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4162 Countryside Dr"vs. antoc*r°'Ilr'' i*ri '•. _. - rte... - BUILDING PERMIT To be used for SF '0 /GAB CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 Est. Value $15611000 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 of Eagan Ordinances. Signature of Permitee A Building Permit is issued to 1 - ^ 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. 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 APPROVALS Planner Council Bldg. Off. Variance OFFICE USE ONLY 1h -1 FEES V11 Bldg. Permit Yfi Surcharge 1 ''0 Receipt # Date JUNE 25 19 91 Site Address 4162 WUNTRYS1DE DRIVE Lot Block 1 Sec /Sub COUNTRY HOLL.t Parcel No 2ND w 0 0 0 iO o� U,1 CC w w U a W Name JOSEPH M MILLER CONST Address 18133 CEDAR AVE S City !ARM1. N RITON Phone 431 -2001 Name Address City Phone Name Address City Phone 20_ Plan Review 54- SAC, City SAC, MCWCC Water Conn Water Meter XX- Acct. Deposit S/W Permit S/W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL 836.00 78.00 543.00 100.00 650.00 660.00 9.5.00 30.00 30.00 .50 276.00 370.00 $3,668.50 m = a CO m < C m a m m DO m 0 m v z xi t 1 t. 0 CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681 -4675 SITE ADDRESS: PERMIT SUBTYPE: INSPECTION RECORD APPLICANT: PERMIT TYPE: Permit Number: Date Issued: TYPE OF WORK: INSPECTION TYPE DATE INSPTR. INSPECTION TYPE DATE INSPTR. PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA139923 Date Issued:11/15/2016 Permit Category:ePermit Site Address: 4162 Countryside Dr Lot:3 Block: 1 Addition: Country Hollow 2nd PID:10-18276-01-030 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 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 - Harold C Mueller 4162 Countryside Dr Eagan MN 55123 (651) 245-5011 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature Pr. Disp. 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 > c C) 00 70 Z Z n 0 o/9y I Permit No. Insp. I Permit Holder Plbg. Inspector — Notify Plumber Comments Date 1 Telephone # CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681 -4675 SITE ADDRESS: PERMIT SUBTYPE: INSPECTION TYPE DATE INSPTR. INSPECTION TYPE DATE INSPTR. L INSPECTION RECORD APPLICANT: PERMIT TYPE: Permit Number: Date Issued: TYPE OF WORK: Pr. Disp. 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 z m CD m m > c H - C) 37 1 OD 5 5 C Permit No. Insp. 1 Permit Holder Plbg. Inspector - Notify Plumber Comments Date Telephone # 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 CO ' 1J C,C • c a APPLICANT STREET ADDRESS TELEPHONE # PROPERTY OWNER .1 C j TN\Q- €.1,1`0( Energy Code Category (Al submission type) Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer /Water Contractor: RESIDEN1IAL BUILDING PERM APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651 - 681 -4675 q)- t SA (\03 op-e_ >n i RMA HOME SERVICES INC. Home Depot Installed Sales 3200 Cobb Galleria Pkwy., Ste. #200 Atlanta, GA 30339 ( 763 -542 -8826 BC- 20268257 MINNESOTA RULES 7670 CATEGORY 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Water Softener Lawn Sprinkler Water Heater No. of Baths Air Conditioning Heat Recovery System I hereby acknowledge that I have read this application, state that the inf with all applicable State of Minnesota Statutes and City of Eagan Ordi Signature of Applicant 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 0 VALUATION 7 , Ouu SITE ADDRESS t i Iti) C.UU+f1 K1 S;CI � MULTI- FAMILY BLDG _ Y N TYPE OF WORK ►`r�>EJ` O�„C�2 �tj; �nC�cL - W �~ ni K1 FIREPLACE(S) _ 0 _ 1 2 COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Phone # No. of R.I. Baths STATE ZIP FAX# TELEPHONE # 661 (093 2 • 1 331 Phone # MINNESOTA RULES 7672 • New Energy Code Worksheet Submitted Not Required _ Fee: $90.00 Fee: $70.00 Phone # mation is correct, and agree to comply nces. Updated 4/02 