4459 Clover Lane BCity of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
MAY 2 4 2011 Cap(,,/\/
Use BLUE or BLACK Ink
lam'
Permit#:
Permit Fee:
Date Received:
Staff:
L
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
RESIDENT /
OWNER
Name: ' t 34 I ni-e_ \-1-c) h' -e L Phone: (; l D - A/S - :: :WOO
Address (City / Zip: i,� a l% C l-%'�_ `
CIOU��- - (..�
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: p Ockc .z 0 lc ) -ec IL. L -1-L .t/ v..%
Construction Cost: i 2 0 v Multi -Family Building: (Yes / No )
CONTRACTOR
Company: .b ec:-/c %, y _cam._ Contact: -Sc--C.c..-41-it,'
.e vte,. A - //') - City: C-ck-c)c-i.f-e-
Address: % 1€ c C: ev.
State: 117 A/ Zip: S"S Ing Phone: C., S (- `) S'? - ?e..? 7
License #: ) (? < 3 0 5 (0-, Lead Certificate #:
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes No 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:
Licensed Plumber:
Mechanical Contractor
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit ane considered to be public informat&ur. Portions of
the information may be classified as non-public if you provide specific reasons ld t wool l p snit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. CaII Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive bates of underground utilities. www.00pherstateonecall.oro
1 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 of plans.
X fCs�t G \L'(.1
Applicant's Printed Name
x
Appli
is Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
99456
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% 1
Census Code
# of Units
# of Buildings
Type of Construction
Fireplace
Garage
Deck
Lower Level
_ Interior Improvement
— Move Building
Fire Repair
Repair
11311
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola) —
Pool
Occupancy
Code Edition
Zoning
Stories
Square Feet /219
Length
Width
Siding
Reroof
Windows
Egress Window
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
REQUIRED INSPECTIONS
Footings (New Building)
,- Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: _Rough In _Air Test __Final
Insulation
Meter Size:
Reviewed By:
/5
314
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
Final / No C.O. Required
HVAC
Other:
Pool: _Footings Air/Gas Tests Final
Siding: Stucco Lath _Stone Lath Brick
Windows
Retaining Wall: _ Footings _ Backfill Final
Radon Control
Erosion Control
Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
-2
zf? 911
Gto
/fog
Page 2 of 3
ROBE
ENGINEERING
COMPANY, INC.
1000 EAST 1461h STREET, BURNSVILLE , MINNESOTA 55337 PN 432-3000
c
CONSULTING ENGINEERS
PLANNERS and LAND SURVEYORS
Ccr Ltz/ cacic
legs .sOt^4,21ort. LOT5 /, 2,5, AND 4, BLOCK 1, EDEM ADINTioN,
• DAKOTA CouNTY, MINNE5QTa.
NORTH
SCALE: 111 = 301
BY:
04.0
N 89° 58' 02" E
97.27
DRA WAGE AND
UTILITY EASEMENT
A
1
rTh
t `
6N 6N
W.
RE
DATE. '
BUILDING IN', 3 _ CTION
t
`^
('i .& DENOT65 CX/ST/Ale, %)'d'°`
ELEVAT/ON o Q6A4
(9/0 .0) LENOTE5 PROPS / c.)4
• 4L.E VAT/OA/ / `y-\
J `
..r._—. 1A!DICA7 'S D/REcT1OAI %\ \
oP SURFACE DRA/NA6E
30' FRONT EluILD/N� fir'
SETBACK LINE ' I Fz � i2:5w-" 5e
P'IAJ/ SHEL) GAR116E FL.oa,?
LEVATI oN 9
14,0
1 hereby certify that this is a true and correct representation of a tract of
land as shown' and described hereon.. As prepared by me on thisI- day of
SEa0r R , 19 8S .
Minn. Reg. No.
r 7
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA094808
Date Issued: 07/06/2010
Permit Category: ePermit
Site Address: 4459 Clover Lane B
Lot: 1 Block: 01 Addition: Eden
PID: 10-22750-010-01
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 altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary:
Valuation: 3,000.00
BL - Base Fee $3K
$88.50
Surcharge - Based on Valuation $3K $1.50
0801.4085
9001.2195
Total:
$90.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
- Applicant -
Owner:
Kristine A Hummel
4459 Clover Lane B
Eagan MN 55122
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
Eagan,
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA094808
Date Issued: 07/06/2010
Permit Category: ePermit
Site Address: 4459 Clover Lane B
Lot: 1 Block: 01 Addition: Eden
PID: 10-22750-010-01
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 altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary:
Valuation: 3,000.00
BL - Base Fee $3K
$88.50
Surcharge - Based on Valuation $3K $1.50
0801.4085
9001.2195
Total:
$90.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264-4777
- Applicant -
Owner:
Kristine A Hummel
4459 Clover Lane B
Eagan MN 55122
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 WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO •
Eagan, MN 55121 DATE.
