1567 Blackhawk Hills RdCITY OF EAGAN Permit No: 9115 pate: 10-1--87
383DZoad Meter No: o2r S3s77 Size: '1 ?_
P.O. `f89 Reader Na G9-??7T ? Q Dat? ''.?
Eagsn, MN 55121
Site Addres
Plumber._
Conn. Chg:
Acct Dep:_
Permit FeEx
Surehargv
Tr. Piant_
Meter. _
t#)JrHh Nte GIly W Eagm .
_ VALVE?REQUIRED g????a?
WATER SERVICE PERMIT
Bros.
This reques[ void "7-;7i? ?'-,-7
16 months from
D 513 5 3 c-z-...
Request Date
?T'? ??? Fire No. Rough-in Inspection
Re?quired? ?w,
Yes .y?y.,n
?'iiegdy Now ? Will NotifV Insper.-
tor When Readv
?S-crcensea tiectricai Contractor I hereby raquest inspection of above
? Owner electrical work installed at:
Street Address, Box or Route No. Citv
1S6*A/
ection o. Township Name or No. Range No. CvyLity
Occu nt (PRINT)
-
-
4 Phone No.
iPr
!
;,
1
PA?J ?er Supplier Address SQ2
Electrical Contractor lCompany Name) Contra tor's License No.
Standard Electric Go. 40837
Mailing Address (ConTractor or Owner Making Instailatfon)
2672 Ma ewood Dr.. Ma le od, Mn 5 5109
Authorize i ture (Contractor/ ner g Installationl Phone Nurnber
484-8044
MINNESOTA STATE BOARD OF LECTRICITY THIS INSPECTION REnUEST WILL NOT
Griggs-Midwey Blde• - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 Universitv Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
- --x?;i REQUEST FOR ELECTRICAL INSPECTION
Ill, See instructions for completiM this form on back o1 Vellow copy
,vered by This Request
D 513 5`3 "X" Below WQrk Co
dft E?B/-00001-06
evw Add Rep. Type of Building Applfancea Wirad Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Electric; Heatin
Commerciai Bldg. Furnace Si lo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm O:nrr pecify othe.lsnec.fvl
t er uecifyi Other Othc,r
Compure lnspection Fee Below
p Pee ServiceEntrance5ize t! Fee Faeders/5uhfeeders tl Fee Circuits
? 0 to200 Am s 0 to30qm s -?- Oto 30An s
Above 20 __Amps 31 to 100 Arnns 31 to 100 Am s
Swimming Pooi Above 100_Amps Above 100_Am s
Transtormers Irrigation Booms SO Partial- Other Fee
SignS Special Inspection s'p TOTA rFEE
t
Remarks
-0"'r_..ti a ? , ? , -
OCJ?
f t,.,. -c/- d cI?-?L C_ G;-
/ /
Rough-in Dnte
? 1 the Ele al
Inspector, hereby
certif
thet the ab
Final y
ove
'nspection has heen
de.
t'his request void 18 months from
This request void -
18 months from
D 5a 1418
? J_Y1??i,
RequBSt Date Eire- o. Rough-in Inspection
Required?
[]Readv NowdE4VCTl1 Notify InsPec-
1Q-29-$7 4*--Pes ?No tor When ReadV
f*?1_icensed Electrical Contractor I hereby request inspection of above
? Owner electrical work installed at:
Street Address, Box or Route No. Citv
1567 B1 aclchawk Eagan
ection o. Township Name or No. County
T 77 Dalcota
OccuGant (PRINT) Phone No.
Scott Mi11er (Lund ren Bros)
Power Supplier Address
Dakota Electric 4300-220th St. W., Farmington 55024
Electrical Cnntractor ICompany Namel Contractor's License No.
Standard Electric Co. 40837
Mailing Address (Contractor or Owner Making Instailation)
267 ?Yplewood Dr., a lewood, Mn 55109
Authori nature (Contractor w r ing Installatiun) Phone Number
484-8044
MINNESOTA STpTE BOARD OF LECTRICITY THIS
Griggs-Midway Bldg. - Room N-191 BE ACICEPTEDNSPECTION REQUEST WII.L NOT
BY THE STATE BOARD
UNLESS PROPER INSPEC7ION FEE IS
1621 Univeraitv Ave., St. Paul, MN 55104
Phone (612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION es-ooooi-os
y„OSee instructions }or completing this form on beCk of yBllow Copy.