Installed Siding and VinTgallOWER OF ATTORNEY OUNTY OF COBB STATE OF GEORGIA KNOW ALL PEOPLE BY THESE PRESENTS: THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania ( "Principal "), and a licensed contractor of RMA Home Services, Inc., DBA Home Depot Installed Sales located at 660 Mendelssohn Avenue North, Golden Valley, MN 55427, having a license number of BC- 20268257, do hereby appoint, name and constitute Elder -Jones Building Permit Service, Inc. ( "Agent ") as my true and lawful attorney -in -fact and do authorize and grant said attorney -in -fact for me and in my name, place and stead the power to execute, acknowledge, sign and deliver (in such form as may be required by the municipality) a permit application, or any other instrument(s) which may be necessary and appropriate, in order to obtain the proper permit(s) from- the City of Eagan, Minnesota for the installation, maintenance and repair of windows and siding (the "Work "). The powers conveyed to the Agent by this Limited Power of Attorney are limited solely to the express powers delineated herein and apply solely to the Work. This Limited Power of Attorney shall expire and automatically be revoked on the 30 day of May, 2003, which date is one year from the execution hereof. Further, the powers conveyed by this Limited Power of Attorney may be revoked by Principal at any time by express revocation and shall also be revoked by the Principal's death, disability, incapacity or incompetence. IN WITNESS WHEREOF this Limited Power of Attorney is executed this 30" day of tV111 , 2002. David . z SWORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this 30 day of May, Notary blic in for the Stat of _ eorgia My Commission Expires: January 21, 2006 396816.v3 Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779 -1300 • Fax (770) 984 -0709 • Toll free (800) 79 -DEPOT 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 (bidgs with 3 or less units) DATE \ PROPERTY OWNER Energy Code Category of submission type) Plumbing Contractor: Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer /Water Contractor: RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EACAN MN 55122 651 - 681 -4675 - MINNESOTA RULES 7670 CATEGORY 1 • Residential Ventilation Category 1 Worksheet Submitted • Energy Envelope Calculations Submitted Water Softener Water Heater No. of Baths Air Conditioning Heat Recovery System 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 2` S `-- SITE ADDRESS 4\ MULTI- FAMILY BLDG _ Y FIREPLACE TYPE OF WORK \ (S)'0 _ 1 _ 2 APPLICANT Catastrophe Restoration Servic's Inc. STREET ADDRESS 2489 Rice St Suite 70 TELEPHONE # 651 - 734 - 9433 CELL PHONE # FAX # 651 -483 -0219 CITY Roseville STATE MN ZIP F5113 COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Phone # Lawn Sprinkler No. of R.I. Baths 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 Phone # Phone # TELEPHONE # MINNESOTA RULES 7672 • New Energy Code Worksheet Submitted Not Required _ Fee: $70.00 Updated 4/02 SEPTIC SYSTEM, new /refurbished (requires two sets of plans and MPC license) includes $40.00 County fee Note: Additional consultant fees may apply $ 100.00 • MODIFICATION /ALTERATION TO EXISTING DWELLING UNIT, INCLUDING: $ 50.00 _ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. Abandonment of septic system. _ Water turnaround - existing dwelling unit (+ 5/8" meter if needed - $118) Other: — RPZ: new installation /repair /rebuild lawn irrigation system $ 30.00 Replacement/additional: _ water softener L- water heater $ 15.00 State Surcharge $ .50 Total $ /5 5 PERMIT # Please complete for: SITE ADDRESS: OWNER NAME: : 2002 RESIDENTIAL PLUMBIN6t PERMIT APPLICATION CITY OF EAsAv 3830 PILOT KNOB RD EAGAN, MN 5518E 651 -681 -4675 ie; ath 0 single family dwellings, townhomes and condos when permits are required for backflow