EA182579 - Building - Commercial/Industrial - Issued Date 05/01/2023 (2) PERMIT
City of Eagan , ® Permit Type: Building
3830 Pilot Knob Rd ®oaao ®®®, Permit Number: EA182579
Eagan, MN 55122 °°®® ®®®• EAGAN
(651)675-5675 1111111111111111111111111111111111111111111111111
www.cityofeagan.com * E A 1 8 2 S 7 9 *
Date Issued: 5/1/2023
Site Address: 4194 Pilot Knob Rd
Lot: 031 Block: 01 Addition: Hilltop Plaza
PID:10-33100-01-031
Use: Becks Montessori Accelerated Learning Center * 1 0 — 3 3 1 0 0 — 0 1 — 0 3 1
Description:
Sub Type: Commercial/Industrial Construction Type:
Work Type: State/County Required Inspection
Description:
Census Code: - Occupancy:
Zoning:
Square Feet: 0
Comments:
Fee Summary: State/County Required Inspection $63.25 1221.4216
Surcharge-Fixed $1.00 9001.2195
Total: $64.25
Contractor: Owner: - Applicant -
Timothy M&Dona S Edmund
10033 Frederick PI
Eden Prairie MN 55347
This permit shall be null and void if work does not start within 180 days of issuance,or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature ssued B : Signature
`ZJ 2'1J1 I DHS Use Only
D
DEPARTMENT OF ate Received
MI HUMAN SERVICES
Interagency Request for Building Inspection
Licensed Child Care Centers
Prior to issuing a license to provide child care,verification is required that a facility is in compliance with appropriate state,county,
and local building codes(Minnesota Rules,part 9503.0155,subpart 1). Please complete this form and return it to the Department of
Human Services,Division of Licensing with any orders attached. A copy of the orders should also be provided to the program.
Building Inspector Information
Building Inspector Name and Address: Date:4/27/23
Building Inspector Email Address or Fax Number:
buildinginspeaons@cityofeagan.com
Licensor Information:
Licensor Name: Phone Number:
Samantha Baker 16514313447
Licensor Email Address:
samantha.baker@state.mn.us
Child Care Center Information:
Program Name,Street Address,City,State,and Zipcode: License Number:
1118798
Becks Montessori Accelerated Learning Center Phone Number:
4194 Pilot Knob Road 8722137659
Eagan, MN 55122 Contact Person Name:
Samantha Denny
Email Address:
sdenny@premiereadychildhood.com
Reason for Inspection:
❑ New Program ❑r Change Ownership ❑ Other(explain)
Areas to be used: Classrooms to be used: Number/Age Ranges of children:
❑ Basement I] Entire Facility 12 6 weeks to 16 months
❑� 1rt Floor Specific Rooms(list below) 28 16 months to 33 months
❑ 2m Floor 61 33 months to Kindergarten
❑ Other 20 Kindergarten through 12 years
Specify: Total: 121
Inspection Results:
13 Not applicable:Facility located in non-code enforced area
Signature of Local Official: Date:
Facility reviewed and inspected for code compliance
❑ Proposed change is not a change in occupancy(enclose copy of original certificate of occupancy)
❑ Facility does not meet requirements and cannot be occupied until orders are met(enclose copy of orders issued)
❑ Facility does not meet requirements,but may temporarily be occupied until (date),pending completion of
orders
Signature of Building Inspector: Phone Number:
671-r6l
Agency Name: ' o Date: 5 7/j//73
Submit completed ins ction to the licensor email address listed above or mail to the Department of Human Services, Office of
Inspector General/Licensing Division,PO Box 64242,St Paul, MN 55164-0242.