4194 Countryside Dr41,11111
City of Eaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date:
Tenant:
Use BLUE or BLACK Ink,
Permit #: V12-91
Permit Fee:
Date Received:
Staff:
;2010 RESIDENTIAL PLUMBING PEF MIT APPLICATION
Site Address: ,CLt.P
aublax-
Suite #:
RESIDENT / OWNER
Name: S��1 h ), l 0 I Phone:1-1 5
.5 -
Address / City / Zip4�`1�-A l i(i 4
CONTRACTOR
CONTRACTOR
I
Nam - - i - 0 # 1 i Chi l Anse #: . U Qj 1 l -1J
Address: .7D1A" 6 �-ve 1et1 City: A' ,
1
State:` 1 \ Zip: 1.------k �0 .,P Phone: n V .--gu Can
Contact: ` 1 Email:
TYPE OF WORK
New Replacement Repair _ Rebuild
_ Modify Space _ Work in R.O.W.
_
Description of work:
PERMIT TYPE
RESIDENTIAL
Water
...........
Softener
Plumbing Fixtures l— Main / _ Lower Level)
i
Water Heater
Add
Lawn Irrigation (_ RPZ / - PVB)
Turnaround
Water
Septic System
New
Abandonment
RESIDENTIAL FEES:
i
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener
(includes $5.00 State Surcharge)
(includes $5.00 State Surcharge)
State Surcharge)
State Surcharge)
TOTAL FEES $L
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround*
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.0q
burned out appliances, ductwork, etc.) (includes $5.04
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. gopherstateonecall.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 wor'9 's 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 . /ala
knr-
Applicant's Printed Name
FOR OFFICEUSE
Required lnOections:
Parcel Files Cover Sheet
Unique ID: 4036
4194 Countryside Dr
101827502001
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4194 Countryside Dr
Lot: 2 Block: 1 Addition: Country Hollow
PID:10- 18275- 020 -01
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code:
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Crew2 Inc
2650 Minnehaha Ave
Minneapolis MN 55406
(612) 276 -1680
e- Windows/Doors
Windows/Doors-New/Replacement
House
434-
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
$88.50
$1.50
Total: $90.00
Owner:
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Permit closed without required inspection(s). Letter sent to applicant 3/2/2010. (pi)
0801.4085
9001.2195
Issued By: Signature
Building
EA091225
09/21/2009
ePermit
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
NO C/O UNTIL ENGINEERING APPROVES. (LIFT STATION) --
CITY OF EAGAN'�'�
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT
To be used for Est. Value
Receipt #
Date
sr /n/2>fre .,
,19
Site Address 4194
Lot Block Sec/Sub
Parcel No.
w
z
0
Name
Address
City Phone
cc
0
t-
o
Ucc
Name
Address
City Phone
0w
U w
W w
z
0—
C)
CC
a W
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 City of Eagan Ordinances.
Signature of Permittee
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System Zoning
On Site Well Type of Const
City Water (Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
APPROVALS
Assessments
Water/Sewer
Police
Fire
Eng r.
Planner
Council
Bldg. Off.
APC
Variance
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
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
Permit No.
Permit Holder
Telephone #
PIgmbing
,5 1 g
'se`"��n-fh
/Date
yl � %
H.V.A.C.
Gj/ L/G,
2%2*&:.�; + �.���%
Electric,//
'v, L,JL -2 E . C
9m/4/2„.1-6
Softener
6
Inspection Date
Insp.
Comments
Footings I
%/734P?(�!%
Footings II
Foundation
Framing
77,s-47
4.77 if
Roofing
4,7...4970tiii
/
i ,./_3
76',,,, �
4';e. io-�' ^� �5. - zet,c,,
Rough Plbg.
Rough Htg.
®_y
Isul.
O7
.fi`i
OD
Fireplace
`.iii
4487
Lt)4
Final Htg.
Final Plbg.
,..//40/4)///
P.R.V. VALVE REQUIRED
Bldg. Final
Cert. Occ.
j,/�,
f y
Temp. LP
f /”
Deck Ftg.
i
Deck Frmg.
Well
r�
c�1� ey-5CGG� (.�
Pr. Disp.
