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3923 Beryl RdRESIDENTIAL ?qrj 3(? g BUfL.DING PERMIT APgL1GAT10N cmr oF EAGaN saso PrLoT KNoB Ro - 55122 631-681-4675 1Cortdnuetlan Reaubmenb • 3m4? ?ump kowin8 s1. R. of IK aQ. A. oi hom; and d moed aness . 2 topies ui ow (10l6 rnwtirtNNn lot coverage aNoMred) • 1 aet t?f ?g?r C?nt ?Ort?ed ?dd?ons • ZcDPies of Pm Wv**D beem 8 whtdow aizes: Poured found deagn, etcj • i eb strM for e#etior addOmt & dedrs • 1 sek of Energy Cakulatlons . Indkc01hart*eerved bY aepe "*m far ed0?ons • 3 coQfes of Tree Pceawtallat Plan I lot ptaM after 711193 • Rim Joist Detai Optiam setection sNest (ddp w1tlh 3 or lm tauls) DATE 09/24/01 VAIUATIfJN ,l,3, 2Q,Q:0_0 ? JOB S1TE ADDRESS 3923 Beryl Road Eagan, M 55122 IF MULTI-FAMiLY BUILDtNG, HOW NIANY tlNtTS? PROPERTIf QWNER Jasan Brubaker TYPE QF Wt7RK Seamless Steel Siding, Roof pIREpLqCIE(S) - p- j T2 APPUGANT Exterior Innavatioons, Inc. PHQNEC952) 884-4814 ADDRESS 9635 Humboldt Ave. S., Bloomington, MN Ap CppE 55431 PAGER # CEI.L PHONE * PAX # (952) 884-57O : : .. Nt?1'RESIDENTIAL BUILD?INI G ONLY - FILL ?,IUT COMPLE'tELY Energy Cocte Category MiNNFSOTA RL1M 7670 CAIWORY 1f? (check one) r - Residential Vertdla#bn Categcry 1 Workshest Subm - Ensrgy Envelope Caicuiations Subnitted _ MINNF•SOTA RtTLE'S 7672. New E„ergy coae worksneet subrtdtted ? Plumbing Contractor. Phone #: Plurnbing Systern Includes: ! Water Softener ., Lawn Sprinkler Fee: $94.00 Water Heater , No. of R.I. Baths No. of Baihs MechcMcoi Contrcctor: Phcsne # Mechanical System Includes: «. Air Conditioning Fee. $70.00 _,_, Heat Recovery System SawaE/Wvter Contractow Phone # - _. . , ,, . Alt above ir*rmation must'be submitted privr ta procefssing of application. 1 hereby aeknowiedge fihat I have read this dpplication, state that fhe inftemaition is carect raiitCgMe tt? cornplI with all applicabie State of Minnesota Statufies and Ci#y of Eag ina es. Signature ot dppNc n# Csrtificates of Survey Received _ Tre+e Preservatian Pian Received ? Nat Required t3pdow 1m9 OFFICE USE ONLY O 01 Foundation O 02 SF Dwelling 0 03 01 of _ plex 0 04 02-plex 0 05 03-plex ? 06 fl4-ptex O 07 05-plex O 13 16-plw O 08 08-piex 0 16 Fireplace ? 09 07-plex O 17 Garage o 10 os-pieX o 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-ptex Pibg,_Y or _ N O 20 Pool O 21 Porch (3-sea.) 0 22 PorctUAddn. (4-sea.) o aa Porcr, (screenea) O 24 Storm Damage O 25 MisceHaneous a 30 AwMawy eWg D 31 E)#. Alt w %A [] 33 Ext. Att - SF C] 38 hluffl ? 31 New 0 35 Int improvement O 38 Dernolish (irrterior) D 44 Siding O 32 Addi#ion ? 36 Move Bldg. 0 42 Dertrolish (Foundation) 0 45 Fire Repair 0 33 Alteration 0 37 Demolish (Bidg)• ? 43 Reroof 0 46 WGxfows/C?oors ? 34 Repiaeement ''Qemoiition (Entiro Bldg only) - Giw PCA handout to appllcant Valualion Occuoancy MClES System Census Code Zoning City Water SAC Units Stortes Baoster Purrip Nbr. of Units Sq. Ft. PRV Nbr. of Bk1gs Length Fire Sprinklared Type of Const Width REQUIRED INSPECTIONS Footings (new bMg) Footings (deck) Foatings (addition) P Foundation HVAC Drain Tile Roof Ice & Water Final Other Framing` _ Pool _ Ftgs _ Air/'Gas Tests ? Fina2 Fiteplace _ RI. ,r Air Test _ Final _ Siding Stucco Stone Insulation _ Windows (new/replaccmtut) APProved By ; Bt?dkng inspector Base Fee Surcharge PI$n Review MC/ES SAC City SAC Water 3apply 8? Storage S8W Permit & Surcharge Treatment Rlant Piumbing P?mit Mechanical Permit Lfcense Search Gopies Other Total FinaUG.O. ? FinaUN4 C.O. _ ?? CITY USE ONLY LOT Cot?