Zoning: _ 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.
Ordinances.
By ; s
Date of Insp.:
-,y
Misc. Charges.
Total -
Dote Paid.
Insp •
CITY OF, EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P.'0. Box 21199 PERMIT NO •
Eagan, MN 55121 DATE:
Zoning: No. of Units.
Owner:
Address:
Site Address.
Plumber•
I 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 08:30 #582 P.020/079
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use l
Permit#: ` 11-4(0
Permit Fee: 3
Date Received: °I , ( 11 Iz
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
J
Date: CI1512.013 Site Address: Li`i59441-i5gB,4yb1,44toIB C1010/ Writ/ Unit#:
Resident/
Owner
Type of Work
Name: UAW th» F CIO.. (1 WA1 CCIYWAIll Phone:
Address /City / Zip: IIM (Ai I((CS1 RtYkhlf,(,(i, Edeh Name, Mr b )-N
Applicant is: Owner Contractor
Description of work: TtQr 6. t and Yt-irtof
cyG '\
Construction Cost: $ i `Q U 1 "I JO.O V Multi -Family Building: (Yes X / No )
Contractor
G
Company:.itlstar CAIiET;UCi1OY1 tilt }+»' ontact: Ott f i�Q(I�stCLt �
dM�al
Address: cj'y�j �Y�US1Y�gI S W' # Iu�J I K, CNAI�
nCitty�:
State: MNa Zip: Phone: C67,—CI'1Z-1494
055359
License #. IJ1✓(P3)515 Lead Certificate #: MFtT- 20qUM-0
, if the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
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:
_Yes _No
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
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
.,..-��..„.s�_ ._..___-_,._., ____ _ _ _,....__..,...- �,.T y .._cone/ude 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.aonherstateonecall.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.
x ItIsfrad
Applicant's Printed Name
x
Ap(ilicfant's Signature
Page 1 of 3
City of Eagan
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA132993
Date Issued: 09/15/2015
Permit Category: ePermit
Site Address: 4459 Clover Lane B
Lot: 1 Block: 01 Addition: Eden
PID: 10-22750-01-010
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: Furnace & Air Conditioner
Comments: Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:
ME - Permit Fee (Replacements) $59.00
Surcharge -Fixed $1.00
0801.4088
9001.2195
Total: $60.00
Contractor:
Blue Ox Heating & Air Llc
5720 International Pkwy
New Hope MN 55428
(612) 238-9709
- Applicant -
Owner:
Kristine A Hummel
4459 Clover Lane B
Eagan MN 55122
(651) 492-9841
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
City of Eagan
PERMIT
IP1' City of Eaan
Permit Type: Plumbing
Permit Number: EA136159
Date Issued: 04/27/2016
Permit Category: ePermit
Site Address: 4459 Clover Lane B
Lot: 1 Block: 01 Addition: Eden
PID: 10-22750-01-010
Use:
Description:
Sub Type: Residential
Work Type: Alteration
Description: Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:
PL - Permit Fee (miscellaneous) $59.00 0801.4087
Surcharge -Fixed $1.00 9001.2195
Total: $60.00
Contractor:
Benjamin Franklin Plumbing
5718 International Parkway
New Hope MN 55428
(612) 238-9709
- Applicant -
Owner:
Kristine A Hummel
4459 Clover Lane B
Eagan MN 55122
(651) 492-9841
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
--------------
� For Office Use 1
Building Permit #:
%I
� � /
i
%-�% ���'
EAGAN
S&WPermit#:
I Permit Fee: ` - 0 I
I
^1
1
I I
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
1 I
1
(651) 675-5675 �FAX: (651) 675-5694
I
I Date Issued: I
buildinginspections(cDcityofeagan.com
I---------------------�
RESIDENTIAL BUILDING PERMIT APPLICATION
Date:. �"I LZLL, Site Address: Unit #:
Applicant is: ❑ Owner JELContractor
Name: ��;Ce t/� —t b vv.e- C> V_ AS'S t, C? 1, a-4 i b U-,.,
Homeowner Address: q` 5-q 6/B u q C+� 1 r city: �aQ 0. V,
r
State:fm Wip: Phone:: Email:
Description of work: 2 Q is C:,,-
Type of Q
i
Work Construction Cost l
Type of building: ❑ Single Family ❑ Townhome, of units Twin Home
Compan Thy
Building Address City:�GcP�G��ti ��
Contractor /
State: Zip: 5-3,1- V P h o n e 6 t z-i2115 Emaill aMQ �C �,�e��CSN� MQ°`
License #: � D Expiration Date:
Sewer & Company:
Water
Contractor Address:
Required for State:
Zip: Phone:
Contact:
Email:
City:
new construction
License iration 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.
Applicant's Printed Name A licant's Signature