f j. s--g -L 4,%r57-C
644-/2- 9‘1447 - /- ! I9-069
CONTRACT PRICE:
ti
PERMIT # / `F Y
MECHAN L PERMIT RECEIPT # "71 ` 9
CITY EAGAN
3830 PILOT KNOB R D, EAGAN, MN 55121 DATE: 9 /-,-).5/5/
PHONE 54-8100
Site Address 4/ 1"/
Lot __T Block r Sec/Sub
N
c
Name .•W r z , ; /�N c., r,,;�10
Address
i � f
City c , r Phone
c
O
Name
Address
City
L
Phone
1 ,
TYPE OF WORK
Forced Air / 00 M BTU$) (.X)
Boiler M BTU $
Unit Heater M BTU $
Air Cond. M BTU $
Vent Ah a CFM $
Gas Piping Outlets # $
Other $
FEE:
SIC:
TOTAL:
—.;
BLDG. TYPE
WORK DESCRIPTION
Res. ie." -New
Mult Add-on
Comm. Repair
Other
FEES
RES. HVAC 0-100 M BTU - $24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU 12.00
ADDITIONAL 6 M BTU 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM — RESIDENTIAL FEE ' - 10.00
MINIMUM — COMM/IND FEE 20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
FOR CITY OF EAGAN
CONTRACT PRICE:
Site Address tot q 1,1 6c_
PLUMBING PERMIT
iN]tlfN!lr- w+ y wR
FC C: 777
PERMIT # 9 c -
CITY OF EAGAN RECEIPT # /
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 9/ S/37
PHONE:.454-8100
Lot Block / Sec/Sub
Name
Ts Address -Si (VV
c City (1.1 L `j
Phone rj 1.1 4,1-1;5-
m
c
0
Name
sr.e
Address
City Phone 1)1
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)
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
BLDG. TYPE
Res.
Mult
Comm.
Other
WORK DESCRJPTION
New
Add-on
Repair
RES. PLBG. ONLY — COMPLETE THE FOLLOWING:
FIXTURES TOT L
Water Closet - $3.00 $ I
Bath Tubs $3.00
In Lavatory - $3.00
Shower - $3.00
Kitchen Sink $3.00
Urinal/Bidet - $3.00
_- _Laundry Tray $3.00 `;ta v�
—Floor Drains - $1.50
4—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:
4c.
STATE S/C:
GRAND TOTAL:
o.c
CITY OF EAGAN Permit No:
Date: 7O
Meter Na 5-3 6 Size: �C c f%
P.O. Box 21199
3830 Pilot Knob Road Reader No:.1)3_471____ Eagan, MN 55121Date:%� �5
Owner.
Site Address:
Plumber.__
Conn. Chg:
Acct. Dep:
Permit Fee:
Surcharge: 1 a • : e to co
Tr. Plant lnply wit the City of Eagan
Meter:
O ances
Misc.:
Zoning: _
No. of Units:
CITY OF EAGAN
3830 Pilot Knob Road
P.O. Box 21199
Eagan, MN 55121
Owner:_
Site Address:
Plumber:_
MWCC:
City Chg: _
Acct. Dep:
Permit Fee:
Surcharge:
Misc.:_
WATER SERVICE PERMIT
Permit No:
B/P No:
Zoning..
No. of Units:
Date:
Date:
I agree to comply with the City of Eagan
Ordinances.
By
SEWER SERVICE PERMIT
TOTAL EXPOSED ROOF/CEILING CALCULATIONS:
Total exposed
roof/ceiling area // 7 -, sq ft
j) Total skylight area O sq ft x
k) Total roof/ceiling framing
area (Average 10) //7. sq ft x
1) Total net insulated
roof/ceiling area / o 5 A,V sq ft x
f total of ,ut, is the same as, or less than
.B.C. Section 6606 (c) 1.
lull C _ 0
Hull
I lu, I
TOTAL j) thru 1)
you have met the intent of
ALTERNATE BUILDING ENVELOPE DESIGN
To utilize the total envelope system method, the values established by the sum
of items -'3 and `14 shall not be greater than the sum of items N1 and !'2.
3.
c.3
+ 2.
+ 4.
CERTIFICATI O N
I 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.
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675
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 /b2_
SITE ADDRESS LP `T 6 -1 -1...4d -
1S1
tWUZ. d-
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 SDv F04..00/74_,
TYPE OF W RK !f92/ .
APPLICANT S.L.c,oGa,-,..
MULTI -FAMILY BLDG _Y )1N
FIREPLACE(S) _ 0 A 1 _ 2
STREET ADDRESS '( l dI CITY STATE,/Lu ZIP SSI 23.
TELEPHONE # (05)(og3-9/7rCELL HONE # FAX # 6,50 686- 2g50
PROPERTY OWNER 14f,2'
Energy Code Category
(J submission type)
TELEPHONE #�05/> 683 'fir
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
MINNESOTA RULES 7670 CATEGORY 1
• Residential Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672
• New Energy Code Worksheet Submitted
Plumbing Contractor: Phone #
Plumbing system includes: Water Softener Lawn Sprinkler
Water Heater __ No. of R.I. Baths
No. of Baths
Mechanical Contractor:
Mechanical system includes: Air Conditioning
Heat Recovery System
Sewer/Water Contractor:
Fee: $90.00
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
Certificates of Survey Received
OFFICE USE ONLY
Tree Preservation Plan Received _ Not Required
Updated 4/02
OFFICE USE ONLY
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 02 SF Dwelling ❑ 08 06-plex 0 16 Fireplace 0 21 Porch (3 -sea.) 0 31 Ext. Alt - Multi
❑ 03 01 of _ plex 0 09 07-plex ❑ 17 Garage 0 22 Porch/Addn. (4 -sea.) 0 33 Ext. Alt - SF
❑ 04 02-plex 0 10 08-plex .18 Deck 0 23 Porch (screened) 0 36 Multi
O 05 03-plex 0 11 10-plex 0 19 Lower Level 0 24 Storm Damage
❑ 06 04-plex 0 12 12-plex Plbg_Y or _ N 17 25 Miscellaneous pt./MVO.%)
❑ 31 New 0 35 Int Improvement 0 38 Demolish (Interior) 0 44 Siding
O 32 Addition 0 36 Move Bldg. 0 42 Demolish (Foundation) 0 45 Fire Repair
❑ 33 Alteration 0 37 Demolish (Bldg)* 0 43 Reroof g 46 Windows/Doors
34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
Footings (new bldg) _ Final/C.O.