- BL / RECEIPT #: SUBD. RECEIPT DATE: 199$MECHANICAL ?ERMIT (RESIDENTIAL) CITY OF EAfiAN 3$30 f'tLOT KNOB RD £A6i4N MN $5188 Date: (618) 6$1-4675 Complete this section only if you are installing HVAC in single family, townhomes or condos under construction and not owner /occupied ' • HVAC: 0-100 M B T U $ 24.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @$3.00 ea.) • State Surcharge: .50 • TOTAL: Complete this section onlv if you are remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Note: Mechanical permit is not reauired for alteration/add-on to ductwork in existing residential units; but is required for the following: X Install furnace Install air conditioning Install air exchanger, i.e. Vanee system, etc. Other Minimum fee applies to all remodel or add-ons of existing residences $ 20.00 State Surcharge C2.5?/ Total: SITE ADDRESS: O WNER NAME: ?r? C,?--t??t,•i I L-f"?? f'l``? PHONE #: ? iNSTALLER NAME_ PHONE #: STREET ADDRESS: Ef' 1'Zrt C' c < 4u{' • CITY: STATE: ZIP: SIGNATURE OF PERMITTEE JS/FORMS BLD/MECH PERMIT (RES) - 1998 L BL SUBD. APPROVED BY: INSPECTOR 199$ MECHANICAL PERMIT (COMMEftCIAL) CITY OF E4fiAN 8$80 PILOT KNO$ ftD EAfiAN, MN 55122 (612) 6$1-4675 Please complete for: all commercial/industrial buildings multi-family buildings when separate permits are not required for each dweliing unit DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: 1% of contract price OR $25.00 minimum fee, whichever is greater. Processed piping - $25.00 CONTRACT PRICE x 1 % PROCESSED PIPING PERMIT FEE STATE SURCHARGE TOTAL SITE ADDRESS: ($.50 per $1,000 of permit fee due on all permits.) OWNER NAME: PHONE #: TENANT NAME (IMPROVEMENTS ONLY): INSTALLER: ADDRESS: PHONE #: CITY: STATE: CITY USE ONLY RECEIPT #: RECEIPT DATE: ZIP: SIGNATURE OF PERMITTEE CITY USE ONLY LOT BL PERMIT SUBD. RECEIPT #: 317 . RECEIPT DATE: c, " C'U 2000 MECHANICAL PERMIT (RESIDENTIAL) Date: p ? 1 -?> -0 6 Complete this section onlv if you are ir_stalling HVAC in a sing!e fa.mily dwelding, townhome or condo urder construction and not owner/occupied. • HVAC: 0-100 M B T U ADDITIONAL 50 M BTU • Gas outlets (minimum of one required @$3.00 ea.) State Surcharge Total $ 30.00 6.00 .50 $ Complete this section only if you aze remodeling, addiniz -to, or re aip rin? an existing single-family dwelling, townhome, or eondo. Please indicate if it is a new item, alteration, or repair. New _ Alteration Furnace Air exchanger Reminder: Call jor inspections , Repair _ Other ? Air conditioning Other Fee $ 30.00 State Surcharge Total 30.50 7? ? v SITE ADDRESS: 1 ??-- OWNER NAME: C) ^.), C (-- ? PHONE #: (AREA CODE) INSTALLERNAME:??????.? Ca a,Ak2.PHONE #: ?k 2- Z'r"i.` (AREA CODE) STREET ADDRESS: S(-) ?'-X`(-_ r?` CITY: m . ("?