4679 Jackstone PtCity of Eapll
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
JUN 21 2011
P
�2011 RESIDENTIAL BUILDING PERMIT APPLICATIO
6ra0Y-06f
Unit #:
Use BLUE or BLACK Ink
For Office U,Se
Permit#:
Permit Fee:
Date Received:
Staff:
Date: Site Address:
RESIDENT /
OWNER
Name: /1.%c,4.t•ctrN. j.) ciA4dt.1 Phone: told ic). S(os 1
���� �1
Address/City/Zip: Joclc: s-fcsr,e P0, r,.1- E. a Jc,n MAI 5S 1aa.
Applicant is: )( Owner Contractor
TYPE OF WORK
Description of work: 13 q )-k raCr" re A -,c,) r t_. (
Construction Cost: 6 5 C> 0 Multi -Family Building: (Yes / No )
CONTRACTOR
Company:
/f'' Contact:
6.----'
Address: City:
State: Zip: Phone:
License #: 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 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.qopherstateonecall.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 ,t)i I4c„mhi.n
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
DO NOT RITEBE'LO HIS L NE
411*
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
Yty
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: Rough In _Air Test Final
Insulation
Sheathing
Sheetrock
eviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Siding
Reroof
Windows
Egress Window
990X,
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
"i( Final / No C.O. Required
HVAC _ Gas Service Test
Other:
Gas Line Air Test
Pool: Footings
Siding: Stucco Lath Stone Lath _
Windows
Retaining Wall: Footings Backfill
Radon Control
Erosion Control
, Building Inspector
Air/Gas Tests Final
Brick
Final
Page 2 of 3
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA095259
Date Issued: 08/04/2010
Permit Category: ePermit
Site Address: 4679 Jackstone Pt
Lot: 3 Block: 09 Addition: Ridgecliffe 4th
PID: 10-63983-030-09
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Quesetions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector,
952-445-2840
Beth Janohosky
207 150th Street W.
Fee Summary:
ME - Permit Fee (Replacements) $50.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $55.00
Contractor:
Apple Lake Heating & Air Conditioning
207 150th Street West
Apple Valley MN 55124
(952) 431-4328
- Applicant -
Owner:
Nathan Hamblin
4679 Jackstone Pt
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
nwtctJars Charge: 305.O0 d
Aceoalrrt Deposit:
Permit Fee• 10.0P pd
* rirlr web 11r i ofSeem Surehorge• ..5t?. .
Misc.. Charges:
Total:
Date Paid.
Date of tnsp.t �f:.. f Z " + , x insp..
MN 15122
S*viCE"'MUM
DATE: 11/12/f:0
1 unit tr+1i
No. of Units:
,ores
ss: 4679 Jac1<.StJ 3E
Plumber Genz Pyan
10/2/C0 21163
tmope i. e..t tr wINF iwe City et
insp.-
Point L3 79 PidEec1if e 4th
100.00
4?S_on
pd
pri
Account, teposit:,
Permit Fee 1 _00 pd
,urchorge• co pe
°
Misc. . Charges:
Coriltetieh Charge:
Total:
Dat. Paid:
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA156489
Date Issued:07/02/2019
Permit Category:ePermit
Site Address: 4679 Jackstone Pt
Lot:3 Block: 09 Addition: Ridgecliffe 4th
PID:10-63983-09-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description: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 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
Nathan Hamblin
4679 Jackstone Pt
Eagan MN 55122
(618) 812-5681
Apple Lake Heating & Air Conditioning
207 150th Street West
Apple Valley MN 55124
(952) 431-4328
Applicant/Permitee: Signature Issued By: Signature