3670 Denmark Ave Jul 28 2014 09:46AM HP FaxGates G.C. 7634987710 page 5
Use BLUE or BLACK Ink
� For ORlce Use �
� j Permit#: / �^ !��� I
Clt of�a�aIl ; . .z� 3�, � � ;
� Perm�t Fee. J �
3830 Pilot nob Road � �r� r �
Eagan MN 5122 � Dale Received: � �
Phone:(65 )875-5675 I I
Faz:(651) 75-5694 I Staff: ' I
I I
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014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: � ` �'� 5ite Address:����� Zl�C��I 36�70� 3G�2 D�l�'1 h���' Un#:
Name� �M�'.YJ!^�./� �._.IIr.,..�..�.,..,._.._ _.__.,.�5...,y`I�.' I'�.
�, ` Phone: ✓ % `�
� Resident! �-
Owner � Address/City/Zip: °�� �o��--
� `,
.
� Contra
g pp icant is: Owne� _ ctor
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� Descriptionofwork: "�%��- ,�'f".�? 0�-f.�����
Type of Work
0 p , , �
� e Construdion`Cost: �O ��f''• �� ' __ �_w �Multi-Family Building: (Yes v I No_J�
Company: !�Cr '.��?iYC,;rcx� ;�.ia.:�aY� Contact: �/:���X �0.qF
7� '� % /,
AddfESS: .7 �"� l 'i-;.w: �r i i C��: / :'/ ' r. ".
Contractor " �
State: iM��% Zip: �5�y:i . Phone� o'�_Ty- ,�3y�., i,�_,�� 7��r�� a.,�,;f a '��,_�±..<:�<.:.
.� Email: -C. r �
.,,� � --_� . , � � ., ^ . _
License#: �' `��� ' - Lead Certificate#� f%% � � ' •-
If the project is ex pt from lead certification, please explain why: (see Page 3 for additional infonnation) �w
�.,.,.....,,,..._..�.�........_..�_....,�.�.,�._...._,... _._.
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 1Y mo�t ,has the Ciry of Eagan issued a permit for a similar plan based on a masber plan?
_Yes �No I yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical CoMra or: Phone:
Sewer 8 Water Co actor: pho�;
_.....,._.._._.�.�_..._... ......a.. - _.,_.... �.._.._..__.___._�..._.
NOT'E:P/ans an� supporting documents that you submit are considered to be pub/ic information. Portions of
�the lnformationj y be classified as non public if you provide speci�ic r+easons that would permit the City to
,__,_,.,,,,,,,,_' .__,. conclude that they are trade secrets. ___ _ _M M.._�
CA BEFORE Y U DIG. Call Gopher State One Call at(651)454-0002 for proteclion against underground utility damage. Call 48 hours
before you intend to dig receive locates of underground utilities. www.ao�herstateonecall.oro
I hereby acknowledge t t this information is camplete and accurate;ihal the work will be in oonfortnance with the ordinances and codes of lhe City of
Eagan; that 1 understa this is not a permil, but only an appliption for a permit, and wark is not to start without a permit;B�al the work will be in
accordance wilh the app ved plan in the rase oFwortc which requires a review and approval of plans.
E:terior w oriz by a bullding pe ft issued In accordance with the Mlnnes ' ing Code must b completed withln 180
days nnit suanc .
x G�- 3 Y
Appli s Printed ame Applicant's Signawre
Page 1 of 3
r
For Office Use
i i 0 Permit#:EAGAN
KtP(191
Permit Fee: i17.;\
I' E C
'� � Date Received:—i3/f l
3830 PILOT KNOB ROAD 1 EAGAN, MN 55122-1810 •
(651)675-56751 TDD:(651)454-8535 I FAX:(651)675-5694 J U L 0 1 2019 Staff:
0)‘
buildinginsoections(c�cityofeagan.com ,� L BY: 0111\ 1
2019 RESIDENTIAL BUILDING APPLICATION 4,1/4'-.1 f/A
Date: 7//! l Site Address: .3(v 7o tX)MAP-X- ( W E Unit#:
Name: tA/%LL i fi rv., Phone: b,</ ' '7
Resident]
Owner Address/City/Zip: 13‘,.$ ArnAley LLi 5 L PINE LA GAN, m ss-)3
Applicant is: X Owner Contractor e 1✓ Tfl'Th Y 1 2f
Description of work: T)&-CK k p L AF rc( -'
Tye o Work
TowN
Construction Cost: /11::,, /Sty x.000 Multi-Family Building:(Yes X /No )
Company: Contact:
Contractor
Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:pI P(t" T kk"r'A1iv iM(r 47/J Cy
Dec- 1.21 AFP r -ciZ S'n A 'T cam p o s rs Se 11/4.10T DIS (Nt01,- 81'noP-&C The.)
a0 5clts pro-E. P T4. AL5 TesTCO nq t-Pt Ar-A 'TEST Si4owc-0 iV e L1-AA 2IS-SE-+:r—
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:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting;documents that you submit are considered to be pubic lniba'aa Bonn;Portions aft inawmasonmay be
classified mmopublit if y u povide Vis:that wed permit Om ail,to canckfde that they are gra areaSts._.
You may 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 www.citvofeacian.com/subscribe.
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.ciopherstateonecall.org
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.la �trL I P,N, eY\ tZR I L L x ( (J�L.t P ltY\\&4_T-0,00
Applicant's Printed Name Applicant's Signature
. DO.NOT WRITE BELOW THIS LINES04.(P-1 0 icn 0 -0 1-4-1.-.A.,vc_. A viz_
SUB TYPES
Foundation Fireplace Porch(3-Season) Exterior Alteration(Single Family)
Single Family Garage Porch(4-Season) Exterior Alteration(Multi)
MultiirY ' 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
Replace Repair _ Egress Window Water Damage
—Retaining Wall *Demolition of entire building—give PCA handout to applicant
DESCRIPTION
Valuation Saw Occupancy ZA4- ! MCES System
Plan Review / Code Edition ;of SAC Units
(25% 100% P ZoningPI) City Water
)
Census Code y lerStories Booster Pump
#of Units I Square Feet /.7U PRV —
#of Buildings t Length 7' li e Fire Suppression Required
Type of Construction 17s8 Width xtz
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
kleb Footings (Deck) Final I C.O. Required
Footings (Addition) 44- Final I No C.O. Required
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 Other:
Reviewed By: �, Building Inspector
,/
RESIDENTIAL FEE / -4 44 pit GCZ. @ ly,/ 01 • ' f*
Base Fee e.8`
Surcharge
Plan Review 7
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
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