Footings (deck) -i( 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
Approved By f , Building Inspector
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
IA -4000k)
/ VO gi/
1987 BUILDING PERMIT APPLICATION - CITY OF EAGAN
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 FOR SALE 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
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: ,c/n541 tc„?1,7/
Site Address / ) LI L„�
Valuation:
Lot J Block
Parcel/Sub
Owner
COu4
I1/7/// no se_/4
Address r/3d 1hc, / s /r/rr/ /3L
City/Zip Code NLf S S y/.3
Phone
3%f/
Contractor MP//..:-' , i.;/J3o t/L
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone #
PLANS,
Date:
OFFICE USE ONLY
On Site Sewage
MWCC System
On Site Well
City Water
APPROVALS
Assessments
Water/Sewer
Police
Fixe
Engr
Planner
Council
Bldg Offs'
APC
Variance
Occupancy
Zoning
Type of Const
(Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit J -]e.
Surcharge GZ.5�
Plan Review 2_69,t§
SAC, City (6c3.
SAC, MWCC 25,
Water Conn
Water Meter 07.
Road Unit
Treatment P1
Parks
Copies
TOTAL
c.r
J
12.
It
P.R.V. REQUIRED CITY OF EAGAN N° 1 4 0 41
MODEL HOME — >`?aarav-Piloturruiob Road, P.O. Box 21-199, Eagan, MN 55121
PLANNING APPROVES. PHONE:454-8100
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. Value $125,000 Date AUGUST 12 9 87
Site Address 4194 COUNTRYSIDE DR
Lot 2 Block 1 Sec/Sub COUNTRY HOLLOW
Parcel No.
cc
w
z
0
Name MCMULLEN/MOSELLE
Address 430 INDUSTRIAL BLVD
City MPLS Phone 378-3981
cc
.0
z
00
Ucc
t -
Name SAME
Address
City Phone
Uw
ww
Fw
Z
X
UZ
¢w
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 City of%Eagan Ordinances.
Signature of Permittee
p.
On Site Sewage
MWCC System
On Site Well
City Water
APPROVALS
Assessments
Water/Sewer
Police
Fire
Eng r.
Planner
Council
Bldg. Off.
APC
Variance
OFFICE USE ONLY
Occupancy
X Zoning
Type of Const
X (Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL $2,632.25
R3
R1
V
V
54
38
$ 578.50
62.50
2R9 25
100 GO
525.00
525 00
67.00
305.00
180.00
A Building Permit is issued to: MCMULLEN/MOSEL1 E on the express condition that
all work shall be done in accordance with all appli le State of Miu pesota Statutes and City of Eagan Ordinances.
�'` `��{ / ((c :
U �
Building Official
1hrtifiraIr of (!rrupanrq
QCitp of Cagan
Er}rttrtrnrnt of Euilbing Jna,prriion
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 Classification
ING/GAR
Occupancy Type R3 Zoning District
Owner of Building MICMLEWMDSELLE
Building Address 4194 COUNTRYSIDE DRIVE
Building Official
,d!�
Bldg Permit No. 14041
R 1 Type ConstV
Address 430 MISTRIAL BLVD • ,
Locality L2, B1, OCUNIRSC HOLUNI
Date. NUMBER 2gt, 1989
POST IN A CONSPICUOUS PLACE
OWNER:
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
SITE ADDRESS:
CONTRACTOR:
DATE: PHONE:
DETERMINE WORKING SQUARE FOOTAGE OF EACH:
1. TOTAL EXPOSED HALL AREA
2. TOTAL ROOF/CEILING AREA
3. TOTAL EXPOSED WALL AREA CALCULATIONS:
(Dr). J sq ft x "U"
Total exposed wall
area above floor
a) Total wall window area:
glazed
sq ft x "U"
3..?oo,i sq ft
.2 92,
sq ft x "U"
glazed sq ft x "U"
b) Total door area [i g sq ft x "U"
c) Total sliding glass door area:
glazed b1 sq ft x "U"
glazed sq ft x "U"
d) Total fireplace wall area
90
sq ft x "U"
0.2
=
o
_454gc = 3.
e) Total wall framing area
(Average Mt.) »/). sq ft x "U" '0?
f) Total net wall area above
floor (Insulated)
g) Total rim joist area �SJ / sq ft x "U" . .p4
sq ft x "U"
, o'f
Total foundation
area (Exposed) (7) sq ft
h) Total foundation
window area sq ft x "U"
i) Total net foundation
area above grade sq ft x "U"
TOTAL a) thru 1)
If item `3 is the same as, or less than item fl, you have met the intent of
S.P.C. Section FOOT, (c) 2.
