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4450 Lakeshore TerRESIDENT / OWNER Name: G ar u k (6 u CZ Phone: Co 5 1 45 2. 7 & 55 Address City ` /Zip: 4450 1- -Lt'(G2 0 r�C �e- re ^a 5512.2 CONTRACTOR - / Name: rai I^ - Pro V f v w.l o License #: 0 G 0 Co t3 PM �, Address: SS) 5 2aq-h„ . - 14 City: L a-ke v11 1 e State: M 0 Zip: 550 4 Phone: 9 51 4-6261 (o' 4 Q Contact: P b( �Yl l Email: 4(U,M be-vtd00 w -. Su. Cr vie, TYPE OF WORK _ New X Replacement Repair Rebuild Modify Space Work in R.O.W. r _ _ _ Description of work: S U a I (4 5 T l ( ,5 b • a 1 W * 1'1 PERMIT TYPE RESIDENTIAL X Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures ( RPZ / PVB) (_ Main Lower Level) _ Septic System Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation $50.50 Add Plumbing *Water Turnaround $100.50 Septic System $90.50 Fire Repair (replace (includes $.50 State Surcharge) Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) (add $166.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee and $.50 State Surcharge) burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 5 a.�j O Applicant's Printed Name City of Eaaali 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675 -5675 Fax: (651) 675 -5694 MAY 2 6 RECD Permit #: Permit Fee: Use BLUE or BLACK Ink Date Received: Staff: 2010 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: •7 • ( ! • I 0 Site Address: 4450 - �e5(^e v' &rra Tenant: Gar rt t o h CZ. Suite #: CALL BEFORE YOU DIG. Call Gopher State One CaII 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.clopherstateonecail.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. x DGb 6reLin YSc Use BLUE or BLACK Ink r----------------� I For Office Use � ' � Permit#: � � �� I Clty of �� , ; � Permit Fee: 3830 Pilot Knob Road � � Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I I 20�I5 RESIDENTIAL BUILDING PE MIT APPLICATION Date: �L 1�/ �S/ Site Address: ��b ��`'��v� ��' �� Unit#�� Name:�� /1 �l YY��,.. ��.��! L, ��.��.o✓� _�,,,�.n,.,�.b��,w.��.,_.�.�.a�,.,�.,,Phone: �..�_,��,��..�.� ti r �, Res�d�.n#� � � � Qyy�gr ,� Address/City/Zip: �� ,� Applicant is: Owner Contractor ��. �.�,�.�,..�,a�..� ,.�x,�.��,��..�. ��..�..��,.�.. �.ti.��....�.�,m�..� e...�_.��,�.,�..��.....��._�.��,.�..W.�..�....,�.,..��.. � Description ofwork: ��✓�� 1 � � �"y�7B Qf I�O�rk � 'I � � Construction Cost: Multi-Family Building: (Yes /No� �� g Company: �t�� (�-hfi�� L.��G��1� �hc. Contact: ��f ��'t u� �-�""��y�� Address:_JSGrb V�G�;�J�?t�w� �� Sui�` u.�sl City: 1 '�/1ti 1� � Cara#rac#or � � � State:�Zip: �SY�(� Phone: 7(�3-S,f��bR'�� Email: ��-� � �av��J,��in,c��1 ��`�e�Y,�- � License#: �G v D� '7ap� Lead Certificate#: � If the project is exempt from lead certification, please explain why: �� ,��.�.b,,.�,�.,�.�_,��„.��.��.�,.�.._.�a,,�....,�� COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING g 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: Fire Suppression Contractor: Phone: , N�T�':P�a�s a��1 s�vort��g c�.o�tr�r�n�s t�a#you 5ub�,�f a�e car�s�al�red ta b�p�i��r•t��#�o�. l�o�a��n-f � �#�e i��vrt�a�o�n�na�r be classi�ed a:s non p��i��yv�r prou�cte s�e�rea�o�tha�wo��per��e C��t� � ��,,.��.�. co,��l�a1e l�a��t l�ae are�ra�l�sec��. __�� 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.qopherstateonecall.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 1 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 S t Building Gode must be completed within 180 days of permit issuance. �u1S, f�r(��-- --�__,__.__ X X ApplicanYs Printed Name Appli s Sign ture Page 1 of 3 Use BLUE or BLACK Ink t`J P� ` t� For Office Use /,' City of Eaau vvo r• , Permit Fee: )-3.41 3830 Pilot Knob Road Eagan MN 55122 JUN 1 4 7g17 Dale Received: � 7 Phone:(651)675-5675 Fax: (651)675-5694 Staff: 2017 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 6/13/17 Site Address: 4450 Lakeshore Terrace unit#: Name: Marilyn Kloncz Phone: 651-452-7635 Resident/ 4450 Lakeshore Terrace, Eagan, MN 55122 Owner Address/City/Zip: Applicant is: Owner X Contractor - Description of Work: Bath Remodel-See Attached Drawing Type of Work Construction Cost: 6799 Multi-Family Building:(Yes /No X Company: US Patio Systems Contact: Ray Madden Address: 218 N River Ridge Circle Burnsville Contractor — --city: state: MN Zip: 55337 Phone: 952-314-9885 Email: asnook@uspatiosystems.com License#: BC661813Lead Certificate#: F119453-1 If the project is exempt from lead certification, please explain why: Built in 1997 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: Fire Suppression Contractor: Phone: -NOTE:Plans and supporting documents that:you submit areconsidered 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. vAvw.eopherstateonecalLorg 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 Minnesot..State Building Code must be completed within 180 days of permit Issuance. x Wendy Rachex A A. Iii l I Applicant's Printed Name Applicant's n .ure Page 1 of 3 Litica r .t1t-es' ic,,,e._ I . . DO NOT WRITE BELOW THIS LINE I 7 SUB TYPES Foundation Fireplace Porch(3-Season) Exterior Alteration(Single Family) Single Family Garage Porch(4-Season) _ Exterior Alteration (Multi) Multi Deck Porch(Screen/Gazebo/Pergola) Miscellaneous 01 of Flex Lower Level Pool — Accessory Building WORK TYPES New _ Interior Improvement Siding _ Demolish Building* Addition _ Move Building Reroof — Demolish Interior it Alteration Fire Repair — Windows _ Demolish Foundation Replace Repair Egress Window Water Damage Retaining Wail *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation lave N Occupancy JnG- 1 MCES System __. Plan Review Code Edition 2‘)/F SAC Units ...- (25% ^(25% 100% Zoning Pd City Water Census Code H 3 1 Stories -.. Booster Pump -- #of Units 4 Square Feet PRV #of Buildings I Length — Fire Suppression Required — Type of Construction 74 Width -- y REQUIRED INSPECTIONS Footings (New Building) Meter Size: __ Footings (Deck) Final 1 C.O. Required `_ Footings (Addition) pke- Final!No C.O. Required __ Foundation Foundation Before Backfill 40•' HVAC Gas Service Test Gas Line Air Test _ Roof:_ice&Water _Final Pool: Footings _Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Rough In Air Test Final Siding: Stucco Lath Stone Lath Brick_EFIS Insulation Windows hea • g Retaining Wall:_ Footings—Backfill_Final ck Radon Control Fire Walls Fire Suppression: Rough In Final Brace• .ails Erosion Control Shower Pan Other: Reviewed By: , Building Inspector RESIDENTIAL FEES q / Qdt Base Fee 7 3 i1ls- ably/ @ d4 �� // � Surcharge Plan Review I/7 MCES SAC City SAC Utility Connection Charge S&W Permit&Surcharge , Treatment Plant Copies TOTAL Page 2 of 3 Use BLUE or BLACK Ink For Office U ell Permit#:.03 3) ' City ofi.03 Permit Fee: 3830 Pilot Knob Road i P Eagan MN 55122 Date Received: '.Q"/ti'r< , Phone: (651) 675-5675 JUN 1 4 7017 staff: al Fax: (651) 675-5694 2017 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 6/13/2017 Site Address: 4450 Lakeshore Terrace Tenant: Suite#: Resident/Owner Name: Marilyn Kloncz Phone: 651-452-7635 Address/city/zip: 4450 Lakeshore Terrace, Eagan, MN 55122 Name: US Patio Systems license#: PC708206 Contractor Address: 218 N River Ridge Circle City: Burnsville state: MNZip: 55337 Phone: 952-314-9885 Contact: Ray Madden Email: asnook@uspatiosystems.com Type of Work New V Replacement Repair Rebuild Modify Space Work in R.O.W. Description of work: Bath remodel-see attached drawing RESIDENTIAL Water Heater Water Softener Lawn Irrigation( RPZ/ PVB) -- Permit Type Add Plumbing Fixtures( Main/ Lower Level) Septic System New Water Turnaround • Abandonment RESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge) *Water Turnaround(add$280.00 if a 3/4"meter is required) $115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$60.00 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.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 approva f plans. x Wendy Rache 20.07.,Q. x� 1 A licant's Printed Name Applicant's* ure pP FOR OFFICE USE ReviewedBy.• Date: Required Inspections:- Under Ground Rough-In Air Test Gas Test Final Meter Related Items: Meter Size Radio Read Manometer Staff: . .. _, . d � �et For Office Use /5'Q r - : `_ ; ? „ SUN 0 41°15 Penn&#: /� Il E AG A N •. 