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Permit Fee
3830 Pilot Knob Road t t
Eagan MN 55122 Date Received:
Phone: (651) 675.5675 i ;
Fax: (651) 675-5694 1 Staff.
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2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 2-~ ( Site Address: Unit
Name: jAJ 4 tjI) 13ZJ`t,3 ~tgZG,)C ! l 3&-,Qhone:
Resident/
Owner Address City t Zip: ")C rrZ~-L OaA-) S ;;Z-f ?4
Applicant Is: Owner Contractor
Type of Work Description of work:~~
Construction Cost: Multi-Family Building: (Yes 1 No )
Company. A` Contact: 11~ u t., R ..r►,~, e ,r -rt t
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Contractor Address: -i Cu V ru d2tP~ i t city: 07 0 Ao
State: W( Zip: J L~ Phone: L~1 Z
License 4 !5 3-b 8 Lead Certificate -A " - $ ` -1
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 they are trade secrets.
CALL BEFORE YOU DIG. Gall Gopher State One Call at (661) 454-0002 for protection against undergfound utility damage. Call 48 hours
betwe you Wend to dig to receive locates of undergsowid uhhties
i hereby acknowiedge that this inforrnaton is complete and accurate that the ::pork will be in conformance with the ordinances and codes of the Gib; of
Fagan that I understand this is not a peimil, bit only an apphcation for a pormil, and.vork is not to staff wilhout a pormii. that the work mill be to
accordance with the approved plan in the case of work w ich 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 of permit issuance.
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Applicant's P ted Name Applicants ignature
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E�gan MN�51� ; Date�tec�+�red:f�-c��—1,� ;
Phc��se:(�a'{�67�-5B75 ' t t
��t:(�51)875-5�94 I StatF:S� F
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��s�����������'������ St�€e:�f�iP: ��G Phone: �. �.��ai��-�°�,+[��1t,'"�'k'"�'.�3.
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if�he pra��ct is�x�mpt frt�m t�ad�erti�i�ip�, plea�e e�xpla�n wh�r:�see P�ge 3 fc�r additi�rrai ictforrrt�tion}
Ct�MPLE`�'E THI�AE��A C?ML�`�F�t)NSTRlJ�T1�#+G�t.�lE�f BUl��il�l�
In the I�st'13 months,F�as ft►e City a#��yan issu�d a�ermt#f�r a sfrn��er pFat�b�setl t��n a m�ster p(an'?
�,Ye�€ ;�lo ff yes.:date and adtlress of rn�ster plan:
Lic;ens�ed Plt�rnt��r. ' Phc�ne:
Me�tt��ticat�+�h#ra�tor: Phone:
��w�c t�tt��r.�tsr�ra�tr�r; Phane:
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�AL1.E3EFQF�E�fQEf Ct1E`a. Caii Gupher Sta#e One Catl at�651��OOti2 fc�r prptection agdinst u�rdergr�unci:ub'iiry damage. �ait�8 hc�urs
b�fc�t�:you intend to dig tta receive to�Ees af un�ierground utiEiti��. wta�t+.gop�,iersta necafl.wq
t heretky actcr�kwAedg�:t(5at this infof�►tl�tiprT is r�tttp{�fe�ntl accur�te;th�t kta�u�rk uuifl be in r,�nf4rr�anCe-�n+ith the brdinances ar�r!cade&af th�City a�
Eagan,that( uriderstarid this•is not a p�rmii,but c�nl�an appiii�aGQn f�r a perm'r�, arrtl w�rk is nc�t tc�sta�t vai�ut a perrr�it; that fhe w4rk vuiil be in
ac�rd�rnce with the approu�i ptan in the case of wrorf�which req�ir�s a revE�w�d app€s�vaf t�f plan5.
E�r�or v�ror�autk�ari�ec�ksy a building permi!#ssaed fn accorc�ance w,'�th�he Minnesota State�uilciing Code rnu�#�+e�cmpfe�d wCtf�i�t��t#
days af permit issuan�e,
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l�►pAl�canf'�Prirt�eei Name Apipli��nt" �3��ure
P�g�1�f 3
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, (. I �I � r,V�S� C�•DO NOT WRITE BELOW THIS LINE I�7 1C�S
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
lace _ Repair _ Egress Window _ Water Damage
_ etaining Wall *Demolition of entire buiiding-give PCA handout to applicant
DESCRIPTION
Valuation �YJ Occupancy -� MCES System �'"'
Plan Review � Code Edition �a`� SAC Units "'
(25%_100%✓ ) Zoning � City Water �
Census Code �34 Stories �" Booster Pump -�
#of Units 1 Square Feet ��i0 PRV �""
#of Buildings / Length � Fire Suppression Required �
Type of Construction �_ Width �
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final/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
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
��_. Other:
Reviewed By: , Building Inspector
� , ,.
RESIDENTIAL FEES
Base Fee 8'�
Surcharge
Plan Review �'� ��
MCES SAC
City SAC '
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies (`j a,S'
TOTAL
Page 2 of 3
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