4159 Countryside Dr2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constru:tion Requirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas
(20% maximum Id 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 (buildings with 3 or less units)
Remodel/Repair Requirements
2 copies of plan
1 set of Energy Calculations for heated additions
1 site survey for additions & decks
Addition - indicate if on-site septic system
Office Use Only
Cert of Survey Recd
Tree Pres Plan Recd
Tree Pres Required
On-site Septic System
_Y N
Y N
_Y N
_Y N
Date 9 / s / .06" i onstruction Cost (A/77 / - D"
Site Addres
1 41.a,- ,�1 V Unit/Ste #
C)9 ili 6•
ii
Description of Work
LTY?h a)l nu itA,u 6 P ' L
Multi -Family Bldg
— Y N Fireplace(s) — 0 _ 1 — 2
Property Owner L% NIL, /" Telephone # 6S/ f):��1Q --"�Q A'5
Contractor
/ i1/ _�'Ph , MN
/ ZJ
Addressdd
ALL> J# City
State r)/V11,r)/V11,f
Zip J 5/4/ Telephone # (69 /,06---t/e2-5°
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category
('1 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 #(
Telephone # (
Sewer/ Water Contractor Telephone #(
Mechanical Contractor
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 acco, dance with the approved plan in the case of work which requires a review and
approof plans.
7
Applicant's Printed Name
611141144.e -j
Applicant's Signature
OITY OF
EXTERIOR kliVF;L p ��,� u�U„1'bllitl LEpAIiII•IF;UI'
(To be submitted with building U UUIIPUTATIOII
g pertuit application)
one or Two Family Dwelling
Owner
All other
COntrao tor,
• :Bite Addreuu
• LI1IEAL FEE'r OF
EXPOSED WALL
OPAgUE WALL
Detail
reference
from
nttaohed
r;heeto
Date
Phone
.ft. above grade n 21521;71 ?4
TOTAL EXEOBFIll 1 ALL iA1iAl EA if FT
COf$TtIUUTIOU I HUH Value x Area
nun i043
Hull
11U11
nUn
nun
HUH
VII1ttx0VtS I HUH Value x Area
Hake & Type��,�, 7-r 1 u.n
11 11 nun
11 11 IIU 11
11U 11
L )OLlS I 11U11 Value x Area
1i ke. & Type i A .
11 n
11
'1 11
TOTAL (U) (A) VALUES
CJI
DIVIDED Dr TUTAI; 17
AVE►tAUE nUn'- ) -'-
t • 1 15 or lees for 1&2 family
TotI'AL AREA: I0(a! I1.
Detail reference
from •
attached sheets.
Describe openingo
ill roof.
"U11
"Un 4-1 x Bq. FT.
nUu x Bq. FT.
nUn 8q. Fr.
Bq. FT.
To'rnl,8 ZSZ://- Bq,� kT.
• AVEIiAUE{ Ui;••11
3c7
x
x Bq. FT.
x 8q. FT.
x Bq. FT.
x 8q. FT. u
x Bq. FT.
14.E
(u)(A)
(U)(A)
•' 2t 0U)(A)
-' U)(4)
(U)(A)
(U)(A)
x Bq. FT. .193, 75".
x 8q. FT.
x Bq. FT.` (U)(A)
FT.(u) (n)
x Bq. F
--- (U)(A)
DooF/UEILIIIU I
nUn
rIU 1i
nun
*nU11`
rHU 1i
TOTAL (U)(A) VALUES DIVIDED Br
TOTAL ROOF/OEILI1IUNAB A
•
l �
dwellings
ZZ.�S
AVEtiAUE 11U i / 6v4;97
•025 fon ventilated roofs.
•
m %, 010 (u)(A)
= (Ul(A)
(U)(A)
(U)(A)
(U)(A)
_x Bq. FT./r_ z Z► -j7 (U) (A )
X 8q. Fr. .. (Uj (A)
_x tins
F r'
Bq. FT. -� (u)(A)
x 8 r n (U)(A)
krr z?-14q.uv) -n
Address:4159 COUNTRYSIDE DRIVE Lot] Blk 2 Sec/SubcOUNTRYHOLLIN 2ND
These items were/were not complete at the time of the final inspection.
