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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