1302 Deercliff Lane
Use ; . or BLACK Ink
For Office Use
t t~{?fr1r1 ?S ~
City of Eapn /
t Permit Fee
3834 Pilot Knob Road
Eagan MN 55122 Date Receved: 3` 3
Phone: (651) 675.5675
Fax: (651) 675-5694 1 staff. 1
1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ] O ID -02
~,r eta fr' tttnit
Name: jAll i i2 c`L Tc•3~--'--an`~ f~3rbr~t hone:
Resident/
Owner Address! City I zip:
Applicant is: O:<mer --tr - Contractor
Type of Work Description of work: Q --R a
Construction Cost: 119.1 y Multi-Family Building: (Yes t fro _
)
Company: U+ " T'~ A8 U C. Ii-I Contact: a f> n >
Contractor Address: 97,0 CU V ru "rte t city: A 0 &
State: --N\N( Zip:j 1 2'_ Phone:, Z { _ (Q
License= : . A S7 b 9 Lead Certificate A I gIctl I
If the project is exempt from lead certification, please explain 1why: (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 speck reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 454-0002 for protection against underground util ty damage. Call 48 hours
beto e,, you intend to dig to receive locate; of underground utilities
I hereby { cknotviedge that this information is complete and accurate:. that the work will be in conformance with the ordinances and codes of the City of
t agan, that I understand this is not a permit; but only an appleration for a permit, and work is not to start wiihoul a permit that the work tt he in
accordance with the approved plan in the case of work i4,41ich 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,
Applicant's P ted Dame Applicanrs ignature
1< rE For Office Use
•y r 0 .,, JUN � � � Permit#:E AGA N TT
2019 / O
••' '•• Permit Fee:
Date Received:
3830 PILOT KNOB ROAD(EAGAN,MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
bui ldinginspections(acitvofeagan.com
/
2019 RESIDENTIAL BUILDING/� PERMITLAPPLICATION
Date: 0/191! /[ Site Address: �0� IJ 44r ,/ - -F LA) Unit#:
Name: AfeCia. r"`_ / rvv 1l.eA. 4LIA2L Phone: 65/^ 4'c 7i3,'
Resident/
Owner I Address/City/Zip: v',1‘1,e___ 6;0612 /t4 5:r0/
4 e (774
Applicant is: Owner Contractor s'-IN
Type of WorkDescription of work: rf a.Mev/ O�c� WM) Si't's /)437141/13' p EP 57415/r41;
0
Construction Cost 9/00^ Multi-Family Building:(Yes X /No )
Q
Company: L cy yfemwria _rte- Contact: 77m. 1))42,I4
966
� Address: 1'�l%+�v Ave_�v� S19. City: �O�sC-(� 6�p ti.�
Contractor / � t/—
State: 1K N Zip: Scold Phone: 6$/-3 t/"3g Email: ,1d4 out ray GO••-c0i.f7 NST
License#: a-66 6 3 6 797 Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW 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 TE:Pis and supporting documents that you submit are considered to be public information. Portions of the inforrnation maybe
classified as • , bhc if • • • . «;- reasons that would• the ' to conclude that , are trade secrets.
Youmay subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at w .citvoteaoan.cornisubscribe.
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.
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:goohecstazacoecadi_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
accordancepwith the approved plan in the case of work which requires a review and approval of plans.
x /%ko Oeiw4 a x
Applicant's Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE
SUB TYPES
— Foundation _ Fireplace _ Porch(3-Season) — Exterior Alteration(Single Family)
_ Single Family — Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
_ Multi a — Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
10 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
�4 Replace _ Repair Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation Ligq/Do. - Occupancy ,�(ZC -3 MCES System
Plan Review Code Edition ,yj i2 Z n I c SAC Units
(25%_100%p ) Zoning P 2 City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings t Length Fire Suppression Required
Type of Construction I, Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) M_nn Final/C.O. Required
Footings•{Addition) 51_ t' e!) Final/No C.O.Required
p Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice&Water _Final Pool: Footings Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:!Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In Final
Braced Walls Erosion Control
—
Shower Pan L Other:
Reviewed By: f O Wk-- M ' Y i y/'f ,Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
SSW Permit&Surcharge
Treatment Plant
Radio Meter Read
Copies
TOTAL
Page 2 of 3