4283 Amber DrEAGAN TOWNSHIP
BUILDING P RMIT
Address (present)y?tt.....P]ICJ?,C,(YI/t?y??" G R' ?+
Builder ........................ - ---------------------
Address --------------------------------------- --------
DESCRIPTION
Stories To Be Used For Front Depth Height Est. Cost Permit Fee
This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST J PT THE EMI H E THE WORK IS IN PRO HESS.,
This is to certify, th as permission to erect a_ -- .__ .... ..... .t ... ...........upon
the above described premise subject to the provisions of the Building r' nce for F'aan owns adopted April 11,
1955.
----------------------- ----°----- ------------------------------------------------------ Per - -' ..........................................
Chairman of Town Board ding Inspector
N2 628
Eagan Township
Town Hall
Date/---- •-.
Remarks
CITY OF EAGAN Remarks Cedar Grove Acquisition
Addition Cedar Grove #2 1 Lot 17 Blk 7 Parcel 10 16701 170 07
Owner ;l,f 1 _y t Street 4283 Amber Dr. State Eagan,MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 5 1985 1266.95 84.46 15 1266.95 C009412 9-13-84
STREET RESTOR.
GRADING
SAN SEW TRUNK
# SEWE1971217ERAL 1972 130 ,00 2. 2
WATERMAIN
WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY of EAGAN N° 3293
BUILDING PERMIT
3795 Pilot Knob Road
Owner ..... -?4? U ........ .n ' ''.--' ........................ Eagan, Minnesota 55122
Address (present) ...- w??s .......... 454-8100
Builder .... e ....... ................................................
Q
/y?
Address ............... .'A&.....Z . ......................... Date .....
DESCRIPTION
Stories To Be Used For Front Depth Height Est. Cost .' Permit Fee Remarks
70
LOCATION p . e-V
Street, Road or other Description of Location Lot Block Addition or Tract
This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST BE KEPT ON THE P EMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, that..... 404.0 ................. 4-'4......._ .........has permission to erect a........................ .. p
the above described premise subject to the provisions of all applicable Ordinances for the i y of E an.
...... ..... .. Per .................. . .. ^:^.?`' i2-c ......
Y..-?
ul . ...........
May Ma Building Inspector
-4. 1- 00
THE SUSSEL COMPANY
1850 Como Avenue
St. Paul, Minnesota 55108
612.645-331
ermit by L....r
Legal Description
? Lot
? Blk
? Add'n
O Value.+...
Type Corm. Afte:i
Slab: d to y Sussel
? By Owner' A prox
22STARTINGS POINTS ONLY
S.P.L.
_..,.,?..?a ?...o? ., S. S. P. L.
R.P.L.
Hey
/%Oe (bn a Ouse
F. Street
Other
asquare With
G Rods
Wesh
? Sod Rem. - By
D6 E330Bag Mix
? Tamping
mping
t ? o Ta
A.B.UJ`"??
b
?3'® Grade Point
R NDUIT
O.H. Dr. Offset
( D, Location
O Blocks OBy Owner ?By Susse
"Indows
Existing garage; No
0 Detached DAttache>a Yes Fl
Size of existing .-_ x
Existing garage wilt be:
O Left as is
O Converted to L.S. - By owner
Removed By: Owner Li
Sussel F-j
Junk Must Be Removed By Owner
0 Specify other removals by Sus-
sel or owner - trees, bushes, etc.
? Show approx. dist. garage to
house and all prop. lines
Stakes visib;e - _ Yes C! No
i , is it b(YLc1;r - ; ' lrri
owner :
1 1-? - WORK ORDER
4S 4' 3?7Z
NAME ?1C TCrl..y?rri VLIO ? P ONE #
??
JOB ADDRESS ? E3 ? ?
BLDG CODE AREA c ""
SALESMAN Z 4L, - CONTRACT DATE3-2?- SIZE I X
FOR OFFICE USE ONLY
CONTRACTOR Toe416- JO # S 4
.,... R.. I Z%/`41 ,._ a / "la
PAcT
Ao ?? ?
MASTER CARD
Permit
No.
