 60u, ,h t S i el e Unit/Ste # Description of Work I, SIN Multi -Family Bldg _ Y &A t,, -. , b or se,w.p,,•. t " 00%4,5i- .` K Ala S CO.-. )e feel Wi,te's $ N Fireplace(s) 4.uts - by, re _ 0 ( 1 _ 2 Property Owner l e. r r.n 1 ► tnn,iJy�p v` S Telephone # ((a$ I) % S - 02_ S— Contractor Address City State Zip . Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Code Category ('/submission type) - Minnesota Rules 7670 Category 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Minnesota Rules 7672 • New Energy Code Worksheet Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Y N If yes, date and address of master plan: Licensed Plumber Telephone #( Mechanical Contractor Telephone # Sewer/Water Contractor Telephone # I hereby apply for a Residential Building 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 the State of MN Statutes; 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. r r t t rA". vv.ahS Applicant'?rinted Name Applicant's Signature DO NOT WRITE BELOW THIS LINE 1(40413 Sub Types ❑ 01 Foundation 0 ❑ 02 SF Dwelling 0 ❑ 03 01 of _ plex 0 ❑ 04 02-piex 0 ❑ 05 03-piex 0 O 06 04-plex 0 Work Types O 31 New O 32 Addition ,2 33 Alteration O 34 Replacement 07 08 09 10 11 12 05-piex 06-piex 07-piex 08-piex 10-piex 12-piex O 35 O 36 O 37 Description: Water Damage Yes Valuation Plan Review /100% or _ Census Code /7, -T41/ SAC Units # of Units # of Bldgs Type of Const 3Goo t Footings (new bldg) Footings (deck) Footings (addition) Foundation Drain Tile Roof Ice & Water Framing Fireplace R.I. _ Air Test Insulation Approved By: Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total 25% 0 13 16 17 18 16-piex Fireplace Garage Deck 19 Lower Level Int Improvement Move Building Demolish Building* ❑ 20 Pool O 21 Porch (3 -sea.) O 22 Porch/Addn. (4 -sea.) ❑ ❑ 23 Porch (screen/gazebo/pergola) 0 ❑ 24 Storm Damage O 25 Miscellaneous ❑ 30 Accessory Bldg ❑ 31 Ext. Alt - Multi 33 Ext. Alt - SF 36 Multi Misc. O 38 Demolish Interior O 42 Demolish Foundation O 43 Reroof *Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy A- 3 MCES System Zoning // City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width Final Final ❑ 44 ❑ 45 ❑ 46 Siding Fire Repair Windows/Doors REQUIRED INSPECTIONS Sheetrock Final/C.O. Final/No C.O. HVAC Other Pool _ Ftgs _ Air/Gas Tests _ Final Siding Stucco Lath Stone Lath Brick Windows Retaining Wall , Building Inspector CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 ... ............ . PLUMBING PERMIT FOR CITY USE ONLY PERMIT # RECEIPT # DATE: RESIDENTIAL: PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION COMPLETE THE FOLLOWING: NO. EA. TOTAL 1 15.00 3.00 3.00 .5, 3.00 b•OO 3.00 G.'p° 3 3.00 ► . p° j 3.00 3...0 0 3.00 3- °° SITE ADDRESS : 4 I S16 C.oAn -1 8e '"'v u 3.00 ► 3.00 LOT: 1 BLOCK / SUBD.��Okc��t,(31-64e0-1.1I 3.00 DWELLINGS & NEW CONST ADD ON REPAIR OWNER NAME: -01 ej 5C -h j�t\- CI e�S FIXTURES ADD-ON MINIMUM SHOWER WATER CLOSET BATH TUB LAVATORY KITCHEN SINK LAUNDRY TRAY HOT TUB/SPA WATER HEATER FLOOR DRAIN GAS PIPING OUT. (MINIMUM - 1) 3.00 3 ROUGH OPENINGS 1.50 OTHER _ WATER SOFTENER 5.00 _ PRIVATE DISP. 15.00 U.G. SPRINKLER 3.00 INSTALLER: h`' PVA`-� ' e IS ADDRESS : I �5 C.0. -r0 0.1/4-1 CITY 7. ZIP : 5-5(:)C" HONE #: �Z3' � 3 0 SI ATURE OF PERMITTEE SUBTOTAL ST. SURCHARGE TOTAL: —676 .0° 4.5-U $ y3 . cou .50 Ley, o() $ COMMERCIAL/INDDSTRIAL 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 SUED. 