3903 Calcite DrCITY OF EAGAN .
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt #
To be used for , .. _ , . . Est. Value Date ,19
SiteAddress
Lot - Block ' Sec/Sub. ?f7'ra
Parcel No.
Q Name
W
= Address 3
0 City Phone
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0 Name
0 < Address
P City ? Phone
a '
W Nart
W
Z' Add
W City
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.
Signature of Permittee
A Building Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
On Sfte Sewage
MWCC System Zonlng
On Site Well (ActUal) Const
City Water (Allowable)
PRV Required ik of Stories
Booster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr./Assess. Permit
Planner Surcharge
Council Plan Review
Bldg. OH. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
P
k
ar
s
TOTAL
Permit No. Permit Holder Dato Telaphone *
Plumbing
H.V_AC.
Electric • ,?
?, -??? ?
? ?j ? 0-7
r>v
Softener
Inspection Dats Insp. Comm811ts
Footings 1
Footings II
Foundation
Framing
Roofing 7A[,k- CO -vx
Rough Plbg.
Rough Htg.
ISUI. ?7'C. --
FireplaCe
Final Htg.
Final Plbg.
Bldg. Final ;?.? /?• (j .
Cert. Occ.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
CITY OF EAGAN Remarks see back
Addition C'edax GrOve #6 Lac ? Bik
Owner Z 4
street 3903 Calcite Dr,
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK L(o 1968 92. 3 3.0$ 30 P31d
* SEWER LATERAL 79 1970 1472.00 20 p31d
WATERMAIN
# WATER LATERAL 1970 20
WATER AREA
* STOR SEW TRK 970 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 200.00 12 -lO-6
BUILDING PER.
s,ac 200.00 1294 -10-
PARK
51,0, v
!(/L4 /c" I
rJ6( 41<11 6?
This repuest void '? ?? 7?A//QF
18 t?ronths irom v ?9
E 3 6 4 7 7! t/?i. (io/iYnn mtv (P ?
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?&a
Requesl ? -'? ' ' Fire No: Rouph-in Inspeciian
R q rteA?
?RCady Nuw W?II Notily Inspec
[
Wh
?os ?NO or
en ReaAy
Ucensed HecVical ConVactor 1 hereby repuasi insoection of ebove
wner alactrical work inatalled et:
Street Address. Box or Route No.
3903 ca c14-e.. Or. City
?a ar?
ecUOn o. Township Name or No. anqe No. Couuty
D
a
OccvuantlMilNTI -t- Phone No.
Power SupDlier Address
Elec/tjlcal ConVactor ICompany Namel
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1
4 Convecto?'s Lir,ense No.
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VOV-Yt7"Ix YL s
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Mailinq Address ICOnVacmr or or Making Inslailxtionl
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Auihori ' nature ICoMr odOw er aking Insiallationi Phone NumOer
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MINNESOTA STATE BOAPD OF EL CT ICIT THIS INSPEC710N EGUEST WIIL NOT
Griggs•Midway Bldg. - Room N-79 BE ACCEPTED eV TNE STATE BOARD
M 5104 UNLESS PROFEH INSPECTION FEE IS
N
1827^UnivarsitvAve..SL Paul, ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION 10 es-ooGo/oi-os
' See instructions for compleking Ihis form on beck o1 Vellow copV. Y6QC(1?
E ^3 07 7 '"1(" Below Work Covered by This Request
Nev, FAd Neo. Tyoe ol 8uilEing Applioncwa Wired Eqaipmant WireA
Home Range . Temporary Service
Dupir.x Water Heater Lightiny Fixtures
Apt. Building Dryer Electric HeaUn
Commercial Bldg. Furnace Silu Unlonder
Industrial BIAg. Air Conditioner Bulk Milk Tenk
Farm oin,r oe,i y .m", ISnec??v1
1 n! SyCCI y IIt(!f nlh?!
Compute lnspectlan Fee Below
p Fee ServiceEntreneeSixe r1 Fee Fexders/5ubleeders N Ferz Ci,coits
U to 200 qm s 0 to 30 qm )s 0 tn 30 Am s
Above 200 qmpsl 31 to 100 Amps 31 to 100 A s
Swinvning Pool Above 100_Am s Abave 100_AmP`%
Transiormers Irrigatlon Booms Partial.'Other Fee
Signs Speciallnspection
?.
$
TOT
Pemarks 6.a
HouOh-in
Final
r 0:?[e
17 ?j
/
D e
p
, Ihe Electrical
Insoactoq hereEy
cerlify thnt the ebove
insoection nes been
maee.
