4190 Amberleaf Tr
Use BLUE or BLACK ink
For G#ice ~_{s i
I
City of Ealan I Permit _ I
I !
7 I Permit Fee: ~ ,
t/ O i
I/
3830 Pilot Knob Road Ea Eagan MN 55122 JUN 1 6 CI l ~
g I Date Received: 1
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 staff:
2011 MECHANICAL PERMIT APPLICATIQN
Date:1 Q ` y \ l Site Address: LAB ULo -(a'x 7j-lo-L~
Tenant: Suite
RESIDENT / OWNER Name: -~-WA-T--Cc) L-~Phone: t y 1-u O l' o l-13
Address / City / Zip: \-A Lo I
CONTRACTOR Name: BURNSVILLE HEATING & A10- ING License #Q l ez)S3~-Qn I
Address; 3451 W. BumsviHe Parkway City:
Suite 120
State: zigumsville, MN 55337 Phone: G S2
Contact: C fy-~, Email:
TYPE OF WORK New X Replacement Additional Alteration Demolition
Description of work: 11 twa~ 4~)C. 4 C-AT-~ L
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
_ Furnace New Construction _ Interior Improvement
Air conditioner _ install Piping _ Processed
_ Air Exchanger _ Gas _ Exterior HVAC Unit
_ Heat Pump , Under / Above ground Tank C_ Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ X11%
$55.00 Minimum (includes State Surcharge)
= $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee = $ Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
= $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454.0002 for protection against underground utility damage. Cali 48 hours
before you intend to dig to receive locates of underground utilities. www.goaherstateonecall.oro
I hereby acknowledge that this information is complete and accurate; that the work Wit 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 t approved plan in the case of work which requires a review and approval of plans.
1
x x
Applicant's rinted Name App tent's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: _Under Ground - Rough in -Air Test ,-,Gas Service Test -in-floor Heat `Final
Exterior HVAC Screening inspection
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: t~ i lit
3830 Pilot Knob Road Permit Number: "
Ea9an, Minnesota 55122-1897
Date Issued:
(612) 681-4675
1 r M7
SITE ADDRESS: I , 1 , APPLICANT:
PERMIT SUBTYPE: TYPE OF WORK:
INSPECTION TYPE DATE INSPTR. INSPECTION TYPE .DATE INSPTR.
11i r1I i i riff 1 11
I II..,1 1 r. II
I it
I
Permit No. Permit Holder Date Telephone M
ELECTRIC 1p6o3~ /O 9(~ Q °O
PLUMBING 7 tp~oq5-ycGy
HVAC C / a /~'QDOS
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH i~ - Z J
PLUMBING Q,
PLBG
AIR TEST
ROUGH
HEATING '2 Z-
GAS SVC
TEST
INSUL /
GYP BOARD
FIREPLACE 4
FIREPLACE
AIR TEST
FINAL PLBG /C Y7
FINAL HTG
ORSAT
TEST
BLDG FINAL L 4~n c !moo o
~r 7 K, r S~ f ~7 Jots jNP T t..rrACC 3r
jr+ a ~ ~~es' f no o~ R,{~[R C.o44in 'rc
BSMT R.I. F- ' f,r+9+ . w ov Sao t
BSMT FINAL
DECK FTG
DECK FINAL
Address 4 M Ah7 M F.AF TRATT Zip 5512 _
Lot , . u Blk I Sub PMN6Y
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage) '
Permanent steps (main entry) X
Permanent driveway x
Permanent gas X
Sod/Seeded grass
Trail/curb damage Z G,vlrLt4 ow
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system.
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
319-743 OFFICE USE O LY This request wod 18 months from validation dam printed in this box
PLEASE PRINT OR TYPE B ~o~U
WeU ❑ No Inspection Other Then Rough-In tied, Now WA Cell
Request Dote Rough-in mspedion required?
, D-9- (1'ou muss oe the impeder when reod,) Dom Ready.
I
I, lye licensed contractor ❑ owner hereby request inspection of the above electrical work at
Job Address (Street, Be., or Route Na.) City Zip Code
IGO Ea on
Section No Township Name or No Range No fire No County
>LG
Occupant Phone No
n
Power Suppler Address
)DLL G l
Eledrical Conhactor (Company Nome) Contmctar Lcense No Master Lie. No. (Plant Elect Only)
aY)n54 E ~i CAOn~x~ Amo~92
Moiling Address (Contractor or Owner Performing Insmllohon)
Authorized Signoture (Contractor or Owner Performing Install itmn) Phone No
Z7 Knnm pr, 94)-9k)o
EB-CODUI -1a 6195 STATE BOARD COPY-SEE INSTRUCTIONSON BACK OF YELLOWCOPY
IIII VIIIIIIII I I III II II I I I I II REQUEST FOR ELECTRICAL INSPECTION~101
t!1} Minnesota State Board of Electricity
1, 9 7 4 3 1 P
1821 Univers hone (sf 2) 622-0800 Rm. S- ? %S ~ul, MN 55104Home Duplex Apt. Bldg. Other:- - - ~f ~I New Addn
Commercial Indus not Farm Remod Re oir
Air Cond. Htg. Equip. Water load Mgmt. they:
Elec. eat Tem .Service
D er Ran 9f
"k' above the work covered by this request and on the back of the white copy only.