1/09/92
Yes
No
Final grade (6" from siding)
V
0 i,-i/j mss,,, 54 eitd
Permanent steps - garage
X
Permanent steps - main entry
Permanent driveway
x
Permanent gas
�(
c��- - 5204
Sod/seeded grass
r�
)(
Li /1 /C nt9z.✓k ,8"r! enc.)
Trail/curb damage
(/h kh pw-31 s )7
Porch
Basement finish
)((
Deck
X
Please verify with the builder the removal of roof test caps from the plumbing
system and the shut-off of water supply to the outside lawn faucet before
freeze potential exists. +i:
RECYCLED PAPER
White - City copy Yellow - Resident copy Pink - Contractor copy
.1)/54-x( flo..t-5tz.c -aa.) 141-9( oma°
• o, ( Z7/O771z2
Z 1,3+
15t. _ l a1,
dw14-3 33,75 X i- 33/7‘,
z.4- ZZ1€.>e Z
GAS -Z = Zoo X I = zz, c
cN Z 35,
/0.5-/ I 1015
cAJI1-=I11z')( k-II,z'.
61415-3=2 411z5x 1 41 1 -.
= . 4 X
g _ s-ri.14149(11-)
fI IO. kg 1 +zd1 o
c/i,o
10(a9
ray 0650
s 5 com,, /n ti64-
11h4.'t,,ico
1' •
w4014).[ I , 7
Az,z2 11 51z.76.
Zo fZ. 9/
-
5zi,.1-
�� R�Ue fermi niug •"U" valuen at hoot, W�►11, 111.14. and Dann' Block•
iv-
• . .
• Udo . 00
Q
0.
A
• )10OF/OEILlltq
1.) Interior Air t'ilm
2.) 5/8" jrp. Bd.
3.) Insulation
4.)
5.) Exterior Air Film
(BTILL)
two a 1/11= , TOTAL Ma 70
•
WALL (R) YALUFI
6.) Interior Air Film 0.68
7.) i".031.1. Bd. :45
8.) insulation 19:00
9.) r uit:, •-• 15, Z•01-
10.) flatmate Siding .67
11.) Exterior Air Film .17 '
nUn
a 1/Ra
v� 3 TOTAL 0).23.0/
Rill (I1) VALUE
12.) Interior Air Film 0.68
13.) Insulation Hoo
14•) 2" Fir Rim Joint. 1.88
15.) goiter- P/TG 204
.
- 16.) Masonite Biding
17.) Exterior Air Film .17
nUn a 1/Rn .040
FOUIlUATI011 (R) VALUq
18.),Interior Air Film' 0.68
1g 19.)
• 20:) �-// y Ik/P/tea • JJ. cro
21.) 12" Honorete Block 1.28
90 22.)
23.) Exterior Air Film .17
TOTAL (11)22.2k1(1-
nue a 1/11a .070 TOTAL 00 . )3.1
954870
COUNTRY HOLLOW SECOND ADDITION
PRESSURE REDUCING VALVE AGREEMENT
This agreement, made and entered into the /S day
of ('AC- ge° , 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 terms "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 home below 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 ELAN
(Date: , $
. T .mas A.
Its: Mayor
Attest: . J. VanOverbeke
Its: erk
OWNER AND DEVELOPER:
PROGRESS LAND COMPANY, INC.
_T1
By: OfirrV rseAEL-
Its: P 5icvr'r
By:.
Its'
STATE OF MINNESOTA )-
) ss.
COUNTY OF DAKOTA. )
On this v7/ -S% day of -Z a , 1990, before me a Notary
Public within and for said County 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.
•ssirrrc.•aorttrrs+ets�rteas,
"'cRR"'
STATE OF MINNESOTA )
COUNTY OF l).�t.t .)
On this
Public within
appeared
persona 1 own,
ss.
day of 4- ,... Si- , 1990, before me a Notary
and for said County, personally
�,
_L-4 C r C' f. l+ r and-- to me
who bei ng -each-by me duly sworn each- did say that
the
-endd-
foregoing instrument, - -
1-1-t ':ij f i
of the corporation named in the
and that said instrument was
signed aair3 on behalf of said corpora ion by authority of its
Board of Directors and said rreS , C.Cu2 '
-exp- acknowledged said instrument to be the
free act and deed of the corporation.