This request void/X.14/7"v
18 months from
D 36913 zoz 4/
c-7
Request/
Date
/`
2
Fire No.
V
Rough -in Inspection
Required?
,. .�
jgReady Now 111 Will Notify Inspec-
XHome
tor When Ready
Licensed Electrical Contractor
❑ Owner
1 hereby request inspection of above
electrical work installed at:
Street Address, Box or Route No.
1 CO 01 A.+
Sec ion No. Township Name or No.
5—¢1
IRange No.
Occu
ant IPjiI,JcJT) aupe,i/ vii / //
/�N s
Address
Powerpull Qr
1-a. E ! r c
City
0c7C74/
County
12q !("-er
Phone No.
Elecal Cont -ctor (Com any Name
c / �t �; C !t�
Mailing Address (Contract or Owner Making In tails ion)
Iv/ / 7 - �� cry � ,t)
37 cri
Siontractor's License No.
Authorizey, ignature (Contractpr/�� Making Installation)
a°`-)
3
MINNESOTA ST :OARD OF ELECTRICITY
Griggs-Midwa dg. — Room N-191
1821 University Ave., St. Paul, MN 55104
Phone (612) 642-0800
5/14//5"17 ; OUESTSee instrUctions FOR ELECTRICALfor r/Owne this formMak
D 3613
£JSFe 15)//)* .51-5-r3,)
RF�one Numt�er
THIS INSPECTION REQUEST WILL NOT
BE ACCEPTED BY THE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
TIon of yellow copy.
X" Below Work Covered by This Request
EB -00001-06
New
Ada
Rep.
Type of Building
Appliances Wired
Equipment Wired
XHome
Fee.
Circuits
4'
1 Z-
Range
Yi
I
Temporary Service
0 to 30 Amps
31 to 100 Amps
Above 100 Amps
Duplex
Water Heater
Above 200 Amps
Lighting Fixtures
Swimming Pool
Apt. Building
Transformers
Dryer
Electric Floating
Partial -"Other
Commercial Bldg.
Furnace
Silo Unloader
Special I/;lc`i
-
$j .�Y
L F�
Industrial Bldg.
Air Conditioner
Bulk Milk Tank
Farm
Other (Specify)
Other (Specify)
Other (Specify)
Other
Other
Compute Inspection Fee Below
#
Fee
Service EntranceSize
#
Fee
Feeders/Subfeeders
#
Fee.
Circuits
4'
1 Z-
0 to 200 Amps
Yi
I
D6,
s
0 to 30 Amps
31 to 100 Amps
Above 100 Amps
0 to 30 Amps
31 to 100 Amps
Above 100_Amps
Above 200 Amps
Swimming Pool
Transformers
Irrigation Booms
Partial -"Other
Signs
Special I/;lc`i
-
$j .�Y
L F�
��
Remarks r1/
Rough -in
`G
(
,,^
�
Di
7e Ele‘c%rfir
, hereby
certify that the above
has been
made.
Final
•
.ry
Date
1/
s request void 18 months from
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
XZXXAZXXXxfl XXccWfl araaaaa a+cxcxxc c c c
* NOTE: PAYMENT OF Yht. AT TIME OF
* APPLICATION DOES NOT CONSTITUTE
* APPROVAL OF PERMIT.
*
* INSPECTION OF SEWER AND/OR WATER
* INSTALLATIONS WILL NOT BE SCHED-
ULED UNTIL PERMIT HAS BEEN
* APPROVED.
*
*
*
************************************
1)
2)
3)
(Please Print)
PROPERTY ADDRESS: 4/i t./ c Ati-ye y L �
LEGAL DESCRIPTION:
(Lot/Block/Subdivision or Tax Parcel
IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
PRESENT ZONING/PROPOSED USE:
Q COMMERCIAL/RETAIL/OFFICE
Q INDUSTRIAL
❑ INSTITUTIONAL/GOVERNMENT
ID # )
(Nbnth/Year)
C R-1 SINGLE FAMILY
R-2 DUPLEX (Two Units)
El R-3 'TOWNHOUSE (Three + Units)
a R-4 APARTMENT/CONDOMINIUM
Units)
Units)
NAME:
AI ota.
i 1 - : ' t -fir
ADDRESS:3l0 7 / ;
CITY, STATE, ZIP: AIPLE 4711'
PHONE: 71y36/1-4/
NAME: ,eUM IriCL_ZZOl , I /1 ),
ADDRESS: 3/0.7 / Y�%� i(
CITY, STATE, ZIP: /�rr/2Lgm
..