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Cither Fee # Service Enhance Size Fee # Circuits/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Sheet Ltg./Fraffic Sig. Above 200 Amps , Above 100 Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL
Sign/Outline Ltg. Xfmr.
Alarm/Remote Control's aO
Swimming Pool r
I hereby ni that I i the ml inswllanon descnbed herein on the datm shied
Irrigation Boom R.,Wa Dale
Special Inspection -
Fnal Gate
inve$}190t,ve Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
3 -x1147 OFFICE USE ONLY This request void 18 months hom validation date pinned in this
IIIIIINIIillili1111111111111111IIIIIU~ei~ 7~g ~
* 0 4 0 6 6 0 3 L* PLEASE PRINT OR TYPE Request Ooh Roughen inspection regonedR Q'~s ❑ No; Inspection Other Than RuugMn: eady Now ❑ yyill Call
.q )You ust Coll thB inapecror when n>ady) IB eady
I, ❑9icensed contractor ❑ owner hereby request inspection of the above electric work h" d0
Job Address [Street, Bon, or Roule No.) City
p
Am {ter
q19 en
Section No. Township Name or No Range No Fire No Count'
Da
O=t,oam n Phone No
W~~.
Po[w~er,,SuppI r Address
Electrical Contractor (Compoay Nomel Camroctor L come No Moister Lk. No. )Plant Elect Only(
I EUCJ1LC-
Matling Address (Controdar or Owner Performing Instollaeon)
LIU60-nind R'lk mtJ 55~ `4
Authorized Signature (Contractor or Owner Performing Installation) Phone No
EBo0001Al I - srerle noepn ropy - srr tuarat trnnrsa and weer nP vat t nw rnpv
10/3019(, REQUEST FOR ELECTRICAL INSPECTION GG
n. Minnesota State Board of Electricity
406--601) 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone (612) 642-0800
LA-liorne Duplex Apt. Bldg. OtherY New Addn
Commercial Industrial tFm Remod Re air
Ar Cnd. Dryer c. at Tem ice
"X" above the work covered by this request. ce and on the back of the white copy only
!15x7+ zo=0,
Calculate Inspection Fee - This Inspection Request will not be accepted without the correct fee:
Other Fee # Service Entrance Size Fee If Circuits/Feeders Fee
Mobile Home Park Stall to 200 Amps 0 to 100 Amps 175
Street Ltg./Traffic Sig Above 200_Amps A Amps
Transformer/Generator INSPECTOR'S USE ONLY TOTAL 5D
Sign/Outline Ltg. Xfmr. CIO Alarm/Remote Control
Swimming Pool hereb eom rhm en eel onon de:edb d here~e oe ri,e dare::cored
Irrigation Boom RoughJn Dole ;
Special Inspection
F,nal Dare
Investigative fee U
THIS INSTALLATION MAY BE ORDERED DISC ED WITHIN 1 MO THS.
~CITY Onob Road EAGAN PERMIT
3830 Pilot Knob PERMIT TYPE: BUILDING
Eagan, Minnesota 55122-1897 Permit Number: 029214
(612) 681-4675 Date Issued: 11/19/96
SITE ADDRESS:
4190 AMBERLEAF TR
LOT: 17 BLOCK: 1
ROONEY
P.I.N.: 10-64560-170-01
DESCRIPTION:
din# Permit Type SF DWG
iaiYrlir g Wq_rk Type NEW
UBC:E.acup,_rtCjcg_ R-3 U-1
F> :Constfuc'tin Type V-N
x R-1
1171,
- ,
Bu'idzn9 E:eitgt h76
BuY~ld3~;Fdth_ 54
a,1Hx' rg 2
..~dci~ ,lre~`a vnkl>`~ 2.513
C,P 2ro"' 101 1 - FAM. DETACH
G 9 .e'i%sg+3-tl}$"^ q 3 3W'& 'bf+Ne1
,r a, va ^tt ~ em E{ . (m`w~v ,Fx ,.tea-. ~ i~ ¢ e
3.A2: sat !6t. ~'~''7 K,3.x ~ eft
REMARKS:
S & W PLBR - QUICKWAY EXCAVATING
FEE SUMMARY:
VALUATION $223,000
Base Fee $1,502.25 MISCELLANEOUS $1,923.50
Plan Review $751.13 Total Fee $5,188.38
Surcharge $111.50
SAC $900.00
SAC % 100
SAC Units 1
Subtotal $3,264.88
CONTRACTOR: - Applicant - ST_ LIC OWNER:
LUNDGREN BROS CONST 14731231 0001413 LUNDGREN BROS CONST
935 E WAYZATA BLVD 935 E WAYZATA BLVD
WAYZATA MN 55391 WAYZATA MN 55391
(612) 473-1231 (612)473-1231
'I "he reb~F, ac:knaw,l,d'gs iyhatI hai±(e- fxeAax~cett~~,s 'app,l.a..ca;:GacsrT x~ Mate that =;tfTe
3rtFor.roatoneor7ect and acts to gtdtly"u.xth],ePFab=ateY Mn
Statutes 'and Cxt tzfi Eae i~ ,Drd> r~anaeg j r
APPLICA /PERMITEE SIGNATURE ISSUED BY SI ATUE
i W* fX '+X?s"Yk~k~K>X:k;k~::b,X< ?k a:*'d~~cr~:X:>X ;:#:k>XM:k:k
C 0 Y OF FAGAN
CE;S'HIEP" S TERMINAL NO-, 539
DATE: H09/96 TIME: H07:48
w
10:
9AMI:_,, LUNDGREN BR.Os
2256 900I. 41PO AM?ERLEAF ,1sess
late! Rewof Amount; SHOWS
CF:O66892
USER IVN vi NEY
3830 PILOT KNOB RD - 55122
14 1996 BUILDING PERMIT, APPLICATION (RESIDENTIAL)/
681-4675 U~// f0~7
New Construction Requirements Remodel/Repair Reauirements CURRJ'^-QU~
♦ 3 registered site surveys ♦ 2 copies of plan
♦ 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions & decks)
♦ i energy calculations ♦ 1 energy calculations for heated additions
♦ 3 copies of tree preservation plan If lot platted after 7/1/93
required: _ Yes _G No
DATE: CONSTRUCTION C~OyS~T~ Z~ L 7O~
OF WOR :
DESCRIPMESS.
ST~ LOT BLOCK SUBD./P.I.D.
PROPERTY Name: 'Leone # ~t 7~~~L 3L
S
OWNER Street Address• 7 w~~/
City:
State: 70040*0c~Zip:
CONTRACTOR Company: Phone
Street Address: License
City; State: Zip:
ARCHITECT/ Company: Phone
ENGINEER
Name: Registration #
Street Address,
City: State: Zip:
~ el.
Penalty applies when address change and lot
Sewer & water licensed plumber: Grl /
change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that information is correct d gree to comply with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received ✓Yes _ No OCT 2 8 1996
Tree Preservation Plan Received !//Yes No
BUILDING PERMIT TYPE
R 6 A
❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish
02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility
o 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous
0 05 SF Misc. ❑ 10 _-plex ❑ 15 Deck
WORK TYPE
Z31 New ❑ 33 Alterations ❑ 36 Move
0 32 Addition ❑ 34 Repair ❑ 37 Demolition
GENERAL INFORMATION
Const. (Actual) J Basement sq. ft. 1?'3 MC/WS System
(Allowable) / J Main level sq. ft. L-7 73 City Water
UBC Occupancy ,2-3.0-r 2~ sq. ft. a 3a Fire Sprinklered
Zoning Q-r ! sq. ft. '7Ho PRV
# of Stories 2 sq. ft. Booster Pump
Length sq. ft. Census Code. )0 1
Depth s 3' Footprint sq. ft. 2-- 51 Code d r
Census Bldg r
Census Unit I
APPROVALS
Planning Building r Engineering Variance
Permit Fee Valuation: $ 22-3 ovo,
Surcharge 3r `ri
Plan Review 3z _ c 7 `r4
License "y 47 K -7. -Sd 328
MC/WS SAC sQ e n, 3,/ 100(o
City SAC z,, sx 9. zS q q
a3.s
Water Conn. a,s~ ~ z . s
Water Meter L-1 .7 z •S `5 = z!., sq Z.-
Acct. Deposit
S/W Permit
S/W Surcharge so-w~ 1-7 7,Z. s m sv = ti s -i 51 . z. -
Treatment PI.
Road Unit ZH~
Park Ded.
Trails Ded. 3a'" sac.
Other 4f q. c 7 r sy. S oq~
Copies 3q -T"?, y.zs 3,q
13.S,17.C-7 104
Total: tz.c7 , 14.2r 5q
- Q, 7S x I'S - 2S
- 1 2
%SAC rL3% 43k6-4% 88 4Sz,-
SAC Units
z 21. $ = LLz
w.3yv zg, s-o
y 78
7410 fb ! r, 8ko.-
2 s.2, L 1dg'. •'20
% 2422 Enterprise Drive
Mendota Heights, MN 55120
* PIONEER LAND SRRVEYORS • CIVIL DaQNEEAS (1012) 681-1914 FAX:681-9488
eng near ng LAND PLANNERS. LANDSCAPE ARCHITECTS 625 Highway 10 N.E-
Blaine, MN 55434
4c * (612) 783-1880 FAX-783-1883
Certificate of Survey for: LUNDGREN BROS. CONST.
