3292 Valley Ridge DrG ity Use BLUE or BLACK Ink
For (at a #J Js se Q f - Permit #: 1 0 "7 Oq
Permit Fee: $3
3830 Pilot Knob Road 9' 00
Eagan MN 55122 � Date Received: +y-ZI -1I
Phone: (651) 675 -5675 Iry
OW 01gt-� f 01qt-ha/it
it
A • p nt's Signature
Fax: (651) 675 - 5681 `` 4 f / Q0 f Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: i-j • Sn • a0 // Site Address: ( may ` ��
ty•
LHLL 6Cr'VKt VU Ulta. 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.gopnerstateonecaluorq
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 app vaI
X 50e,1 r - { -P-Cs(m ._
Applicant's Printed Name
Page 1 of 3
- 1 4 unit Fr
RESIDENT /
OWNER
Name: Omo n H4 �a er✓u41 -1- r Phone: 7 3 - yy9 - 9/n«
Address f City / Zip: * • e t • . it , , 11 i `/
`
Applicant is: Owner X Contractor
TYPE OF WORK
Description of work: Re, -roo -P
Construction Cost k , =, . '3y /, ,5b Multi- Family Building: (Yes X / No
CONTRACTOR
Company: ctt n r, se...- PC.e.yvt�nd edema 3 S Contact: e P �i:�
Address: 59 7 (o 140b.e- �ci n c- City: i-( P0 `'t l
State: M N Zip: 55//0 Phone: / - 76,;1 - 9a y'5
License #: c`.S j�,S/ g Lead Certificate #: pi Q I - ,2a9 , ? -t
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
I n the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
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 spec reasons that would permit the City to
conclude that they are trade secrets
G ity Use BLUE or BLACK Ink
For (at a #J Js se Q f - Permit #: 1 0 "7 Oq
Permit Fee: $3
3830 Pilot Knob Road 9' 00
Eagan MN 55122 � Date Received: +y-ZI -1I
Phone: (651) 675 -5675 Iry
OW 01gt-� f 01qt-ha/it
it
A • p nt's Signature
Fax: (651) 675 - 5681 `` 4 f / Q0 f Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: i-j • Sn • a0 // Site Address: ( may ` ��
ty•
LHLL 6Cr'VKt VU Ulta. 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.gopnerstateonecaluorq
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 app vaI
X 50e,1 r - { -P-Cs(m ._
Applicant's Printed Name
Page 1 of 3
Use BLUE or BLACK Ink
For Office Use I
1 I
I Permit
I I
City of EqdR
Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 1 Date Received:
I
Phone: (651) 675-5675 1 Staff: j
Fax: (651) 675-5694 1 -
2013 RESIDENTIAL P U BING PERMIT APPLICATION
Site Address: 32L l 2
Date:
I K~~ `YAA N.)
Tenant: Suite
~ I Z--9go -9p) q
JC.
R sident/Own r Name: Phone::
2") J-/
Address / City / Zip: X- I
Name: Goa- , \1 U) License 0 sek)zt - PH
I
o'Itra+~tblr Address: City:
V lS~'
State: \A Zip: Phone: S
Contact: NAA U-XV l.1\ Email: 'li a 0,1-
`T e of W6 irk - New X Replacement _ Repair _ Rebuild Modify Space _ Work in R.O.W.
y~ - Description of work: 1 _
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation RPZ PVB)
Permit Type
Septic System Add Plumbing Fixtures (-Main Lower Level)
New Water Turnaround
Abandonment
TIAL FEES:
$6 - ater Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Tumaround" (includes $5.00 State Surcharge)
"Water Turnaround (add $200.00 if a 5/8" meter is required)
$115.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) 00
TOTAL FEES $
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.goi)herstateonecall.org
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
accor nce with the approved plan in the case of wor which requires a review and approv I of plans.
x C~~ l x
Applicant's Printed Name Applicant's Signature
%
I=OR OFFICE USE r RevT~i~veil; ? y e-
Required Inspections` Under 0?60nd v tgfi-ln , i if Tett Gnss Test
Meter Related1tems: Mekel✓' i e 2adio Deed Staffs
Use BLUE or SLACK lnk
r__��__ ����.�_�.�_;
l Fcr Offlce lfse �
�j 1
�.' � � Pertnit#:,��c��l �S �
c
�1t �i, i � .SZ� i
ib� �� lJ��� I Permi�Fee: � I
3830 Pilot Knob Road � I
Eagan MN 55722 � Date Rece'rved: 1
P�one:(651)675-5675 �
' j Staff: _- �
�ax_(6599 675-569+6 �
--E'�iMC�t�� � `, �, �f��.�:��' L;�-J a° �e.�t�c.n c::�y' �----------------�
2015 RESID�NTIAL �ll,llL.Di�Vt; PERIVI6�ls►PPLICA'TION
c-���� ���a -����� �,��� s�s�
� �� � � - _ _ . -
Da2e: ' ' S�te Ad�dress: -- - •� - — -
_
_r.�.:>=-:,,�_�:.-�....-,�<.t-x.-,r.,.�.�.-.�.ra.i�,. G A�-..�......�`� 'oZ oZ�l�O r/3��'1 �y 3`3.C�C�`
:��nL +� ���� ' ��� �3
•. Name: J �i j Phone:
R@5lcien�l
- ��,�r � Address 1 City/Zip: n
, �
? '; Appiicar�f is: Ov,mer �Cont�acto� .�,..�.zu. ..-._n.�-
; .:�......_:..,.._.._:.__..::�,:.. �,,.w„_,�....R..... . . .. . � � n c
� ° Descriptio�of work: ��
� '�ype of 9�/urk
J
` � Cons�ruction Cost: � �����C��G _ Mul'U-Family Building:(Yes�1 No_� ,
T��.....�. ,._._...._...,......, ... Company:��;.Y1 M�;.1-£'_ �-�s� cx�:1-2 t'S`ConEact:'�C::�.� �-�'�.� �:.'1 .