PHONE: 7(- ( MASTER LICENSE# X23
For City Use
'Plumbers License:
Active
Expired
Not recorded
Staff Initial
4)
.5)
6)
7)
OCCUPANT OWNER
NAME: I1C MULL -VA) HOS
ADDRESS:
CITY, STATE, ZIP:
PHONE:
•INDICATE= WHICH"iPERMIT"ISa BEING+ • • 'ESTER':,
E CONNECTION TO CITY SEWER ISq CONNECTION TO CITY WAIF ❑ OTHER
INDICATE ONE:
PLEASE HO
L
-APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE
APPROVED PERMIT TO 1, 2, 3, 4, ABOVE
(Circle one)
ITI
r 1.
«:, •, a o- r
DATE:'
• ' SEWERi.AND: WATER+ PERMI . PERSONS REQUIRING •
$ • OOd•FEw •! i• i
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ SEWER PERMIT (INCLUDE SURCHARGE)
$ WATER PERMIT (INCLUDE SURCHARGE)
$ WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP (INCLUDE CORPORATION STOP)
$ SEWER TAP
ACCOUNT DEPOSIT - SEWER
$ /; ACCOUNT DEPOSIT - WATER
$ tr ? S ' 7) $ WAC
$ S -6 $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ $ / TOTAL
RECEIPT #
RECEIPT #
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
El YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
city of cagcin
3830 PILOT KNOB ROAD, P.O. BOX 21199
EAGAN, MINNESOTA 55121
PHONE: (612) 454-8100
Special Assessment Search
Date: November 30, 1987
Requested by:
First Security Title
Re: 10-18275-020-01
L2 Bl, Country Hollow
BEA BLOMQUIST
Mayor
THOMAS EGAN
JAMES A. SMITH
VIC ELLISON
THEODORE WACHTER
Council Members
THOMAS HEDGES
City Administrator
EUGENE VAN OVERBEKE
City Clerk
On the attached form is the City's response to your search request
on the identified property. The information includes the original
amount of the assessments and the payoff amounts of the assessments.
on the parcel. In addition, pending assessments are included for
improvement projects that have been ordered to be installed by the
City Council as they may affect this parcel.
The City's policy is to levy assessments based upon the current
zoning or existing use of the parcel (whichever is higher) as
reflected in the above assessments. If, and when, the parcel is
rezoned or developed to a higher use, a condition of development
approval will require that this parcel assume any additional
assessment obligations that have not been previously paid for
existing public improvements. The City Engineering Division can
provide further clarification.of this policy if you desire.
WAIVER/DISCLAIMERz
Neither the City of Eagan nor its employees guarantees the accuracy
or completeness of the information provided which was requested by
the person or persons indicated. Nor does the City or its employees
assume any liability for the correctness thereof. In consideration
of receiving and using information on the attached form and for all
other consideration of any nature whatsoever, any claim against the
City or its employees rising therefrom is hereby expressly denied.
Pending assessments cannot be paid until levied. Levied assessments
can be paid to the CITY OF EAGAN.
Very truly yours,
SPECIAL ASSESSMENTS
Attachment
THE LONE OAK TREE...THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY
114
TRANSACTION ID: R768
PROPERTY. I.D.
SF EC 1 AL.• ASSESSMENTS
•SF'EC I AL ASSESSMENTS iSMEN'TS SEAl t'C 1 SUMMARY
TODAY S•l_)A1 r...." 11/27/87 FLAGS ----7 •
10-18275-020-01• •
S."A. ## ASSESSMENT DESCP. `YR YRS RATE TOTAL •ANN. -F :1 N. •PAYOFF COMMENT
1.01.473 STREET W199 87.;}0i'e 112.62 .4_ti_.`_'�:
10F'491 UTILITIES 00 0 .00% 1255.84 1265.84
10P505 UTILITIES 00 0
.00% 1331.31 13 1 _1
****** SUMMARY OF ACTIVE 112.52 22.53
*. **..* THIS YEAR'S y .... _ j
34.3,L-
****** SUMMARY OF PENDING 2h 7,.15
•1265,84'PEND
1331.31 PEND
2597.15
Pres ENTER (Comrents) , FA ar F2 (Hte d er. Form) or •F7 (Restrt R768.)
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Construction Requirements
A 3 registered site surveys showing sq. ff. of lot, sq. ff. of house
and all roofed areas (20% maximum lot coverage allowed)
A 2 copies of plans (show beam & window sizes; poured fnd. design; etc.)
A 1 set of energy calculations
A 3 copies of tree preservation plan if lot platted after 7/1/93
//' /
DATE:
DESCRIPTION OF WORK: rl C
STREET ADDRESS: 11-19
LOT: � BLOCK:
Remodel/Repair Requirements
2 copies of plan
1 set of energy calculations for heated additions
1 site survey for exterior additions & decks
CONSTRUCTION COST:
)
SUBD./P.I.D. #: . C) v X
5 i3r °=
4,6°6
d
PROPERTY
OWNER
CONTRACTOR
Name:
Last
Street Address: f l
/"! ti� Zip: State: S5l23
Company:
Phone #: 6 57 J %S
First
Phone #:
(area code)
Street Address: License # Exp.