BENCH MARK N
TOP OF PIPE CI
ELEV.=909.90
h CVO
~~co yo3°'' S6
N85°58'0 E NV
it 90> pO
'10-0 37
t~V 22.62 1 8 ~1 907.6 lb 7
0.4 15
SERVICE(INV. EL =900.0
915,0
/ i 917.9 X5 '
\ 1~ 915 x 00%s J
x N
918,3 919,0 Y`O
3 i + 916.3a
00 CIq
A 912.7 919.6 d
b
b
S O'.0~~ 1 3~ 9202.. 919.6
o / q1 i h
/914.5 O 920.5~ x n.~ OP 0~
0 U 921.7
2y \
r L 3~3~0 CL,V. x
CI
i
' 91 .4 921.5x " x , 17
921.6
3T,zz 922.1 v
lyl ~Q) Ilk"
2 9228` i ,V x 922.6 I tij
S6g0924.6 EASTM CT & U u 75.5 9,7 >
91 N7 ~S4 J7 925.3 p ~E_ DER Pcq I15
1 ~I :~~~f~1d { 920.8
BENCH MARK 919 B
TOP OF PIPE
ELEV.=921.62 18 By _ (y/?,g E N I E W E D
'PING ELVCi dI..i DES. V
ra
NOTE. PROPOSED GRADES SHOWN PER GRADING PLAN BY: PIONEER UT PROPOSED HOUR
NOTE: BUILDING DIMENSIONS SHOWN ARE FOR HORIZONTAL AND VERTICAL LOCATION LOWEST FLOOR ELEVATION:
OF STRUCTURES ONLY. SEE ARCHITECTUAL PLANS FOR BUILDING AND
FOUNDATION DIMENSIONS.
TOP OF BLOCK ELEVATION:
NOTE: NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ON THIS LOT BY THE
SURVEYOR. THE SUITABILITY OF SOILS TO SUPPORT THE SPEGFIC HOUSE GARAGE SLAB ELEVATION: l .
PROPOSED IS NOT THE RESPONSIBILITY OF THE SURVEYOR.
NOTE: THIS CERTIFICATE DOES NOT PURPORT TO SHOW EASEMENTS OTHER THAN X 000.00 DENOTES EXISTING ELEVATION
THOSE SHOWN ON THE RECORDED PLAT, ( 000.00 ) DENOTES PROPOSED ELEVATION
NOTE: CONTRACTOR MUST VERIFY DRIVEWAY DESIGN. - - - DENOTES DRAINAGE AND UTIUTY EASEMENT
DENOTES DRAINAGE FLOW DIRECTION
NOTE: BEARINGS SHOWN ARE eASEO ON AN ASSUMED DATUM DENOTES MONUMENT
---r3-- DENOTES OFFSET HUB
WE HEREBY CERTIFY TO LUNDGREN BROS. CONST, THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A
SURVEY OF THE BOUNDARIES OF:
LOT 17, BLOCK 1, ROONEY ADDITION
DAKOTA COUNTY. MINNESOTA
IT DOES NOT PURPORT TD SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR
UNDER MY DIRECT SUPERVISION THIS BTH DAY OF OCTOBER, 1996.
SI NED• PIONEER ENGI E~RI 'G, P-A.
SCALE : 1 INCH = 30 FEET pp
I~ J'7il ~b'✓J E~O4A C..P f
1037 94322.13 SWK REVISED 10/25/96 MOVED HOUSE John C. Larson, L.S. Reg. No. 19828
T0'd
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL:
DATE OF GR
J
> LATEST REVISION:~r~-T
F DOCUMENT STANDARDS
a z
rdr~❑ ❑ • Registered Land Surveyor signature and company
❑ • Building Permit Applicant
❑ • Legal description
❑ ❑ ❑ • Address
ra'O'❑ ❑ North arrow and scale
M", ❑ ❑ • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
2'-' ❑ ❑ • Directional drainage arrows with slope/gradient %
Cam/ ❑ ❑ • Proposed/existing sewer and water services & invert elevation
!1 ❑ ❑ • Street name
I" ❑ D • Driveway
ELEVATIONS
Existina
t~ ❑ • Sewer service (or Proposed)
R ❑ ❑ • Property comers
❑ ❑ • Top of curb at the driveway
❑ ❑ Elevations of any existing adjacent homes
Proposed
❑ • Garage floor
❑ First floor
❑ Lowest exposed elevation (walkoutWndow)
~~333 ❑ • Property comers
[3 ❑ ❑ • Front and rear of home at the foundation
/ PONDING AREA Cif aoolicable)
❑ • Easement line
❑ • NWL
❑ ❑ HWL
❑ 1~ • Pond # designation
❑ ❑ Emergency Overflow Elevation
DIMENSIONS
Z/ ❑ ❑ Lot lines/Bearings & dimensions
❑ • Right-of-way and street width (to back of curb)
❑ • Proposed home dimensions including any proposed decks, overhangs greater than 2',
/ porches, etc. (.e. all structures requiring permanent footings)
ry/~ ❑ • Show all easements of record and any City utilities within those easements
Setbacks of proposed structure and sideyard setback of adjacent existing structures
❑ ❑ • Retaining wall requiremen "
Reviewed: any 10&0124
N me / Date
January 19M
CR4M19QB18LDGPRMr.FM
681 9488
IT-108-1996 11:33AM FROM PIONEER ENGINEERING 681 9488 P.2
.y 2422 Enterprise Drive
Mendota Heights, MN 55120
a
:(612) 681-1914 FAX:681-9488
` Ir'~£:5®~•.:. $=K un0 susvsvons . uw~ wcwccas _ _
x W''d`k~[t'9~Tr:.T°[49~... w+o rcwnoes" wiosrre waeaazers ;.•625 _Nighwoy....,O N.E....