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) //// 9/9/ 1 64177/I.-fai /0.3.5'6.5 /l�l d x'70 oa Request Date `1— �� /�/ / /% Fire No. New ough-in Inspection squired? ..lr�s C No ❑Ready Now ill Notify Inspector When Ready? I Icensed contractor D owner hereby request inspection of above electrical work at: Job Address Street. BoxorRoute ,/� /�T� V lam!/� ��%/� 'f �� n,/ .�6./C�C.GCIi' '/,l_ly////✓ l Range No. City County Section No. Township Name or No. Occup RINT) Phone No. Power ;:i4 _ , Address ,,,,,, ' Elects al : ractor (Company Na .e) .,%I, . / n) /3i Contractor' icense No. (V/?25-.3 Mailing Address ( retractor or Owner Making Installat' , Author ed 0.nature (Contractor/Owner Making InstallationPhone 14 / i Nu ber Re)/ MINNESOTA STATE BOARD OF ELECTRICITY Griggs -Midway Bldg. — Room S-173 1821 University Ave., St. Paul. MN 55104 Phone (612) 642-0800 09A/ REQUEST FOR ELECTRICAL INSPECTION ► See instructions for completing this forrn on back of yellow copy. X" THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. EB -00001.08 D3S66 New dXd-Ftep. Type of Building AppliancesWired Equipment Wired / Home 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 0 to 200 Amps " r 1-3 0 to 100 Amps 5T -2 -- ,Transformers Transformers Above 200 Amps / Above 100 Amps Signs Inspector's Use Only: THIS INSTALLATION MAY BE O COMPLETED WITHIN 18 M • j7 76 DERED , ,66 TOTAL 70 a Irrigation Booms Special Inspection 1 ONNECTED IF NOT Alarm/Communication Other Fee 5 I, the Electrical Inspector, certify that the above inspection been made. hereby has Rough -in t...)s Final`/ ;t47,13a Tee ^ �� OFFICE USE ONLY ` This request void 18 months from .2 1 1991 BUILDIN P CITY OF EAGAN TINGLE FAMILY DWELLINGS MULTIPLE DWELLINGS SETS OF PLANS REGISTERED SITE SURVEYS . SET OF ENERGY CALCULATIONS 2 SETS OF PLANS REGISTERED SITE SURV (CHECK WITH BLDG. DE 1 SET OF ENERG # OF RENTAL UNI # OF FOR SALE ENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, B OF MONTH IN WHICH REQUEST IS MADE LOT CHANGE IS REQUESTED ONCE PER OTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MI DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DA' PERMIT MUST SHOW A LICENSED PLUMBER. 'o Be Used For://v/l-/ .f/9/74 Valuation: dte Address '7/51' ejv 5W/t PAW) Occupancy Zoning 'arcel/Sub (!00A: 4f //o/40 c2 Actual Const _ / Allowable _ owner # of stories Length _ ddress Depth - S.F. Total _ ity/Zip Code Footprint S.F._ .ot 2:/. Block hone On site sewage_ On site well MWCC System _ /� City water ddress 9)5i/3/244:47' /14/V4, PRV / Booster Pump _ ity/Zip Code i/ l /rc.0/1�/l, % -�7v N APPROVALS _ hone 4/6/-33P/ Planner Council rch./Engr. Bldg. Off. Variance ontractor ddress ity/Zip Code one # ewer/Water Licensed Contr. / //A (Sig ature of Contractor) agrees that all F 11 applicable State of Minnesota Statutes and City of EE BUILDING PERMIT CITY OF EAGAN N0 19855 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 1 Receipt # To be used for SF DWG/GAR Est. Value $104,000 Date NOV 4 , 1991 Site Address 4158 COUNTRYSIDE DR Lot - 4 Block 1 Sec/Sud 0UNTRY HOLLOW 2ND Parcel No i 0 0 Name PIETSCH CONST Address 9543 BIRCH LN City LAKEVILLE Phone 461-3381 Cc =0 OV Ucc Name SAME Address City Phone Uw ww ImZ¢z Q W Name Address City Phone I hereby acknowlege 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 f Eagan Ordi ances Signature of Permitee A Building Permit is issued to• PIETSCH CONST