-i J C L ( a i�rrteun
Notary Pubic
APPROVED AS TO FORMS
City Attoiney
,bated: /#
erS
APPROVED AS TO CONTENT:
Public Wo rffs Department
Dated: Av l h, / 9 f
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
clot, --590'1 /
SIDENT
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
MECFIANTCAL PERNIT
PLEASE COMPLETE UPPER PORTION ONLY FOR
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR
FOR CITY USE ONLY
PERMIT #
RECEIPT # /9&9&9 -.-
DATE: 9//4-/9/
SINGLE FAMILY DWELLINGS &
EACH UNIT.
WORK DESCRIPTION
NEW CONST V
ADD ON
REPAIR
OWNER NAME:
SITE ADDRESS: 1/45, CZ
LOT: ' BLOCK SUBD.
INSTALLER:
ADDRESS: 14745 South Robert
GENZ-RYAN PLUMBING
& HEATING COMPANY
Trail
CITY: Rosemount
ZIP: 55068
PHONE #: 423-1144
FEES
ADD-ON MINIMUM $15.00
HVAC 0-100 M BTU 24.00,."-
ADDITIONAL
4.00✓ADDITIONAL 50 M BTU 6.00 ✓
GAS OUTLETS - MINIMUM 3.00 l�
OF 1 PER PERMIT
SUBTOTAL: $33 O)
STATE SURCHARGE: .50
TOTAL: $ 33
SIGNATURE OFyRMI TEE
COMMERCIAL/INDUSTRIAL! : 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:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE #:
FOR:
CITY OF EAGAN
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE _ $.50 FOR
EACH $1,000 OF PERMIT FEE.
riwur.SED PIPING = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1%
STATE SURCHARGE .
TOTAL: $
(SIGNATURE)
9/e/v / /0713
1 5 0 7 3 54 7,[3,2 ,tdb�xCr aJ"' 751
Requesipe
(/
Fire No.
h -in Inspection
ed?
es C No
❑Ready Now,{1.•lhen t eadyify W?ector
��
1censed contractor E owner hereby request inspection of above electrical work at:
Street. Box or Route No.)
Job AVJr7 CouwrtY J70(4- VA
City
'',11-6.4.-81
Section No.
Township Name or No.
Range No.
County
r
44 � irrA
Occupant (PRINT)
)345/e 41,/de# r ..0j C
Phone No.
Power Supplier
Dot. atA-�•4.T
Address
/n 4 iA
Electrical Contractor (Company Name) Contractor's License No.
,eolie•d 6lLCt CD e Vi/Ye-f
Mailing Address or Owner Making Installation)
/292s- 446(.4..,fr e.)0 y ,ase.a,o
Authorized Signal a (Contractor/0 r Making Ins 1 tion
Phone Number
512,3- irf2 i
MINNESOTA STATE BOARD OF ELEC RICITY
Griggs -Midway Bldg. — Room 9-173
1821 University Ave., St. Paul. MN 55104
Phone (612) 642-0800
/0/
REQUEST FOR ELECTRICAL INSPECTION
► See instructions for completing this form on back of yellow copy.
THIS INSPECTION FIEQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
¢n..
EB -00001-08
/002397
' V
"X" Below Work Covered by 1 nis rtequesrh=
New
Add
Rep.
Type of Building
c AppliancesWired
EquipmentWired
1
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
to 100 Amps
Fee
SCia
Swimming Pool
/
0 to 200 Amps
`Ars
f Yo
Transformers
Above 200 Amps
Ili
Above 100 Amps
Signs
Inspector's
THIS
COMPLETED
Use Only:
INSTALLATION MAY BE ORD-
WITHIN 18 MO S.
7�-�
_ '-.ells NNECT119
p�''��•
TOTAL
79 -
Irrigation Booms
Special Inspection
IF NOT
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby
certify that the above inspection has
been made.
Rough -in `�l
�a//
/6
Final
'at s
/'-"�! 1
OFFICE USE ONLY ,
This request void 18 months from
,
REACTI`IATE
PERM i
6
CIN OF EAGAN
1993 BUILDING PERMIT APPLICATION
681-4675
SINGLE & MULTI -FAMILY
COMMERCIAL
2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month --
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issjed.
Date t f / a9 / /99-3'
Valuation of work �--5 500
(Site Address: 4-1 9 C_oo,k k
¢_ (t�€___ V____o. 0.k
STREET( SUITE #
Tenant Name: (commercial only)
_
LOT __
BLOCKZ-
SUED.
