3748 Burgundy Dr
n Use BLUE or BLACK Ink
I For Office Use I
--I 1
City of Ea Permit#:
IbJ I o~, T
I Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 I Staff:
I
)1031 3 RESIDENTIAL BUILDING PERMIT APPLICATION
7~~ y .
Date: Site Address;_92~/ Or -
S" ?&4q
7 Unit
Name: l.C )004 ,S Phone:
Resident/ n
Owner Address / City I Zip: 375W-3751-6- 37`~~ ,t /-~C1 2 (j s✓t
Applicant is: Owner Contractor
Description of work:
Type of Work
Construction Cost: ® _;/00 Multi-Family Building: (Yes / No
Company: 4L~111er ~A/rlJa/hCf7C C, Contact: Ry/ carol <
Address: a100 ,~ijM 77ef--'✓ YJ go city:
Contractor
State: Zip: Ja Z// 13 Phone: 49/a _Sy - 9_45~59
License #:Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
I
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:
1
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
i
Sewer & Water Contractor: Phone:
z
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. 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.oopherstateonecall.oro
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 Stale Building Code must be com 0
days of permit issuance.
X_ L L
Applicant's Printed Name Applic nt's Signature
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CALL t, C3. :Y :`DIC�:.Ca';' erStafe:bii�e.Gait01-.05ti 4 4sptt2#nr'prcat o.: ^gift-...:ct• Jao rdetitity:tlarriage.: iA tthe ..' ,:: ,.
:-.40,,--.7..77-:.••••:r ntend<to`dig to receivefocatr.*s o.:k1 nderground trfl i v +i•a•.�fi a rsf....zr si�i; f:r�
I:tiereityy.arckn•wle§...4 at tli:s inforrtiet oit.is: epieEe<ai'id,i tis#.:that it;e.:ywaik mate..in:conic"stance with.tlio vrdinar ces..'and i oiles':o the City"of
Fagan:that 1 un nci this is trot a"p unit but only an applicatis n for a:perrnidt,Arid work,is not to start withou t:a J Irmit;tin• tiie'•work vill be.In
ccordarieewith`tfie,approved plan'iii:the?else of:work'+ihich iegirirssareview grid app'ruuai C'•P---,.:::',,:•-...,..-
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:'; 5xterior:work thorized..lsya building=p rmtt issued.in a�coar(en a with the win.
i nine .State Buildin Coos must tie.com :wi•-..n:'18Q..•••. :.:
9 ^ Pl
days of permit issuance .::
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710 5 L t{4d(y /-'100 NOT WRITE BELOW THIS LINE lq/ 7
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
f/ WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building*
— Addition _ Move Building _ Reroof _ Demolish Interior
Alteration Fire Repair
Windows Demolish Foundation_
Replace _ Repair Egress Window _ Water Damage
— Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation 21 VDT) Occupancy :S..V 4- I MCES System
Plan Review Code Edition oiri 2®(.'- SAC Units
(25%_100°/1O) Zoning R -3 City Water
Census Code Stories Booster Pump
#of Units
Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction \to 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
,X, 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: `d Al. 11C lL� , Building Inspector
RESIDENTIAL FEES /
Base Fee ' "�✓M �e <-
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
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