yr Blaine. MN 55434
k (612) 783-1880 FAX:783-1883
EE ERTIFICATION
Certificate fo : LUNDGREN BROS. CONST_
t LOT 17. BLOC, I OONEY ADDITION (AMBERLEAF)
Z*1CAN. MINNESOTA (DAKOTA COUNTY)
REVISE: OCTOBER 25.1996
RE VI NOVEL49ER 8,1996
N
"
Tree Protectiea -
Fencl S 9D ,
SC LE = 30' 40.51
907.6
07.6)
° 7Cw 11
'x9 A722~'-o SERVI (I
10.4 NV. E 900.0) i 5
~x •697 i
I
i 5-7 #
7 r9r 915.ox x9696 r
• ~ ~ 917.9 ~'fs 2g !
• / 9i 6.3 rr I Y^ 695•!
o _33 1 $~pen •
_ °j~o- ' ?00 r-3 694 J 90 3
/ 680.4 7 ' ^919Sj 1V
/ row! PT-"~ 1 !
/914.5 rO /920.Sy x 'V MVP • 9 Op ` 92171
1 x•. ` ~3e 82,.6
4- x
9154 921.5 • 7 17
914.8) #65 • ~ , ` 98 % x 9221
! g h
i X648• X647 0 9.
922 s
1$4 37~,c -DAMec6e~ eR 17)- 1I 919.7 W
18 car j s
szo.s
SIGNIFICANT TREES 919.6
NO SIZE TREE TYPE (ORIG.. tD) PROPOSED STATUS (919 ^8
#646 13' White Oak Remove-grade
Ira 4`
)1686 15 Red Oak-Dbi Remeve-Roues pad 1
i #687 14" Red Oak-DbI (White Oak) Remove-w/in 20' Of House
i #668 13' White Oak Remove-House pad
#689 6" White Oak Remove-House pod
#690 T1" White Oak Remove-House pad SITE SUMMARY
#691 Sr White Oak Obi (I6" W.Oak) Remove-House pod
#692 28' White Oak Removed prior to 10/18/96 Trees Sow": 9 507.
i #693 26r Red Oak Save Trees Removed: 9 50%
#694 14" White Oak Save Total Tree*: 16 100%
#695 14" White Oak Sava
#695 14r White Oak-DbI Save [ ] not included in cummory
#697 17- White Oak Save Allowobie tree removal - 20% (4 trees)
#698 12" Birch-Dbl Save Required tree replacement - 6 cotogory
#699 14•" Cherry Save A trees (2) replacement trees required for
[#722 14' White Oak Removed for ROW) tree #69'22
I #723 31' White Oak Save
fi Am. Elm Save
,7' Ouoking Aspen Remove-House pad
I hereby certify that this plan was prepared by me or under my direct
supervision and that I am a duly regtatered Landscape Architect under
the tows of the State of Minnesota
SIGNED- PIONEER ~ENGINNMEREERIe 23 20 RING. P.A.
DATE
1 Theeree H600114, R-~
I SIG RE DATE
Th
p/SIYIO~ r /C~"~'y OBERLIN PARADE
iLfq cUnDG®Rqs.