City State: Zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone #: area code ( )
Street Address: Registration #:
City State: Zip:
Sewer & water licensed plumber (required for new construction only):
Penalty applies when address change and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No _ Not Required
BUILDING PERMIT TYPE
❑ 01 Foundation
❑ 02 SF Dwelling
❑ 03 1 of _ plex
❑ 04 2-piex
❑ 05 3-piex
WORK TYPE
❑ 31 New
❑ 32 Addition
❑ 33 Alteration
❑ 34 Repair
❑ 06
❑ 07
❑ 08
❑ 09
❑ 10
4-piex
5-piex
6-piex
7-piex
8-piex
OFFICE USE ONLY
❑ 11 10-piex 0 16 Fireplace
❑ 12 12-piex 0 17 Garage
❑ 13 16-piex 0 18 Deck
❑ 14 Apartments 0 19 Lower Level
❑ 15 Lodging 0 20 Pool
❑ 35 Tenant Impr 0
❑ 36 Move Bldg. 0
❑ 37 Demolish Bldg.* 0
❑ 38 Demolish (Interior) 0
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
39 Gas Line Only
40 Gas Insert
41 Wood Stove
42 Reroof
❑ 21 Porch (3 -sea.)
O 22 Porch/Addn. (4 -sea.
❑ 23 Porch (screened)
❑ 24 Storm Damage
❑ 25 Miscellaneous
❑ 43 Siding/Soffits/Fascia
❑ 44 Windows/Doors
❑ 45 Fire Repair
* Give PCA handout to applicant for demolition permit
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Planning Building
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Purnp
PRV
Fire Sprinklered
Variance
Permit Fee
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SIW Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
Valuation:
City of aaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: C\jC1 \C:)'"fj
Permit Fee: •
Date Received:
Staff:
2010 MECHANICAL PERMIT APPLICATION
\
Date: 1-3-1 0 Site Address: L\ t9L-1 (611fthyy tic Or,
Tenant: �( TC1I le -
Suite #:
J
RESIDENT / OWNER
Name:
Address / City / Zip: Li 1CqFopi e'357d.3
CONTRACTOR
Name:
Address:
3URNSVILLE HEATING & A/C, INC.
3451 W. Burnsville Parkway
Suite 120((';;City:/ y::: �
State: g rnsville, MN 55337 Phone: QS L O "t `f a.,j
Contact: -_( Email:
Phone:l.(' S /- J 7"- a W Y
License #:1-1ji 3. 3Ei 1c) 7/3
TYPE OF WORK
New Xi Replacement
Description of work:
Additional Alteration
�2c�yJu�/, Staff
Demolition
PERMIT TYPE
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
Heat Pu ,
X- ^p
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank ( Install / Remove)
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
$55
TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal
$50.50 Minimum (includes State Surcharge)
OR Contract Value $
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
x1%
= $ Permit Fee
= $ Surcharge
= $ TOTAL FEE
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.gopherstateonecaliorg
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.
xE 1',c k
Applicant's Printed Name
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA114776
Date Issued:09/18/2013
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
Merl Jensen
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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
(651) 683-9175
Jensen & Jensen Construction Llp
21143 115th Ave NW
St. Paul MN 55119
(651) 600-4497
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA125145
Date Issued:07/18/2014
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of house wrap and leave on site for final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
(651) 683-9175
Jensen & Jensen Construction Llp
21143 115th Ave NW
St. Paul MN 55119
(651) 600-4497
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA131421
Date Issued:06/18/2015
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
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)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
Haley Comfort Systems
122 3rd St W
Hastings MN 55033
(651) 437-0338
Applicant/Permitee: Signature Issued By: Signature
Receipt:#395607 3088509
Attested Copy
AT P $$2.00 �IIIIII IIIII IIIII IIIII I��II IIIII III���III IIII
Recorded on:9f4/2015 9:23 AM
Return to:
RONALD TRENDLE By:STG,D2pUiy
4794 COUNTRYSIDE DR
EAGAN MN 55723 Office of the County Recorder
Dakota County,Minnesota
Jcel T Beckman,County Recorder
CERTIFICATION OF PURPOSE OF SECONDARY
KITCHEN FACILITIES WITHIN SINGLE FAMILY DWELLING
I, Ronald Trendle, duly sworn and under oath, certify that I am the Owner of the one-family detached dwelling as
defined in Section 11.30 of the Eagan City Code located at 4194 Countryside Dr legally described as Lot 2, Block 1,
Country Hollow, PID# 10-18275-01-020.
A building permit application has been submitted on my behalf to the City to enlarge, alter, improve, remodel,
and/or finish the above-referenced dwelling, or a portion thereof, to include the installation of facilities for a
secondary kitchen within the dwelling.