` ".' t= _ STATE: -M P'j_ ZIP: CITY OF EAGAN 3830 PZLOT IQNOB RD EAGAN I•IIt 55122 651-681-4675 SIGNATURE OF PERMITTEE CITY USE ONLY L BL PERMfT SUBD. RECEIPT#: APPROVED BY: , INSPECTOR RECEIPT DATE: 2000 MECHANICAL PERMIT (CObMRCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, 1rIlN 55122 651-681-4675 Please complete for: all commerciaUindustriai buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: WORK TYPE: New construction Install U.G. Tank Interior Improvement Remove U.G. Tank Processed Piping When installing/removing underground tank, call 651-681-4675 jor inspection by fire marshal and plumbing inspector. Description of work: Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater. Underground tank removaUinstallation = minimum fee Contract price: $ x 1%_$ (Base Fee) State surcharge calculate at $.SQ for each $1,000 Base Fee TOTAL $ SITE ADDRESS: OWNER NAME: PHONE #: (AREA CODB) TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? _ Y,_ N. NAME: INSTALLER: ADDRESS: PHONE #: - (AREA CODE) CITY: STATE: ZIP: SIGNATURE OF PERMITTEE 0_ 29 6 9S ? ? &tL 8? ?c Request ate 2 7 Fire No. ugh•In I spection Required (You must call inspector when ready) ? inspection Other Th n ugh-In ? Ready Now Will No[ify Inspector ? Yes No Date Ready I licensed contractor ? owner hereby request inspection of above electrical work at: Jo. ?AJdtlress (Street, Box o Route No.) .?...! ? ? 12?..i' City ? Section No. Township Name or o . Range No. County o F'(PRINT) Phon No. Power Supplier Address Ele ic ?Conlraclor ( ompan Name) /?' ? i j CN License N??N"°'_..! Y°/ c Maili dress (CQ ctor or Owner Makin Insta ation , th ized gnature (C ractor/Owne tallation) &044V%2__\.i Phone Number 7"r _ -- ? ?g?gUM'zs y B?$?SRoPmS-M128E'?I ?III?IIIIIIIIIIII?III(IIIIlill?illlllllrll(IIIIIII ? ENC OSEDOPER WSPECTIONBOEE 3T `EQUEST FOR ELE 9TRICAL INSPECTION EB_000909 See instructions for completin this form on back of eilow copy. ?- x1 7f?? ? '?"`?"" Be%w Work Covered bv This Reauesf ? Buiiding Appiiances Wired Equipment Wired Home Range Temporary Service 'Duplex Water Heater Electric Heating Apt. g Dryer Load Management ustriai Furnace Other (Specify) Farm Air CondiYioner ContraQtPr's Rem)arks: 74c? /5$_ ? ee(ow: +G? # Other Fee # Service Entrance Size Fe # CircuitslFeeders F e Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps Above =1,Q0 Amps SigtiS Inspector's Use Onry: ? TOTAL Irrigation Booms ? Speciai Inspection AlarmtCommunication THiS INSTALLATION MAY BE OR DISCONNECTED IF NOT Other Fee COAAPLETED WiTHIN 18 MONTHS. i, the Electrical inspector, hereby tif th t th i b ti h Rough-in Oate y cer a e a ove nspec on as been made. F;nai oate OFFICE USE QNLY This request void 18 montbs from - CITY OF EAGAN Remarks * C@dar G3:OV@ Acqu3sition Addition CEI3AR GROVE #5 Lot 22 Bik 1 Parcel 10 16704 220 Ol Owner ?Street 3923 Berv] RDti3d State Fa??1T'1, MN 55122 ' Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 7, 1967 100.00 5.00 20 Paid SEWER LATERAL I961 540.00 27.00 20 P3]. WATERMAIN * WATERLATERAL 1972 607.00 24,28 25 PS(ld WATER AREA 1 STORM SEW TRK V'7 197¢ 70.00 4.66 15 P11d STORM SEW LAT CURB & GUTTER , SIDEWALK STREET UGHT WATER CONN. BUILDING PER. sAC zov. oo soz 11--14-67 PAR K EAGAN TOWNSHIP BUILDING PERMtT Owner ._....-5?:?:??_`..'••-???'L:?.r?:....??'?,-.?Z'`::_.._.?_c?!.,-•----.. Address (present) ...?.`----?:....?r. =?::?..,............... --,• ---- Builder .._.._....-•---•-•-• ....................•--•----- .......................•---••---------..._. -•- Address .......................................... ---..._----------- _..._............. ...------•------ DESCRIPTION N° 168'7 Esgan Township Town Hall Date ._.-•?.t_.?`7?`.??-•...__..._............ Siories To Be Used For - -Fronf Uepih Heighf Est. Cost Permit Fee Remarks if -- I I LOCATION s2reet, Hoad or otrier DescripYion ot Locaiion ' Lo3 Biock ? Addii3on or Tract This permit does not suihorize the use of streets, roads, alIeps or sidewaiks nor does if give the owner or his agent the right to cxeaie any siiuation which is a nuisance or which presents a hazard io !he heaith, safeiy, convenience and generai weifare to anyone in 2he community. THIS PERMIT MUST BE ?K+EPT ON THE P?tEMI5E WHILE THE WORK IS IN PROGFiSSS. • • - - - - ------• - - This is to certify, that___.5..?.__.2?. -:??"....... e .? .............. has permission to erect a__.,.d.f1 __ ------------------ upon ihe above described premise subject to the provisions of the Building Ord"snance for Eag Townshi adopied Aprii II. 1955. ................ Chairman --._..__._.. Per -------- ...... •-----•- ? /. ?? ?-?-?.'+?-z., ........ .--•._...._... . .. _.. ..._ . _ .....-?.=--:-..._....._ _. ..... , .._.. . -- ........------ r af Tnwn Bosrd ! Buiiding Inspecfor t?? ? ?. EAGAN T7+?t1S"THIP 3795 Pilot K:iob P,oad St. Paul, Minnesuta 5'a111 Telephone 454-5242 PERMIT FOR SEWER SERVICE GONNECTiON DATE:_ _ November 10, 1967 OWNER: Cedar Grove Const. Co. PLUMBER -Stein, Inc. NUMBER Z, 'o r - Addxess 3923 Beryl Road TYPE OF PIPE Cast Iron A ESCRIPTION OF BUILDING Iiuiustrial CommerciaI Residential Multiple Dwelling No. Qf units X 1 Location of Coni:ections: Connection Charge 200 00 Permit Fee 7.50 SCreet Repairs Tota 1 ?2 G °7- Tnspected by: Date Remarks: sy _ Chi?:f Trwpector In consideratfon of t2?.a issu.P and delivery to me of the abc±ve pemit, T hereby agree Co do the proposed work in accordance Eri.th the rules aad regulations of Eagan Towrship, Dakota County, Minnesor_a Stein, Inc. -• By )r- .? c Please notif.y vihen ready for insPection aad coinection and before any portion of the work is covered. ?IN???;yl 016 1 MEMO - city of eagan TO: DIANE DOWNS, UTILITY BILLING CLERK FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN DATE: AUGUST 239 1993 SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5(208 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. 5 Addition. Block 1, Lots 1-22 22 Block 2, Lots 1-19 19 Block 3, Lots 1-11 11 Block 4, Lots 1-16 16 Block 5, Lots 1-25 25 Block 6, Lots 1-22 22 Block 7, Lots 1-25 25 Block 8, Lots 1-5 5 Block 9, Lots 1-2 2 Block 10, Lots 1-23 23 Block 11, Lots 1-14 14 Block 12, Lots 1-9 g Block 13, Lots 1-15 15 208 The City is currently being billed by Dakota Electric for streetlighting in the above listed subdivision. 9, r/u ?/'Q' &12-? i Z Edward J. irsc t Sr. Engineering Technician cc: Mike Foertsch EJK/je EAGAN TC]WNSHIP BUILDING PERMIT ...`-...-' Owner ...... A,,.°.?-..._..........:?G. Address (psesent) ..:.?.} a? .........??._....••-•--•---•.__._...... Builder ..... ..................... ......... ??..??..