on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. aq Ikli.t.I TrO 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 OFFICE USE ONLY R-3 M-1 R-1 APPROVALS Planner Council Bldg. Off. Variance V—N V—N 58' 52' x x x Qlrrtifiratr of (!rrupaxtrj QCitp of Cagan BPpartatpttt of BaitingAwn-thin FEES Bldg. Permit 654.00 Surcharge 52.00 Plan Review 425.00 SAC, City 100.00 SAC, MCWCC 650.00 Water Conn 660.00 Water Meter 95.00 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 , 342 . SO This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building Code certifying that at the time of issuance this structure was in compliance with the various ordinances of the City regulating building construction or use. For the following. Use DamiraUon SF TiOrw Bldg Permit No 19855 y'Type RM41 Zoningt rio RI Type coos* VN owner of Building :PIETSCH (INST. Address 9543 WWII TANK, TAKF:VTTTR Building Add= 4158 r UNZRYSIDE DRIVE Building Official Locality Du= L4. BI, COUNTRY IOW 2ND 1/11/92 POST IN A CONSPICUOUS PLACE EXTERIOR ENVELOPE AVERAGE "U" COMPUTA`IION OWNER: �tGv� MIANIE Aif jtm SITE ADDRESS: L. -OT ThLoc k / co Tzar CONTRACTOR: _e c'1(�-_! 2 1L&Eh _ DATE: lD DETERMINE WORKING SQUARE�FOOTAGE OF EACH: 1. TOTAL EXPOSED WALL AREA �2.90.p SO' FT. X r%j F 1 2. TOTAL ROOF/CEILING AREA (M110 i 10 SQ . FT. X (D 2 PHONE: 2t7 36 z - TOTAL EXPOSED WAIL:, AREA CALCULATIONS: Total exposed wall 2312.0 area above floor ------- Q� a) Total wall window area 229,2 SQ.FT. :t "i'" 9.__= v gra b) Total door area ;7:7 SQ.FT. X "zU" JO? = 24 c) Total sliding glass door area ""7%3 SQ. FT. X "0" _= 2 `n d) Total fireplace wall area 0 SQ.FT. X "U"= 0 e) Total wall framing area 23ZZ' SQ.FT. il9� = "Zi t5 (average 10%) f) Total net wall area above 2l0 floor (insulated) _ c .::gal rim joist area /47(< Total foundation area pI7 SQ.F'.C. (exposed) h) Total foundation window area i) Total net foundation area above grade SG.FT. '0. SQ.FT. X "Ti" 1043=e7r.a SQ.FT. X "U" - 0 SQ.FT. X '0'_..�17 l¢7 TOTAL, a) t: ro ,gh If item *3 is the same as, or less than item *1, you hive met the intent of 4, MCAR 1.16008 A and O. 2€0 PAGE 1 4. TOTAL EXPOSED ROOD CEII:,ING CALCULATIONS: 4. Total exposed roof/ ceiling area (i.oSQ_F'r. J) Total skylight area C.f Z ) n. E,T X "U --I C) k) Total roof/ceiling nq I J 11 / S "U" ,e)24;.,`;j framing area (average 10%) 1) Total net insulated /Zal SQ. FT. X "U" t OZ7i = 27i <- roof/ceiling area TOTAL j) throuat: 1 ) If total of #4 is the same as, or less than #2, yc:u have mot the intent of 2 MCAR 1.16008 A and U. 3b l c z ALTERNATE BUILDING ENVFLJPE DEEIGN To utilize the total envelope system method, the value- established by the sum of #3 and #4 shall not be greater than the sum of items #1 and #2. 1. +2. 3- +4. CERTIFICATION I hereby certify that 1 have calculated mated the "U" factors and "R" values herein and that the building here described meets or exceeds the State of Minnesota Energy Conservation Act. (signature (144r, (Date) PAGE. c E 2 v 6 Studs CONSTRUCTION WALL FRAMING SECTION: (1 Interior air film (2 ' S17eetrocTc 43 51i Inches soft wood (1, 157J2 ' ildrite htg. 5 .,id A iter or a r M WALL SECTION (INSULATED) (1 Interior (2 5 air film (3 s, Ins l'11 ten h 25(32Biillu to ShtR (5 $ cin Exterior air film 15.17 TOTAL,. R • 23.17 U • 1/R • •045 R VALUE 0.AA b. 2. TOTAL R - u.:• 1/Il AAR 4 19.00 2.06 JOIST SECTION: (1 (2 (5 - A • ;'• r Interior air film �1- Tnsulaticn lk t.bod 25/32 Bildrite ra rtir Exter or air film FOUNDATION INSULATION REQUIRED: Min. R-5 on entire wall OR Min. R-10 down to frost depth FOUNDATION SECTION: 1 interior alr ell c h Exterior air • • -•,r • • 1.1 14, 11.A•,• 4 • .: •••. `�•�, a a : • .