2, z��, Permit Fee: Cj "`= Date Received: `'(i 3830 PILOT KNOB ROAD(EAGAN,MN 55122-1810 (651)675-56751 TDD:(651)454-85351 FAX:(651)675-5694 LStatf: buildinginspections(o)cityofeagan.com a 2018 RESIDENTIAL BUILDING PERMIT APPLICATION Date- (o i /I Site Address: 41150 LI eSlU✓'e iC s vV u.� vNatUnit#- T = Name: C6v'I vt IC IO v,4.-Z-- Phone: 657- 4'S? —2635 Resident! y E Owner = Address/City I Zip: ifYS0 AAt"11,-A,„4._ 7c c-.c__f f yo,.,r ��12 Z - { Applicant ism 'er C°ntrartor � aa — '-071,17f__971, )/Z watt � , A/c-�.-.� .�.A. 12c� i • 1',.� . Type of Work Description of Qc ' , f t st i Construction Cost: S.-/7 / r 2. Multi-Family Building:(Yes )c /No ) Company: Set!I-c. ilem.i._ .7+4-r p✓tt1e. 4..o44,' Contact fv rs— 5'a 4 f--� f i Address: f O. t O)C 3 1� City_ (js4'e.- F Contractor t 5X.6/�f�o,,..tir.,,t a [�ira�/.Gm+---- State �l�p: s5D3 ( Phone: CO-7d d- P E License#: O< 0 G I a.(o fr lead Certificate# _ �� ,�, _ e. - t vim. 'v-..--- _«z_�. --._---- -- ------------------ - -max.-.�^_ ......�.,,...stx..n_ tithe project is exempt from lead certification,please explain why.: �� i ( COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING 1 . s in the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan? k l Yes No if yes,date and address of master plan: Licensed Plumber: Phone: t Mechanical Contractor: Phone: 1 fSewer&Water Contractor: Phone: 3 iFire Suppression Contractor: Phone: NOTE:Plans and supporting documents that you submit are consldened to be public Information_ Portions of theinformation may be i i classified as ,if you provide specificreasons that would permit the Cityto conclude that they are trade secrets: ...r_1L _ You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's ` website at www.citvofeanan.comIsubscxibe. Exterior work authorized by a building permit issued in accordance with the Minnesota State Budding Code must be completed within 180 days of permit issuance damage. Call 48 hours before you CALL BEFORE YOU EMG- Call Gopher State One Call at(651)454-0002 for protection against underground utility intend to dig toreceivelocates-of underground utilities. www.aobherstateonecaU.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 ofof.plans x f' ['V G P�4 4 f,G x l� t Applicants Signature Applicant's Printed Name qq"--_-_)6) //24-k-',-(1?0,-6 k-/M,ACC--::. DO NOT WRITE BELOW THIS LINE V SUB TYPES Foundation _ Fireplace Porch(3-Season) _ Exterior Alteration(Single Family) Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) Multi ')[, Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex T" Lower Level Pool Accessory.Building WORK TYPES New _ Interior Improvement _ Siding — Demolish Building* Addition — Move Building _ Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows Demolish Foundation _ Replace Repair Egress Window _ Water Damage Retaining Wall *Demolition of entire building—give PCA handout to applicant DESCRIPTION Valuation _247___4!9_ Occupancy �,, ,- MCES System Plan Review Code Edition '0,41\9,t5 f ri SAC Units (25%_ 100% '''f..) Zoning City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) Final/C.O. Required Footings(Addition} Final/No C.O.Required Foundation Foundation Before Backfill HVAC_Gas Service Test Gas Line Air Test Roof:_Ice&Water Final Pool:_Footings Air/Gas Tests _Final Framing 30 Minutes 1 Hour Drain Tile Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: v20,, , Building Inspector RESIDENTIAL FEES Base Fee , Surcharge ,( ,- 1, k41,6" I, Plan Review � , ` ll MCES SAC V '11111 City SAC Utility Connection Charge S&W Permit&Surcharge ( ; Treatment Plant Copies01r� TOTAL ( Page 2 of 3 PERMIT City of Eagan Permit Type:Building Permit Number:EA154336 Date Issued:03/13/2019 Permit Category:ePermit Site Address: 4450 Lakeshore Ter Lot:23 Block: 03 Addition: Cliff Lake Shores PID:10-17785-03-230 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:Two or More Windows/Doors 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: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Gary R Kloncz 4450 Lakeshore Ter Eagan MN 55122 Renewal Andersen 1920 County Road C West Roseville MN 55113 (651) 264-4777 Applicant/Permitee: Signature Issued By: Signature