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1540 Clemson Dr - Unit B441Pij' Cityofaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 RECEIVED DEC 15 2010 Use BLUE or BLACK Ink Permit #: Permit Fee: Date Received: Staff: 2010 MECHANICAL PERMIT APPLICATION Date: \ - l O Site Address: ITh L-1 � l Qt LU307A (Dr' a I tg Tenant:—Mtly1i \C ;\AO kO\.,A Suite #: RESIDENT / OWNER Name: ais�� T C��115 Address / City / Zip: L .1 .a Or, Phone: U) C)5gI CONTRACTOR Name: hili NSVILLE HEATING & A/C, INC, License #: L 1_(?7AC (e.ai (-j 3451 VV. Bumsvilie Parkway Address: Suite 120 City: State: C. -1)Q( zip urnsvilie, MN 55337 Phone: C � Z tL� (XY5 Contact: �.Email: TYPE OF WORK Additional Alteration Demolition b- , "1- PERMIT TYPE RESIDENTIAL X Fumace `NiL. Air Conditioner Air Exchanger Heat Pump Other Q 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 bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge) 95i on TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x 1% $50.50 Minimum (includes State Surcharge) _ $ Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). = $ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaII 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecali.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x (2)CC x 1 @ iG j I'm �`�. i Applicant's Printed Name Applicant's Signature CityofEa�au 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 JUN 1 2 2012 la Use BLUE or BLACK Ink For Office Use Permit #: /D1%/b Permit Fee: /0J` cs— Date Received: c -- Staff: / l / 2011 RESIDENTIAL BUILDING PERMI APPLICATION Date: LQ " O ' � Site Address: 6 5-40 A Unit #: Name: / i7i / 1 C t/��Ld Phone: I) re g' --0 s O I Address / City / Zip: /5%U t J ( Cd ilk.) b' �Nl 7s c� Applicant is: Owner Contractor J RESIDENT / OWNER TYPE OF WORK CONTRACTOR Description of work: -31 Construction Cost:l 61-4 ' uu_kAALrw-a.) Company Address: State: m it) Multi -Family Building: (Yes / No Contact: Ilk _ _ City: /A A__A a -f&-(1 1016MIL Zip: g6-2-9 License #: 1, 174 z g Phone: Lead Certificate #: / v Pr—r 0.-70104— If .-701'7 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.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 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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code mut be completed within 180 days of permit issuance. x Applicant's Print4d Name x Applica Signature Page 1 of 3 CITY OP EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P.O. Box 21199 PERMIT NO • Eagan, MN 55121 DATE• I,, n Zoning* No. of Units. Owner: Address: Site Addess: Plumber: Meter No.: Connection Charge. Size: Account Deposit: Reader No.: Permit Fee. I agree to comply with the City of Eagan Surcharge. Ordinances. Misc. Charges. P) Total By Date Paid. Date of Insp.: /D — v- Insp • CITY OF EAGAN 3830 Pilot Knob Road P.,0. Box 21199 Eagan, MN 55121 Zoning: Owner: Address: Site Address: Plumber: SEWER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: 1 agree to comply with the City of Eagan Ordinaeee1. By --__ Date of Insp.: Insp.: Connection Charge: Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: �r Date Paid: 0 Date: Ciliy of Eaaall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use I Permit #: t t� 110 d 1 Permit Fee: Y U 1• 1 5 - Date Received: Staff: Sib t3 2013 RESIDENTIAL BUILDING PE(RM)IT APPLICATION - 11- 13 Site Address:.L��_,,_ /5 3A1e3)) $ itO).60 Name: /00.26,/ '7-11r ItS 77, t.) hf '1_L� _ Phone:. -Z• 72/- 3-3-0411 J Address / City / Zip: Applicant is: Owner Contractor Description of work: Re rec # m n j Construction Cost: _L (`I 5 Multi -Family Building: (Yes _ / No Company: f} ( C()/?