The secondary kitchen facilities to be installed under the building permit are for the sole purpose of providing
cooking and food service facilities for private entertainment of guests by the property owner at the dwelling.
I acknowledge that the Eagan Zoning Code prohibits the existence of a second kitchen facility within a dwelling unit
to serve a complete, independent and secondary living or housekeeping use within the dwelling. I certify that the
installation of the secondary kitchen facilities under the building permit is not for the purpose of providing a second
complete, independent and separate living and/or housekeeping unit within the dwelling.
Dated: September 3, 2015 �� �
Owner's Signature
�
Subscribed and sworn to before me this�day of � (/1� , 2015.
' JULIE AN1TA STRID
Notary Publio-Minnesota
Nota ublic ;�� MYCommisalonExpires,1an91,�o
I hereby verify that the above said Certification of Purpose of Secondary Kitchen Facilities within Single Family
Dwelling was recorded at the County Recorder's Office on , 2015.
By:
Its:
THIS INSTRUMENT WAS DRAFTED BY:
City of Eagan
Community Development Department
3830 Pilot Knob Road
Eagan, MN 55122
G:\Building Inspections\FORMS\Certification of Kitchen
. � VJC�LVG V� �LMVn��11N
i_���_ _1
� For Offlce Use --- -- I �N�
' ' 1��� �s 7 �-- � ��,
City of �a �� ; Perrnit#: �
� ,�,�.
� Pertnit Fee: i
3830 Pilot Knob Road i ��in �
Eagan MN 55122 � �ate Received: � �,����
Phpne:(651)675-5675 � staff:
Fax:(65y)675-5694 !----------------� �j.
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION N ��
, _� .
Date: . ..'J1' ..�I� Site Address:��'�'"���i'�-�/��b� � �+�."�P`�t 1`�1N �)�Z�
,.,� T
Tenant: Suite#•
Resident/�+vner
Name: �N�j' �U�1 f�l ���-1 fl� Phone:(�)'�7,t`�."�,3' `'1 ���
Address/City/Zip: a`� �--�✓� �� �"�-�
Name: License#:
C411t�aCt01' Address: City:
State: Zip: Phone:
Contact: Email:
Ty�Of WOPk —New _Replacement _Repair _Rebuild _Modify Space `Work in R.O.W.
Description of work: �L�►1�(� K�"T`G�--��%.��� 1 •-1-L�J � �el'��.,._"
RESIDENTIAL �
Water Heater
Water Softener
Lawn Irrigation(_RPZ/_PVB)
Permit Type �A�d plumbing Fixtures(_Main/ Lower Level)
Septic System
New Water Tumaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (inGudes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Tumaround"(inGudes State Surcharge)
`Water Tumaround(add$210.00 if a 5/8"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge)
TOTAL FEES$
CALL BEFORE YOU DIG. Ca1l Gopher State One Ca11 at(651)454-0002 for rotection against under round utility damage.
Call 4$hours before you intend to dig to receive locates of underground utilities. wvwv.caopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start arithout a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans_
,- —. �_
,� �_. _
.
� ,,� .:�,
X xy�.: l}-�_.� � � � ,(� " t�i..�__ �''� ,� �,,
�-�..^di x � E�...�,.i.
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:�
Required lnspec�ions: Under Ground Rough-tn Air Test Gas Test Final '
Meter Retated ltems: Meter Size Radio Read Manometer Staff:
. Use BLUE or BLACK ink i
� For Office Use � ��k-V
' � P rmit#: � � �
Cit of Ea�)�� , _ � e � c� � f .�`'��
� b 9�;� . � Permd Fee: � � � ,
3830 Pilot Knob Ro� �
I
Eagan MN 55122 �f'"' � ;;�,� j Date Received:����� �
r�f �
Phone:(651)675-5675 �.a t r ���� I Staff: �J`-`1 I
Fax:(651)675-5694 � �
� V����������������J
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
__ �
Date• f� Site Address•�'�� ����I���f� Unit#•
('� F
• Name: 1�U i�t� �US;�� ���L:� Phone:��.���� �7 'J
ResidenU � � � �
Owner aaaress i c�ty i z�p: �-� - U ') �' ��
.,�-�.
Applicant is: Owner �Contractor <�( �y �''� , ���,.��,r� '" ���,r --�y�,��
Description of work:�_C�i.�� —�.'�-� t���� �� ������^� '� ����� l��'� ���
Type of Work � �.,��
Construction Cost:$L'�O O O� o'D Multi-Family Building:(Yes /No� -
�f` f��� � � ��
Company:���d•.l��J�h1�=i�1 L E�t�Si����Contact: 1� � �'
1�
Contractor
Address: �1�'`� �� �'T City: �1 f� �`1� �' �
State: l�Zip: - �. U Phone:�1�Z �Z�2�mail: `�J��'145�-'�'1,��:h.�n51T'c�`�#t�'�t
��z.�' . �
License#: � G - Lead Certificate#:
If the project is exempt from lead certification, please explain why: �
. �v� �._T� N p �'-f-�-{ t_.fJ.. _,_ -�
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 morrths,has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documerrts that you submit are considered fo b�public intom►atian. Portions of
the informazion may be ctassifi�l as nonpublic it you provide specif�c r�svns fhat wou/d permit the Crty to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at 651 454-0002 for rotection against underground utility damage. Catl 48 hours
before you intend to dig to receive loCates of underground utilities. www.aooherstateonecall.ora
f 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.