? � �y-
Address:�� �"' �1L' V�'L �-ct i/1-� Ciry: S�"'� �t.c.ti �
�ntrac�o� , �
' State: i1��Zi ��i I U Phone: Ernail:s Y1�� �' S`.e��r-�v r��v►,�:c►-z l�:s,
,�. P� �c�-+-
Lead Certi#icate#• �- �� � ����
.._....,.._w.__..._....Y,,1,.,._ License#:���� ����,..�,� - -�--��.._...�.,�_...,�.
` If the proJect is exempt from i�arl certificatio�, p�ease explain why:
'�-.^����x���.�F'��C01111iPd.ETE THlS AREA ONL1(!� CONSTRUCTlP1G A NEW BUILt3ll�1G
; 1n the last iZ months,has the Ciiy oT Eagaea issued a pe�mit for a similar plan based�n a Enaster plan? '
Yes No If yes,date and address ofi master plan:
>
' Licensed Pl�mber. Phone:
> .
' k�echarticaf CoMractor: _ Phane: :
t
` Seuier 8 Wa�er Contractvr: F+hone: �
; Pire Suppression Contractor. �hOi1.,r _
e:
.._.„ ..x.-..�...,,_,_._..._,,.��.,.,,-..,-..-_..._._.��>.�-_....�..�.-.....��,.-�..._......�..�.,....�._��..r_.._�..._ ..,_ ...
� r-��dOTE:P/ans end supporting a�osumerrts f�at,irou submi�are considereal to,be Fub/ic inf�rmation. �o�iflns ot ;
�Pre ie�forrnation ma,�be classified as non•pzr�ilic if yora proyirle specific r�asons thaP woufd permit#h� City to ;
', : �or�clude fha��heyare trade seciets<__...._,... ..�_,._:.m.:,_�..__.�..:.._.F.k...�...�..__,._..,_...�_„_.
,
�
:._..:,..._...:_.:_,,:-.:._.....:.._._._......._�.:.:_:.:....................._._..�._..:._.._�.r._..:�_..-.:,..._..._..:,_..:a..,.._,_._.__ �
C.�LL BEFORE YaU DIG. Calf Gopher State One Call at(651)454-0002 tor protection agai�t�mdergcound uUllty damage. Ca0 48 hours
befiore you i�tend to dig to receivz locates of underg�ound uG1ities. w�w�aooherslateonecaU.om
I heeeby acknovvle�dge ihat lhis infflrmatior�is complete and accurate:that the work v�n'd be irE confamance with ihe ordinances and codes ot ihe City of
Eagan;that I undersWnd ihis is not a permit, but only an applicatian for 9 permit, and umrk fs not io start vuithoat a permit; that f!'�e�nroric wi��Ise��
accardance wfth 1he approved plan in the case of work which requires a review and appro�al ofi plans.
' Exterior woric authorized by a buitding parsnit Issued tn accoMancewith the Mirmesota State B�eilding Code rreust be complete��nrithin 180
days of gennit issuance, ---""
� ��� QL'-�-��i''� C3 r'� � �
ApplicanYs Prirrted�lame A 's Signa�ture .
Page 9 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
' ���� � i
C�� �� �� �� j Permit#: �
� � I permit Fee: d �� �'-� �
3830 Pilot Knob Road � I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
� I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Sr� ' Sc� <-� � � � ���
���Unit#:
: Name: Phone:
Re�i:d�► � '/ `7YJN, .�5 �3
()y���� Address/City/Zip�� �� Y�L��H ���&e's -� L�A�6nl�►�. �
Applicant is: Owner Contractor
' Descriptionofwork: �L�Pu4[r ��4R.46��8�
Ty�� Q�=w��� �
w
Construction Cost: � 3 Multi-Family Building: (Yes�/No�
� � ; /�
' ' Company: ( 4n�t�n�V„��.r.�„ �riq-RA-t� 9�,_ LLG Contact: S'7SI�f3 Vt�/���
' Address: �5-180 �jo�` � City: �,v�� �s
�c��tra+�tn�
State: '/�N Zip: ,5`5�,� Phone: �S/-�ys-03/� Email: SJoNn+Sc�et�ivMr�k�sy(rAR�,t�.
License#: r1� �" Lead Certificate#: N�� �
If the project is exempt from lead certification, please explain why:
N� �� -P���.�-r
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:
N�T�:Af��rs ar�d�u�#�or��n�do�t�r��rr#�i�;�t,�ou;st��imi#are cor�.�de�er!':to b�e pr���c 1r�fc�r►���t?�;:l�or�,s c�3':
t�e:int'armafiic�r�may�e ct���fi�d as nvn-�wbl����'yc�u�rowi�le spe�r'��rea�on�t��t wcir�ltl�r�ti�tl�e C�iy td
c�r�c,��d�that the �re�ra�e sec�ts. '
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.qopherstateonecall.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.
Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance. ^
x S"7�1l� �J01"1'NSo,� x —
ApplicanYs Printed Name Applic t's Signature
Page 1 of 3