preventer for irrigation system INSTALLER NAME: STREET ADDRESS: CITY: ' % _ ' ' STATE: RECEIPT DATE: TELEPHONE #: l h (AREA CODE) ELEPHONE #: 1 ' 1,�� (AREA CODE) 1 (_J hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liabili for any damages caused b operational and maintenance activities to the facilities constructed under this permit within City pr p rty /right -of- way /easeme /,i21 ,l SIGNATURE PERMIT1'E ZIP: j),-)U lL - 6 ityof Eagan ordinances. It the City during its normal f j U`) 1/02 CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681 -4675 SITE ADDRESS: REMARKS: FEE SUMMARY: Base Fee Surcharge Total Fee APPLICANT /PERMITE IGNATURE PERMIT 4162 COUNTRYSIDE DR LOT: 3 BLOCK: 1 COUNTRY HOLLOW 2ND P.I.N.: 10-- 18276- 030 -01 DESCRIPTION: (GAS) Permit Type rk Type $25.00 $.50 $25.50 ci CONTRACTOR: — Applicant — ST. LIC. FIREPLACE SPECIALIST 14511970 0003924 1200 9TH AVE S ST PAUL MN 55075 (612) 451 -1970 PERMIT TYPE: Permit Number: Date Issued: FIREPLACE NEW oi g n OWNER: MUELLER 4162 EAGAN (612)686 -9884 BUILDING 025164 02/23/95 HARRY COUNTRYSIDE DR MN 55121 2.511.4 DATE: 3 -cis CITY OF EAGAN 3830 PILOT KNOB RD • 55122 1995 FIREPLACE PERMIT APPLICATION 681 -4675 DESCRIPTION OF WORK INSTALL NEW FIREPLACE: - WOOD BURNING GAS INSTALL GAS LOG ONLY IN EXISTING FIREPLACE _ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE OTHER AREA TO BE INSTALLED IN: STREET ADDRESS: y) C cur,' ,S i cL LOT .3 BLOCK / SUBD. /P:I.D. #: CAM dn� 0 PROPERTY OWNER CONTRACTOR APPLICANT: (circle one only) OWNER 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. Name: XQJ 6.-j LAST Signature: Street Address 4 c, Cn City: &- P t FIREPLACE Company: INSTALLER Signature: Street Address: ),oc City: S . S" PGA or r Phone #: 6 C FIRST tv- r State: Zip: 5S- / 21 q k S(mac %v 1s Phone #: License #: State: v Zip5S 6`7 GAS LINE Company: Phone # INSTALLER Name: Signature: Street Address City: State: Zip: CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681 -4675 REMARKS: FEE SUMMARY: Base Fee Surcharge Subtotal $25.00 $.50 $25.50 COPIES Total Fee OWNER: _, Applicant MUELLER HAROLD 4162 COUNTRYSIDE DR EAGAN MN 55123 (612)459 -1158 $1.00' $26.50 SITE ADDRESS: P.I.N.: 10- 18276 -0 DESCRIPTION: PPLICANT /PERMITEE SIGNATURE PERMIT 4162 COUNTRYSIDE DR LOT: 3 BLOCK: COUNTRY HOLLOW 2ND PERMIT TYPE: Permit Number: Date Issued: BUILDING 021610 08/05/93 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 issued. Date j ue . Z N / Valuatio of work ( Site Address: Tenant Name: f, (t Cc' Limit e . STREET (commercial only) 7 SUITE LOT BLOCK h-� i �3� Ls / t' C ti P.I.D. 0 Description of work: bc-4- The applicant is: PtkOwner • Contractor • Other (Describe) Property Owner Name /OM A. -� Phone LAST FIRST tf — (i S K i Address ( S' STREET STE # Ci ty S G State c\ Zip S S / 23 Contractor Company b')1 ' Phone Address License # Exp. City State Zip Architect/ Engineer Company Phone Name Registration # Address City State Zip Sewer & water licensed plumber sewer & water permits is two . Processing_ time for days once area has been approved. I hereby acknowledge correct and agree Eagan Ordinances. Signature of that I ha e read this application a• state that the information is to comply wi h all applicabl State o /Minnesota Statutes and City of ' Applicant: .5"1-4 REACTIVATE PMMIT 2410 CITY OF EAGAN 1993 BUILDING PERMIT APPLICATION 681 -4675 BUILDING PERMIT TYPE ❑ 0I Foundation ❑ 02 SF Dwg. ❑ 03 SF Addition ❑ 04 SF Porch ❑ 05 SF Misc. WORK TYPE 14,31 New 32 Addition GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy R -3 Zoning # of Stories Length Depth 1 ' APPROVALS Planning Engineering REQUIRED INSPECTIONS ❑ Site ❑ Wallboard ❑ 06 Duplex ❑ 07 4 - Plex ❑ 08 8 -Plex ❑ 09 12 -Plex ❑ 10 Multi. Addl. ❑ 33 Alterations ❑ 34 Repair p. Footing St Final OFFICE USE ONLY Basement sq. ft. 1st F1. sq. ft. 2nd