P.I.D. *
Description of work:
,c_
The applicant i s :
•
Owner, EU Contractor ,■
Other,. (Describe)
Property
OwnerAddress
—ThName ,n 0,c4 n �� 4 \ f Phone 6 g4, - t47,2C-
LAST FIRST
� o� 4\CL, `� +kJ�---
A«�
STREET 71
City \-- a_ a > State
STE * _
Zip SS /off
10111V—
Contractor
Company , t\e- `L ikt &• 0 N C._ Phone S - 5 b
,
Address (401:,. • d& aka Lac nse #000Z3'N Ex P• 3/
CityState V k. Zip S5 /a-
Architect/
Engineer
Company Phone
Name Registration #
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that av- -.d this -e' nation
correct and agree to comply it -'\i ab e tate
Eagan Ordinances.
and state that the information is
f Minnesota-ota-Statutes and City of
Signature of Appl i can : \ , 0-4 c 0._f �-f
BUILDING PERMIT TYPE
❑ 0I Foundation
❑ 02 SF Dwg.
❑ 03 SF Addition
❑ 04 SF Porch
❑ 05 SF Misc.
WORK TYPE
Q 31 New
0 32 Addition
OFFICE USE ONLY
❑ 06 Duplex
❑ 07 4-Plex
❑ 08 8-Plex
❑ 09 12-Plex
❑ 10 Multi. Addl.
❑ 33
❑ 34
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length —
Depth /4
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
❑ Site
❑ Wallboard
Alterations
Repair
❑ 11 Apt./Lodging
❑ 12 Multi. Misc.
❑ 13 Garage/Accessory
❑ 14 Fireplace
Q15 Deck
❑ 35 Tenant Finish
❑ 36 Move
Basement sq. ft.
1st Fl. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
Footing
E, 'Final
❑ Framing
❑ Draintile
❑ 16 Basement Finish
❑ 17 Swim Pool
❑ 18 Comm./Ind.
❑ 19 Comm./Ind. Misc.
❑ 20 Public Facility
❑ 21 Miscellaneous
❑ 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code yf�l�
4 ► T
Assessments
X134/
O
❑ Insulation
❑ Fireplace
� Permit Fee
5.00
valuation: $
1 Surcharge
.56
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
►3v
Other
Total:
,1l..00
SAC %
SAC Units
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
b0sc
/d-975.
BUILDING
020803
04/29/93
SITE ADDRESS:
4159 COUNTRYSIDE DR
LOT: 7 BLOCK: 2
COUNTRY HOLLOW 2ND
P.I.N.: 10-18276-070-02
DESCRIPTION:
Building Permit Type
Building Work Type
Building Length
Building Width
DECK
NEW
20
14
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Subtotal
$25.00
$.50
$25.50
COPY
Total Fee
$.50
$26.00
CONTRACTOR: - Applicant - ST. LIC.
WHITNEY HOMES CREATIONS 14549150 0008344
4160 LANTERN LN
EAGAN MN 55123
(612) 454-9150
OWNER:
SYNDER ROBERT
4159 COUNTRYSIDE DR
EAGAN MN
(612)686-9436
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 Mn.
Statutes and City of Eagan Ordinances.
APPLICANT/PERMITEE SIGNATURE
0 s4.-- 71
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 IZ � I
SITE ADDRESS n 9 CC ICI
TYPE OF WORK C� N X?L . reef c r sft cW
APPLICANT \LOn
STREET ADDRESS •
TELEPHONE #
PROPERTY OWNER L\
rci 1 ��
Energy Code Category
Mechanical Contractor:
(1 submission type) • Residential Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
Mechanical system includes:
Sewer /Water Contractor:
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651- 681 -4675
MINNESOTA RULES 7670 CATEGORY 1
Air Conditioning
Heat Recovery System
Signature of Applica
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received
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 1 gr)c o
--C n
CITY 1 STATE ZIP
CELL PHONE # FAX # v �b"l
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Plumbing Contractor: Phone #
Plumbing system includes: Water Softener Lawn Sprinkler
Water Heater No. of R.I. Baths
No. of Baths
Phone #
Phone #
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 Eag
r Inan. es.