• • •••. • (5 (F A.AR 11.$ 22.00 A.if TOTAL R • 24.6 l - •1/R • _14. film A.AR 3; Insultion 1i.0b film A.17 SLAB ON GRADE •.•• Heated Slabs: Minimum R ■ 8.5 Unheated Slabs: Minimum R = 6.2 • TOTAL R • 12.9 U• 1/11•.08 • 6 • 4 • • de 1 .4• • 4 , p •••4► •I • t• . w , • •• • • • • . . • Page 3 VENTED CtIlllin SECTION (INjvlAltitf i 1 Interior air filmn' ,6 2 5/R" Sr 3 .�].21a Insul - Oji (� Exterior air film 'still) n: TOTAL R -478 U• 1/R• .027 CEILING. FRAMING SECTION: 1 Interior alr film n,A1 2 y8 " SR. �" . .56 3 Insulation 31.r ti Interior air film (still) O.M 5 3 k " inches soft wood 4.35 TOTAL R ..,37. 11 tU - 1 /R - .026 CEILING SECTION (INSULATED): 1' lnterlor air fila, 2 6.61 3 Exterior air film (stl11) n.61 TOTAL R - CEILING, FRAMING SECTION: 1- Interior air film 2 3 U - 1/R • 4 Exterior air flim [st1I1) 5 lnchei soft wood TOTAL R - U• 1/R - 0.61 1 ,Inside alr.film A.61 2 3 li 5 butslde air film TOTAL R • U- 1/R 954870 COUNTRY HOLLOW SECOND ADDITION PRESSURE REDUCING VALVE AGREEMENT This agreement, made and entered into the C:7?/ -5 day of (-i-7 %�'it ! � , 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 terns "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 homebelow 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 EiqpIN (Date: mas A. Its: Mayor OWNER AND DEVELOPER: PROGRESS LAND COMPANY, INC. By: L-ir 9 J, ZSeREc,4..,1 Its: pe?CStyN Attest: Its: . J. VanOverbeke erk STATE OF MINNESOTA ) ss. COUNTY OF DAKOTA ) On this c/ S% day of GCT 1990, before me a Notary Public within and for said County/1 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. i • *ill rtrr°tct!tttN1tt*tt6:st • • ? ..r STATE OF MINNESOTA ) ss COUNTY OF l)A t ) Notary Public --//' On this day of 4-)L.-\ t,, Public appeared l: %!+ra— persona 1 .known, who being ch by me duly sworn, eas4 did say that the t1 L‘,fA-t of the corporation named in the , 1990, before me a Notary within and for said County, personally to me - foregoing instrument, , and that said instrument was signed -gin-- on behalf of said corpora i.on by authority of its Board of Directors and said rrr 5 , cCua't- acknowledged said instrument to be the free act and deed of the corporation. VP IP Mr S+..A -:;:.:1.; Ur WO Mr Oii Notary Pubic APPROVED AS TO FORM: //-/ II City AttoYne ,bated: APPROVED AS TO CONTENT: Public Works Department Dated: A, F //Fe 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 , o L -595'I /rte CITY OF EAGAN FOR CITY USE ONLY 3830 PILOT KNOB ROAD EAGAN, MN 55122 PERMIT # PHONE: (612) 454-8100 RECEIPT # /039yY ±I C 1A1T P +R T DATE: 4/5,// PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS & TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. WORK DESCRIPTION NEW CONST X ADD ON REPAIR OWNER NAME: PIETSCH BUILDERS SITE ADDRESS: 4158 COUNTRYSIDE, EAGAN LOT. INSTALLER: BLOCK SUBD. FREDRICKSON HEATING IR CONDITIONING ADDRESS: 3650 KENNEBEC DRIVE CITY: EAGAN ZIP: 55122 PHONE #: 452-2775 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: $ 33.00 .50 $ 33.50 SIGNATMRE OF PERMITTEE ...................................... COMM R.0 A ......................... USTRIAL; 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: FEES 1% OF CONTRACT FEE. STATE SURCHARGE = $.50 FOR SITE ADDRESS: EACH $1,000 OF PERMIT FEE. PROCESSED PIPING = $25.00 LOT: BLOCK SUBD. $25.00 MINIMUM FEE. INSTALLER: ADDRESS: CITY: ZIP: PHONE #: FOR: CITY OF EAGAN CONTRACT PRICE x 1% STATE SURCHARGE TOTAL: $ (SIGNATURE) Address: 4158 COUNTRYSIDE DRIVE Lot 4 Blk 1 Sec/Sub co Ry 'inky 2ND These items were/were not complete at the time of the final inspection. 