F1. sq. ft. Sq. Ft. total Footprint Sq. ft. On -site well On -site sewage Building Variance ❑ 11 Apt. /Lodging ❑ 12 Multi. Misc. ❑ 13 Garage /Accessory ❑ 14 Fireplace 5C 15 Deck ❑ 35 Tenant Finish ❑ 36 Move ❑ Framing ❑ Draintile Assessments 1 - 16►BasementAinish ❑ 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 y7y ❑ Insulation ❑ Fireplace Permit Fee Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trails Ded. Copies Other Total: SAC % SAC Units Valuation: * PIONEER engi* eering P i c.r,eer En a i r i n� LAND SURVEYORS• MIL ENGINEERS LAND PLANNefts • L*NOJCAPE ARCr4ITEC1 Certificate of Survey for: JOE • / e1 l L L Eg I7 O! "1 E ..9o0.0 Denotes Exisfin¢ Elevation Pro os4o HOUSE ELEVATION , 41 - 0707 o Denotes larop° ed Elevation lowe'f Floor Elevafioo 6.3,s - - Denotes Drama e E Wilily Easement Top ar Block E /evoti on a B 1, 3 — }- --�- Denales Darin Oi Floor Direction Gars e Slab £/evatiorr s • . o Denotes Monument 8earin s shown at assumed o D es c et h(ub LOT 3 , BLOCK / CDCIN f Y 1;101-LOW SEC'A L) ADD',A z�A orA CO(JNTY, MINNESOTA I hereby certify that this survey, plan or report was pr, *red by me r under my direct supervision a at I am duly fl : 'stared (.and Surveyor under the laws of the State of Minnesota, Dated this day of _ A D 19 It ' ? 4 RG/ / :1 t 9/253 �1.p0r7,Pr _ • N WY' 5s 015"C 6E:19488 c � R se 6 . 51 IC L.S. REQ. O. 146 ?t 2422 Enterprise Drive Mendota Heights, MN 55120 (612) 681 -1914 P.0 NORTH SINGLE FAMILY DWELLINGS 2 SETS OF PLANS 3 REGISTERED SITE SURVEYS 1 SET OF ENERGY CALCULATIONS PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY OF MONTH IN WHICH REQUEST IS MADE. LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED. NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED. PERMIT MUST SHOW A LICENSED PLUMBER. To Be Used For: new home Site Address 3 Lot Parcel /Sub Country Hollow 2nd Owner Address City /Zip Code Phone Contractor Joseph M. Miller Const Address 18133 Cedar Av S City /Zip Code Farmington. Mn 55024 Phone 431 -2001 Arch. /Engr. Address City /Zip Code Phone # Block 4162 Countryside Dr 1 (Signature of Contractor),, 1991 BU A ICA N CITY OF EAGAN LDI PERMIT MULTIPLE DWELLINGS COMMERCIAL 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL REGISTERED SITE SURVEYS - & STRUCTURAL PLANS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS 1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS # OF RENTAL UNITS # OF FOR SALE UNITS Valuation: Date: June 19,1991 Occupancy Zoning Actual Const Allowable # of stories Length Depth S.F. Total Footprint S.F. On site sewage On site well MWCC System V City water PRV Booster Pump APPROVALS Planner Council Bldg. Off. Variance OFFICE USE ONLY 70' 5 FEES Bldg. Permit Surcharge 76',0: Plan Review 54/3, ct SAC, City /Oa, SAC, MWCC 4 "0."' Water Conn. b '` Water Meter Acct. Deposit SUBTOTAL Penalty Lot Change TOTAL ra' S/w Permit S/W Surcharge , S c, Treatment P1. :.' ")6,� Road Unit " 9 r�, Park Ded. Trail Ded. Copies S agrees that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. SF DWG /GAR 3; 2 BUILDING PERMIT To be used for Signature of Permitee Building Address CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 B uilding of iiaaL ; Est. Value I hereby acknowlege that I have read this application and state that the information is correct and agree to comply with 24 applicable State of Minnesota Statutes and Ci pf Eagan Ordinance.4. ' Site Address 4162 COUNTRYSIDE DRIVE Lot 3 Block 1 Sec /Sub COUNTRY HOLLOW Parcel No 2ND cc z 0 2 00 Ua cc U w w z U Z x a Name JOSEPH M MILLER CONST Address 18133 CEDAR AVE S City FARMINGTON Phone 431 -2001 Name SAME Address City Phone Name Address City Phone $156,000 A Building Permit is issued to OSEPH M MILLER CONST on the express condition that all w rk shall be done in accordance with all applicable State of Minnesotaptatutes and