$?tit %/f' Contact: Live.) Address: _an. 3 e2. M city: M lnr)ea. poh`s State: MAJ Zip: 5-5-4i0 ` Phone: _ol ' / Z. - 55 5 License #: t^ - 1 92.0 2- Lead Certificate #: N 2 412.'7 " % If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 48 hours before you intend to dig to receive locates of underground utilities. www.00pherstateonecali.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days ofjpermit issuance. E x t204. ' -M ., t e/? Applicant's Printed Name x Applica s Signature Page 1 of 3 City of Eagan PERMIT IP1' City of Eaan Permit Type: Building Permit Number: EA132291 Date Issued: 08/04/2015 Permit Category: ePermit Site Address: 1540 Clemson Dr B Lot: 3 Block: 01 Addition: Thomas Lake Heights 2nd PID: 10-75951-01-030 Use: Description: Sub Type: Windows/Doors Work Type: Replace Description: One Window/Door Census Code: 434 - Zoning: Square Feet: 0 Construction Type: Occupancy: 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 Fee Summary: Valuation: 500.00 BL - Base Fee $500 $40.00 Surcharge - Based on Valuation $500 $0.50 0801.4085 9001.2195 Total: $40.50 Contractor: Minnesota Rusco 5558 Smetana Dr Minnetonka MN 55343 (952) 935-9669 - Applicant - Owner: Donna Mae Mccloud 1540 Clemson Dr B Eagan MN 55122 (651) 688-0581 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature City of Eagan PERMIT IP1' City of Eaan Permit Type: Plumbing Permit Number: EA139720 Date Issued: 11/04/2016 Permit Category: ePermit Site Address: 1540 Clemson Dr B Lot: 3 Block: 01 Addition: Thomas Lake Heights 2nd PID: 10-75951-01-030 Use: Description: Sub Type: Residential Work Type: Alteration Description: Fixtures 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 (miscellaneous) $59.00 0801.4087 Surcharge -Fixed $1.00 9001.2195 Total: $60.00 Contractor: Benjamin Franklin Plumbing 5718 International Parkway New Hope MN 55428 (612) 238-9709 - Applicant - Owner: Donna Mae Mccloud 1540 Clemson Dr B Eagan MN 55122 (651) 688-0581 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature City of Eagan PERMIT 41' City of Eaan Permit Type: Building Permit Number: EA148882 Date Issued: 04/26/2018 Permit Category: ePermit Site Address: 1540 Clemson Dr B Lot: 3 Block: 01 Addition: Thomas Lake Heights 2nd PID: 10-75951-01-030 Use: Description: Sub Type: Windows/Doors Construction Type: Work Type: Overhead Garage Door Description: Census Code: 434 - Residential Additions, Alterations Occupancy: Zoning: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openings, 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 Fee Summary: Valuation: 1,500.00 BL - Base Fee $1500 $62.50 0801.4085 Surcharge - Based on Valuation $1500 $0.75 9001.2195 Total: $63.25 Contractor: Twin City Garage Door Co 5601 Boone Avenue North Minneapolis MN 55428 (763) 533-3838 - Applicant - Owner: Thomas 0 Mccloud 1540 Clemson Dr B Eagan MN 55122 (651) 451-0428 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature City of Eagan PERMIT 41' City of Eaan Permit Type: Building Permit Number: EA153556 Date Issued: 01/02/2019 Permit Category: ePermit Site Address: 1540 Clemson Dr B Lot: 3 Block: 01 Addition: Thomas Lake Heights 2nd PID: 10-75951-01-030 Use: Description: Sub Type: Fireplace Construction Type: Work Type: Gas Insert Description: Census Code: 434 - Residential Additions, Alterations Occupancy: Zoning: Square Feet: 0 Comments: Improvements to the home may require smoke detectors in all bedrooms. Chimney / flue must be inspected prior to concealing. Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Fee Summary: Valuation: 3,000.00 BL - Base Fee $3K $88.50 Surcharge - Based on Valuation $3K $1.50 0801.4085 9001.2195 Total: $90.00 Contractor: Fireside Hearth & Home 2700 Fairview Ave N Roseville MN 55113 (651) 633-2561 - Applicant - Owner: Thomas 0 Mccloud 1540 Clemson Dr B Eagan MN 55122 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature