1273 Timbershore Lane Jul 28 2014 09:50AM HP FaxGates G.C. 7634987710 page 17
Use BLUE or BLACK Ink
� For Offlee Use �
� j Pertnit#: �� ""��� I
Cit of Ea�a� � Permil Fee: � • � �
3830 Pilot nob Road I I
Eagan MN 5122 � aate Receiued: �� /� �
Phone:(65 ►675-56T5 I I
Fax:(651) 5-5694 I Staff: I
I I
`��_-�����___.�-__J
, 014 RESIDENTIAL BUILDING PERMIT APPLICATION
f ', r �� J' J ; ' `� � I' � � r 4 �� ��c�s�e✓G � f�1
Date: � �°� ' SiteAddress: L ` � i ' • - � Unitl�:
....._�.�,.. . ._.,.�..�..__..�. _.�..�.�..,.:....__.�._....._ _.... .,.,
.�f�✓'�t %y� � � , f•'� F � �j� /� i � �n,-. -
Name� � �"`' � Phone: ��. �''
Resident!
� OWn@� Address/City/2ip� ,;� c• �r>o/c-•
3
� i Applicant is: Owner " Contractor
.,...�.._..... Oescrip[ion of work:«-°-3-_ � --f,:��f�- ,.,..._.___��_.�....._. _�..
Type of Work � `
;�. ?�"�. 4:=
, :
; Construction Cost: . ' Multi-Famity Building:(Yes=/No�
�..,.,_ Company._.�r.�%'vS :�Cti+..P,�/,.�! ...:.c,.�i� p�,;. _._._.._ Contact: �/� ;".c. .._.,..�_____�_..
' �
� Address' ���� :/,•":=;.r?�="` �--/``� /-, City: �✓;-r.:�.%--•
� Co�tractor ��
` l,��f ,�!1_!�-' , �� , , ��f � �
� State: / � Zip:-'� Phone > _ ���v, Email: ,�y!�..�r :����?;_,rc�'Y�ar�r>�..�,z-� ,
µ r.�� � �� . � ., ,,,�.� ;
t ! License#: � '' • '-' Lead Certificate#: �:r`,!?��'" `
If the project is ex mpt from lead certification, please explain why: (see Page 3 for additional information)
� ��W COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Y�~^
In the last 12 mon ,has the Ciry of Ea�an issued a permit for a simila�plan basod on a mastar plao?
_Yes _No I yes, date and address of master plan:
Licensed Plumber. Phone:
Mechanical Contra r: Phone•
;
Sewer&Water Con ractor. Phone:
_....� . ___ —_ .�_ .:_,.....__ _.___ .:..... �...._ ...�...�.�_....._..._., ......._. _�
NOTE:P/ans an' supporting documents that you svbmf�are considered to be public inl�rmation. Portions of
1 the informatioti y be classNied as non public if yoa provide specific reasons that would permit the Cify to
�� conclude that fhe�are t_rade secrets. _ ����
...._.__.._..w ___�..,..�..�._....�..___.. ._.
CALL BEFORE Y I U DIG. Call Gopher Sfate One Call al(65f)454-0002 for protection against underground uGlity damage. Call 48 hours
betore you iMend to dig p receive locates of undergrvund uUlities. www.00nherstateonecall.ora
I hereby acknowledge t Mis information is complete and accurale; tliat the work will be in conformance with the ordinanCes and codes of the City of
Eagan; that I undersfary this is not a permit, but only an application For a permit, and work is not to start wilhout a pertnit; thal the work will be in
accordance with the app ved plan in the case of work which requires a review and approval of plans.
Exte�ior wor riz by a building pe issu In accordance wilh the Minneeata Stada Building Code must be completed within 180
days o it' auane .
x G`!/ x
Applican rinted ame ApplicanYs Signature
Page 1 of�
�
RECEIVED For Office Use
t + A I
e„ " t o; ' permit#: CC
OCT 1 5 2019
iy mr q
Permit Fee: 9 a
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 I Staff: C. -
huildinoinspections(c' cityofeadan,com , �,t
O A t 1�
2019 RESIDENTIAL BUILDING PERMIT APPLICATION o
Date: Site Address: Unit#:
Name:_. 7;',./7 evS,roee !<irvn f7Grn S Phone: 55 `23 9— 9OC ,z,+
Resident/
Owner Address l City/Zip: /2 7 t rn ? errs, uy� - (t/-7 e
Applicant is: Owner X Contractor
s i
Type of Work I Description of work: G c r S f fi ,
Construction Cost: Multi-Family Building:(Yes I No
/�
Company: 6 ►^USS / uwav 6U hCee�� Contact: V re, A e /
Address: l Flit GetC. /,a City: rGUf'r>>,45 /U
1ft
Contractor l -r—t�
State:/ / Zip: ,7.7 l. ?'hone: 95)-742 3 fi_W441:n2.. . r t7 /-074(
•License#: Lead Certificate#:
If the project is exempt from lead certification, _..__ ♦-��-�-�w_ ,._.�wa
P .�.�.�. ,.. please explain 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?
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 supportini documents that you submit are considered to be public Information. Portions of the information may be
classified as non-public if you provide sEeciflc reasons that would yermlt the City to conclude that they are trade secrets.
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.cityofeaoan.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.nopherstateonecall.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
accordance with the approved plan in the case of work which requires a review and approval of p ns• .
x V fe%tz' J
Applicant's Printdd Name J Applicant's S' ature
DO NOT WRITE BELOW THIS LINE D-13�-13 1-', -,,'1Jyr ,h-ore. L✓�-� j j b 411 J
SUB TYPES l
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
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 )tillaOccupancy fl\L MCES System
Plan Review Code Edition / SAC Units
(25%_ 100%..) Zoning City Water 1
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction W Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings (Addition) X Final/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 FEES41i1O14rL.(
f �' Y
Surcharge '
Plan Review VOW
MCES SAC
City SACOh
Utility Connection Charge
SSW Permit&Surcharge
Treatment Plant )1 0 i ' U
Radio Meter Read
Copies
TOTAL
Page 2 of 3