t 1,
MULTI - FAMILY BLDG Y '✓ N
FIREPLACE(S) _ 0 _ 1 _ 2
•
TELEPHONE# o 1 0
MINNESOTA R
• New Energy Cpck
Not Required _
Fee: $70.00
44-01_1(
Updated 4/02
❑ 01 Foundation ❑ 07 05 -plex ❑ 13 16 -plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 02 SF Dwelling ❑ 08 06 -plex ❑ 16 Fireplace ❑ 21 Porch (3 -sea.) ❑ 31 Ext. Alt - Multi
❑ 03 01 of _ plex ❑ 09 07 -plex ❑ 17 Garage ❑ 22 Porch /Addn. (4 -sea.) ❑ 33 Ext. Alt - SF
❑ 04 02 -plex ❑ 10 08 -plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi
❑ 05 03 -plex ❑ 11 10 -plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04 -plex ❑ 12 12 -plex Plbg_Y or _ N ❑ 25 Miscellaneous
❑ 31 New
❑ 32 Addition
❑ 33 Alteration
OFFICE USE ONLY
❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding
❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair
❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows /Doors
❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC /ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings (new bldg) Final/C.O.
Footings (deck) Final/No C.O.
Footings (addition) Plumbing
Foundation HVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air /Gas Tests Final
Framing Siding Stucco Stone
Fireplace R.I. _ Air Test Final Windows (new /replacement)
Insulation Retaining Wall
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
Approved By , Building Inspector
FAMILY DWELLINGS
OF PLANS
:STERED SITE SURVEYS
OF ENERGY CALCULATIOr
'Y APPLIES WHEN: TYF
OF
LOT
ADDRESSES FOR CORNER
DESIRED. NO CHANGES
PROCESSING TIME FOR S
PERMIT MUST SHOW A LI
Used For:
.ddress '/P.)
/ Block 2_
644 — 49
ctor :Zi
s ; Yo j9-7;
ip Code
En . D/e /e-e,
ip Code
Water Licensed Contr.
g :ture •" ontracto:
?licable State of Min]
MIMEO
NEW CONST ✓
ADD ON
REPAIR
OWNER NAME:
CITY: Rosemount, MN ZIP: 55068
F .oNE #: , (612) 423 -1144
FOR:
CITY OF EAGAN
SIGNATURE P TTEE
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454 -8100
PLEASE COMPLETE UPPER PORTION ONLY FOR
=THRONES/CONDOS WREN PERMITS ARE REQUIRED FOR EA
WORK DESCRIPTION
JOE MILLER CONSTRUCTION CO. INC.
SITE ADDRESS: __
LOT:_/_ BLOCK SUED. ,./ t .'- A /4
INSTALLER- 6E NZ -
RYAN PLUMBING & HEATING CO.
ADDRESS: 14745 South Robert Trail
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK SUBD.
INSTALLER•
ADDRESS:
CITY: . ZIP:
PHONE #:
loOmmlwrir
SHOWER
WATER CLOSET
*BATH TUB
LAVATORY
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00
HOT TUB /SPA 3.00
WATER HEATER 3.00
FLOOR DRAIN . 3.00
GAS PIPING OUT.
(MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER
WATER SOFTENER 5
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
PLEASE COMPLETE THIS PORTION FOR ALL COMMCIWINDUSTRIAL BUILDINGS AND
MULTI= FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT FOR EACH
DWELLING UNIT.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES — TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
'9.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
RE:
Secretary, Building Inspections Dept.
AUG 22, 1991
DATE:
4159 COUNTRYSIDE DR (BASIC BUILDERS INC)
IK
Your Sewer & Water Permit for the above property has been completed. It will be held at the
Pbilie+4Vorks Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CL PUBLIC WORKS (454 -5220) FOR YOUR PERMANENT WATER TURN ON
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors — 454 -8100) before issuance.
PERMITi
13 PI EI
B: P. RECEI
GE RYA
14 4 ` S ROSERT TR
R
YS1DR11&IV
COUNTRY RO
ZIP y
P IEOUE.