\
BROS. EXTERIOR ENVELOPE AVERAGE U COMPUTATION
CONSTRUCTION
INC
Site Address* &A Z'Lot lock
R & U Factors R U
Opaque Walls .043
935 E Wayzata Blvd
W ,y al3 Wall Framing Areas .09
Mirmrsota55391 Ceiling Insluation Area .023
(612)473-1231 Ceiling Framing Area .027
Rim Joist .04
Masonry Wall .469
Windows .35
Doors .31
Skylights .55
1) Lower Level (Basement)
Total Exposed Wall Area 5-~ZD
Opaque Wall Area 3~a X (U) .043 = ~3lO
- Wood Frame Area 3 S X (U) .09
Rim Joist X (U) .04 =
Exposed Block X (U) .132
Window Area C X (U) .35
Sliding Glass Door X (U) .35 =
Door Area X (U) .31 =
Total ~5~
BROS. 2) First Or Main Floor
CONSTRUCTION G
Total Exposed Wall Area
INC
Opaque Wall Area lal.24 (U) .043 = S~~
Wood Frame Area X (U) .09
Rim Joist//U X (U) .04 = O 0
Window Area 7t4 /L'X (U) .35
935 E. Wapla Blvd /
Wapia Sliding Glass Door X (U) .35 = 141
Minnesota55391 Door Area Je X (U) .31 7 G~
X612)473-1231 Total
a ✓
3) Second Floor If Two Story 7 /J
Total Exposed Wall Area / p
Opaque Wall Area ~ X (U) 043 =
r
Wood Frame Area X (U) .09 =
Window Area c~ 7~-X (U) .35 = -2-
Sliding Glass Door X (U) .35 =
Door Area X (U) .31 =
Total
~ r
4) Total Ceiling Area r/ j'S
Wood Frame Area l -1b X (U) .027 = -4 ~Sr
Opaque Ceiling Area S ~ X (U) .023 = 9/0,
Skylight X (U) .55 =
Total ~O(~
LUDGREn
BROS.
CONSTRUCTION
INC MINNESOTA U FACTORS Total Exposed Wall Area 4(4/Z3 X .11
MINNESOTA U FACTORS Total Exposed Ceiling . 7
Area ~~sS X .026 = `TS
(A) Total = 5~~2,/ ~o
935 E Wayzata 8110
vaav7ala Item 1 /~v?,/-5 + Item 2o2ay~j+ Item 3+ Item 4 411, e)(Ji
f 9
Minnesota 55391
(612)473-1231
If Total Of Items 1-4 Is Less Than Item (A), Building Complies With
SBC 6006 (C)s
L B~ CITY USE ONLY RECEIPT#: 7I8~~
SUBD. ~/fl~6 N 2 ice" RECEIPT DATE:
3 3/ 97
1997 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: . single family dwellings
townhomes and condos when permits are required for each unit
backflow preventer for underground sprinkler system
FIXTURES EACH NO. TOTAL
Shower 3.00 x
Water Closet 3.00 x =
Bath Tub 3.U0 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet ° minimum - t 3.00 x =
Rough Openings 1.50 x =
Water Softener " for dwellings under construction 5.00 x =
Water Softener "for existing dwelling 20.00 x = D
U.G. Sprinkler °fordwelling under const. 3.00 =
U.G. Sprinkler ° for existing dwelling 20.00 =
Alterations ° to existing residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System ° Dak Cty lic. 75.00 =
(new and refurbished systems)
Private Disposal Systems "Abandonment 20.00 =
STATE SURCHARGE .50
TOTAL s~Q
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
damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within
City property/right-of-way/easement.
SITE ADDRESS: q o
OWNER NAME: J~
INSTALLER NAME: ONE
STREET DDRESS:
CITY: STATE: (J4 ZIP: 3
/ 'l7 GN RE O PERMITTEE
L 17 BL CITY USE ONLY RECEIPT:
SUBD(~/Gro~a~/ RECEIPT DATE: r~ 9
1997 PLUMBING PERMIT (RESIDENTIAL)
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for. single family dwellings
townhomes and condos when permits are required for each unit
backtlow preventer for underground sprinkler system
FIXTURES EACH ~Q TOTAL
Shower 3.00 x _
Water Closet 3.00 x
Bath Iub 3.00 x el -
Lavatory 3.00 x
Kitchen Sink 3.00 x I = °O
Laundry Tray 3.00 x
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x 19-7
Floor Drain 3.00 x = 3
Gas Piping Outlet * minimum - f 3.00 x
Rough Openings 1.50 x
Water Softener * for dwellings under construction 5.00 x =
Water Softener *for existing dwelling 20.00 x =
U.G. Sprinkler * for dwelling under oonst. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00 -
Alterations * to existing residence 20.00 =
Water Turn Around 20.00 =
Private Disposal System * Dak cry lic. 75.00 =
(new and refurbished systems)
Private Disposal Systems * Abandonment 20.00 =
STATE SURCHARGE .50
TOTAL 53 ~
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 applicants responsibility to notify the property owner that the City of Eagan assumes no liability for any
damages caused by the City during Its normal operational and maintenance activities to the facilities constructed under this permit within
City property/dghtof-way/easement. ~j
SITE ADDRESS: `zz
OWNER NAME: LH," ~zzvk P~lo-s®
INSTALLER NAME: 01(k rev r V` Q Ci TELEPHONE* V ~'S--!546 5ol-
STREET ADDRESS: 59 / e, ~ r On it I'/ p
CITY: STATE: 'j zip:
I k
SIGNATURE OF PERMITTEE
L BL CITY USE ONLY RECEIPT 9
SUBD.~ DATE: 7
1996 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
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. Vanee system, etc.
