EA183035 - Building - Commercial/Industrial - Issued Date 05/22/2023 PERMIT
City of Eagan Permit"':
Building
3830 Pilot Knob '.° a® ®e EAGAN
Permit Number: EA183035
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Eagan,MN 551222 °�®® ®•®B
(651)675-5675 1111111111111111111111111111111111111111111111111
www.cityofeagan.com * E R 1 8 3 0 3 S *
Date Issued: 5/22/2023
Site Address: 1250 Lone Oak Rd
Lot: I Block: 1 Addition: Eagandale Lemay Lake 3rd
PID:10-22527-01-010
Use: Eagan Montessori Academy * 1 0 — Z Z S 2 7 — 0 1 — 0 1 0
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 -
Lone Oak Plaza LLC
%Tri Star Mgmt Ann Mark Ravich
600 Highway 169 S Ste 701
Saint Louis Park MN 55426
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 slued B : Signature
DHS Use Only
D
3 DEPARTMENT OF ate Received
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:
City of Eagan
Building Inspector Email Address or Fax Number:
buildinginspections@dityofeagan.com
Licensor Informations
Licensor Name: Phone Number:
Pamela Tuft 1651-431-4557
Licensor Email Address:
pamela.tuft@state.mn.us
Child Care Center Information:
Program Name,Street Address,City,State,and Zipcode: License Number:
1119234
Eagan Montessori Academy Phone Number:
1250 Lone Oak Rd 507-779-1000
Eagan MN 55121 Contact Person Name:
Priyanga Chandrakumra
Email Address:
priyangack@gmail.com
Reason for Inspection:
❑ New Program ❑ Change Ownership ❑ Other(explain)
Areas to be used: Classrooms to be used: Number/Age Ranges of children:
❑ Basement ❑+ Entire Facility 16 6 weeks to 16 months
111 Floor Specific Rooms(list below) 25 16 months to 33 months
❑ 2nd Floor 55 33 months to Kindergarten
❑ Other 10 Kindergarten through 12 years
Specify: Total: 106
Inspection Results:
El 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 Build ector: Phone Number:
Agency Name: , Date: ,,Z Z
G, o 8` a�
Submit completecOnspection to thW 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.