1/13/92 Yes No ^s E Final grade (6" from siding) i/ Permanent steps - garage 47 Permanent steps - main entry AV ice'' Permanent driveway Permanent gas IX Sod/seeded grass Trail/curb damage ti/ Porch u/ Basement finish Deck Please verify with the builder the removal of roof test caps system and the shut-off of water supply to the outside lawn freeze potential exists. White - City copy Yellow - Resident copy Pink - from the plumbing faucet before rte« RECYCLED PAPER Contractor copy SITE ADDRESS TYPE OF WORK PPI.ICANT ADDRESS LEPHONE # 4 1H1 w..r. rr.••......-..wr-rc.. F......i-raa+ ...:isr irwif►j siirr F,r d�w..ria#as; A. 7670 CA ., t'. RY� overy System I hereby acknowie tit l have toad this t ppl a#O with all applicable f' nr oto Statutes and C ❑ 01 Foundation ❑ 02 SF Dwelling ❑ 03 01 of_piex ❑ 04 02-plex ❑ 05 03-piex ❑ 06 04-piex ❑-31New ❑ 32 Addition '14 33 Alteration ❑ 34 Replacement Valuation Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const ❑ 07 ❑ 08 ❑ 09 ❑ 10 ❑ 11 ❑ 12 05-piex 06-plex 07-piex 08-piex 10-piex 12-plex OFFICE USE ONLY 16-piex Fireplace Garage Deck Lower Level Pibg_Y or O 20 Pool O 21 Porch (3 -sea.) O 22 Porch/Addn. (4 -sea.) O 23 Porch (screened) O 24 Storm Damage O 25 Miscellaneous O 30 Accessory BIdg O 31 Ext. Alt Multi O 33 Ext. Alt - SF ❑ 36 Multi O 35 0 38 Demolish (Interior) 0 44 O 36 0 42 Demolish (Foundation) 0 45 • 37 0 43 Reroof _O 46 *Demolition (Entire Bldg only) - Give PCA handout to applicant 9.,c/00 u3u 0/ int Int Improvement Move Bldg. Demolish (Bldg)* Occupancy Zoning Stories Sq. Ft. Length Width REQUIRED INSPECTIONS Footings (new bldg) Footings (deck) Footings (addition) Foundation Drain Tile Roof Ice & Water Final Framing Fireplace R.I. Air Test Final Insulation -x Final/C.O. Final/No C.O. Plumbing HVAC Other Pool Ftgs _ Air/Gas Tests Fina Siding Stucco Stone Windows (new/replacement) Retaining Wall MC/ES System City Water Booster Pump PRV Fire Sprinklered Siding Fire Repair Windows/Door Approved By Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total Diettitc a vua A 7 1;c) RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 651-681-4675 New Construction Requirements • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas (20% maximum lot coverage allowed) • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 set of Energy Calculations • 3 copies of Tree Preservation Plan if lot platted after 7/1/93 • Rim Joist Detail Options selection sheet (bldgs with 3 or less units) DATE 5—Lq -- SITE SITE ADDRESS LII S S Co0,sJ-y1--Vif TYPE OF WORK .:.i Remodel/Repair Requirements • 2 copies of plan • 1 set of Energy Calculations for heated additions • 1 site survey for exterior additions & decks • Indicate if home served by septic system for additions VALUATION 5S4755.4 -e2- 3 MULTI -FAMILY BLDG _ Y _ N FIREPLACE(S) _ 0 __C:)_2 APPLICANT —Tie CITY Mks' STATEkN,. ZIP -.5--5€-/9 STREET ADDRESS (0/Y0 ii70/GAV G11 - TELEPHONE # ZT09/(7-7 CELL PHONE # 2h, Op( eefL PROPERTY OWNER I?