Date:
r
FEES
► 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) 6y) aso
► State Surcharge .50
TOTAL
SITE ADDRESS: /RD
OWNER NAME: ZaliciQ/1A L3,PA5 PHONE YZ L3%
INSTALLER NAME: t '
STREET ADDRESS: f12d ~7-5 -1
CITY: STATE:__ ZIP: -SS378
PHONE ( ) X I~ ~DD~ a
CITY USE ONLY
L BL RECEIPT
SUED. DATE:
1996 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612)681.4675
Please complete for: ► all commercial/industrial buildings.
multi-family buildings when separate permits are required
for each dwelling unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: $25.00 minimum fee Q 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
L /7' B_L
SUB)
c- 0
NEW RECEIPT /I/~f Q
RECEIPT DATE
DATE
TO 1 I n l1J
JOB ( `/yVI* L~ 47
OWNER
PLEASE BE ADVISED THAT THERE IS A FEE SHORTAGE ON THE ABOVE
ELECTRICAL INSTALLATION IN THE AMOUNT OF $ cj
SHORTAGE MUST BE PAID WITHIN 14 DAYS.
REMARKS
23 0 - 30 AMP CIRCUITS = S
31 - 100 AMP CIRCUITS =
0 - 100 AMP SERVICE _
101 - 200 AMP SERVICE = W
TOTAL FEE DUE
LESS FEE RECEIVED ~D
O
TOTAL FEE SHORTAGE DUE = r~
PERMIT #
ORIG RECEIPT #
RECEIPT DATE_ ~2
PLEASE RETURN A COPY OF THIS FORM WITH YOUR REMITTANCE.
/~~19 7 THANK YOU !
_ RESIDENTIAL IS.
~5 BUILDING PERMIT APPLICATION CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651.681-4675
New Construction Requirements RemodelfReoair Requirements
• 3 registered site surveys showing sq. ft. of lot, sq. ft of house; and all roofed areas • 2 copies of plan
(20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for exterior additions & decks
1 set of Energy Calcuiations • Indicate if home served by septic system for additions
• 3 copies of Tree Preservation Plan if lot platted after 711193
• Rim Joist Detal options selection sheet (bldgs with 3 or less units) ~7
DATE C-) VALUATION l\t D~~<
SITE ADDRESS 61 / tYY~ IILcZ S 1 i rc. 1 MULTI-FAMILY BLDG _Y _N
TYPE OF WORK f lF'i li"Zf i;Lnr -1- on ' O. 6- &.6-r049~IREPLACE(S) _ 0 _ 1 _ 2
SELA ROOFING & REMODELING
APPLICANT 4100 EXCELSIOR BLVD
ST. LOUIS PARK, MN 5541E
STREET ADDRESS in *mn+nsn CITY STATE ZIP
TELEPHONE #CtIZ-'~Z1-'S0 4L___ CELL PHONE FAX #
PROPERTY OWNER TELEPHONE # G z 7 - Cj
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I _ MINNESOTA RULES 7672
(J submission type) . Residential Ventilation Category 1 Worksheet Submitted New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone #t
Plumbing system includes: _ Water Softener _ Lawn Sprinkler Fee: $90.00
Water Heater _ No. of R.I. Baths
No. of Baths
Mechanical Contractor. Phone # s Cut f~
~$70.00
Mechanical system includes: Air Conditioning Fee- D
Heat Recovery System Kov 1 2002 ~
Sewer/Water Contractor: Phone #
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinance.
Signature of Appllconf
- - - _ ° -
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required
Updated 4102
OFFICE USE ONLY
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi
❑ 03 01 of _ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF
❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi
❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair
❑ 33 Alteration ❑ 37 Demolish (Bldg)' ❑ 43 Reroof ❑ 46 Windows/Doors
❑ 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) _ Final/C.O.
- Footings (deck) Final/No C.O.
