1272 Deercliff Lane
Use or BLACK Ink
For office Use
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CL
y t
City of E
Permit Fee
3830 Pilot Knob Road t
Eagan MN 55122 Date Received: ,
Phone: (651) 675.5675 (7
Fax: (651) 675-5694 1 staff:
x-
- - - - - - - - - - - - - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: I ~j site Address: -"]7i{ -'J~~~'c,,reL `F(r fluff Unit
t
jAll rU1J Y QYtJtJ .j~b,J,~hone_ ! -46z - sq417
Resident/
Owner Address ; City ; Zip: ,ate A-3 3.J
Applicant is: Odmer 4 Contractor
Type of Work Description of work: e- -RA
Construction Cost: ~l} a t '5-z, Z- Multi-Family Building: (Yes ? No
Company: A bn ' F+ tees Ai 3 c. S~ Contact: t u 6 R. n „1
Contractor Address: 9 Z-0 C(J V rsi 17_" t L..- City: G a A NL
State: _h'\M Zip: Phone: inn Z j10
(c,
License _ 1~j Ea s 7 b Lead Certificate -get - $ 1 g1cf 1 i
If the project is exempt from lead certification, please explain why. (see rage 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 R 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 speck 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 protectifl-~ against underg~ound uti ty damage. Call 48 hours
beiwe you ?mend to dig to receive locates of underground utrlihcs
I hereby ac_knowledge that this inforrriat-on is complete and accurate that the work will be in conformance with the ordinances and codes of the City of
I agan. Mal I undrrstand this is not a permrl lit only an appkcahon for a permit: and work is not to start whlhoul a prrmil, tnat the work wtl bc: 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 of permit Issuance.
X x
Applicant's P `red Name Applicant's ignature
Use IIILAIE or BLACK C kilt
1 For Office Use ry
•CI 4
i k" ofEal;-
, : Permit* 1( tiI: v.., ;k i
Pena*Fee: '(9.-'1 1Q
3830 Pilot t Road RECEIVED --._/ '/ A
Eagan MN 55122 Date Received:
Phone:(681)675.5675 JUN 2 1 2017i
Fax:{651)675.5694 stat► t
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ( t 7-4 I I/ Site Address: 1 2 7 a. e<,-CLi Pc L.,) Unit#:.
Nom: VN4 tap ave-.0- w PJ 1\--5) tnc Ass cis t ;,Phone: 40-1-\ —`i c i - `7"5
�d�fi T E.f G>e-wrP V-
no ' ,,"lal.`" '.. boa_ It ' is J
()timer ._- "t Address/City t2ip;. ". Ty •
Applicant is: Owner \ Contractor '�
Typet ftN , F D of%York: R.g.f C pt C. .. 1 y-t b-A-, N c
Consbuction Cost tldul-Fatally Building:(Yes 1No: ; _)
Address: 1. Z'<--.t Cu vnel 1',4'°et..t— City: ?c§-1',,
st : r .�: 55`1 V it e: 4 t'Z.-21c -1 a V R t p p e...�t'4`-r�, V , ,
t License#: 0 5 4 `7 ( Lead Certificate#: a , K , e ...
If the project is exempt from lead certlecatIon,please expiain.why:
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?
1 Yes No tires,date and address of master plan:
Licensed Pte: Phone:
IMechanical Contractor Phone:
I
Sewer Sr Water Contractor: Phone:
I:Fire Suppression Contractor Phone:
mom: li ', S Oi'Ill tifiCti' #41t 1 f s `
the ieteneettion maybe choeshUia,nonlati ',you Ptd c teastmsthat the'Ci
CAI-L BEF )RE YOU Die. Cae-.Gepiter State One Call at 0651)454.0082 for protection against underground^_^_y Cal 48 hours
before you intend to dig to receive locates of underground utilities. wkwigocherstateorrecolli.orn
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 1 urularstend itis is not a parrot but only an application for a permit,and work is tare stat without a pent*:that die work wit 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 f80
days of permit Issuance.
x ` a u II 1,05 R l'ID 'Cr N x �.Cla)li ---- -
Applicant's Printed Name canes i mature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE ,. / J
SUBYES /27 `mak e L.6-4,
-
Foundation — Fireplace — Porch (3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage — Porch(4-Season) _ Exterior Alteration(Multi)
Multi )0 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
`f' Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation ' 7, e .- Occupancy C 3 MCES System
Plan Review Code Edition 04 h Zo I 5-- SAC Units
(25% 100% ? ) Zoning ?P City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction V (7 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) _ 2p 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
II
Other:
0/21 �
Reviewed By: / O (K`C " , Building Inspector
tESIDENTIAL FEES
Base Fee AO • Xd/ c €.0 59 • / *T
Surcharge /,$- 59. ft-
Plan Review X
MCES SAC ----
City SAC `4 /2. o ,ev
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant A74 0 IN Lino') 74-GC
Copies
TOTAL
Page 2 of 3
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7 Y I112.rgyt.i $
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