TMnrepuestvoiClemonttufrom </
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EAGAN TOWNSHIP
BUILDING PERMIT
Ownac .. ?/? . ? ?'
'" r'C..._.................... _........_.......
.
Addreu IDrecenll .`1.,3..V.3....6t,,-`---'y"l....y.c"'..-'.?.__??.:......
Builder
Addresa
DESCAIPTION
N° 1975
Eagan Township
Town Hall
Dale --?7!-f'?="?-.. ?..°L /. ...............
5SOrias
-- - To Se Used For
/? ? ..? - Froni
-- Depfh
-- Heigh! Esi. Cosf I Pezmi! Fee
°Z4r. Remarks
«? .a-.-=c•-
?? " ??o,•-• I
LOCATION
street, xoan or otne: uescnpxion ot i.oesiion I Lo! ock Addition or Traci `
?,.? 6-7+9 ? 'y? l?Ffd !3-e 8 ?
? l? !? y I.??y? y
.
1'his permit does noi aufhorize the use of slreela, roads, alleps or sidewalks nor does it gioe the owner oz his agent ,
the sigh2 fo creafe anp situafion which is a nuisanee or whieh presenls a hasard to fhe heellh, safety, convenience and ??
genesal meltare ia anyone in the eommunity. ?
THIS PERMIT MUST BE KE$T ON?THEREMISE WIiIL£ THE WOAK IS IN PROGRE55. ' j
This is !o ceriifp, l6af.._a :..•?1._..........'__' .........................._.-..has permission 3o ereef a...? 7.: .. ....:. ..... .. upoe l
............ . .
the above deseribed premise subjec! !o the provisione of the Buildinq Ordinance for £agan T wnship adop ed .......... April 11,
1955.
-' "-' ....... -.' .................... Per ..._...---------.. .?.q......f/.?!::.`.c?.x. P?Le?c.?1
. . .?. . . " .....'._.." ..................1
.. '
Chai an of Tnwn Board - Bvildinq7 Inspecfor ........
A. ? ,
s/ a4-11- 1Y
2007 RESIDENTIAL BUILDING rERMiT arrL[cnTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New CansVUCtion Reauirements
3 registered site surveys showing sq. R of lot sq. ft. of house; and ail roofed areas
(20%maximum lot coverage allowed)
1 SoiLs Report if proposed 6uiNing is lo be placed on disNrbed sdl
2 copies of plan showing heam & window sizes; poured found dwign, etc.
1 set of Energy Calculations
3 copies of Tree Preservafion Plan if lot platted after 711I93
Rim Joist Detail Op6ons sdection sheet (buldings with 3 or less uni6)
Minnegasco mechanical venUlation form
?a,zf)
RemodeVReoair Reouiremenls Office llse OnN
2 copies of plan showing foolinqs, beams, joists Cert of Suney Rerd Y _ N
1 setofEnergyCalculatlonsPorheatedaddi6ons SoilsRepod _Y _N
1 site survey for adEitions 8 decks Tree Pres PWn Recd _ Y _ N.
Addtlion - indicafe il oo-sife sepfic system Tree Pres Required - Y _ N
On-siteSepUcSystem _Y _N
Plans are considered public information unless you state the are trade secret and the reason.
Date I I / 2?1 / _O Z n Construction Cost
Site Address 3 9C' Unit/Ste #
Description of Work Kn?
Multi-Famity Bldg _ Y? N Fireplace(s) _ 0 _ I_ 2
PropertyOwner Pah) elliaiPlE1 Telephone#( )
r
Contractar cfp<tlrF ?n ?cf?i?{inAddress City S?T?
State /yn zip 5537ff Telepnone #( 9/,2) y1 S1 -15 7S
COMPLETE THIS AREA ONLY IF
Energy Code Category - Minnesota Rules 7670 Cate2orv 1
(J submission type) Residential Ventila6on Category 1 Worksheet
Submitled
• Energy Envelope Calculations Submiried
A NEW BUILDING
Minnesota Rules 7672
• New Energy Cotle Worksheel
Submitted
In the last 12 monihs, has ihe City of Eagan issued a permif for a similar plan based on a master pian2
_ Y. _ N If yes, date and address of masTer plan:
Licensed Plumber
Mechanical Contractor
Sewer/WaTer Contractor
herebv apply for a
Telephone # (
Telephone #f
Telephone # (
BuildinQ Permit and acknowledae that the information is complete and accurat
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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.
