EA187984 - Building - Commercial/Industrial - Issued Date 01/29/2024 PERMIT
City of Eagan Permit Type: Building
3830 Pilot Knob Rd °* ® � °,` Permit Number: EA187984
Eagan,MN 55122 """ "'' 1111111111111101 111MIM
EAGAN
(651)675-5675 * E R 1 8 7 9 8 4
www.cityofeagan.com
Date Issued: 1/29/2024
Site Address: 4333 Medary Ave
Lot: 5 Block: 3 Addition: River Hills 9th
PID:10-64400-03-050
Use:
Description:
Sub Type: Commercial/Industrial Construction Type: II-B
Work Type: Alteration
Description: Change of Use to Assisted Living Facility
Census Code: - Occupancy: R-3
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 -
Giam M Nguyen
4333 Medary Ave
Eagan MN 55122--191
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.
ApplicantTermitee: Signature Issued By: Signature
--------------------------
For Office Use I
r Building Permit#: ✓ j
plot I I
�� �. .• .• S&WPermit#:
EAGAN
i r^
Permit Fee:
I Date Received:
3830 PILOT KNOB ROAD I EAGAN, NIN 55122-1810 1
(651)675-5675 I FAX:(651)675-5694 1 1
Date Is=u=d� 1
Plan Submittal:building inspectionsta"�citvoft;a4an cvm ;.____— —_____________�
COMMERCIAL BUILDING PERMIT APPLICATION
Date: 1/19/2024 site Address: 4333 Medary Ave, Eagan, MN 55122 suite#:
I Tenant Name: Tenant Is: ❑ New io Existing
!i
------ Former Tenant(if applicable):
Applicant
Name: Than Trinh Phone: 651-428-1799
Applicant iso Owner ❑ Contractor ❑Agent Email;
Type of Description of work- Single Family to Assisted Living (R3 Dwelling Unit) convert
Work
Construction Cost:
Company: Giam Nyugen contact: 612-840-8044
Building Address/City/Zip: 7947 Claiborne LN, Inver Grove Heights, 55076
Contractor 612_840-8044 giammn@gmaii.com
Email: 9 @gmail.com
License#: Expiration Date:
company: Habitat Architecture contact, Hamid Kashani
Architect!
Engineer Address/City/Zip: 4951 77th St Suite#17, Edina, MN 55435
Phone: 952-946-9700 Email: Hamid@habitatarchitecture.eom
Sewer& Company: Contact:
Water
Contractor Address/City/Zip:
Required for phone:
new construction Email:
and additions
License#. Expiration Date:
❑ I understand that Plumbing, Mechanical, Fire Suppression,and Sign work require separate applications.
NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the Information
may be classified as non-public if you provide specific reasons that would permit the Ci!y to conclude that they are trade secrets.
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 nd1cantr4's—ffZ1—gnature
thout a pe ';that the work will be in accordance with the
approved plan in the case cf work which requires a review and approval ofplans.
X Christopher Armstrong
X
Applicant's Printed Name A
FOR OPF10E US'E ONLY
SUB TYPES Site Address: 4333 MedaryA
Foundation Public Facility Antennae
Tenant:
Commercialllndustrial Accessory Building
_ Apartments Greenhouse I Tent Permit#:
WORK TYPES
New _� Interior Improvement Demolish Building*
Addition Exterior Improvement Demolish Interior
Alteration Retaining Wail Demolish Foundation
*Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation_ Code Edition ZGZ d G MCES System G
Plan Review Zoning SAC Units _-
Census Code Stories City Water v
#of Units Square Feet Fire Sprinklers _-
Type of Construction — Length --
Occupancy Width
REQUIRED INSPECTIONS
Footings_New Building_Addition Retaining Wall
Foundation Foundation Before Backfill Other:
Vapor Barrier Other:
Framing 30 Minutes 1 Hour
Insulation
Sheetrock Final l C.O.Required
Roof:—decking _Insulation ilce&Water Final Final/No C.O.Required
Siding:_Lath _Brick_EFIS
Fireplace: Rough In _Air Test _Final
Pool: Footings —Air/Gas Tests Final
Final C/O Inspection: Schedule Fire Marshal to be present: Yes No
New Business to Eagan;
Reviewed By: /�; , Building Inspector
FEES
Base Fee _ Landscape Guarantee (9001.2257)
Surcharge Tree Mitigation (9111.4677)
Plan Review Tree Performance Security(9111.2257)
MCES SAC Stormwater Performance Security(6501.2257)
City SAC
S&W Permit& Surcharge
Treatment Plant
Treatment Plant(irrigation)
Park Dedication (9328.4670)
Trail Dedication (9375.4671) TOTAL: $ 0.00