SEWER :F)ATE
COMMAND
N EW
t awn Sprinkler Meters are to °1
Ahead of Domestic Mete on
.,, dit WILL NOT
T .C •' 1f~WITH+
A
NATURE #IEN METE IS 3
LEASE ALLOW TWO VybRlttl G D YS 4
ER TS, CONT ENGIN
� IN F
Parcel Files Cover Sheet
Unique ID: 4016
4159 Countryside Dr
101827607002
Receipt #
Date ABU ST 19
BUILDING PERMIT
To be used for
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN
PHONE: 454 -8100
Est. Value
$123,0
2 Sec /Sub =MT HOLLOW
214);
Site Address 4
Lot 7 Block
Parcel No
W
3
0
z
101 SW*
Name
Address 1811 W NINNI*AN ANN
City IT PAUL Phone 646
Name BAS1C IVILDNIS INC
A&fress 2810 143TH 8T ii
City 11092340ifirt Phone 423• - 3114
Name
Address
City Phone
I hereby acknowlege that I have read this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota Statutes angCity of Eagan Ordinances. f
Signature of Permitee V1," '
A Building Permit is issueti.tb• WtSig SUILININS INC
on the express condition that all work shall be done in accordance with all
applicable State of Minnesottatutes and City of Eagan Ordinances.
Building Official ✓`"" "'; 4
APPROVALS
Planner
Council
Bldg. Off.
Variance
OFFICE .U$E;O
Occupancy g`f�"'
Zoning 11"1
(Actual) Const ire Bldg. Permit
(Allowable) V Surcharge
# of Stories
Length. Plan Review
Depth 35
S.F. Total
S.F. Footprints
On Site Sewage
On Site Well
MWCC System U
City Water U
PRV Required n
Booster Pump
SAC, City
SAC, MCWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI
Road Unit
Park Ded.
Copies
TOTAL
I Pr. Disp.
I Well
Deck Final I
Deck Ftg.
I Bldg. Final
I Engr. /Plan
Const. Meter'
I Final Plbg. A
I Orstat Test
I Final Htg.
I Fireplace
I Isul.
I Rough Htg.
I Rough Plbg.
I Roofing
I Framing
I Foundation J
Footings I
I Inspection Date 1
m = r m
m y C rn- 0 co 33 33
n 0
.0
I,5- ?'
1 7 / 2 0/ _)
P. /9/
rU
I9-1/]
I �/ 7 / ?L
2--sr
iuu
il
i
I Permit No.
gel
Insp.
1 1 Permit Holder
Plbg. Inspector — Notify Plumber
L. ^7\
■ �
■
ls
!tiY1[' Cf IhSb/ I Q I/C - 0 ut -
Comments
1111
Date
I �3 //,4/1
403- i /6/
Telephone # I
INSPECTION TYPE
DATE
INSPTR.
INSPECTION TYPE
DATE
INSPTR.
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
PERMIT SUBTYPE:
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
3'3 / I
TYPE OF WORK:
Pr. Disp. l
Well
Deck Final
Deck Ftg.
Bldg. Final
Engr. /Plan
Const. Meter
Final Plbg.
Orsat Test
Final Htg.
Fireplace
Isul.
Rough Htg.
Rough Plbg.
Roofing
Framing
Foundation
Footings I
Inspection Date
M m S 10 fn
M m D C
� � n
xi xi W
n n Z
G)
W
wl
Permit No.
b
Insp.
Je1 Uwaed
Plbg. Inspector — Notify Plumber
Comments
Date
Telephone #
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PERMIT
City of Eagan Permit Type:Building
Permit Number:EA129543
Date Issued:02/20/2015
Permit Category:ePermit
Site Address: 4159 Countryside Dr
Lot:7 Block: 2 Addition: Country Hollow 2nd
PID:10-18276-02-070
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 -
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 by law in ALL single family homes .
Valuation: 500.00
Fee Summary:BL - Base Fee $500 $40.00 0801.4085
Surcharge - Based on Valuation $500 $0.50 9001.2195
$40.50 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 -
Robert G Felter
4159 Countryside Dr
Eagan MN 55122
(651) 686-6755
Champion Window Company Of Mpls
5100 HWY 169 N, #B
New Hope MN 55428
(763) 574-2054
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA146009
Date Issued:10/04/2017
Permit Category:ePermit
Site Address: 4159 Countryside Dr
Lot:7 Block: 2 Addition: Country Hollow 2nd
PID:10-18276-02-070
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:Does not include skylight(s)
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Robert G Felter
4159 Countryside Dr
Eagan MN 55122
(651) 717-8629
Builders & Remodelers Inc
3517 Hennepin Ave S
Minneapolis MN 55408-3830
(612) 827-5481
Applicant/Permitee: Signature Issued By: Signature