-":".?......... -.._..,.................. ....... Address ' ....................... 21- .................................................... DESCRIPTION Na 2320 Eagan Township Town HaIl Date ......d >d ...................................... ...,. Stories To Be Used For Front Depth Height Est. Coa2 'P.rmit Fse Remarks -- o,ltg LOCATION Strset, Road os othez Descrip3ion of Location ( Lo3 Black Addiiion os Trac! This permit does not authozise the use of streets, zoads, alieys or sidewalks nos does it give the ownes or hia agent the sight io cresie anp situsiion which is a auisance or which presents a hasard to the healih, safeiy, convenience aad general welfare !o anyone in !he community. THIS PERMIT MUST BE K PT ON THE PREMISE WHILE THE WORK IS IN PROGRE5S. This is !o cerlify, tha3 ......1 .............................. -' ' haspermission to ezect a....,?-?-;:....?... ............ ........ ...... .......... ...... upon I the above desczibed premise subject to the rovisions of !he Building Ordinance for Eagan Towaship adopt April il. 1955, .........p ... . ......................................................... ...........?.l.-?.-? :.................... Per .........._.......`' ?l-s---? Chaixman of Tnwn Board ? Building Inspaclor ? ?3 C?-o , ??. ? /,Y ?. ,c3 e l 'f'? g ?. L o t- z? 23 L/ ? LOCATION I OWNER MASTER CARD V"' STRUCTURE AND LAND USED AS Permit No. Issued Issued To Contractor Owner BUILDING ?!/ PLUMBING ??rf /` V • / ' / N1'Yl ?dJ? N d C. ? ? ?? CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING GAS INSTALLING SAN{TARY SEWER OTHER O7HER 0 Items u FOOTING FdUNDATION FRAMING FINAL ELECTRICAL _ HEATING GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER COMMENTS: Approved (Initial) Date Remarks Distance From Well SEPTIC CESSPOOL AO ?ILE FIELD FT. DEH OF WELL J# Violations Noted on Back 1! a ? COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VfOLATfONS • PERMIT NO. DATE OF IfVSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVlDENCE OF NON-COMPLIANCE OBSERVED. ? ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: F-I NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED 8Y CONDITIONS BEYOND CONTROL. ? REINSPEC710N REQUIRED REINSPECTION REVEALED DATE OF RE(NSPECT(ON CERTI FICATION - I certify that I have carefuliy 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. ? ALL IMPROVEMENTS ACCEPTABtY COMPLETED COMMENTS: BUILDtNG WSPECTOR DATE ? E ct!? 2 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA116243 Date Issued:10/04/2013 Permit Category:ePermit Site Address: 3923 Beryl Rd Lot:22 Block: 1 Addition: Cedar Grove 5th PID:10-16704-01-220 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Renae Frienwald 2200 Hwy 13 W Burnsville, MN 55337 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 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 - Paul Schott 3923 Beryl Rd Eagan MN 55122 Genz Ryan Plumbing & Heating 2200 West Highway 13 Burnsville MN 55337 (952) 767-1000 Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA117853 Date Issued:10/24/2013 Permit Category:ePermit Site Address: 3923 Beryl Rd Lot:22 Block: 1 Addition: Cedar Grove 5th PID:10-16704-01-220 Use: Description: Sub Type:Reroof & Siding Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. 