Jasoi? L.ctj?oleu ??- ^-
Applicant's Printed me ? pp nt' i ature
?
Ssy 3?
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
Naw Conshuction Reouiremanta
• 3 registered sile surveys showirg sq. R. of Io1, sq. fl. af house: and all roofed areas
(20% manimum bt wverage allowed)
• 2 copies of plan showing 6eam 8 vnndaw s¢es; poured found design, etc.)
• 1 set of Enert?y Calculalions
• 3 capies af Tree Preservation Plan il lol platted after 7l1193
. Rim Jaist Detad Options selec?an sheet (Gdgs with 3 or less units)
DATE "I- I o?-? l ,?
SITE ADDRES
TYPE OF WO
APPLICANT
iULTI-FAMILY BLDG _ Y _ N
FIREPLACE(S) _ 0 _ 1 _ 2
? v??vva
STREET ADDRESS Coon Rapids,?N ?ae?? CIiY
TELEPHONE #,b°J??SS'o??'ICELL PHONE #
STATE _ ZIP
FAX # -II?3'?J? ???lJ
PROPERTYOWNER ??,1 YY? ?,P?YY?T ,l'C?,K? TELEPHONE#L????ISy-?5??
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ ?IINVL•'S0'C,l RCI.@S 767q G,"CEGOR?' I ?fi\\ESO"1'A RI Ll•:S 767?
(J submission type) . Residential Ventitation Category 7 Worksheet Submitted . New Energy Code Worksheel Submitted
• Energy Envelope Calculatlons Submitted
Plumbing Conhactor:
Plumbing system includes:
Mechanical Confractor:
?Iccli?tnical svs[em includc?:
Sewer/Water Contractor:
_ ?Vater Softener _
__ Water Heatcr _
No. of Baths
Air Condiuoning
Hcat Rccovcr} Sy'slcm
-------°-----------------------------°---------------°--°-----.......
I hereby acknowledge that I have read this application, state that
with all applicable State of Minnesota StafuTes and City of Eagar?
Slgnafure of Applicanf
OFEICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _
Z?
,?? /
RemodellRawir Reauirements
. 2 copies of plan
• 1 set of Energy Calculations for heated addilions
• t sile survey for exiencraCditions 8 decks
. Indicate if home served oy sepfic sys[em ior additions
VALUATION ?.JLT"I • ?Jt-?'
Phone ?
Iawn Sprinkler
No. of R.I. Baths
Fee: 590.00
Phone #
r•e?: 5?0.00
Phone }F
-------------------------°----------
on is c¢trect, and agree to compiy
3 2002
_ ?- upaa??d a?oz
Cedar Valley Exteriors, Inc.
noen ?:u_ ...---
4b?
MEMO
- city of eagan
TO: DIANE DOWNS, UTILITIf BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECH
DATE: AUGUST 25, 1993
SUBJECT: STREETLIGHT ENERGY COSTS
CEDAR GROVE NO. 6(141 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition
as listed below:
Block 1, Lots 1 1
Block 2, Lots 1-8 8
Block 3, Lots 1-18 18
Block 4, Lots 1-11 11
Block 5, Lots 1-9 9
Block 6, Lots 1-53 53
(Lots 54 through 61, 81ock 6, should not
be billed at this time)
BloCk 7, Lots 1-12 12
Block 8, Lots 1-18 18
Block 9, Lots 1-11 11
TOTAL 141
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
0 ?
? C-?
Ed Kirscht L`
Sr. Engineering Tech
cc: Mike Foertsch, Asst. City Eng.
EK/je
.".S
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date:Number• 258
Billing Name: Site Address:f-J -6 390 3
Owner• Billing Addreas
Plumbe'r:
Location of Connection Meter Size Coanection Chg.2nn_o0 ?.
Meter No. lPermit Fee 7.5o nd.
NO ITotal Chg.
Building is a:
Residence,L
Multiple A'o. Units
Cammercial
Iadustrial
Other
Meter Readinp.I Meter Dep.
Meter Sealed: Yes- lAdd'1 Chg.
Inspected by
DaCe
Remarka:
By:
Chief Inspector
In consideration of the issue and delivery Yo me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules and
regalations of Eagan Township, Dakota Count , Minnesota.
By: ?Z-CA
Please notify the above office when ready for inspection and connection.
. ?.
EAGbN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT I'OR SEF7ER SERVICE CONNECTIOH
DATE:__?' NUMBER 380
OWNEF.. -la Pddress//-(o
PLUMBER TYPE OF PIPE
OF BUILDING
Industriall Commerciall Residential I Multiple Dwelling I No, of units
Location of Connections:
Inspected by:
Date
Remaxks•
Connection Charge 200.00 pd.
Permit Fee 7.50 pd.
Street Repairs
Total
By
Chief Inspeceor
In consideratioa of the issue aad delivery to me of the above permit, I
hereby agree to do the propoaed work in accordaace with the rules and
regulations of Eagan Towmship, Dakota Couaty, Minnesota
By.
`
Please notify when ready for inspection and connectioa aad before any portion
of the work is covered.
CITY OF EAGAN N° 15 3 6 f
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55127
BUILDING PERMIT PHONE:454•8700 Receiptn?6-7H
To be used for FIRE REPAIR Est. Value $28, 000 Date_
SiteAddress 3903 CALCITE DR
Lot 1 ebck i Sec/Sub. CEDAR GROVE 6TH
Parcel No,
x Name JONN KORABEK
3 Address 3903 CALCITE DR
a City EAGAN Phone
On Site Sewage
MWCC System _
On Site Well
City Water
PRV Required _
8ooster Pump _
ao Name LINDSTROM CONSTRUCTION
oQ Address 9621 lOTH AVE N
? City PLYMOUTH Phone 544-8761
Uiy
WW
z
U?
a=
aw
Name _
Address
City_
I hereby acknowledge that I have read this appiication and state that Ihe
information is correct and a9ree to comply with ail applicable State of
Minnesota Statutes and,\EJ?y of Eagan Ortllnances.
SignalureofPermittee ?'\,1'I.l(a].?`?BQ....
A Building Permit is issued to: ? IND57ROM G ?$7?
on the express condition that all work shali be tlone in accordance with all
applicahle State of Minne"""so???ta S'ta'Itutes and City of Eagan Ordinances.
BuildingOffidal ?„()(AI? 1`?1FA I??
APPROVALS
Engr./Assess.
Planner
Council
Bldg. Off.
Vadance
Occupancy
Zoning
(ACtual) Gonst
(Allowable)
# ot Stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
SAC, Gry
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TOTAL
,19 ilS
244.00
14.00
258.00
u
1988 BIIILDING PERMIT APPLICATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS t .5 .5 4 '
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEt ADDRESSES FOR CORNER LOTS - CONTR9CTOR/HOMEOWNER MOST DESIGNATE WIiICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BOILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL ONITS FON SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CEATIFICATE OE SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
CONII4ERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
3l+sAW41roN? W,?icaus?Zwb? c4Beu875
To Be Used For:^ Valuation: OQn Date: 7^ N-'U
Site Address 3403- ?L&E&
Lot I_ Hlock I
Parcel/Sub
Owner, ?/jhn KD('0.-b21L
Address CAt l a . I,f .
City/Zip Code f'Q n,,,MA)
OFFICE USE ONLY
On site sewage Occupancy
I•IIdCC system _ Zoning
On site well _ Actual Const
City water _ Allowable
PRV required _ # of stories
Booster Pump _ Length
Depth
S.F. Total
Footprint S.F.
Phone
Contractor LhdS?ypYYi QDaS{-Y,
Address q.?l- tp? Aue, Ktp.
City/Zip Code -Plumptt+hj3l??441
Phone JT4 4^g 7(o J
Areh./Engr.
Address
City/Zip Code
APPROVALS FEES
Engr/Assess Permit Zqq,oO
Planner Surcharge IL1, 00
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Aoad Unit
Treatment P1
Parks
Copies
TOTAL
Phone 1f
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112659
Date Issued:08/21/2013
Permit Category:ePermit
Site Address: 3903 Calcite Dr
Lot:1 Block: 1 Addition: Cedar Grove 6th
PID:10-16705-01-010
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 Total:
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.
