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