D ?71418 "X" Below Work Coyered by This Request
dd Rep. Type of Building Applinncea Wired Equipmenl Wired
Home Range Temporary Service
Duplex Water Heater Lightin,y Fixtures
Apt. Building Dryer Electrie Heatin
Commercial Bidy. Fumace Silo Unloade.r
Industrial Bldg: Air Conditioner Bulk Milk Tank
Farm Ocner Peci v Other (SUor:ifv)
mmnrifP ln.cnnrfinn Fup
tt Fee ServiceEntranceSize t! Fee Feeders?Suhfeeders # Fpe Circuits
a
? 0 to200Am s Oto30Am s ! 0 to 30l1n s
Above 200 qm??s? 31 to 100 qmps ,S' 31 to 100 A s
Swimming Pool Above 100_Am s Above 100_Am s
Transformers Irrigation Booms ;AD Partiai- Other Fee
aigns bueciai inspection S.t,' ?
Herrv?rks lfb??, TOT FE ?
Rough-m ( Lif1e ^? I, the E?heet+? I
???) 'S / Inspector, hereby
? certily that the above
Final ? A a D?e inspeetion has been
made.
TAia request vold 18
. .-. ..-_'^`?^"Pi.6s% n•tit^rfx; ^_-wr,l::,". ?. ?' -F?m •.. ' .
CITY OF EAGAN Permit No: ?3830 Pilot Knob Road Meter No:
P.O. Box 21199 Reader No:
Eagan, MN 55121
Owner. -
CITY QF EIiGAN Permit No: 10265 Date: 14-1-87
3830 Pilot Knob Road B/P No: 778$0 Date: X= 9'"3Q"??.
P.O. Box 21199
Eagan,'MN_55121 y,
= '
Owner B'ren $m$•
Site A?dress: ? ??lackhaWk Hills Rd L31 Bl Black3saut. Gl+en
Plumber: Lundgren Brns. Pltteb3,og
MWCC: 525: 00-Dd .- ±i
City Chg: 100.00Pd, `
Acct. Dep: lg • 00Pd
Permit Fee: la. 00pd
Surcharge: ` U
Zoning• Ri
No. of Units: I
I agree io comply with the City of Eagan:
Ordinances.
Misc.: By
SEWER SERVICE PERMIT
_ . • 5i? 4 . ' ' ? ? ? ? -, ? . $'I; 1
CAVH'Rt4E?
e S + ?
s,
t ?
M¦ ? 0-IF
?-jp Y-
' 3$30 P(LOt??C?
EAQAN,MIN?WESE3t?'?i#?? ?h ?,?,
.7' J
Ci,pTE
---Hl«, _ . ,
AMdU1V7
- . ? ?:i?, ?' ?'??•
i. yZ p^t S; ? p
? CASN `?G`?iAC'a °?? y .i` ??? ,?•.
, . ;?,r:; ? s °•ki: +? ?;.,,
a *' ?
? rVND CODE
a
w
x
?
?
• ;5
?
4 f
Thallk Yo11
• gy r
i°
? . . . {''•• ??
Nf 77880
?
BLD6.
<24
O1-3422
01-3445;
01-3445
01-2155
17-3860
? 20-2275
za3sbs
' 20-3868
20-3716
20-2252
20-3713
20-3743
79-386b
11-3855
PERMIT NO.? : ; • f/???
dg. Permi
PZan Check
Surch./Adm.
SACJAdm.
Surcharge
Road Unit
SAC
Water Conn.
Water Trmt.
Water Meter
Acct. Dep.
Water Permi
Sewer Permi
Sewer Conn.
Park Ded.
TOTAL
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-198, Eagan, MN 551'21
PH O N E: 454-8100
BUILDING PERMIT
To be used for Site Address +
Lot Block Sec/Sub. j???`t "????r?Y F?•R?r; ?
Parcel No.
oc Name
? Address
0 City Phone
, o Name ?- ..
? Q Address
11 City Phone
?
WW Name
NW
? za Address
cc W City Phone
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 Ordinancft.
Signature of Permittee !
.i..;,? ; .. . , C.,; :.':., i..-'? •. i
A Building Permit is issued to:_
on the express condition that all work shall be done in accordance with alt
applicable State of Minnesota Statutes and City of Eagan Ordinances
Building Official
Est. Value *'- i •k;"-0
Receipt #
Date " k;PYk.?';a?.:; 1+.:
1 .
' OFFICE USE ONLY
` i
, On Site Sewage T Occupancy
I MWCC System ' Zoning
On Site Well (Actual) Const
i ? y?l
City Water (Allowable)
PRV Required # of Stories ?-
Booster Pump Length
?,..-
Depth
S.F. Total
, Footprint S.F.
APPROVALS FEES
. :; , .
Engr./ASSess. Permit
, Planner Surcharge
Council Plan Review
, Bldg. Off. SAC, City
'
Variance SAC, MWCC
water Conn. ' `
Water Meter r• ;
'
Road Unit
Treatmeni P1 ?
Parks
TOTAL
„ PsrmFt No. hrwFt Hotdsr Dsb TNWpfions 0
Plumbing
H.v.ac.
Electric
Zf' 00
.?
Softener
lnspection Osta NoP. Comnlents
Faotings i
Faotings 11
Foundation
Framing a ? P
Roofing
Rough Plbg.