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. Valuation: 8,000.00 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 - Paul Schott 3923 Beryl Rd Eagan MN 55122 (612) 723-6345 Gates General Contractors, Inc 3500 Vicksburg Lane North, Suite 400-351 Plymouth MN 55447 (763) 550-0043 Applicant/Permitee: Signature Issued By: Signature AUG 05,2014 13:04 7154265209 page 1 Use BLU�or BLACK Ink � Fo�Office Use^�r i �l 0��� � , ' /������ � (� {�� .� I � � Permil tl� . I y a�a � S �, . � . i , s�-� � U� i N e r i»i t�d d.____�� � i 3830 Plloc Knob Road � .�'j t y Ea gan MN 55122 1 � � O a t o R e c e i v e d:.� � � Phone;(651)675-5675 �� ) � �,,,Q � Fax:(6 5 1)6 7 S•5 6 9 4 j S I a H:__... /�'^"7---- � 2o�a RESIDENTIA� BuILDING P�RMiT APPUCaTioN a Data• � Site Address• ���� �('N �_ ��0.-��. Unit�!: n - ,__ Name'���`�-_`- sJ ? o_ _. „Phone: Resident! � ( . .. ..— _ �...._ �WII@r �� Address/City/Zi�:_� G�� '�Q��.YI-`""".'/ � !'1/�.... 7��7i� _ ....__. �T" ; Applicant is: __,.,, Owne1 �Contractor Type pf WOt'k Description of work: _ � .. , �LC�vi.. l�� �b C �G�S � ��, '� � Construction Cusl: - '�� ' Multi•Family Building:(Yes �1 No ... , .,.............. .. - , ) , � �. , /v . _.. : Company;�1!�r S - '. _ ""� .. ...—Con ct_ _ U�� _ ���1� ,. l ..... . ... � C011tl'BCtOf. , Address:--6��� � CIIY. � 1r`""f' �(�-�A��_ State;,�Zi ��D�-Phone: . __ � •�"'� p�. tmail:.����� License#: 6Cy �� CR. 11�. ..__.__Lead Cartificato#: __1�I�7 ' � _ .. .-- . , If the project is exempt from lead certification, please oxplain why: (see Paye 3 for additional information) .. __. . .. -•-•- COMpLETE THIS AREA ONLY IF CONS7RUCTING A NEW BUILDING In the last 12 montha,has the City of Eagan Issued a pertrNt for a similar plan based on a master plan7 .,__Yes _ No If yes,date and address of master plan: lice�sed Plumber: . _ Phone: Methdnical ContrdCtor: Phone: Sewor 8 Water Contractor. Phone_ _ . .. . NOTE:P/ans and supportinq docurnents fhat you submif are consielered,to be publlc.lnformation. Portions of the Informadon may be c/as��fied as non-publlc if you provide specific reasons that would permit the Clfy to ... .............. ... .. .. ,., _,_ conclude thaf they are trade secrets, ' ......... ........_ . „ , . CALL BEFORE YOU DIG. Call Gopher 9tat0 One Cell at(851)�54-0002 for prot��liun againsl undergrounU ulility d3nlayo. Csli 48 hours � beforu you intenQ lo dig lo recelva Ioce�eF of widerground ulilitiea. w�vr.;;uNhrr�;t,i��,�iinr�yp i�,,.� ...•-_ i hernby acknowlcdye d�et tMS inFom,aliun is complele and accurate;lhal thg w�rk will be in confqmt�nce wilh(hd nrdina�lCus and r.ptlCS of the Cily of Eagan;that I understend thl::is no��perrnil,bul only an appllC�lion fof a permit, 3ntl work ig nOl lo st»rt wi0iout e permit; thel Ihe work w111 be in accordana,wilh the 2pproved pl3n in the r.sse of work whiCl�requireg e raview anp approva�of pla�s. Exte►lor work euthorized by a bullding pQryn�(iseued In accordance with ths Mlnne� • S1ate 8ullding Code rnust be tomplet9d wlthln 180 dt1y3 of pe mlt Isauance, x ° b �� ' ,�/ Appllcant's Printe Name "— x— ��• Y Appllc t's 8lgnature � Page 1 ul 3