*<< 1- /11,5 FAX ytL n.,9//-7-2 TELEPHONE # COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category ('I submission type) MINNESOTA RULES 7670 CATEGORY 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted MINNESOTA RULES 7672 • New Energy Code Worksheet Submitted Plumbing Contractor: Phone # Plumbing system includes: Water Softener Lawn Sprinkler Water Heater __ No. of R.I. Baths No. of Baths Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Air Conditioning Heat Recovery System Fee: $90.00 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 Pte_ OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4/02 ogn 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and d roofed areas (20% maximum lot coverage allowed) 2 copies of plan showing beam & window sizes; poured found design, etc. 1 set of Energy Calculations 3 copies of Tree Preservation Pian if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (buildings with 3 or less units) RemodWReoair Requirements 2 copies of plan 1 set of Energy Calculations for heated addf 1 site survey for additions & decks Addition - indicate if on-site septic system W3-1). o -o Date I b / 1 0 / 0 ' "4-11,s i ck 1 t.1-00 Co"stro c•k l a ".. Construction Cost 14 300 o ftc.e. f 6 Ce - a.Site Site Address q 1 C e Co u Dr i ) c.- �� c airs t'l Air Unit/Ste # t Description of Work a u>ura irwr,oi Multi -Family Bldg _ Y . N - Mv.sEar -,roc v#,.;+ 5as Pi,re p ac_e. Fireplace(%) _ 0 1 _ 2 Property Owner -T.': r r 1 r w1/4.w-oris Telephone # ( (tel ) (0-74- -PUT Work qo sf) 43i * se rpl Contractor h Ov".Q Ow A* - 6 -P► r.; Sl w r IN.. Bus e.e LA it ;;,a+all -4;re Pl ace,,, City - t-400./..e.ou 't'r Address _ • a t :re_ elate_ � State or 1 rs-E43 11 w K V e er cr S Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTIN Energy Code Category (J submission type) - Minnesota Rules 7670 Category 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on Y _ N If yes, date and address of master plan: A NEW BUILDING Minnesota Rules 7672 • Nerar Energy C qts Worksheet Licensed Plumber Teleph+ Mechanical Contractor Telephone Sewer/Water Contractor Telephone { I hereby apply for a Residential Building 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 the State of MN Statutes; 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. Applicarles Printed Name MECHANICAL (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 (U / (0 / U� Site Address 4/ l of) 4if , Unit # S Property Owner (1,C/ O�//tp') T 1 rneY'elephone # ( 60'6.7 ) e75 024---is- Contractor Contractor nZ - kqa,h) Street Address /q7 .q6 d Iez &el-- 1 leai 6dress rah ,,,i State 4/111 Zip 7./ JNd Telephone # ( 257 )-q/ 3 / C 7 The Applicant is Owner XContractor Other Add-on, modification or alteration to existing dwelling unit Xfurnace replacement air exchanger air conditioner other $ 30.00 State Surcharge $ .50 Total $ 50. 5-0 I hereby apply for a Residential Mechanical 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 Mechanical 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 w which requires a review and approval of plans. Applicant's Printed Name Applicant's Signature Parcel Files Cover Sheet Unique ID: 4015 4158 Countryside Dr 101827604001 830 Pitot Knob BUILDING PERMIT To be used for " { Est. Value `; $104, Site Address 41 C Lot Block Sec/Su Parcel No. CITY OF EAGAN Road, P.O. Box 21-199, Eagan PHONE: 454-8100 OFFICE USE ONLY s 3 0 Name Address City SA Phone Occupancy Zoning (Actual) Const (Allowable) # of Stories Length • Depth S.F. Total S.F. Footprints On Site Sewage Onsite' MWCC System City Water PRV Required Booster Pump Name Address City Phone I hereby acknowlege that I have read this application and state that the information is correctand agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permitee 4 A Building Permit is issued to: Pi . `R T 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 a APPROVALS Planner Council Bldg. Off. .Variance Bldg. Permit Surcharge Plan Review SAC, City SAR,MCWCC Water Conn Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P1 Road Unit Park Ded, Copies TOOL • 276.00 70.00 — Pr. Disp. a, Deck Final I Deck Ftg. I Bldg. Final m -Ti w Const. Meter Final Plbg. Orstat Test Final Htg. .8-71--.5- 2C c Rough Htg. o s _%. g to m �. c _8' = IFootings I Inspection Date m < c a D P z T c7 0 n Permit No. 4 i p v l � y s t f i°,7 °X— Plbg. Inspector — Notify Plumber "Qi V ... i , Q \ N ....„) , ^ P Comments 1 t .,) t, l\�1 c, v v Telephone # 2007 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date ` / 2 Z i C Unit # Site Street Address 4 1 Sr 8 (o lcv..r S' f Property Owner e r r t w1- V1"- o "-S Telephone # ( (;S-1) rc-7<S- a2 SS Contractor Telephone # ( ) Address City State Zip The Applicant is: Owner & Occupant_ Licensed Plumbing Contractor Septic System New Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 $ 10.00 _ Per as -built Fire Repair (replace burned out fixtures, etc.) This fee applies when extensive plumbing repairs are made to a building. $ 90.00 Alterations to existing dwelling XAdd plumbing fixtures to main level lower level. This fee includes $ 50.00 installation of a water softener and/or water heater at the same time. If you are installing only a water softener and/or water heater, do not complete this section; move to the next section and place a checkmark next to the appliance(s) you are installing. System Abandonment _Septic Water Turnaround (add $136.00 if a 5/8" meter is required) Other: Water Softener Water Heater $ 15.00 new _ replacement Lawn Irrigation RPZ repair $ 30.00 _ _PVB _new _rebuild State Surcharge $ .50 Total $ 50,oP 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 the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be r (.,5v,4* ApplicanH Printed Name Applicant's gnature DATE: NOV 5> 1991 RE: 41,3 COUNTRYSIDE DR (PIETSC) fT} Your Sett► & Water Permit for the above propertys been completed. It vsr►t( be` field at the Public 'tt Garage (3501 Coachman Road) unti the meter is picked u , 81 :`SUITE CALL PUBLIC :ilkfORKS (454-5220) FOR YOUR PERMANENT WATER T Yom Sewer & Water Permit for the above property cannot be completes for 3ti to ffi(itw reasa[s' buri r & Water Permit for the above property has been completed, but issued or occupancy allowed until further notice. IAL,PROJECTS -ONLY: Please pay form r at City Hall. Meter size .must'b irtr9ed by Bill Adams or Dirk House(Plurribing inspectors 454-810d) before issuance..: tr r FC RE' DIGGING., CALL LOCAL UTILITIES — TELEPHONE, ELECTRIC, GAS, ETC. -REOki1RED BY LAW. TACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY. Secretary, Building Inspections Dep! SITE AI DRfw l . C Y$Th `. A . LOT 4-, BLcK EC C613f3 CO> RY A 'PLICANT' - ADDRESS. CITY, STATE ZIP PHcNE• ` n? P SEWER WATER COMM/IND RESI©Ei lI1 &'. NEW — EXISTING Lawn Sprinkler Meters are to be Ir Ahead of Domestic Meters on WatE ADDRESS. 