Rough Htg. ?
Isul. ? t-Of .
Fireplace
Final Htg. .. ?
Final Plbg. •
Bldg F(nai
cert occ.
LP
Deck Ftg.
Deck Finsl
Well
Pr: Disp.
. } PER
-? _,
MECHANICA ' . IERMIT
?
RECE
# =?? ??•
CITY OF E ` AN
?`? 3830 PILOT KNOB ROAD;?yfAGAN, MN 55122 DATE: J C?'h4? ffi- G 7
CONTRACT PRICE: PHONE: 454,91100
site Address
L
t? BF
k ' DG. TYPE WORK DESCRIPTION
o
o Sec/Sub New
?
r
Name Add-on
?
c Address
City
MIL4dao
' , Phone Repair
er ? .
FEES
? Name `
Y ROS. HVAC 0-100 M BTU
?
3 Address ?
. AbDITIQNAL 50 M BTU -
8.Q0 ,
O Cih' -T 4,ta Ohone ?' (R?S. HVAC INCLUDES A/C ON NEW
CGhNSTRUCTiON)
T
G?ky? OU
LETS. (Ml1MlAUM -1 PER PERMIT) - 1.50 EA..,..'
TYPE OF WORK ? C?MMM/44D FEE - 196 OF CQNTRACT FEE
Forced Air E?-? ?M BTU -+ AP`f BLD`GS. - COMM. RAYE APPUES
° Boiler
M BTU T??VNHC9USE & CONDOS - RE3. RATE APPLIES `
M NIMUIuy RESIDENTIAL FEE - ALL ADD-ON &
Unit. Heater M BTU REMODELS - 12.itti '
Air Cond.
Vent M BTU
CFM MINIMUM COMMERCIAL FEE - 20.00
.
StATE SIyRCHAHGE PER PERMIT - .gp -?
'
? (ADD $.SOs
S/C IF PERMtT PRICE GOES :
Gas Piping Qutlets # BEYOND l61,000) ?
Othef
;
FEE:
S/C: •?-? SI('3NA UAE OF PERMITTEE
TOTAL:
Ff7R: CITY ?OF EAGAN ?
. ._ , _ .._ . . . , . .? , . . •? - , . _, .. _... _ ,., ..... . . _.?_??,._??.., ,?z
'?i'+e??^wr?'?;<: ?ryur,^rreY?-ip";?k?•?i'??6u7tsx??.zr?'F. .;?.a...-r:Tr. ,.,-??-"`!""?P"'?`,-,i?Y'"?Y?y fi°",;'^,???,q?u, ?!!?R
PER
PLUMBING PERMIT RECEIP # ?-
CITY OF EAGAN
' 3890 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 164,y- A?
CONTRACT PWICE: PHONE: 454-8100 Site Address ??^?T'? ?'f?.4i-?,?L.4' 4
Lot -??4, . ¢Iqck Sec/Sub
Name :?? ce ? ?^? ? ti?e? 6.?---#
? Address r4.a4 f c,lf.{ 1,•
c City Phone
? Name I
3 Address
p Ciry Phone
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPUES
-MtNIMUM - RESIDENTIAL FEE - $12.00
MINlMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
- BE'POND $1,000:00)
BLDG. TYPE WORK dE8CRIPTION
Res. ?- New ?
Mult Add-ort . '
GOmm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES T TAL
?_Water Closet - $3.00 $.
-,LBath Tubs - $3.00
_3-Lavatory - $3.00 "
-LShower - $3.00 "
Kitchen Sink - $3.00 ?
Urinal/Bidet - $3.00
? Laundry Tray - $3.00 "p
?-Floor Drains - $1.50
-.J_Water Heater - $1.50 Whirlpool - $3.00
_t-Gas Piping 04idets - $1.50 /• ,
(MINtMUM - 1 PER PERMIT)
Saftener - $5.00 _
Weii - $10.00 -
Private Disp. - $10.00
Rough Openings - $1.50 .-
FC)R: CITY OF EAGAN
. . . ... ,r.. ?_ .,_ . ., .•? , x
, FEE
STATE S/C:
GRANID:TQTpL
_ . ... ?. .., _ . . ......hyF _,,. ...._ ?:a.,._. s. _: ?.:?a°?
'.. . ?
(tertifirafie uf (Orruvttnry
Cttp of (Eagart
oPpurbltpttf Df llt[lbwg jtt9.pPtfiMt
This Cernficate issued pursuant to the requiremenu of Section 306 of the Unifarm Bui/dtng
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regu/ating building consiruction or use. Fos the following.•
use cleffcation Bidg. PBrmit No.
OmWancY T)W Znning District Type Conat.
OwllefOf Md1I1g AftlSS - .. . t .:` I TS t - '? r• ? T..
f
?? '
?
t '.k' .
1•Y. ?• 1a'?? i
:???.E' i
Bttildillg AddRSS _ .
.
.
?,
• .
pau:
Bwlding 66da1:
POST IN A CONSPICUOUS PIACE
CITY OF EAGAN Remarks D/ V 0 16a,19
addicion-Blackhawk Glen ist Lot -31 aik ? Parcel 1[?-?635r?= 3?o-?1
owner screet 1567 Blackhawk Hills Roadstate Eagaa MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 7n7A iQS2ti ') S2 /. s2 cn I n S
STREET RESTOR.
GRADING
3AN SEW TRUNK
SEWER LATERAL
SPT.TPI^ T.:irPY:-1
WATERMAIN Rn
WATER LATERAL
WATER AREA
e*,,...,, e,,.., m,.
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
13UILDING PER.
SAC
PARK
i ' CITY OF EAGAN N° 14 2 2$
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Receipt # ??f r(o
To be used for SF DWG/GAR Est. Value $87,000 Date SEPTEMBER 30 19 87
Site Address 1567 BLACKHAWK HILLS RD
Lot 31 Block 1 Sec/Sub. BLACKHAWK GLEN 1
Parcel No.
rc Name LUNDGREN BItOS CONST
z Address 935 E WAYZATA BLVD
o City WAYZATA Phone 473-1231
,o Name SAME
? Q Address
? City Phone
? W Name
WW
_ z
Address
Q W City Phone
I hereby acknowledge that I ha read this application and te that the
information is correct and agr comply II appl? ab State of
Minnesota Statutes and City E Ordin nc
Signature of Permittee
?Q?I
A Building Permit is issued to:_-UNDGREN B?QS
on the express condition that all work shali be done in accorda ith all
applicable State of Minne ta Statutes and C of Eagan Ordinances.
BuildingOfficial_
OFFICE USE ONLY
R3
On Ske Sewage Occupancy __
MWCC System X Zoning ?r
-
--
Vn
On Site Well (Actual) Const
?-
-Vn-
City Water (Allowable) _
PRV Required X # of 5tories _5-9___
Booster Pump _ Length _
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES $ 458.00
Engr./Assesa Permit
Planner Surcharge
Council Plan Review
Bldg. Off. SAC, City _ 100.00
Variance __ _ SAC, MwCC _ 525.00
Water Conn. _ 525.00
Water Meter 67.00
Road Unit 305.00
Treatment P1 _ 180.00
Parks
50
F3-2
?2
TOTAL _
,
CITY 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 hf I-W+s/GAR Est. Value 4 e, 7 +0,C;O Date ?EPTEMBER 30 ,19 A7
Site Address _
Lot j 1 Block
Parcel No.
1 j67 $1.ACY.HAWiC ziil.l.S RD
1 Sec/Sub. HLAC'H.RA?tY; C;1,r:t4 .1
ac Name LL':N[)t;RLh Bhtt?5 Ct}iu;;T
3 Address ' 9 W xZArA i' P
° City `dA ZATA Phone i--I'l
, o Name 5A,r3E
? 4 Address
? City Phone
W yu Name
V W
i ? Address `
Q W City Phone
•
I hereby acknoWledge that I have read this apptication and staie that the
information is correct and agree comply all applicable State of
Minnesota Statutes and City of?E?;fn Ordin nc?.
Signature of Permittee
A Building Permit is issued to: -??#<tiG+:?'?i
on the express condition that ail work shall be done in accordanCe ith all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official_
OFFICE USE ONLY
R3
On Site Sewage Occupancy
? ^„r?_
MWCC 5ystem ' Zoning
--VT-1
On 5ite Well (Actuaq Const
?- Vn-
City Water (Allowable)
PRV Required ?
n # of Stories
.
_
Booster Pump Length ?
?
Depth
S.F. Total
FootprinY S.F..
APPROVALS FEES ? 458.00
Engr./Assess. Permit -
4
Planner Surcharge
---1
?
Council Plan Review 11
.
Bidg. Off. SAC, Gity loo ' ?
variance SAC, MwCC 525.00
Water Conn. 525• 0t)
Water Meter _ 0.00
RoadUnit 305•00
Treatment P1 18U•00
Parks
???U
TOTAL
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
420
Mc.9jf VG
New Consiruclion Rea iremenis Remodel/Reoair Requirements t?e E?e?O?shz
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan
(2096 maximum lot coverage allowed) 1 set of Energy Calculations for heated additions r8s WRe0 1f ?l
2 copies of plan showing beam & window sizes; poured found design, e1c. 1 site survey for additions & decks ?ree #?res ??i?d` ? .
1 set of Energy Calculations Add'rtion - ind'icate if onsite septic sysfem C3?-s?i? SeFM? S?fem >? .....N
3 copies of Tree Presenration Plan rf lot platted after 7/1l93
Rim Joist Deiail Oplions selection sheet (bidgs with 3 or less units
Date Construction Cost
Site Address ilnitlSte #
/'?
Description of Work ?r25 T ??[, /leri ?a / Vr' GcS ? w
,S
?-i
u
Multi-Famfly Bldg _ YYN Fireplace(s) _ 0x 1 _ 2
Property Owner KV Je- (O f'O KhrT Telephone # ((pa f ??J?D -? J? ?
Contractor MAS i ER GAS FlTTEt?? i'JC.
Address 2263 N0. MCKNIGHT RD. SUITE 2 City
State . s 1. vAu ' Zip Telephone # (? ( ) 711Y- 9c;2_77
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cate?or? _ Minnesota Rules 7672
Energy Code Category Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
(?1 submission type) ' Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eqgan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber IN, Telephone # ( )
Mechanical Contractor (`AK", 0 V Telephone # ( )
Sewer/Water Contractor ey 2 O Telephone #( )
""* I hereby apply for a Residential Building Permit ackn ge that the information is complete and accurate;
that the work will be in conformance with the ordi ces d codes of the City af Eagan and the State of MN
Statutes; I understand this is not a permit, but only an a ication for a permit, and wark 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.
"ZJJ'te& JOAI?
C? -
rj Q/ c h
Applic t's Printed Name Applica ignature
OFFICE USE ONLY
S u b Types
? 01 Foundation ? 07 OS-plex ? 13 16-plex 0 20 Pool , ? 30 AccessoryBldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) 0 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 0 23 Porch (screen/gazebo) ? 36 Mufti Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level 0 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscel{aneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
O 32 Addition ? 36 Move Building O 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Btdg) - Give PCA handout to applicant
Valuation
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
Occupancy
Zoning
Stories
Sq. Ft.
Length
Width
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Founda.tion HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Franung _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ RI. _ Air Test _ Final
Windows
_ 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
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
L (o 40 ?j 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauiremenis RemodeURepair Requirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan
(20°/a maximum lof cwerage allowed) 1 set of Energy Calculations for heated additions
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey fa additions & decks
1 set of Energy Calculations Addition - indicate if on-stte sep6c system
3 copies of Tree Presen+alion Plan if lot platled afler 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Ij-1 1? 6 c) C3
t7ffiC?-ilse?a?lv
C?tt c? ?uive? Rec? 1" t?
Tt? f'res P[ar? ?tec? .? Y ?3
.... .
?r? 1?es d;
C3?s?te:SPp4i??y:s#?m :'#? IU.
?
Date ? l 2- l I a 7 Construction Cost
Site Address 041e???tl- LC 5 Unit/Ste #
Description of Work
Multi-Family Bldg _ Y??i I+irepiace _ 02
O 7L C-- Telephon?e
wner
Property a
Contractor n 'r4
L+? J L L-5- t
Address b City
5tate ? Zip " Telephone # ( ?q efj v-2
ld ,'
Z
COMPLE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
? - Minnesota Rules 7670 Categ°ry 1 _ Minnesota Rules 7672
Energy Code CateRmry 0 Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet I
(4 submission type) Submitted Submitted
• Energy Envelope Calculations 5ubmitted
Have you previously constructed a building in Eagan with a similar planZ
fee applies.?
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
_ Y _ N If so, 25%a plan review
? :5, I ? w ._ko c oz-'k Ori k Is
Telephone # (
Telephone # (
Telephone # f
I hereby apply for a Residential Building Permit and acknowledge that 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 rk which requires a review and
approval of plans. ,
r
W?
Applicant's Printed Name App i ' Signature
OFFICE USE ONLY
Sub Types
0 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 (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-piex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
13 31 New ? 35 Int improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolftion (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Wdth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof
Ice& Water Final _ Pool _ Ftgs _ Air/Gas Tests Final
_
_ Framing _ _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
Ciry SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
PERMfT # E1AM
? . i . . . „ - .
-
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Please oDmpleft for single fsrngy dwefnM Wwnh4mes ahci cwwd+ae wown'Pertnb a* vdt 16*wk;
backNow prevemter far irrlgfim sYsbsm=
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StTE ADDRES.S: Qc;77 .?
/NER NAME
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Other:
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t hwebyacknowledge that1havemdg&aWYcMnn,SftB#WftII*1111N8ilO1TIStSSfhDf:tr91'iEF wwiIt? C, 004
is ft appNcaM's rosponWhiHty b noUlp ihe propeity awar ihit ft 'fkY of Ea?1
aperptlonal and meintenanoe advales 1chtFe tecOes canshxWmdor lhla pwm ,?.
51 Tun OPPERMITM
q RESIDENTIAL ?
BUILDING PERMIT APPLlCATION ?? ?
CITY aF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-689-4675
New Construction Reauirementa RemodeUReoair ReauiremeMS ?`o\
• 3 registered site surveys showing sq. ft, of lot, sq. ft. of hause; and all roofed areas • 2 aopies of plan ?
(20% maximum lot coverage al4owed) . 1 set (yf Energy Calculations for heated additirrris
• 2 copies af plan showing heam & window sizes; poured faund design, etc.) . 1 sibe sunrey for exterior additions & decks `
• 1 set of Energy Calculations . Indicate if home served by septic system for additions C 4?.?
• 3 copies of Tree Preservation Plan if lot pfatted after 711193
• Rim Joist Delail Options selection sheel (bldgs with 3 or less units)
oATE
VALUATIDN
SITE ADDRESS l5b 7 jig Jt 4t4 ? i k &d MULTI-FAMILY BLDG _ Y X%s-N
TYPE OF WORK Fijq;? 10%azir jfv-e.I FIREPLACE(S) _ 0 - 1.62
APPLICANT
STREET ADDRESS r I S'Ia7 J? ",kwL ?? 1L_?r-LCITYFaa.vSTATE Nkt ZIP 9_,"7_/A2
TELEPHONE # b51' 4A-00Aq # FAX #
v 'rnc 1?ow1?
PROPERTY OWNER ?V JP_ R r/`0 k KP w I tti I Ye2 I??'Vt/ & TELEPHONE#
p0w?work t+ QS 2'-0 - 5,11
COMPLETE f4R "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Cade Category - MINNESOTA RULE,S 7670 CATEGORY 1 MINIVESOTA RLTLES 7672
(J suhmission type) ?
Plumbing Contractor:
Plumbing syslem includes
• Residential Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
Phone #
• hlew EnerBY Gode Wnrksheet Submitted
? Water Softcner ,.._ Lawn Sprinkler
Water Heater No. of R.I. Bal;hs
No. of Baths
Mechanical Confractar:
Mechanical system includes:
Sewer/Water Contractor.
Phone #
Phone #
Fee: $90.00
I hereby acknowledge that I have read this application, state that the information is c"qt -?o comply
with all applicable State of Minnesota 5tatutes and Gity of Eagan Qrdinances.
t? ?`
Signature af A}?pllcant tTV•
4FFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4l02
Air Conditioning
? Heat Recovery System
OFFICE USE ONLY
? 41 Foundation ? 07 OS-plex ? 13 'f 6-plex 0 20 Poal ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 Ofi-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ piex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
0 04 02-plex ? 10 08-plex ? 18 Deck O 23 Porch (screened) ? 36 Multi
? 05 03-plex ?'E 1 10-plex 1419 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex PlbgkY or- N 0 25 Miscellaneous
? 31 fVew C] 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundatifln) ? 45 Fire Repair
IK, 33 Alteration CI 37 Dernolish (Bldg)* ? 43 Reroof ?46 Windaws/Doors
? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applican#
Valuation ? Occupancy MClES System
Census Code Zoning ? City Water
SAC lJnits ` Stories Baoster Pump
Nbr. of Units " Sq. Ft. PRV -
Nhr. of Bldgs Length ? Fire Sprinklered -
Type of Const ? Width
REQUIRED INSPECTIONS
- Footings (new bldg) FinaUC.U.
_ Footings (deck) ? FinaUNo C.O.
_ Footings (additian) _ Plumbing
_ Foundation ? HVAC
Drain 'I'ile Other
? Raof _ Ice & Water
Framing ? Final = Pool _ Ftgs _ Air/Gas Tests
Siding Stucco Stone _ Final
? Fireplace X R.I. , f?Air Test X Final _ Windows (newheplacement)
jt Insulation _ Retaining Wall
Base Fee
Surcharge
Plan Review
MCfES SAC
City SAC
Water Supply & Storage
5&W Permit & Surcharge
Treatment Piant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
--------- ------
26?
Approved By
Building Inspector
•
/
` .
zlz
1987 BIIILDING PERNaT APPLICATIOH - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF S[1RVEY, 1 SST OF ENERGY Cgi.CQLATIOHS
ATOTE: ADDRESSES FOa CORNER LOTS - CONTRACTOR/HOMEOdiNER MOST DESIGAATE WHICH ADDRESS
IS DESIRED. NO CHANGSS WILL HE ALLOWED ONCE BDILDING PERMIT IS ISSIISD.
MOLTIPLE DWSLLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UHITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVSY - CHECK TiiITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIlI.
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
S t NGLE a 02
- p
2
?
To Be Used For: ?wEL_??NG Valuation: / " ' oI/TJ
? Date:
0 O?
Site Addressj.s(a OFFICE IISE ONLY
,L 8?, boc? ?
Lot ::51 Bloek / On Site Sew.-:ge Oceupancy ?- 3
T MWCC System ? Zoning 1Z-1
Pareel/S b On Site Well Type of Const
City Water (Aetual) Y-N
Owner (Allowable) 1(-?
