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Use BLUE or BLACK Ink
For office use l
Pennrt 0. ~ I
' I P 1 Of Eivan I
Pemnt Pea. 1
3830 Pilot Knob Road
Eagan MN $5122 i Date Received:
Phone: (651) 675$678 I
Fax: (661) 676.6684
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -5 --,Z7,4/ ~ a- y; s-41 , s r, (.1 o; b A, t. Y,
Site Address:1 Yw., by. 7 0, 7A, 7q, 7 ScurHPe ~a 7`~ .T. 2~ Unit: P
Name: c c 19 C T /r1 A,J 4 l0 4 M L s,) , Phone. 743 -.r9i 3 5 7 70
~
Ovtmer . address I city i zip: 8so kS e~ o+ ~u Q Av ~ ,2 A aotD S•.! vos-t cs-y
Applicant is: Owner X_ Contractor
TypR+e. f1E c• Description of work: '7'-'.+h2 OP l- (Z E - Qvo ~
onstruc Lion cost 3 1.7 .5. X h
. Multi-Family Building: (Yes_ I tJo.~
Company: 1 £a~ r~e.lt~aR N47,i r . [.errZ>D Contact: trav,~ I~v R_R r 5
Address: Yo s- W 6 7 T. City: M p4. $
State. /19a' Zip:.~~'// 9 Phone: ~O x y3
License 0: 4d e- .1 III/ / Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
~~Aios I.J~e>r I~,,,cT Pas; i 9~ s'
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?
_Yss _No If yes, dots and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor Phone:
Sewer S Water Contractor: Phone:
O t) . Call GaPherst~ Ons Call st (661) 461-0002 for protecWn againA underground udlky damage. C40 48 hours
bafm you intend to dig to rtiOelVa locates of underground Lfiftes. ! aoohersts ll or g
I h@mby acknowledge that this information Is COmplete and acudrate; th®t the work will be in conform mce with the Ordinances and codes of ttte Ciy of
Eagan; that I understand this is not a permit. but surly an appuoadon fa a permk, and Morrk k is not to titeA Ndthout a
a00ord®nq with the approves plan in trio ce" or %VDM wttlt:h regWre d rabieW and approval plans, permit: that d w Nark will be in
E"0"rior work authoriz8d by a building permit imuod in accordanco with the Mtinnesoia g~ gulldl
days or WWI: isetmnce, Code must be completed within 180
aAt,,~ ~~2.R►s
appllcanCe Printed Name x
Applicant's Signature
Page 1 of 3
TO/TO 39Vd 1NIVW 1X3 139 L9Z9T98ZT9 bS:OT bTOZ/LZ/SO
• Use BLUE or BLACK Ink
I For OfNce Ua�e�y.r-----—�
(���} f c� I Pemtit�f •�J� (
U11�� Ol �U � � i �� . 7� �
� � Pe Fee•
I
3830 Pllot Knob Road
E��n MN 66122 j Oate Reaeived: j
Phon�:(651)87fi�6676 I �
Fax:(6s1)s76�s68a � � �
�
�----___.�-------__..
20�3 RESIDENTIAL BUILDING PERM�T APP�ICATION
Da�e: S� ,!�/ ,d�sy SG,S"a�,l�, G�., G��/
SFte Address:is�b�,��;'��.�7:t, 7`/�y�. So�rr/iPa�•J 7-� � Unit�:
;J�,:::�.�. N�,e:��o A e r �►�.�a��n� Lv; .7-a e Phone:��3 -s-�� - ���o
� , Address/City/Zip: �l S� 1� ��.►4�'—�,2 A✓ �u � ,2 19 �oi,.�E.; (�i�'t�r'
, . �,�,� s.��x ti
� � Applicant is: Owner �C Contractor
� . .,..,. . D�scripdon of worlc: Q E K o✓� a 2 ti-P��c� �Ai�1 e'o
TYp�,,�f 1IV!'or�c
� Construct;on Cost��9 �� r Multi-Family Building:(Yes�/No�)
. .. . .. . ,. " Company; ��.! �,�'r'f_!��o R /1'1?�i.a� �+�--� Corrtact �v4 v� �J f��(�R�5
����or��.-;. Aadr�ess; �os k� 6�� S>. �;�,. �PGS.