Exterlor work authorized by a building permit issued in accc�rdance with the Minnesota Building Code must be completed within 180
days of permit issuance.
x � _�k�-( ��1� V�� x
Applicant's Printed Name Applicarrt's Signatu
' Page 1 of 3
� (�
y�C� ��1,��,1��5t���- U�` DO NOT WRITE BELOW THIS LINE � ���� �
•SUB TYPES
_ Foundation _ Fireplace _ Porch (3-Season) _ Exterior Alteration(Single Family)
_ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration(Multi)
_ Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous
_ 01 of_Plex � Lower Level _ Pool _ Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
�(, Alteration _ Fire Repair _ Windows _ Demolish Foundation
T�
_ Replace _ Repair _ Egress Window _ Water Damage
_ Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation � Occupancy �• MCES System
Plan Review Code Edition �;����� SAC Units
(25%_100%� Zoning � City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final I C.O. Required
Footings (Addition) � Final/No C.O. Required
Foundation � HVAC Gas Service Test Gas Line Air Test
Roof: _Ice &Water _Final Pool:_Footings Air/Gas Tests _Final
� Framing Drain Tile
Fireplace: _Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
� Insulation � Windows ��,,��"�,,�
Sheathing Retaining Wall:_Footings_Backfill_Final
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Page 2 of 3
Dale Schoeppner
From:
Sent:
To:
Subject:
ARROW LIFT ACCESSIBILITY:
Bjorklund, Gary (DLI) <Gary.Bjorklund@state.mn.us>
Thursday, July 14, 2016 1:44 PM
'permits@arrowlift.com'; Dale Schoeppner; DU.EIevator.ETrakit
Final Approval for Permit Work at 4194 COUNTRYSIDE DR, EAGAN
The ELV INSTALL permit work has been completed and approved for the following project:
Permit Number: ELV1509-00078
Project ► . e: Ron Trendle
Sit= Location: 4194 COUNTRYSIDE DR, EAGAN
The Departm- •..Industry is required to inspect and provide approvals on elevator related devices
prior to allowing them to be placed into service.
An Inspector from the Elevator Safety Section recently performed an inspection of the work performed under
the permit listed at the site above.The new installation is in compliance with the Department rules for
elevators.
NOTE: Compliance with Minnesota Rules and the ANSI/ASME A17.1, Safety Code for Elevators and Escalators
does not necessarily assure compliance with the Americans With Disabilities Act of 1990.
CONSTRUCTION CODES & LICENSING DIVISION
Elevator Section
1
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA138141
Date Issued:08/11/2016
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
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 within 10 feet of all sleeping room openings in residential homes (Minnesota State
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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
(651) 683-9175
Home Depot At Home Services
6224 Lakeland Avenue N, #102
Booklyn Park MN 55428
(763) 542-8826
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA142973
Date Issued:05/25/2017
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
(651) 683-9175
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature
For Office Use / v
• , Permit#:E AG N
zzz----
Permit Fee: / 52
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinainspectionsc citvofeagan.com
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: c9 ti ( (2-�1�Ia t-C' Phone: f `�
Rowne►� Lk\C� Coo s t ►4-
t�7111/netr Address' /City/Zip: 1 `f �0
Applicant is: )(--- Owner Contractor
Type of Work Description of work: !i9((/1 �1,�(��(!'S S�/�?F �� v I `�`6-
yp__
Construction Cost: Multi-Family Building: (Yes /No X)
Company: � ( Contact:
Contractor Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: 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 wouldpermIf the City to conclude that they are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaoan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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.goaherstateonecall.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 ap
(�
led),N Pr1/4— S R—VuV
Applicant's Printed Name Applicant's Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA158655
Date Issued:10/23/2019
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(763) 852-1044
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA160481
Date Issued:03/12/2020
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
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: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Ronald P Trendle
4194 Countryside Dr
Eagan MN 55123
(651) 587-7884
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(763) 852-1044
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA167305
Date Issued:03/09/2021
Permit Category:ePermit
Site Address: 4194 Countryside Dr
Lot:2 Block: 1 Addition: Country Hollow
PID:10-18275-01-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Ronald P & Susan J Trendle
4194 Countryside Dr
Saint Paul MN 55123--162
(651) 683-9175
Bettin, Inc
3208 1st Street South
Waite Park MN 56387
(320) 251-2505
Applicant/Permitee: Signature Issued By: Signature