4030 Cedar Grove Pkwy ' Use BLUE or BLACK Ink
� For Office Use
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Cl�� af �a�a� � Permit#: � I
iPermit Fee:_sT—��
3830 Pilot Knob Road
Eagan MN 55122 � Date Received: j
Phone: (651)675-5675 � I I
Fax: (651)675-5694 ��� `V �
I Staff: I
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2015 RESIDENTIAL BUILDING PERMIT APPLICATIO f� .
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Date: sl Site Address: C�aar �v� pkw � N'�°�J �a� � Unit#: ��li� a
� � �YLf�W� ��E� Phone: �.�Z'2 Z`l^ 6�.3�
; Name:
Residentl �
Owner Address/City!Zip: 7s9' ���jrwwt �r � Ec�q (�i-�i�^ft � l�'IN S'.5�,3`/� �
� Applicant is: �Owner Contractor �
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Type of Work � Description ofwork:_ a�'^��r RC�iK��� �k�1 Cnny{-v�c�{'�o�'I k� 3 �QCa�'4i��1,}'
� Construction Cost: �Ig$I�V�^ Multi-Family Building: (Yes /No�
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� � �r�v�hc.cd Wa(� ,f-�-�-�c-F�r-es L�c �'�'v4 u���c I
g Company:_ � Contact: �e Q '
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Contractor Address: ��-r� ✓'��`►�Vl�w Ln City: ��rj��v L�kc
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' � W1N z�p: SS3�Z Pnone:6/2�387-Y7G� Ema�i: .�-rv�.v e ao I . ��w►
� State: _
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License#: n�0. Lead Certificate#: n/A
' v/�/� CE��—��O NOT W IT�BELOW THIS LINE � 5����cc�0
�' 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
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 ��� Occupancy ���� MCES System
Plan Review Code Edition �` ,� `' SAC Units
(25%_ 100%�) Zoning � City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction 1�� 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
Framing Drain Tile
Fireplace: _Rough In �Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick f
Insulation Windows 2 _ �� �,���y��""��y,,�-�c:-��
Sheathing � Retaining Wall: �C Footings�Backfill�Final
Sheetrock Radon Control �
Fire Walls Fire Suppression: _Rough In_Final
Braced Walls Erosion Control
_ --�
Other:
Reviewed By: � �- ' , Building Inspector
RESIDENTIAL FEES
Base Fee �
Surcharge �� �11�J�`� �''� �
Plan Review �ls " 4 �
MCES SAC
City SAC �� ;��� �
� +..��
Utility Connection Charge
S8�W Permit& Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
� � � ����
. LOT SURVEY CHECKLIST FOR RETAINING WALL
BUILDING PERMIT APPLICATION
� 1 �
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Address � � f� �����i,�� r- ���(�� .S� �,. �3� �.�-C f �"� ��, ; 7��
Applicant Name:
L
DATE OF SURVEY: Sl���-�%J
LATEST REVISION:
a�
a�
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� **Permits required for Retaining Walls 4 feet high or greater.
Y a �
o z a DOCUMENT STANDARDS
,� ❑ ❑ • Registered Engineer signature and company
Ja' ❑ ❑ • Building Permit Applicant
�' ❑ ❑ • Address
� ❑ ❑ • Legal description
❑ �+l ❑ • Lot lines/Bearings&dimensions
p' ❑ ❑ • North arrow and scale
,2f ❑ ❑ • Street name
,F�1' ❑ ❑ • Show all easements of record and any City utilities within those easements
� ❑ ❑ • Setbacks of proposed structure and side yard setback of adjacent existing structures
ELEVATIONS
❑ � ❑ . Property corners
❑ �' ❑ • Top of curb at the driveway and property line extensions(only if wall is within 30 ft. of curb)
❑ � ❑ • Elevations of any existing adjacent homes
�' ❑ ❑ . Adequate footing depth of structures due to adjacent utility trenches
❑ ,jr7' ❑ • Waterways (pond, stream, etc.)
❑ �' ❑ • At the foundation of the building and/or nearest structure
PONDING AREA(if applicablel
❑ �d" ❑ • Easement line
❑ �' ❑ • NWL
❑ � ❑ . HWL
❑ ,� ❑ • Pond#designation
� ,B' ❑ • Emergency Overflow Elevation
❑ .s" ❑ • PondNVetland buffer delineation
Y . Shoreland Zoning Overlay District
Y � • Conservation Easements
RETAINING WALL INFORMATION
� ❑ ❑ • Location of Retaining Wall on property
y3' ❑ ❑ . Top& bottom elevation at each end of wall and any change in elevation in between
� ❑ ❑ • Type of material (i.e. modular block, boulder, etc.)
�' ❑ ❑ • Directional drainage arrows with slope/gr ent
J
Reviewed By: � Date � �
GFORMS/Building Permit Application-Retaining Walls Rev.5-4-09
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