# of Stories
Address Length 59 v?
Depth A/D, op
City/Zip Code S.F. Total
Footprint S.F.
Phone APPROYgLS FEFS
Contractor Asaessments Permit 8•00
Water/Sewer Surcharge y -?,50
Address Police Plan Review 229.00
Fire SAC, City / pD,p(a
City/Zip Code Engr SAC, MWCC s ?- ":? ,
Planner Water Conn ?5 2.1;
Oo
Phone Council Water Meter 6,0, op
Bldg, OffRoad Unit 305,
Arch./Engr. APC Treatment P1 00
Variance Parks
Address Copies
TOTAL
City/Zip Code
Phone #
6,406E
Z Zx 3z= '7oU 8q q 8
??4SEM EN i ? /s r Fux??
I:2 X??-- 9 Z
ly u Ia = iLt o
a4
-?
Sbo x 59
= 4 9 g8 0
?
14 Xa7= (-48 X4y = Z? s??
66,8yL)
' r
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tSURVEY0R'?J.
. -+ L_ ?.? ! ^
829.8
CERTIFICATE*
. I 1
' Lr
t `?
_ C? / N 50°28'53" E
_ 107. 96
SIENNA CORPORATION
.? _ 832.3
5 ? ORA/NACE !A (/T/Ll T Y ?
I EASEMENT PER PLAT
?
.-?
i
"?? 1?1
38331 L4T _31-----f=??.g2= x? h ?
. x
N p?_ Y 14.0 oxea2.-i ;i ??l 0
p, o -?5?7•3? 833.6 Q0) x 838.0
1353 0
41 ?v) ' xeas.x ? ? .
i
o ? PROPOS?ED 3?•67
N FS
?IpUSE o GAR./N
14,0 ;?•/ ? .ea2sx r'? \
. j
12.33 32.67 1_ ? 842.43
? e40.27 ox `$41
? '. ' W?`'? • '? . N
y'•4l
O 0
cc>+' '?? '• . . O
4
g x841. 7
O ? A' 839.4
SET NAIL? ,' 83e 5 76 ' I
p 838.7
.,ROAO?
837.9 639.3
RFVtSED 9-22-87 TO SHOW
l 837.9 ' • ELOE\(,QS EF O?LUND?REN SB OS.
CONST.
-4--- DENOTES PROPOSED SURFACE DRAINAGE O DENOTES IRON MONUMENT SET SCALE: 1 INCH = 30 FEET
O DENOTES IRON MONUMENT FOUPJD PROPOSED GARAGE FLOOR = 541.3 FEET
X000.0 DENOTES EXISTING ELEVATION PROPOSED LOWEST FLOOR = g33.6 FEET
(000.0) DEPIOTES PROPOSED ELEVATION PROPOSED TOf' OF BLOCK = S 41.7 FEET
b1E HERE[3Y CER7lFY TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT
ltEPRESENTATION OF A SURVEY OF 711E QOUNDARIES OF:
Lot 31, Block I. aLACKHAWK GLEN 15"f' ADDITION, according to the recorded plat
thereof; Oakota County, Minnesota.
IT DOES NOT PURPORT TO SH0I4 IMPROVEt1EN7S OR ENCROACHMENTS, IF ANY. AS SURVEYED aY
ME OR UNOER MY DIRECT SUPERVISION THIS 13TH DAY OF Nov. , 1985,
SIGPIED: JA?p--- . HILL, INC. ?i
C/ ..
. (3 Y :
NAROLQ C. PETERSON, LAND SURVEYOR
MINNESOTA LICENSE NUMBER 12294
PAOJECT NO. BOOK ! PAGE ' JAMES R. H[LL, INC.
85618 (875/4) Zo-7133
Planners / Engineers / Surveyors
F1LE N0. 8200 Humbo{dt Avenu• Souih
FOLDER 6loomington, Mn. 55431 612-e84-3029
, .,
}
, - ?
.. . ?
CONSl RUC110N ?
?
-(6 --- ---- -
..r?iJ..U'? • 2?
v,?f1YZf, i k E:OULCVARD •?';hYZl;1f?,, IJ?II..I?'ESUT/-.
5, ?5 E?:S7
EY.1EP,]OR EI?IVELOPE h.VEP,I-.GE U C0:'iPU7AT)Oit
Lot 31 8locc: ?
Site Nddress Es ??
--7
R U -
R & U Faciors ' ' .
.058
ppaoue blalls
.117
4Ja11 Framing Areas .023 -
j Ceiling Insul.ation -Area .027
•, Cei1 i n9• Frami ng Area _ •
. . .04
Rim Joist .
.14 .
tiasonry Wall . . .26
!•Jindows Double Hung ___ .
