4286 Meghan LaneI * ) City of Eaall
Date:
3830 Pilot Knob Road
Eagan MN 55122 RECEIVED
Phone: (651) 675 -5675
Fax: (651) 675 -5694 JAN 2 4 2012
2011 RESIDENTIAL BUIL
/ Site Address:
RESIDEN
OWN ER'.
Licensed Plumber:
Name:
Sewer & Water Contractor:
CA
Applicant is: Owner Contractor
Description of work: R�v„ r kACA 1 iagr)1L, fr c l
SC-
Construction Cost: t , l9 f) 0 °�'
Company: IVITP -tom c.
Address: I LI Si) S (Ou04 rLct
State: .Yy \.) Zip: (0 Phone:
License #: )(_ wog. (3'j3 1
Mr) ft0
Lead Certificate #:
ING PERMIT APPLICATION
/- 6-66
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:
NOTE: Plans and supporting documents-that you submit are considered to be
the information maybe classified a s non- if you provide sp "eciftc reasons t
conclude that they are trade secrets..,
tra q et l - - 7 4 -00'
Use BLUE or BLACK Ink
For Office Use
Permit #:
/4
Permit Fee:
Date Received:
Staff:
Phone:
Unit #:
Address / City / Zip:
t \fL sled / I2 (pCc,a f r,F/Jef'l -� e�
Multi - Family Building: (Yes Y / No )
ContactTT • F� ik12._e_,ri /_
City: )0U("1 .Y
If the project is exempt from lead certific tion, please explain why: (see Page 3 for additional information)
a /9
ittr.t
Phone:
Mechanical Contractor: Phone:
Phone:
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 Buil no ' ode , st be completed within 180
days of permit issuance. ! l
x lvyi [ r �. /"tom Li_S' x 0„ -• ::
Applicant's Printed Name pp ican'rture
J
Page 1 of 3
SUB TYPES
Foundation
Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25 %_ 100% y)
Census Code
# of Units
# of Buildings
Type of Construction
) /IA
DO NOT WRITE BELOW THIS LINE
Fireplace
Garage
Deck
Lower Level
Interior Improvement
Move Building
Fire Repair
Repair
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: _Rough In _Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S &W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Porch (3- Season)
Porch (4- Season)
Porch (Screen /Gazebo /Pergola)
Pool
Siding
Reroof
Windows
Egress Window
(i 3
Meter Size:
Final / C.O. Required
Final / No C.O. Required
_ Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
_ Miscellaneous
_ Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
HVAC Gas e;vp a Te Gas Line Air Test
Other:) (t t .Tr&
Pool: _Footings _Air /Gas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill Final
Radon Control
Erosion Control
, Building Inspector
� �0
1O-72
Page 2 of 3