Contractor:Owner:- Applicant -
Pamela K Korabek
3903 Calcite Dr
Eagan MN 55122
That Construction Company
14105 Heritage Court
Apple Valley MN 55124
(800) 380-7069
Applicant/Permitee: Signature Issued By: Signature
� � ' Use�3Lt�� or BLACK Ink
r-----------------�
I For Officc Use �
� I
' j Permit#:� I
C�t� of����� �
� � �
� Permit Fee: F �
3830 Pilot Knob Road � � l_,� �
Eagan MN 55122 �?���i��� � Date Received: V/ �J ,
Phone:(651)675-5675 � � ,
Fax:(651)675-5694 � �ff� �,�,
�i�� � � ����.�i E------------------� �V
Lc��� �
2075 RESIDENTIAL BUILDING PERMIT APPLICATION � �i,�)
Date: � G Site Address: �� �� / 1 '.��� �� Unit#: ��
r„ �., x�. . . .r�ti ���,� .. ,��.� .�.,.��� .�,N.,,_,�ti„r. . _. ,_ .,_.,� . ,n���,�...w,�.��,.,.�, �..�_v ���� ,. ....,...� �E,.��.v��.� ._.�� ......_.�._..
Name: Phone: "�—�3�
Residentt
L?�nrner ��� Aaa�a��c�ty i z�p:�_�f'��''a�E �,� ,�C�'�! ftit nS ��1 Z 2 ;�rYl �
'� � � Apphcant is Owner �Contractor J� ���� ��
. .,s.o:._ . ,. �w.r_,.� . ��.. .�... _�._.�. ,,.�y�. _� r, ,.. . .�_. �..,��.�,�oo,�,.__ . ...�_n_.
� �. .�4 ,.... ,�. �.�.�r ._. .r _. a. ,, ..
�0��°
� Typ£�Of WOTk : Description of work: ��� (L� �1 S�L 6�'�f-i �Z��C (�'� ��.Ci.�
eo
? Construction Cost: Z S� Mutti-Family Building:(Yes_i I�o �)
,w�_� ��.� . _ _r. �. ,�.�, .. �.__� . n ,�r, _.,. ��. .. � _ .,....�. ..� �_., D...�M.�_. �..�..��._. ..,. ,...�. .__.. e_ _,
�. ,�...�.� ��;
t � .
� j Company:D�A�IS �� ��.���1.l�ontact ��"G�l�l�5 �/�C�i
Contractor ' Address:� I`t'I ����]LlYSL'�— � City: �^�f'��f�� �N�
a State:,�Zip:d���.-Phone:b �maiL ��1i�tlS��pCC--�`i►'1�t1�, C��
� License#:�.loLt7��T� Lead Certificate#: � � �
' If the project is exempt ftom lead certification, please explain why:
�C��d r� .D�1C_
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
` In the last 12 montfis,has the City of Eagan issued a permit for a similar plan based on a master pfan?
Yes Np If yes,date and address of master pian:
; Licensed Piumber. Phone:
Mecha�ical Confiractor: Phone:
'' Sewer�Water Contractot: Phone:
f Fire Suppression Contractor. Pho�e:
< NOTE:Pians and suppurting docum�tts that yau submit are consrdered ta be pubtic informatton. Partions of ?
the information may be classified as non publfc if you provide specifrc�asons that rvouid permit the City to
conclude that rirey arse trade secrets. �
CALL BEFORE YOU DIG. Call(3opher State One Call at{651)454-0002 far proted'an agamst undet�ground utifity darrrage. CaN 48 hours
before you intend to dig to receive locates of underground utilities ��_.av��i�Rr *_�_e��c,c, ;i,_:r}
i hereby acknowledge that this information is compiete 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 appfication for a perm�,and wbrk+s not to start without a perm�;that the work will be in
accordance with the approved plan in the qse of wa�lc which requires a review and approval of piaru.
Exterior woHc authorized by a building permit iss�d in accortlance with the Mi Buldi�g Caide must be compieted within 180
days of permit issua�ce.
R �
x ���15 ��c�' x .
Appiicant's Printed Name ApplicanYs Signature
Page 1 of 3
�
` DO NOT WRITE BELOW THIS LINE l � � �
SUB TYPES � `�� tC' �� '^
_ 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 II
Valuation � Z,S�Z � .p c-�.. Occupancy �R C_— t MCES System i
Plan Review Code Edition �M r� '�ol S' SAC Units
(25%_100% Cb) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction �_ Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
� Footings (Deck) Final/C.O. Required
Footings (Addition) �D 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 WaIL•_Footings_ Backfill Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Other:
Reviewed By: �d Y� t/� 1K.��1� , Building Inspector
RESIDENTIAL FEES
Base Fee � Z �( � y }�, � 5.�c�
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of3
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sa:rch,apprdisai,surv¢v,c�.krzonmg veri6'cation.Liakota Cavnty assum¢s oo lega7 respcnsibNfty far the infr,rtnation carthinad in th;r data. 1 inch=35 feet
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