- Footings (addition) - Plumbing
- Foundation _ HVAC
- Drain Tile Other
Roof - Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
- Framing _ Siding _ Stucco _ Stone
Fireplace Air Test _ Final _ Windows (new/replacement)
Insulation _ Retaining Wall
Approved By Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
RESIDENTIAL BUILDING
Permit Application
lX City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements Remodel/Repair Requirements Office Use Only
3 registered site surveys showing sq. ft of lot sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd -Y _ N
(200h maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pies Plan Recd _ Y _ N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Prey Reqd _ Y _ N
I set of Energy Calculations Addifron- indicate ifonsde septic system On-site Septic System _Y _N
3 copies of Tree Preservation Plan it lot platted after 711193
Rim Joist Detail Options selection sheet (bidgs with 3 or less units
Date 1- / k / `)3 Construction Cost 3 5LC>
Site Address Lt l cl 1 A &k, k„ C; 64; -1 Q-sn L Unit/Ste #
eA~Aa
Description of Work 1r~51'Au 6R5 ~l(Lt'~C~CC
Multi-Family Bldg - Y - N Fireplace(s) - 0 / / - 2
((p mil) (pivi~ d / 7✓
Property Owner r COA) C r4-ko?-k Telephone #
Contractor itGL
Address 3~J~ W- 4}W l3 City lyUit,c'
State Zip QQAD g';3 ~elephone # (~~7 ) 85J -f 7
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Category • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber n _Telephone )
le
Mechanical Contractor C JI E~)e
phone Sewer/Water Contractor 1 Z0o3 elephone )
~
I hereby apply for a Residential Building Permit and ackno e-d'g`e t at the information is complete and accurate;
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 work which requires a review and
approval of plans.
Applicant's Printed Name Applic is Signa e
OFFICE USE ONLY
Sub Types
❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg
❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi
❑ 03 01 of - plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF
❑ 04 02-plex ❑ 10 08-plex ❑ 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc.
❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage
❑ 06 04-plex ❑ 12 12-plex Plbg_Y or- N ❑ 25 Miscellaneous
Work Types
❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding
❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair
❑ 33 Alteration ❑ 37 Demolish (Bldg)' ❑ 43 Reroof ❑ 46 Windows/Doors
❑ 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
- Footings (new bldg) _ Final/C.O.
- Footings (deck) _ Final/No C.O.
Footings (addition) _ Plumbing
Foundation _ HVAC
Drain Tile Other
Roof - Ice & Water _ Final - Pool - Ftgs _ Air/Gas Tests _ Final
- Framing _ Siding _ Stucco Stone
- Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacem_ent)
- Insulation _ Retaining Wall
Approved By Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
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_ Use. BLUE or BLACK Ink
City of Ea n n i Permit 90
i , h
h
3830 Pilot Knob Road Permit Fee: "5 5` d v j
Eagan MN 55122 REGFIVED I i
Phone: (651) 675-5675 i Date Received:
Fax: (651) 675-5694 JAN 7 0 2011 staff-------
- - - - - - J
0 2011 MECHANICAL PERMIT APPLICATION
Date: 1- o- Site Address: y &MjQgzL0(1Li acco-L
Tenant: C-skcr-n A-f Suite
RESIDENT / OWNER Name: -4 L I ~e,no -a TCL Phone: IsCI-1 Q)K'T
Address/ City /Zip: .
CONTRACTOR Name: BURNSVILLE HEATING & AIC, INC. License y 1r2LB~_4 -a'1 I
3451 W. Bumsde Parkway
Address: City:
State: ZipBumsville, MN 55337 Phone: -KGB-1-OW6
Contact: ryc Email:
TYPE OF WORK New X Replacement Additional Alteration Demolition
Description of work:
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods,
PERMIT TYPE RESIDENTIAL COMMERCIAL
A Furnace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / _ Remove)
" When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $~t (Do TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x1%
$55.00 Minimum (includes State Surcharge)
Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
TOTAL FEE
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.oopherstateonecall.ora
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 C Y~ L(~LSrVI x
Apant's Printed ame App 's Si'g at e
FOR OFFICE USE Reviewed By: Date:
Required Inspections: -Under Ground Rough In _Air Test _;Gas Service Test In-floor Heat -Final
Exterior HVAC Screening Inspection
Use BLUE or BLACK Ink
r-----------------+
I For Office Use �
C' � Permit#: ���� I
lty of ����� I Permit Fee: t� - �� I
4
3830 Pilot Knob Road I �'� I
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 1 Staff: � �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: �� �% ���''� ��� Phone:
Resident/ �j��� � /_ � /
OWttel' Address/City/Zip: � �M"JC�r'' ��e� 1 �"
Applicant is: Owner Contractor �.
Description of work� \ ` ���-x=
Type of Work
Construction Cost: G(�U• `'� Multi-Family Building: (Yes /No_�
Company: � �tC � U�� Contact�rll f ��z'��� ��� � �
C n r Address: I� � � � �t �� City: ��1, ck�,,��� ��C1
o t actor
State: Zip: Phon . �'�-��F`2��� Email: � �
License#: �ead Certificate#:
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. Porfions of
the informafion may be classified-as non-public if you provide specific reasons thaf would permit the City to
conclude that the are tratle 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.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the inances 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 wit t 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 Minneso tat il ing ust be completed within 180
days ot mit i�uance. � �
x �� �� � ���/ X �
ApplicanYs Printed Name Applicant's Signature
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