Issued Issued To
Contractor Owner
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
Items
FOOTING
FOUNDATION
FRAMING
FINAL
ELECTRICAL
HEATING
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAIN FIELD
PLUMBING
WELL
SANITARY SEWER
Approved
(Initial) Date
sol'm
Remarks Distance From Well
SEPTIC
CESSPOOL
TILE FIELD FT.
DEPTH
OF WELL
COMMENTS:
Violations Noted
on Back
LAND USED ASV !L /? 2
It 911p%.-
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DA
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
TE OF INSPECTION
AND DESCRIBED AS FOLLOWS:
F1 REINSPECTION REQUIRED
REINSPECTION REVEALED
NON-COMPLIANCE. BUILDER DOES NOT
.
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
DATE OF REINSPECTION
CERTIFICATION-1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
E ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR DATE
COMMENTS:
23
CM USE ONLY
L BL RECEIPT #:?
SUBD. 2ZaCt?c DATE:
1995 MECHANICAL PERMIT RESIDENTIAL
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 6817b
Please complete for: single family dwellings
? townhomes and condos when permits are required for each unit
New construction Add-on furnace
Add-on air conditioning Add-on air exchanger, i.e. Vane system, etc.
Date: zxfjlol7l'f?
/'? 0110 *4 1P_
? Minimum Fee: Add-on/Remodel (existing residence only) $ 20.00
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required $3.00 each) State Surcharge c-,n
TOTAL D.S1?
SITE ADDRESS: Vat Jr3 44mt602 Z//U
OWNER NAME: PHONE #:
INSTALLER NAME- SEDCWICK
Fi
EATING & AIM 1N IO
6910 MIEN i"WORTH AVE. SO.
STREET ADDRESS:
CITY: 881-90ATE: ZIP:
PHONE #: ( ) f
7ir'Llrt?
CITY USE ONLY
L BL RECEIPT #:
SUBS. DATE:
1995 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KiO RD
EAGAN, MNa58122
(612) 681-4675
Please complete for ? all oo niert Windust l building%:
? mufti-family buildings when separate permits are nQ required
for each dwelling unit
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: ? $25.00 minimum fee 2r 1% of contract price, whichever is greater.
? Processed piping - $25.00
? State surcharge of $.50 per $1,000 of permit fee due on all permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:
ADDRESS:
CITY: `STATE: ZIP.
PHONE #:
SIGNATURE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
CITY USE ONLY
L BL
RECEIPT #:
SUBD. ?U V RECEIPT DATE: U 0
PERMIT # t O
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, VIN 55122
651-681-4675
Please complete for: > single family dwellings
> townhomes and condos when permits are required for each unit
> backflow preventer for underground sprinkler system
FIYTIIRFS Ksire IrdNrAl
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners,- etc.
- - ------- ---------------------------------------------- ---------------------------------------------- ------
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances.
It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damag
normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of- eo nr
SITE ADDRESS: ncp c)
OWNER NAME:: TELEPHONE 5'`J J, 7Z
(AREA CO JYy
INSTALLER NAME: !?2? d22 ,t TELEPHONE #: r,3 5377"S
STREET ADDRESS: ZeoO (AR CODE)
CITY: STATE: ZIP: SS4?6,/
1-100,
SIGNATURE OF PERMITTEE
Alterations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas piping outlet * minimum - 1 3.00 x $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavatory 3.00 x = $
Septic System new/refurbished * requires MPC lie. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repair/rebuild 30.00 x = $
Rough opening 1.50 x $
Shower 3.00 x = $
Underground sprinkler if dwelling is under construction 3.00 x = $
Underground sprinkler if existing dwelling 30.00 x = $
Water closet 3.00 x _ $
Water heater 3.00 x = $
Water softener if dwelling under construction 5.00 x = $
Water softener if existing dwelling 30.00 x = $
Water turnaround 30.00 x = $
State Surcharge .50 -> -> ---> $ .50
Total -> $
44 _
2351 31 OFFICE USE ONLY This request void 18 months from validation dote printed in this box.
I/ CAD
PLEASE PRINT OR TYPE -7
Request Date Rough-in inspection required? C] Yes o
PrI Inspection Other Than Rough-ln: eady Now ? Will Call
Z _ Z9 ? u '
(You must call the inspector when ready) Date Ready:
I, 'licensed contractor ? owner hereby request inspection of the above electrical work at:
Job Address (Street, Box, or Route No.) City Zip Code
Section No. Township Name or No. Range No. Fire No. County
tip ?n
Occupant Phone No.
Power Supplier Address
Electrical Contractor (Company Name) Contractor License No. Master Lic. No. (Plant Elect. Only)
Harrison Electric, Inc. CA00808
Mailing Address (Contractor or Owner Performing Installation)
Authorized Sig lure (C ctr or Owner Performing Installation) Phone o.
SEE INSTRUCTIONS ON BACK OF YELLOW COPY
REQUEST FOR ELECTRICAL INSPECTION
I <. _ 1
Minnesota State Board of Electricity
1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Industrial Farm Remod a air
Air Cond. Ntg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
X' above the work covered by this request, Enter remarks in this space and on the back of the white copy only.
3
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps D to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps Above 1 0 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control
Swimming Pool
that I inspected the electrical installation ed herein on the dates stated
I hereb
certif
Irrigation Boom y
y
Rough-In Date
ecial Ins
ection
S
p
p
Investigative Fee Final , ote a
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
For Office U.
•
Permit #:
City of EaWall
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 i Staff: I
L - --------- .
2008 RESIDENTIAL PLUMBING PERMIT. APPLICATION
Date: {ko V Site Address:
Tenant: Suite #:
d Phone: (61- Z to - Of
/
b
RESIDENT/OWNER (
Name:
o
Address / City / Zip: s2ao)e, AA t4 5512-1-
CONTRACTOR Name: License #: ILJ r r J ?.LL
Address: 651-365-1340
3670 Dmzj
..
City: Eagan, MN 55123-1339 State: Zip:
Phone: Contact Person: I'( 01 c4
TYPE OF WORK New L/Replacement _ Repair _ Rebuild Modify Space _ Work in R.O.W.
Description of work:
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener
Lawn Irrigation Add Plumbing Fixtures
RPZ PVB) Main _ Lower Level)
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State harge
*Water Turnaround (add $136.00 if a 5/8" meter is required) MAY 2 1 2008
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) By
TOTAL FEES $
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 not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X x
Applicant's Printed Name Applicants nature
FOR OFFICE USE Reviewed By: Date:
For Office Use ------------------
-2
City of l EPermit #:
Permit Fee: 3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 staff:
- - - - - J
2008 RESIDENTIAL BUILDING PER IT APPLICATION
Date: Site Address: 2 3 4Li"
Tenant: Suite #:
RESIDENT/OWNER Name: ` t?•V I t Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work __.?V i?,?:?^'?? %jV
Construction Cost: Multi-Family Building: (Yes / No _j
CONTRACTOR Name License #:
r •
Addres tesidettti21I MN Llc.120249486
2478 HidMrood Drive. St. Paul, MN 55119
C' State: Zip:
Phol VId Johnson - Cell: 651-274- &ct Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
_
Energy Code • Residential Ventilation Category I Worksheet • New Energy Code Worksheet
Category Submitted Submitted
('l submission type) • Energy Envelope Calculations'Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
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 City to
conclude that the 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 f understand this is not a permit, but only an application for a permit, and work is not to start without ermit; that the work will be in
accordance with the approved plan in the case of work which requires a review and appro f plans
X .JoVV > X
Applicant's Printed Name Applicant's Signature
Page 1 of 3
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4283 Amber Dr
Lot: 17 Block: 7 Addition: Cedar Grove 2nd
PID:10- 16701 - 170 -07
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Renewal Andersen
1920 County Road C West
Roseville MN 55113
(651) 264 -4777
PERMIT
City of Eaan
If altering the opening size, a framing inspection is required.
Smoke detectors are required in
all sleeping rooms prior to final
inspection. When wall studs or
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
$90.00
Owner:
David B Dekeizer
4283 Amber Dr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Building
EA077547
05/01/2007
ePermit
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
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Use BLUE or BLACK Ink
For I For Office Use
l
I
q lie
; Kermit City of Eab I
1 1
I Permit Fee: `D S, a~ 1
3830 Pilot Knob Road l 1
Eagan MN 55122 ; Date Received: 13 _ ;
Phone: (651) 675-5675 l
Fax: (651) 675-5694 1 Staff:
f 1
J
2013 RESIDEN'T'IAL BUILDING PERMIT APPLICATION
Date: C, Site Address: L, Z D I "e'r- y 1 V Q__ Unit
Name: 11 1 Je 17-p- r Phone: QS I - ZJV (
Resident/
Owner Address / City / Zip: LA213 A m);Lg rC p, 1-\ S S(22..
Applicant is: Owner Contractor
Type of Work Description of work:
Construction Cost: Oc~'ln Multi-Family Building: (Yes / N
Company: Contact: CA 4 )
Contractor Address: , b_~ tQ~-Aa- ~C City: ( 2
State: MN Zip: a -3, 09 Phone: W L 2 - G
License* Lead Certificate !L_ i . l IN f2-
If
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
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 City to
conclude that the are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
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 not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x J1 rVx x
App ant's~Printed Name Ap icant's Signatur
Page 1 of 3
Use BLUE or BLACK Ink
� ForOfficeUse ----- —�
' 12� v� ��
Cl� of �a a� � Permit#: I
� � I U� I
� �
� Permit Fee: �
3830 Pilot Knob Road i Date Received: I
Eagan MN 55122 i i
Phone: (651�675-5675 � Staff: �
Fax: (651)675-5694 �-----------------�
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: � '�2'/'Y Site Address: �2�3 �r�lo�Gr- {�r- ��q a.r,. 1M.IJ �^5!� Z
- v
Tenant: Y C'�'�r �a-v�we-rt�,.►r��,G. Suite#: ��
Resident/Owner Name: T'�t�'i-ow� I�Au��R'D 1 N� Pnone: �Zd•Z5�•Z&G�5
Address/City/Zip: �"'�2�� p'cw�b�er' �r � � ��''�'�z Z
Name: License#:
COt1tC1Ct01' Address: Y�
State: Zip: one:
Contact: EmaiL•
Type<Of W01'k —New _Replacement _Repair _Rebuild �Modify Space _Work in R.O.W,
Descriptionofwork: l' 5�+..tr'S �kt'�'` 2'M1=� � �`
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation(_RPZ/_PVB)
Pe:1'tilit TypB �Add Plumbing Fixtures(_Main/_Lower Level)
Septic System
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge)
$60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Turnaround*(includes$5.00 State Surcharge)
"Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 Septic SVStem New($10.00 per as built)(includes County fee and $5.00 State Surcharge)
TOTAL FEES$
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities: www.gopherstateonecall.orq
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 not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x �h�'c� �PtV W£2 D 1�IL x 1�i.--.�` 1�- ��----�`-"
Applicant's Printed Name Applicant'�s S g tureT
FOR OFFICE USE Reviewed By: Date: `
r �
Required inspections: `Und,er.Gra��d>,. " Rou�h=ln ArrT'e`sfi': Gas Test FinaP
� ���.
Meter Related Items: ' Meter�ize' �..' .. Radro°R�ad- Staf�;,: �
. . �
Use BLUE or BLACK ink
�----------------�
� For Office Use �
I / ��%✓;.Y / I
� ���� �� ����� I Permit#: � �
I �
I �
Permit Fee: �� �
3830 Pilot Knob Road RE�E��IED i C� �� �
Eagan MN 55122 I Date Received: �
Phone:(651)675-5675 � I
Fax:(651)675-5694 AUG 2 Z �0�� , � Staff: �
� . . . L-----------------I
2014 RESIDENTIAL BUILDING PERMIT APP�ICATION �� .�
Date: Site Address: Unit#: � ��
Name: 'K�.�'�'C�Y1 ����'1�� Phone: ���•O`�''('�fG�J
Resident/ .
Owner Address i city�zip: `�oZ��3 �m��r I�r
Applicant is: �Owner Contractor
E► S ,�
Type of Work Description of work: �, �,9�AT/�1
�
Construction Cost: . �� Multi-Family Building: (Yes /No_)
Company: Contact:
Contractor ` Address: City:
State: Zip: Phone: EmaiL
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additionai information)
O �!+ N`��%o � --�
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
NOTE:,Plans and supporting documents`that you submit are considered to'be public information...Portion�of
the information may be'�lassified as non-putili�if you provide specific reasons that woultl permit the City to
concluale fhat they are trade secrets. ''
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.orq
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 not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X f�i�".��tJ ��t�..�.�,� tP�1�. X ,1,/�,.�-
ApplicanYs Printed Name ApplicanYs Sig ature
Page 1 of 3
� . �. ��1 �� ����'�� ��.
l ��a 7
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Fireplace Porch(3-Season) Exterior Alteration(Single Familyj
� 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 *Demolitiorr of entire building-give PCA handout to applicant
DESCRIPTION ¢
Valuation OOO Occupancy Z'�G'f MCES System ^
Plan Review Code Edition �G—a'� SAC Units ^
(25%_100%� Zoning /G~/ City Water ^
Census Code �31� Stories �" Booster Pump �"
#of Units � Square Feet �" PRV —"'
#of Buildings 1 Length -" Fire Sprinklers '`
Type of Construction _� 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
� Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Erosion Control
Braced Walls Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES 1 �� j�J � �D '%" ����
�
7"
Base Fee -
Surcharge
Plan Review �J / �--
MCES SAC
City SAC
Utility Connection Charge
S8�W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
� Use BLUE or BLACK Ink
♦ r----------------�
I For Office Use � ,A/�
• I Perrnit#:__�,a!>/ J �� ����
City of ���a� �
, �,��« ��� ��/.��S
� Permit Fee:
3830 Pilot Knob Road � -� �
Eagan MN 55122 � Date Received: �y�f�� �
Phone:(651)675-5675 I I
Fax: (651)675-5694 I Staff: ' I
I I
-----------------�
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: cs i � Site Address: ���� �`��-2-f� Unit#:
�* ,
Res� ������ Name: ��.ri�o��c,�v.w�es`��r�.�C.- Phone: !Z[�-ZS`�' Z�GsS
�° ` �-2�� � b.��- �- � 55�z z
�` .Qyyi��r 5�� Address/City/Zip: � 'M a- a.
��.. �
�.
'��� Y Applicant is: �Owner Contractor �
,;
�
�� � ,
� '�#��� Description of work:�-�*��4� a �oo� ��e-�.—�r�q W°�`�
�' �`�I11�5i��C` ..
� ti � , �
�:�y , . Construction Cost: Multi-Family Building:(Yes /No�)
�-� ; � : Company: `�c...�� Contact:
�� ��� h ;
� ��-���" ` Address: City: �
� `�1�#�G�O�' �
� i }���
� State: Zip: Phone: Email:
����� �
�� ����.
�� s License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOrL���'�'�n�ar�y � Olf�ft�t�OCU/►'l�/`� �c��,�/DU SUb�tl��'� , •� to �� �� �n. P� ii�����
�##����'nwmatio�may ����sr� ��s���-pc��b� � �`�u provide spec��c reas �s#hat w� ' #,y.�� ��
y=� ; * . � � �r� � y v , � � � �
�, ��. � �� ���� ,�x.�n�� ��s��orfc�l��� , � are traale s+�cre�s �:�,� � s , ��.. r�
��
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoaherstateonecall.org
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 not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X �rc�c�`I�v..v.�erc��►`�� X -� 2--�--�
ApplicanYs Printed Name A�plicant's Si natu e
Page 1 of 3
`7.? b� �V1��j�.., DO NOT WRITE BELOW THIS LINE ���� �'� f �
s
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 � 2� �� •"� Occupancy L12C—� MCES System
Pian Review Code Edition t/Yl✓1 Zd IS 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 �!/j 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
�?C. Framing Drain Tile
Fireplace: _Rough In Air Test Final Siding: _Stucco Lath _Stone Lath _Brick
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control j
Fire Walls Fire Suppression: _Rough In_Final I
Braced Walls Erosion Control
Other:
Reviewed By: ��� �� �� 'Y/�" , Building Inspector
RESIDENTIAL FEES ¢/ Z/ D�� y _
Base Fee ����
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3