1 +SAX Credit WILL NOT be given f •!ed t t;ITY, STATE Rt ZIP, 'Stf�►�. PHONE: 1 AGREE TY ITH CITY fF' EAGAN'ORM NANCES Ab0RESSFe. + 3 .ICT CH LN CITY, STAT u:y1LLE MN IGNATURE V1E 0 FOR INSPECTI 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 EA090926 08/31/2009 ePermit Site Address: 4158 Countryside Dr Lot: 4 Block: 1 Addition: Country Hollow 2nd PID:10-18276-040-01 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: Improvements to the home require smoke detectors in all bedrooms. If alte inspection. Call for final inspection after installation. ng window openings, call for framing Carbon monoxide detectors are required by law in ALL single family homes. 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: Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 - Applicant - Owner: Terry P Timmons Tste 4158 Countryside Dr Eagan MN 55123--162 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 City of Eagan PERMIT City of Eaan Permit Type: Building Permit Number: EA116902 Date Issued: 10/14/2013 Permit Category: ePermit Site Address: 4158 Countryside Dr Lot: 4 Block: 1 Addition: Country Hollow 2nd PID: 10-18276-01-040 Use: Description: Sub Type: Reroof Work Type: Replace Description: Census Code: 434 - Zoning: Square Feet: 0 Construction Type: Occupancy: Comments: Please print pictures of ice and water protection and leave on site. Carbon monoxide detectors are required by law in ALL single family homes. Brian Preuss 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: Aspen Exteriors Inc 14245 St. Francis Blvd Suite 101 Anoka MN 55303 (763) 277-8869 - Applicant - Owner: Terry P Timmons Tste 4158 Countryside Dr Eagan MN 55123--162 (651) 675-0255 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 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use ) Permit �UJ Permit Fee: Date Received: Staff: 2017 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. Date: 6/21/2017 Site Address: 4158 Countryside Drive Tenant: Suite #: Name: Colleen Timmons Phone: 651-675-0255 Resident/Owner Contractor Type of Work Permit Type Address / City / zip: 4158 Countryside Drive, Eagan MN 55123 Name: Metro Heating & CoolingLicense #: 20090002249 Address: 255 Roselawn Avenue East #41 City: Maplewood State: MN zip: 55117 Phone: 651-294-7798 Contact: Micah New Email: micah@metroheating.com Replacement Additional Alteration Demolition Description of work: replace existing NC NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City Code. Please contact the Mechanical Inspector for information on permitted screening methods. RESIDENTIAL COMMERCIAL Furnace New Construction Interior Improvement Air Conditioner Install Piping — Processed — Air Exchanger Gas Exterior HVAC Unit — Heat Pump Under/Above ground Tank (_ Install tRemove) Other RESIDENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge = $ 60.00 TOTAL FEE COMMERCIAL FEES $60.00 Permit Fee Minimum $75.00 Underground tank installation/removal, includes State Surcharge Surcharge = Contract Value x $0.0005 If the project valuation is over $1 million, please call for Surcharge Contract Value $ x .01 =$ _$ Permit Fee Surcharge = $ TOTAL FEE 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 witj,out a pe mi hat th; work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x Micah Vail Applicant's Printed Name pplicant's Signature FOR OFFICE USE Required Inspections: Underground Rough In Air Test Gas Service Test In -floor Heat Final HVAC Screening Reviewed By: Date: