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4178 Countryside DrParcel Files Cover Sheet Unique ID: 4027 4178 Countryside Dr 101827506001 x w z 0 a Z ° o a U x 1- I- ix U w 111 z 1 U Z x w a BUILDING PERMIT To be used for CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 Est. Value Site Address Lot Block Sec /Sub Parcel No. 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. Signature of Permittee A Building Permit is issued to 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 Receipt # Date ,19 Name Address City Phone Name Address City Phone Name Address City Phone OFFICE USE ONLY On Site Sewage Occupancy MWCC System Zoning On Site. Well (Actual) Const City Water (Allowable) PRV Required * of Stories Booster Pump Length Depth S.F. Total Footprint S.F. APPROVALS FEES Engr. /Assess. Permit Planner Surcharge Council Plan Review Bldg. Off. SAC, City Variance SAC, MWCC Water Conn. Water Meter Road Unit Treatment P1 Parks TOTAL o Permit No. Permit Holder Date Telephone # Plumbing 9 '2, % : _,t7'71,, " , l .._ _ > �1G' -y H.V.A.C. 9,Z,//2 < 'e., •.� ✓' 4 Electric k.Y/ (5'l C r p 4. '1 u , , t / /�e5` cs / °' Softener Inspection Date Insp. Comments Footings I jai /�,G Footings II Foundation Framing 3,94 / © '� Roofing /� to 3 .. ( -og / , Rough Plbg �/i Rough Htg. /y/�f ,p� Isul. / Fireplace �/� / si P4G' ee� t t -c6 Final Htg. 'i0 Final Plbg. fi�2,er 7 /340 - Bldg. Final Cert.Occ. v Z "/ °' Temp. LP 1 c, -/--$' Ftg. .T /V CO /C> - 2/ .g ,k ,ff Deck Final ( - - - W e l l Pr. Disp. CONTRACT PRICE: Site Address 0 Name Addres City rr TYPE OF WORK Forced Air Boiler Unit Healer Air Cond. Vent. Gas Piping Outlets # Other Lot BI o k / Sec /Sub 1. fr , "GI . ` /1 -tt ,� LrZ U ' • Name U(� l f Her/ Address ref j (` ri /7T C i f / /lf • City I Phone fir 9"3 f �!1 Phone MECHANICAL PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE: 454 -8100 �( M BTU $ MBTU $ M BTt_' MBTU - $ CFM 6 BLDG. Res. Mult Comm. Other FEES RES. HVAC 0 -100 M BTU - $24.00 ADDITIONAL 50 M BTU - 6.00 (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) COMM /IND FEE - 1% OF CONTRACT FEE APT. BLDGS. — COMM. RATE APPLIES TOWNHOUSE & CONDOS — RES. RATE APPLIES MINIMUM RESIDENTIAL FEE — ALL ADD -ON & - - REMODELS _ 12.00 MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT .50 (ADD $.50 S/C IF PERMIT PRICE GOES BF,Z'OND $1,000) SIGNATURE OF PERMITTEE FOR: CITY OF EAGAN 'DEM/fit # : 14" RECEIPT # a / U ▪ C 0 DATE (V43 WORK DESCRIPTION New Add -on Repair !, ? 1.50 EA. is PERMIT # RECEIPT # DATE: �.. BLDG. TYPE WORK DESCRIPTION Res. eg New . Mult Add -on Comm. Repair Other CONTRACT PRICE: Site Adress Lot er'' c 0 ,Bock Name / `f= Address Ciry/ 3 (.44 !. Name Address Cityr off–,, SIGNATURE OF.PERMITTEE FOR: CITY OF EAGAN ' r 1 Sec /Sub Phone PLUMBING PERMIT CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PHONE. 454 -8100 .4J Phone' /‘ FEES COMM /IND FEE — 1% OF CONTRACT FEE APT. BLDGS — COMM RATE APPLIES TOWNHOUSE & CONDO — RES. RATE APPLIES MINIMUM — RESIDENTIAL FEE - $12.00 MINIMUM — COMM /IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000.00) RES. PLBG. ONLY - COMPLETE THE FOLLOWING: 40, FIXTURES TOTL Water Closet - $3.00 $ / Bath Tubs - $3.00 Lavatory - $3.00 tt Shower - $3.00 Kitchen Sink - $3.00 Urinal /Bidet $3.00 +# Laundry Tray - $3.00 f Floor Drains - $1.50 _Water Heater - $1.50 /. / Whirlpool - $3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIT) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 FEE: STATE S /C: GRAND TOTAL: �'' PERMIT #: Date: 1 D 11 -02r SITE ADDRESS: OWNER NAME: LARRY & BARB 0' SHEA INSTALLER NAME: RON' S MECHANICAL. INC. STREET ADDRESS: CITY: SHAKOPEE 4178 COTTNTRYSTDR T)R Place a check mark next to the permit work type CITY USE ONLY RECEIPT DATE: 800E RESIDENTIAL MECHANICAL PERMIT APPLICATION CITY OF LAGAN 3830 PILOT KNOB ED EAGAN MN 55122 651-681-4675 Please complete for: > single family dwellings townhomes and condos when permits are required for each unit 12010 OT,T) RR TCK YAPD PD STATE: MN TELEPHONE #: 6� 1 —405 -1 847 TELEPHONE #: q92- 449 -6985 ZIP: 55379 v SIGNATURE PERMITTEE 1/02 Add -on, modification or alteration to 4 fur iiai;e i Cpiaeement • air exchanger • air conditioner • other Nature of work: • 1 0 ' existing dwelling unit Q 0 By � 9. 7 $- 30.00 1 I ist c i, PC- State Surcharge $ .50 Total $ 3 PERMIT #: Date: 1 D 11 -02r SITE ADDRESS: OWNER NAME: LARRY & BARB 0' SHEA INSTALLER NAME: RON' S MECHANICAL. INC. STREET ADDRESS: CITY: SHAKOPEE 4178 COTTNTRYSTDR T)R Place a check mark next to the permit work type CITY USE ONLY RECEIPT DATE: 800E RESIDENTIAL MECHANICAL PERMIT APPLICATION CITY OF LAGAN 3830 PILOT KNOB ED EAGAN MN 55122 651-681-4675 Please complete for: > single family dwellings townhomes and condos when permits are required for each unit 12010 OT,T) RR TCK YAPD PD STATE: MN TELEPHONE #: 6� 1 —405 -1 847 TELEPHONE #: q92- 449 -6985 ZIP: 55379 v SIGNATURE PERMITTEE 1/02 CITY USE ONLY PERMIT #: RECEIPT DATE: APPROVED BY: , INSPECTOR 2002 COMMERCIAL MECHANICAL PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 651- 661 -4675 Please complete for: all commercial /industrial buildings multi - family buildings when separate permits are not required for each dwelling unit DATE: SITE ADDRESS: OWNER NAME: PHONE #: TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME: INSTALLER: WORK TYPE: Specify Nature of Work: New construction Interior Improvement Processed Piping Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater. Underground tank removal/installation = minimum fee STREET ADDRESS: CITY: STATE: ZIP: TELEPHONE #: Install U.G. Tank Remove U.G. Tank When installing /removing underground tank, call 651- 681 -4675 for inspection by Fire Marshal and Plumbing inspector. Contract price: $ x 1% = $ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SIGNATURE OF PERMITTEE Updated 1/02 SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For: Lot Owner Address City /Zip Code Phone Address City /Zip Code Phone # 1987 BUILDING PERMIT APPLICATION - CITY OF EAGAN c- // 4 75 9 /90 Valuation: /29 COO FOR SALE UNITS Site Address !/ 7 OFFICE USE ONLY Block Parcel /Sub ( y / Contractor s T C 44U ; Address /99 yi A/ 17 //Z /J City /Zip Code .< i� f /�� /,✓j�,(.. Phone �/�;1 Arch. /Engr. On Site Sewage MWCC System +/ On Site Well City Water APPROVALS Assessments Water /Sewer Police Fire Engr Planner Council Date: REC'0 DEC 6 1447 Occupancy R-3 Zoning R-1 Type of Const (Actual) v -N (Allowable) v -14 # of Stories Length Sb O` Depth 1/ S.F. Total Footprint S.F. FEES Permit . 5$'7.54 Surcharge 6' Plan Review 293.75 SAC, City 100.00 SAC, MWCC S26. Water Conn 55.00 Water Meter 601.0O Bldg Off '7 12111 Road Unit Z APC Treatment P1 1/90,00 Variance Parks Copies TOTAL 1 /A1 LTA TIL16.1 NO C.O. UNTIL ENGR. APPROVES CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121 PHONE: 454 -8100 Site Lot Parc cc . 0 z 0 o V cc x U W W z - (5 U W BUILDING PERMIT SF DWG /GAR To be used for W z 0 Building Official /ZSS n '•r Est. Value $128,000 Address 4178 COUNTRYSIDE DRIVE 6 Block 1 Sec /Sub. COUNTRY HOLLOW el No. Name PIETSCH BUILDERS Address 8543 BIRCH LANE City LAKEVILLE Phone 461 -3381 Name SAME Address City Phone Name Address City Phone 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 Ci • Eagan Ord ances Signature of Permittee_ A Building Permit is issued to PI TSCH BUILDERS on the express condition that all work shall be done in accordance with all a Statutes and 9jly of Eagan Ordinances. applicable State of Mi�•e On Site Sewage MWCC System On Site Well City Water PRV Required Booster Pump APPROVALS Engr. /Assess Planner Council Bldg. Off. Variance O.Iu tifiratr of O rrupanrj (lCitp of Cagan Erpathntnf of liuitbing Jiwprrtion POST IN A CONSPICUOUS PLACE Receipt * c ; "< )( L) Date DECEMBER 18 19 87 OFFICE USE ONLY Occupancy Zoning (Actual) Const (Allowable) X # of Stories Length Depth S.F. Total Footprint S.F. X X 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: Bldg Permit No li3i 10 RI Type Const Vn Use Classification SF DWG /GAR Occupancy Type Zoning District Owner of Building MUMS Address 8543 BM: 7 E 4178 ODU TIAYSIDE DRIVE L6, B1, 001.1 KM BOUM Building Address ' Locality r.' Building Official Date OCIOBFR 20, 1988 N_ 14510 FEES Permit Surcharge Plan Review SAC, City SAC, MWCC Water Conn. Water Meter Road Unit Treatment P1 Parks TOTAL R3 R1 Vn Vn 51 45.5 $ 587.50 64.00 293.75 100.00 525.00 525.00 67.00 305.00 180.00 $2,647.25 OWNER EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION SITE ADDRESS � CONTRACTOR / l /; TSC /( / PHONE e 3 g e( ADDRESS y59.2 ,8 )1/(JLv/// )/ vim. 'soyy DETERMINE WORKING SQUARE FOOTAGE OF EACH. . Total exposed wall area ,2c9&6" sq. ft. _x il 2. Total roof /ceiling area .... /17 sq. -ft. x .Q,e, Total exposed wall area above floor = e24 a. Total wall window area b. Total door area 3949 c. Total sliding glass door area AzAIL. d. Total fireplace wall area e. Total wall framing area (average 10 %) oZ' e ,'`'� f. Total net wall area above floor /ln 7t? •«2 " g. Total rim joist area exposed foundation area = h. Total foundation window area 1. Total net foundation area above grade Determine "U" value of each wall segment. a . ..25-g..5" x " 1//ii _ / 01- o r b. 37,444 x "U" .5,/,/l, _ /s c. X.92-, x "u" Via a 30 .4' d. 9f x "u" -6.3 _ /• . 2 51, y 51 X "U„ -o9 a x23..3 f . /6> g . as x "u" . MA a 69, /3 • .2y6., 2e X " y oy 9, P7 • 0 x "u" b i. at 77.2 x nun .. /(..) 3. Total If item #3 is the same as, or less than item #1, you have inet the intent of SBC 6006 (cj2. - 1 - hi zfiht/ coaill' 4/A0 0 DATE D,C• 0 ..299/aV /•1Po New Add Rep. Type of Building Appliances W ired Equipment Wired 8 r �- t �,�.� Ready Now Epot -T I Notify Inspec- for When Ready Home Power Supplier Address o T '" 77 e a - ..- 'r�� Range Electrical Contractor (Company Name) " ki-L e y a6e'f�Jc/ ....0 Temporary Service ontractor's License No. x /570 -.s' ailing Address ontractor or Owner Making Inssailation) - 2. , 4 P,e. i9e 164.4-45/ 70,O'b Duplex ss Phone Nu ber f3/ 73 70 Water Heater Above 200 Ampsj Lighting Fixtures 31 to 100 Amps / Apt. Building 31 to 100 Amps Dryer Etectric Heating Above 100 Amps Commercial Bldg. Furnace Silo Unloader Transformers Industrial Bldg. Air Conditioner Partial :Other Fee Bulk Milk Tank Signs Farm Special Inspection Other [Specify) TOTAL Other (Specify) Other )Spec Other Other Request 1 / ? + 3 o — 8 7 Fire No. e h -in Inspection uir ? es ❑ No 8 r �- t �,�.� Ready Now Epot -T I Notify Inspec- for When Ready Street Address, Box or Route No. 72 L&i,.T ri,7) F I,e . Fee City id ectron lo. Township Name or N. Range No. 8 County Pi Phone No. Occup ant (PRINT) 1 ET5c .h 0 5 1 • A) / Power Supplier Address o T '" 77 e a - ..- 'r�� - s •J At Electrical Contractor (Company Name) " ki-L e y a6e'f�Jc/ ....0 ontractor's License No. x /570 -.s' ailing Address ontractor or Owner Making Inssailation) - 2. , 4 P,e. i9e 164.4-45/ 70,O'b A- ss Phone Nu ber f3/ 73 70 Authorize Signature ( Contract ner Making Installatiu ./.4.44.01e M Fee Service EntranceSize tt Fee Feeders /Subfeeders 8 Fee Circuits / fl, ret, 0 to 200 Amps 0 to 30 Amps JO 70,O'b 0 to 30 Amps Above 200 Ampsj 31 to 100 Amps / Sop 31 to 100 Amps Swimming Pool Above 100 Amps Above 100___Amps Transformers Irrigation Booms 0 6Q Partial :Other Fee Signs Special Inspection �J r� g !•9� TOTAL Remarks it • This request void ` /42l /sx 18 months from D 81616 , tai Licensed Electrical Contractor ❑ Owner rr f��� MINNESOTA STATE B0 4D OF ELECTRICITY Griggs- Midway Bldg. — Room N -191 1821 University Ave.. St. Paul. MN 55104 Phone (612) 642 -0800 Rough -in Final This request void 18 months from 1 hereby request inspection of above electrical work installed at: i i.) // 477?" REQUEST FOR ELECTRICAL INSPECTION See instructions for completing this form on back of yellow copy. 61 6 "r" Below Work Covered by This Request fir Tarr ly n Da e THIS INSPECTION REQUEST WILL NOT BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS ENCLOSED. EB 00001 - 06 ^� I. the Ele ® G- Inspector. hereby �/ / certify that the above /el O made ction has been Total exposed roof /ceiling area - j. Total skylight area k. Total roof /ceiling framing area (average 10%) S 1. Total net insulated roof /ceiling area Determine "U" value for each roof /ceiling segment. j. k. /59.9 1. /$/.3 ?. x " ti " D X " Un •l� X "ti" l.)o'Z l 4 Total s' If total of #4 is the same as, or less than #2, you have met the intent of SBC 6006(c)1. Alternate Building Envelope Design To utilize the total envelope system method, the values established by the sum of items #3 and 44 shall not be greater than the sum of items #1 and #2. 1. + 2. 3. +4. rs -99 Page 2 of 2 0 3 0 - 5-e 2 0 8 PLEASE ... Home - 12 3 OFFI E USE ONLY This request void 18 months Jj, Q / 0, t from validation date printed in this bc4/9 r y / nn( ,e�', 00 � okko- -- `ff''' J PRINT OR TYPE Request Date 11/10/95 Rough -in inspection required? iin Y- lJo (You must call the inspector when ready Inspection Other Than Rough -In: 0 Ready Now 0 Will Call Date Ready: 1, ( licensed Remod owner hereby request inspection of the above electrical work at: contractor • Job Address (Street, Box, or Route No.) 4178 Country Side Dr. City Eagan Zip Code Section No. Township Name or No. Range No. Fire No. County Dakota Occupant StephAn Homes Phone No. >filifri 681 -9777 Power Supplier Dakota Electric Address Electrical Contractor (Company Name) Joos Electric Co. Contractor License No. CA 00961 Master Lic. No. (Plant Elect. Only) Mailing Address (Contractor or Owner Performing Installation) 3980 Beau D' Rue Drive, E 55172 Authorized Signature (Contractor or Owner Performing Installation) Phone No. 688 -6180 EB- 00001A -10 6/95 1111 0 2 0 8 1 2 3 STATE BOARD COPY - SEE INSTRYETIOIQS'ON BACK OF YELLOW COPY I REQUEST FOR ELECTRCA INSPECTION M innes ot a St B oar d o f El Ictri L 1821 University Ave., Rm. S- 28, t. Paul, MN 55104 * Phone (612) 642 -0800 jil yi- ... Home Duplex Apt. Bldg. Other: New Addn Remod Repair Commercial Industrial Farm Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other: Dryer Range Elec. Heat Temp. Service "X above the work covered by this request. Enter remarks in this space and on the back of the white copy only. Basement Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee: Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps Street Ltg./Traffic Sig. Above 200 Amps Above 100 Amps Transformer /Generator INSPECTOR'S USE ONLY TOTAL $40.50 Sign /Outline Ltg. Xfmr. fj � Alarm /Remote Control Swimming Pool 1 hereby certify that I inspected the electrical ' stall. - r'.ed herein on tRe d es stated Irrigation Boom Rough -In , .- / r .. / Dotir /41).0 Special Inspection Final Da ,�� g/er Investigative Fee THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS. EB- 00001A -10 6/95 1111 0 2 0 8 1 2 3 STATE BOARD COPY - SEE INSTRYETIOIQS'ON BACK OF YELLOW COPY I REQUEST FOR ELECTRCA INSPECTION M innes ot a St B oar d o f El Ictri L 1821 University Ave., Rm. S- 28, t. Paul, MN 55104 * Phone (612) 642 -0800 jil yi- 5) LEGAL DESCRIPTION 4) IM NAME: ADDRESS: CITY, STATE, ZIP: PHONE: rINDI 6) IMETi tarc A • APPLICATION DOES NOT CON- STITUTE APPROVAL OF PERMIT. SEWER AND/OR WATER CONNECTION * • INSPECTION OF SEWER AND /OR WATER * INSTALLATIONS WILL NOT BE SCEDULED * UNTIL PERMIT HAS BEEN APPROVED. t****** * * * * * * * * * ** * *** * * * * * * * * * * * * * * ** city of ecac can APPLICATION FOR PERMIT ( (PLEASE PRINT) 1) PROPERTY ADDRESS: 2�" , � ppL/ (0DE (Lot /Block /Subdivision or Tax Parcel ID #) IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: PRESENT ZONING /PROPOSED USE: COMMERCIAL/RETAIL /OFFICE r SINGLE FAMILY INDUSTRIAL I [ R -2 DUPLEX (Two Units) INSTITUTIONAL /GOVERNMENT f I R -3 TOWNHOUSE (Three + Units) ( Units) 2) "PLICANTI. NAME: ?Act' ct' C ` - - ADDRESS: 4/14c.- ;2,4E CITY, STATE, ZIP: j_ih y, uut.c J 4 0,1 PHONE: 923 --- _5 11 3) rPlf. i i s NAME: /4/ / � 7 � . 'G 2 4 'i' c-5 � 209tCi ADDRESS: /�7 C -cr S C ( kJ` CITY, STATE, ZIP: PHONE: //Z3. ^ 7j7G_ _ MASTER LICENSE # ,OWNER (. CONNECTION TO CITY SEWER CONNECTION TO CITY WATER ) 1 OTHER ;WWWWWWWWWKW WWWWWWWWWW XXXXx....R., R.; :NOTE: PAYMENT OF IhT: AT TIME OF R -4 APARTMENT /CONDOMINIUM ( Units) T (Month /Year) /; For City Use Plumbers License: Active Expired Not recorded ar/P7 Staff Initial * * THE GOLD COPY OF THE PERMIT WTTJ, BE SENT DIRECTLY TO PUBLIC WORKS TO FACILITATE METER PICK -UP. * * PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. SOMEONE FROM THE CITY WILL CONTACT YOU IF THERE * * ARE ANY PROBLEMS. PERMIT # ISSUED Pd w /Bldg. Permit $ /6 SEWER PERMIT (INCLUDE SURCHARGE) // $ /D _ -C WATER PERMIT (INCLUDE SURCHARGE) $ C!' - 2 ' $ WATER METER /COPPERHORN /OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ /j ' 6 6) ACCOUNT DEPOSIT - SEWER $ $ /5 ( ACCOUNT DEPOSIT - WATER $ C 2 J . 0 $ WAC $ 6, Z- ,- .6 d $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT /TRUNK SEWER $ $ LATERAL BENEFIT /TRUNK WATER $ ! Vv e G` 0 $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ ( r> l /0 ( ` $ - /' TOTAL RECEIPT # RECEIPT # DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? I NO SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE: FOR CITY USE ONLY FEES: YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING DIVISION. LIST AS A CONDITION. IN TESTIMONY WHEREOF, the LANDOWNER has caused this easement to be executed as of the day and year first above written. STATE OF MINNESOTA) ss. COUNTY OF 4C2+A.. ) On this 23r day of N u-- , 1989, before me a Notary public within and for said County, personally appearedDWAYNE L. JOHNSON and DARLENE E. JOHNSON, husband and wife, to me personally known to be the persons described in and who executed the foregoing instrument and acknowledged that they executed the same as their free act and deed. CINDY GRABOW NOTARY PUBLIC- 4(NNESOTA DAKOTA COUNTY MY COMMISSION EXPIRES 34313 APPROVED AS TO FORM: '\ :3 () City ttprney'j Office Date: 6 - . 2 1 . S 1 APPROVED AS TO CONTENT: Public Works Department Date: Cq - z_3 L3 THIS INSTRUMENT WAS DRAFTED BY: McMENOMY & SEVERSON, P.A. V N° 7300 West 147th Street P.O. Box 24329 Apple Valley, MN 55124 (612) 432 -3136 JPE DARLENE E. JOHNS N 1 DWAYNE L. JOHNS Notary k Public , '.I 1 1 • • • 7 60 EXHIBIT A DRIVE l0i ( lo EXISTING DRAINAGE 8 UTIUTY EASEMENT -: ►+,I TEMPORARY 8 1 1 - T No CONSTRUCTION t‘i N — 6 o � -' X2000 N° EASEMENT 1 0 � � � z n � - 142.00 N 89 °38'31 W N 89 °3831" W 142.00 C.) 0 J j.--- PERMANENT STORM SEWER EASEMENT 0 50 100 SCALE IN FEET PROGRESS ENGINEERING, INC CONSULTING ENGINEERS 14300 NICOLLET COURT SUITE 235 BURNSVILLE, MN 55337 Date 5 / 3 V / 0 (0 Construction _ Dv, Cost q / T'7 = 00 Site Address 111 —1, s't, c g 5' "7 oCe Unit/Ste 1i -� i Description of Work -( ,ter 0 f= " ire_4t i . , - , .. Multi- Family Bldg _ Y X Fireplace(s) -_ 0 — 1 _ Property Owner La-4 (- -.- C tA- 61 -' Telephone # 657) 4 7 ( " 93 - / ' (49 (' Contractor !�? S . C S c Ca l- i .. Address ' 1 L{ 1 (,,t) - 76 4-4- ' City 17 CAI iz_:-, v State . - 7 / " 1 ' ) Zip 5 % Telephone # , ) ? 3 /'- 1 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 (buildings with 3 or less units) Minnegasco mechanical ventilation form Licensed plumber COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Code Category (J 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: Telephone # ( ) Mechant .d1 c ontractor Telephone #( ) Sewer /Water Contractor Telephone # ( 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 accordance with the approved plan in the case of work which requires a review and approval of pla �4M C CA, Applicant's Printed N. f 2006 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651- 675 -5675 FAX # 651- 675 -5694 Remodel/Repair Requirements 2 copies of plan showing footings, beams, joists 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 Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA164793 Date Issued:10/08/2020 Permit Category:ePermit Site Address: 4178 Countryside Dr Lot:6 Block: 1 Addition: Country Hollow PID:10-18275-01-060 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: 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 - Lawrence P & Barbara Oshea 4178 Countryside Dr Saint Paul MN 55123--162 (651) 357-4443 Evergreen Construction Company Inc 1200 Centre Pointe Curve, #175 St Paul MN 55120 (651) 209-3130 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA176873 Date Issued:06/06/2022 Permit Category:ePermit Site Address: 4178 Countryside Dr Lot:6 Block: 1 Addition: Country Hollow PID:10-18275-01-060 Use: Description: Sub Type:Furnace & Air Conditioner Work Type:Replace Description: Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) 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 - Sally Gene Cortez Ngo 4178 Countryside Dr Eagan MN 55123 (612) 388-6053 4front Energy Solutions 3230 Gorham Avenue, Suite 1 St. Louis Park MN 55426 (952) 933-1868 Applicant/Permitee: Signature Issued By: Signature