, �': _' � State: �� zip: SS'�/� 9 Phone: �O'.; - �C�i- �x 4/3
� .� , Llicenr�e� �� ��/J I 3/ lsad Ca�tificab#:
If the project is exempt from lead certification, plesse explain whjr:(see Page 3 for add'Rional iMormation)
�L�loS L.��2� �v�Lr Pos: / Q7 �'
CpMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW 6UILDIN�
�n the last 12 mo��,has the Ctqr af Eagan Issued a permit for a simitar plan bs�sed on a rna�be�pla�n?
Yes ".,No If yds,dabB and addnass of master plan:
Licansed Plumber: Phone:
Mecha�ic81 Contractor. PhOnO•
Sew�r&Weter Contractor. Phone•
NOT�:.R�al�a�o�d� .. � . ,' K .. ,
� �. .��'� :-'� . •. +e, ,. ,. . �. � �rJ'
• bf@.;� . , • • ••' .
':Y� '� ;�'.K�"��� :,j',"%,.;.,,;� r� �. 1., ,,a.. , � � �Y"�s�
�. :�t-� �,i:. 4:A: ,� a •,�f�• +��o.�5r,?ui;:.r�..v�
C�.4 B�EQB�Y�U D�• Ca��Gopher Slam One Call et�661)45s.ppp2 fcr protedion aqainsl und�t+ground utlll[y Camege. Call 46�oura
Defo�e you�r�end to dlg ro reoeive locetes of underground udlrtJes. �W W.�O]Lh615t8t�OneGgll.om
I her�by aGcnowlQdge that this infama6on is oomplele and accurete;thet the work witl be in confamance with the wdinences and codes of the City of
Eagdn; tl1aC I under�nd this is npt a p0lmit,but oNy en OppGcetion for a p�►mit.dnd wak i6 noC to start withart a parnut: 1haR the waic will be in
aoconea�ee wkh tha approve0 p1511!n tne case W woffc wRICr1 I�DQWr�9 8 18vi@w 8f1Q BpplVVel O(p18n5.
Ex�ria'+wwk autho►i�sd by a bullding pBrm7t lssued tn accord��ce wfth tDe Mlnnesota st�e 8ulldln Cods must M complebd wkhln 180
days of psm�ft issupnCe.
x ��i�r� ��R2r5 x
AppllcanYs Printed Name APPllcanY�SlgnAture
Page 1 ot 3
�0/Z0 3Jvd 1NICW 1X� I3S L9Z9T98ZT9 b5�80 bZ9Z/ZZ/90
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA174161
Date Issued:01/03/2022
Permit Category:ePermit
Site Address: 1876 Southpointe Ter
Lot:017 Block: 03 Addition: Sun Cliff 3rd
PID:10-72977-03-017
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
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.
Contractor:Owner:- Applicant -
Stephen T Koch
1876 Southpointe Ter
Eagan MN 55122--228
(651) 452-4159
Appliance Connections Inc
12850 Louisville Road
Shakopee MN 55379
(952) 445-4803
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA174399
Date Issued:01/24/2022
Permit Category:ePermit
Site Address: 1876 Southpointe Ter
Lot:017 Block: 03 Addition: Sun Cliff 3rd
PID:10-72977-03-017
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
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
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 Total:
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.
Contractor:Owner:- Applicant -
Stephen T Koch
1876 Southpointe Ter
Eagan MN 55122--228
(651) 452-4159
Window Concepts Mn
291 Eva St
St Paul MN 55107
(651) 905-0105
Applicant/Permitee: Signature Issued By: Signature