Cit f Eagan Ordinances. Building Official 1L a C f 11rrtifiratr of (orrupattrq QCitp of Cagan f rpzrtnwut of Nuithing Atom tiun Date POST IN A CONSPICUOUS PLACE N°_ 19330 Receipt # ( / ( F. (7 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 APPROVALS Planner Council Bldg. Off. Variance Date JUNE 25 19 91 OFFICE USE ONLY R -3, M -1 FEES R -1 Vn 11 70 5/' XX XX XX 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 Oass4 cation SF DWG /GAR slag. Permit No. 19330 occupancy—rm. R3/1111 Zonin District R1 T Ct VN Owner of Buildiog josaflum Kum 90NST Address 18133 MAR AVE S, FA I TITTT 4162 TU1'TL'RYSIDE DRIVE co�tay L3, B1, 0JUNNY ROLLOd 2ND 9/23/91 Bldg. Permit • 836.00 78.00 Surcharge Plan Review SAC, City SAC, MCWCC Water Conn Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI Road Unit Park Ded. Copies TOTAL 543.00 100.00 650.00 660.00 95.00 30.00 30.00 .50 276.00 370.00 ,3,668.4^ 1 * PIONEER engineer " Certificate of Survey for: J L7 M 1L L4011 coo r 0../ g r; $"cal :1ima= LAND SURVEYORS• CIVIL ENQjiiNE£R$ LAND PLANNERS • L} NAPE ARCHITECTS P i oneer Ena Weer 68194 ,1.0v N 69° 55 5' o,g' 4 .3 1 w y C N 0 z N 1 2422 Enterprise Drive Mendota Heights, MN 55120 (612) 681 -1814 f 1 NORTH • P FOL .900.0 Denotes Exisfini E•le valron PRoPos ,Co Houss ELEV . Derrvfes /arum ed Eleva/ion tows loor EI va /0f' B /3,$ - - -� -- Denotes L7rainc,,e i Ufilify Easement TOp or Block Elevation e sr.3 --}- — Deno/es Drain Oe' rlot4 r Direcfion Gcxra Slab Elevation a”,.'2, Denotes Monument Bearings shown c r e ossumet/ o Deep es o/ Pei !-fib LOT 3 BLOCK 1 , of N� foLL0W SECOND AO.D t�AxoTA cowry, MINNESOTA 1 hereby certify that this survey, plan or report was pr *red by me r under my direct supervision a at I am duly Re..'ster Land Surve or wider the laws of the State of Minnesota, Dated this IF j clay of A D 19 q j !' y , P. 8 Owner Site Address L. Contractor �. ' ` ' �{l 1 G _ (9 y�) Phone . Building Classification: Type Al (Single Family & Duplex) Type A2 (Residential, 3 stories or less) (Over 3 jOT: Complete :aaaes 3 and 4 first. GENERAL INFORMATION 1. Building Perimeter 2. Wall height (ground to 3. 1. X 2. (above) gross wall 4. Building dimensions (L) 5. Sq. foot area of rim joist 6. Doors - Area I 10 Thicknes Type of Construction Manufacturer ft. ti 8. Windows: Manufacturer 'Wilt. C - - State approved U factor 7. Total door's perimeter TYPE BASED ON CHAPTER 5 OF THE MQDEL JIJRGY CODE - - -- -1 983 ED TLQN Adoption Effective ft. eave) H ft. area '295',#'24) I sq.ft. X (W)__ -_= i sq.ft.roaf & floor area - Floor jo st size (2 X) ,_ X (Perimeter)• 12 in U. factor SIZE AREA (Sq.Ft.) NUMBER OF UNITS v► EACH 9. Total sq.ft. Glass 41 10. Fireplace area: Width X Height = X _ = sq.ft. 11. Exposed foundation: Height X Perimeter, ✓4 x (77 = A sq.ft. COMPLETION OF THIS FORM IS REQUIRED FOR ALL NEW CONSTRUCTION, MAJOR REMODELING AND BUILDINGS BEING MOVED WHERE ENERGY, OTHER THAN THE MINIMAL CODE ALLOWANCE, IS USED. Phone 4 *,4 Perimeter Date stories) (Other) ft. TOTAL SQ FEET Address: 4162 COUNTRYSIDE DRIVE Lot 3 Blk 1 Sec /Sub COUNTRY HOLLOW 2ND These items were /were not complete at the time of the final inspection. 9/23/91 Yes No Final grade (6" from siding) 1. Permanent steps - garage ✓ Permanent steps - main entry Y - Permanent driveway V Permanent gas ,..,/'" Sod /seeded grass t„/ Trail /curb damage Porch Basement finish t.r Deck L/ 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 otential exists. Js p A: RECYCLED PAPER White - City copy Yellow - Resident copy Pink - Contractor copy 12. Fxaming area = 10% gross wall area. 13. Gross wall' area sq.ft. Window area A 410t6 sq. ft. Rim joist area A 14 sq.ft. Door area A 56 sq.ft. Other doors area A.. M' _sq, ft. Exposed fndn A 144f sq.ft. Framing area A,:3OI l 1 \ fl) sq.ft. 1 Oe Net wall area A ft. 15C. Net ceiling U ceiling x A c u framing x A f = 15D. TOTAL U x A 16. Ceiling area (15A) x = allowable UxA /Code x } P� A(15A)y l.� x U Code Date (138) TOTAL 14. Gross wall area x 0.11 (A -1 single family & duplex) = allowable UxA /Code (13. above) x 0.23 (A -2 other residential) x .23 (Other buildings) x .28 (Over 3 stories) BTUH must be larger than or same Ai x U Code 01\ _ 5" I/ 0 F. as 138 above 15. Ceiling framing area (A equals 10% of ceiling area 15A. Gross ceiling area = (L) `�` _ x (W) sq.ft. // 158. Joist area (A = 10% ceiling area = 159 sq.ft. area (A (15A - 158) _ 14 / sq.ft. - 6 /4 414 �4?Z. x 5 U windows = $ U rim joist = U door area = U other doors= U foundation= • 01 U framing area = + U wall= +e Signature UxA = 1411 UxA = co «02 UxA =. 1 UxA = A UxA = p UxA = + UxA = Ux 0.026 (A -1 single family & duplex) 0.033 (A -2 other residential) 0.06 (other j BTUH must be larger than or same r 0 F. as 15D above NOTE: Use U and A values obtained from pages 1, 3 and 4. cERTIFICATIQ1[: 1 hereby certify that I have calculated the "U" factors and "R " values herein and that the building here described meets or exceeds the State of Minnesota Energy Conservation Act. Request Date 8 -6 -91 Power st/(KOTA ELECTRIC, ASSO Authorized Si re (Contra Township Name or No. ough -in Inspection Required " des G No + contractor owner hereby request inspection of above electrical work at: Job Addre siSyeet, COUNTRYSIDE IDE DRIVE Occupant (PBIN CONSTRUCTION Electrical kfiff°A5.,p2LtRIC , INC . Contractor's Licensee No Mailin Ad/ nl1onia4tj , APPLE VALLEY, MN 55124 ner Section No • Range No. ❑ Ready Now QlALiff Notify Inspector When Ready? City EAGAN County DAKOTA Phone No. 612 431 -2001 Address FARMINGTON, MN 8/3/ 9/ 1 31780 MINNESOTA STATE BOARD OF ELECTRIC Griggs- Midway Bldg. — Room S -173 1821 University Ave., St. Paul. MN 55104 Phone (612) 642 -0800 OFFICE USE ONLY This request void 18 months from REQUEST FOR ELECTRICAL INSPECTION I► See instructions for completing this forrn on back of yellow copy. X" Below Work Covered by This Request 00 • Phone Number 61 432 -6688 THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED Apt. Building Comm. /Industrial Other (specify) Contractor's Remarks: Other Swimming Pool Transformers Signs Irrigation Booms Special Inspection Alarm /Communication Other Fee I, the Electrical Inspector, hereby certify that the above inspection has been made. r Conditioner Inspector's Use Only: THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 M(ARHS, f Rough -in 0 to 100 Amps TOTAL 3. 5 0 to 200 Amps Above 200 Amps Equipment Wired Temporary Service Electric Heating Other (Specify) Circuits /Feeders Above 100 Amps c,92•AD 5i ox 14) = loto - rn 7,4x( (M 3-f. 3 loe„j(„1221e2Y-____ e'q/ I Z-c Iii 01-)047. ktt. )4s'71..111251 141705 IU Itektb (1,0x4 %7 t, Or7,1 _11 1 - 4 I<VO".„:7 4 11 Zoi SiXV 73./45. 11 t4 „ bo, . Ki1 5eP (0 0 - km 0 Pi _,V4e) tb &7e 41 4 2, • \do, WALL. ' SECTION STUD SECTION RIH JOIST 4 ...••••••"' inside alt film Interior wall, Insulation ' Sheathing Siding Outalde air film R TOTAL • .68 . 45 1 Wall) U 4 Pi.c Lou, Biotic c Inside.air film 1 .68 Interior wall .45 • 4" stud R2 .4r4V (FritMin Sheathing Siding Outside air film ' .17 R TOTAL interior air (Lim . col . .17 c:) 11. 00 Rd .68 3. • Interior wall insulation all ) U 00 xterior wall cover n Exterior air. fLlm R R TOTAL Interior air Rm .68 insulation Inch soft wood RA1.88 Sheathing .062 Exterior yap covering '(.il Exterior air Iitm R .17 ToTAL 2-4 6, 1 1 (Rim u.g. Joist) .041A ,Insulation 11, ' 1 Fbundition It"' ' trdn.) u a k = Exterior ali film RA .17 • 0 —.===zz Ub 12" concrete block no insulation Ub 12" concrete block insulated cores = Ub 12" lightweight block Ub 12" lightweight block insulated cores = U single glass = 1.13; with storm window .54 U double glass = .55 U triple glass = .41 All exterior walls and ceilings must have a vapor Vapor barrier must be on the inside (heated side) Vapor barriers of the polyethelens thin film have R VALUE FRAMING 0.61 AirFilm, '• 0 Insulation, i V//7-------- 4.38 Joist 1111111 di , dill ceiling A IPIIIIIIIIIIIIII1II 0.5s ing 0 AirFilm 0.61 i ill 42 ,16 TotaiR 4 49 re R VALUE CEILING 9�1 4 . a �- p = 1 /R, Window infiltration 0.5 cfm /lineal foot of crack Residential door infiltration 0.5 cfm /square foot or door and minimum code requirement Non - residential door infiltration 11.0 cfm /lineal foot of crack • .47 R 2.1 .26 R 3.8 .32 R 3.1 .12 R 8.3 barrier (0.10 perm max.). of wall. no R value. WORK DEESCRIPTION NEW CONST ADD ON REPAIR OWNER NAME: ;� U 1 \ ' \\"9..A \ d11 SITE ADDRESS : ADDRESS : ° 1 1 INSTALLER: FOR: CONTRACT PRICE: CITY OF EAGAN CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122 PHONE: (612) 454-8100 PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY TOWNHOMES /CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. LOT: d- BLOCK / SUBD. t_. J c' ZIP: SCa a TOTAL: FOR CITY USE ONLY PERMIT # RECEIPT # D / r 7 DATE: jot/ / DWELLINGS 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: .50 DUST 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. FEES OWNER NAME: 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: STATE SURCHARGE. CITY: ZIP: PHONE #: CONTRACT PRICE x 1% (SIGNATURE) LERPENT WORK DESCRIPTION NEW CONST _°" ADD ON REPAIR OWNER NAME: JOE MILLER CONSTRUCTION CO. INC. SITE ADDRESS: I/I S d, _ y ,..x�c�`- k LOT: 3 BLOCK / SUBD. - r)u INSTALLER: GENZ -RYAN PLUMBING & HE TING CO. ADDRESS: 14745 South Robert Trail CITY: Rosemount, MN ZIP: 55068 F= :ONE #: (612) 423 -1144 PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS TOWNHOMES /CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. SIGNATURE OF PEMITTEE CITY OF EAGAN 3830 PILOT KNOB ROAD EAGAN, MN 55122 PHONE: (612) 454 -8100 NAM CONTRACT PRICE: OWNER NAME: SITE ADDRESS: LOT: BLOCK SUBD. INSTALLER• ADDRESS: CITY ZIP: PHONE #: FOR: CITY OF EAGAN TOTAL: NO. .3 77 $25.00 MINIMUM FEE. CONTRACT PRICE x 1% STATE SURCHARGE FOR CITY USE ONLY PERMIT # RECEIPT # 2) I '2 S DATE: 6 / c2 / / COMPLETE THE FOLLOWING: FIXTURES EA. 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) ROUGH OPENINGS OTHER WATER SOFTENER PRIVATE DISP. U.G. SPRINKLER SUBTOTAL ST. SURCHARGE TOTAL: FEES 1% OF CONTRACT FEE. STATE SURCHARGE — $.50 FOR EACH $1,000 OF PERMIT FEE. (SIGNATURE) 15.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 3.00 6 TOTAL / 7777 3 3.00 3 ` II) 1.50 5.00 15.00 3.00 5 .50 tIISTRIAI' PLEASE COMPLETE THIS PORTION FOR. ALL COMMERCIAL /INDUSTRIAL BUILDINGS AND MULTI- FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. our' Sewer & Water Plamitt for eve 'Public Works Garage (3501 a . an F CALL PUBLIC WORKS (454 Your Sewer & ,Water .per riri for reasons: Your Sewer & Water Permit for the aboveProPerty above has been co be issued +art occ panty allowed until further not . ,, CI?NLM RGIAL. PF : Ple pay confirmed Bill Adams.or Dirk House (P fnspe Afilillfs}(; BEFORE D GG1NG, CALI LOCAL U REOUIRED BY LAW. ti ACT CO t1t47Y DEP Secretary, Buiidingispections De SITE ADDRESS 4162 Countryside Dr LOT —3—BLOCK 1 SEC/SUB Country Hollow 2nd SEWER , &WATER PERMIT CITY OF'EAGAN X 30 Kn6b Rd. Eagan, 55122 -1897 DATE June 1' 1991 APPLICANT: J p h 14 . .. ; � s i 1 A ADDRESS: 18133 Cedar A.v CITY, STATE Farmington, .Mn PHONE: X31 -2001 C ► T t OFFS $ E` ONL METER #4 9i0' PERMITDATE 06/27/91 CHIP # 0 / 4 ! . a &' 5 PERMIT # 12° METER SIZE S 5*. B P RECEIPT # C 1 ISSUE MATE' } 1 i(' x/ B P RECEIPT DATE 06/27/91 X ° PRV BOOSTER PUMP ZIP 5 5 t#!4 ZIP 6 PERMIT REQUESTED X X SEWER WATER TAP COMM/IND x RESIDENTI�A NEW EXISTING Lawn Sprinkler` °Meters are to be Instafle Ahead of Dornestio Meters on Water LiN' Credit L NOT be`gO#/en.for t I AGR EAQA 0 fi E GNATURE t RISSU L k 454 -5220' FOR INSPECTIONS. FOR nk' J PLUMBER: rA y ti ADDRESS: 14745 R _ Robert Pr CITY, STATItto s e xno u n t, I n PHONE: 423 -1144 OWNER: ADDRESS: CITY, STATE ZIP PHONE: PL E3CkA'L LCW TVfX4 WORK DAYS FOR PR SEWER PERMITS, CONTACT ENGINEERING DEPT. TORM 954870 COUNTRY HOLLOW SECOND ADDITION PRESSURE REDUCING VALVE AGREEMENT This agreement, made and entered into the c7? S/ day of ( f, f wit.- c -,ZL- , 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, Biock 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. Block provide Recording. County Recorder and Lots 1 -17, execute recording of this agreement. This agreement shall be recorded with the Dakota so as to provide notice to the owners of Lots 1 -4, Block 2, and Lots 1 -10, Biock 3. The Owner shall any and all documents necessary to implement the 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 EWN OWNER AND DEVELOPER: (Date: PROGRESS LAND COMPANY, INC. Thomas A. By: 1-Ar961 .;, neArt,fc•) Its: Mayor Its: POCSiL '1/ Attest : . J. VanOverbeke Its: erk By: Its' STATE OF MINNESOTA ) COUNTY OF DAKOTA ) On this o' /-S% day of ,,2 ate', 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. • iv signed an Board of - nd-- free act and ss. Ha,tre>scrflNN• _ , E, • . ... STATE OF MINNESOTA ) ss. COUNTY OF r), ~'t ) On this ' ., day of Public within and fo'r ( ; own, who being rc3pcctivcly` appeared personally thcy Y ‘ niJ foregoing instrument, St said by me duly the of the co 1990, before me a Notary County, personally to me sworn, earl did say that Li j ' ; 1 - t rporation named in the and that said instrument was aer►l on behalf of said corpor ion by authority of its Directors and said rrrS , (1 c4z. t' acknowledged said instrument to be the deed of the corporation. fcrviril Notary Pu APPROVED AS TO FORM: APPROVED AS TO CONTENT: Public Worlfs Department Dated: Avg 6� l ra 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 ï ÿ þñ ÿ þ ÿþþýýþ üÿÿ ûþí ÿ äüùó ë ú ýüûúùø õó á ä üúùø õúùø õó á ô óáî ø ï øü ä ü ä ííãüø ù Ýÿ ýÜü ÷ ïøå ï ì ìï Üü ï û ï é ð ÿóóø ÿ þ ðð ïÿ ø éä ðð ø ð é ä ûïö Üü ûù ó ÿ ð ïùìï é ÷ æÛæééí ÷ü ýüì ÿ ê ü æÛæéé ê ü þé öô úóò øø î ó äòü äüùî äõ íëäüù î å òô ÿ òô èëçëíí ì ûù ó ÿ ì ì å ì øø ì ì ðï ÿ ïøùóì øø û ý ðò ý ü äùð ÿ ã é øø á ï ýÿ ü ü ùýÿ ü ï ÿ þñ ÿ þ ÿþþýýþ üÿÿ ûþí ÿ äüùó ë ú ýüûúùø õó á ä üúùø õúùø õó á ô óáî ø ï øü ä ü ä ííãüø ù Ýÿ ýÜü ÷ ïøå ï ì ìï Üü ï û ï é ð ÿóóø ÿ þ ðð ïÿ ø éä ðð ø ð é ä ûïö Üü ûù ó ÿ ð ïùìï é ÷ æÛæééí ÷ü ýüì ÿ ê ü æÛæéé ê ü þé öô úóò øø î ó äòü äüùî äõ íëäüù î å òô ÿ òô èëçëíí ì ûù ó ÿ ì ì å ì øø ì ì ðï ÿ ïøùóì øø û ý ðò ý ü äùð ÿ ã é øø á ï ýÿ ü ü ùýÿ ü PERMIT City of Eagan Permit Type:Building Permit Number:EA163106 Date Issued:08/17/2020 Permit Category:ePermit Site Address: 4162 Countryside Dr Lot:3 Block: 1 Addition: Country Hollow 2nd PID:10-18276-01-030 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 - Harold C Mueller 4162 Countryside Dr Eagan MN 55123 (651) 245-5011 Pella Northland 15300 25th Ave N #100 Plymouth MN 55447 (763) 745-1400 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA171601 Date Issued:08/23/2021 Permit Category:ePermit Site Address: 4162 Countryside Dr Lot:3 Block: 1 Addition: Country Hollow 2nd PID:10-18276-01-030 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. If water damage is encountered, please call (651) 675-5675 to schedule a site visit to verify the extent of the damage. Any repairs must be inspected prior to covering. The inspector will determine if an additional permit will be required to repair the water damage. 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 - Harold C & Martha L Mueller 4162 Countryside Dr Saint Paul MN 55123--162 (651) 245-5011 Encompass Builders 17754 Icon Trail Lakeville MN 55044 (608) 280-1877 Applicant/Permitee: Signature Issued By: Signature