Casements
., : ---- Doors : ; • . . .s? . 46
;. ° Patio Doors ; ; . .
? 47 ? . - -
' Si del i tes ? ? .
. 1) Lovrer Level (8aserrent) ?O
. ' ?g, .
Total exposed wa11 area
' X (U) ?.058 =
Opaque Wall Area X (U)
.117 = 14ood Frame Area
.Q4 = .
• x (U)
Rim Joist. .
? - - 7g,7Dx (u) :14 = ??.ol `• . Exposed bl ock :
Window Area Casement ' f x (U) .46 =
' Double Hung (U) •26 '
' . _ . - x (?) .46 = .
Sliding Glass Door .
. "-- x ' ( U ) .18 =
Door Area
?= Total /l.d/
; ?.. ? -? _ •? - -
. . ?.7 ?a
?
?
? DROCCONSIRUC110N ----- ?df?YZ/1TA, IJ?IIJhJCS07l1 5`_%39 i • (E12) 473-1231
935 EJ;S7 ?'ti/?.YZ/-.T1-. BOULEv/,RD • 1
2) 7st or rnain floor
Total er.ocsed "ral1 orea
7al.So x (U) .058 =
ppaque Wall area
. gp. lqx (U ) .117 =
blood frame area . ?
!lLx (U) .04: _ ?.72,
Rim joist
Casements ?a, x (U) .46 = .?5
? 1•:indow Area . j pouble }?ung ?{5,' X (u) '26.
' ' ' .3Sx (U) .46 15.34
, ` , •. 33
.
: Sliding Glass Door.
_18 = lo.SC?
? ? . . . x (U)
' Door area . . .
(3.y? x (ll) .47 = !v a --
- Sidelites Total
; 3) Znd fl oor i f 2 s tory
' Total exoosed wall area
:. .;
; Opaque wall area ?
Wood frame area 1•Jindow area
Sliding glass door
Door area
4) Total ceiling area
Wood frame area
Opaque ceiling area
Skylight
C._
Casements
Double Hung
?x ( u ) .058 =
9G.Il x (v) -117 =
3,55x U
?U? .46
26 =
= ?3.3
3?X .
-- x (U) :46 = .
x
( U ) .
.18 ?_ .
-
' Total
9?10
8? x (U) .027 = a,3a
7?X (U) .023 = i7.86
x (U) .55 =
?o, ia
Total _
i ,? ;?•_ ..
..•tt';; !'; ? r. ?
iDGR
??',?COl?S1RUCIIOrJ ^
. ?? ?. INc.
? ? - -- ---
9,15 'r-AST WAYZI;7A BC)ULEV/,PD • 1'Jf+YZATA. Il?II.1IjCSOTA 55::91 •(612) 47::-1231
f 95? , 7D x.??= ozi?5"
?;»n, 11 Factors Tatal er.pQSed wall area
area g(? x. .026 = .? • ?
1•iinn. U Factors Total erp?sed ceil?ng ?
' (q) Total
S
?- Item 3 6 --?- + Itern 4 ?_o•iA
I tem 1!?. ?'? X tem 2101,121 ' If toi.al of Iter:?s 1-. 4 is less than Item (A), building ,
complies with SBC 6006 (C)s
t.
??
. ? ****???*?*?*?*?*************???f*?
*
?.
ClTY C) F E A G A N '"'oF FEEAT TIm OF
. _ * APMscATrcN DOEs rxxr ooNsrrTcaM ?
APPROVA,L OF pFRMIT. x*,
APPLlCATION FOR PERMIT If *
- ?. TNSPECTTON OF SFWER AND/Cfft W4'1FR *
, . •: . ' ,?*, Jrnr.r.aMQNS WBZ NOT EE SCHED- ?
SEWER AND/OR WATER C4NNECT[4N L11TIL PMUT Ms MM *
. . - , . - • ? APPROVID. • *
_ . _. _.. ?**?r*****?r??r?r**?**********?*?#****,r*
(P1.ease Print 1) PROPERTY ADDRESS :
LEGAL DESCRIPTTON:
Lot $lock Subdivision or Tax Parcel ID U
IF E}QSTIAIG STRLiC'Ii}RE, DATE OF ORIGINAL BL?ILDING PERMZT ISSC'ANCE : '.?• f?r?
Nbn eat'
PRESENT ZONING/PROPOSID USE: [] Ca4MERCIALA2EI'AIL/OFFICE ? R-}. SINGLE FAMILY .. .
Q IPIDC'STRIAL - G R-2 DL'PLEX (ZWo Units ) .
? INSTIZLITIONAL,/G+OVRWE= ? R-3 'TOWDIIiOLSE (Three + Units ) ( Units )
. ? R-4 APART'MENTrCONIDC)NJINIL?NI ( t3nits )
2) .,.
1VAME: ??,vc?r.y,
, ?j,-sS ?3 -
ADDRESS :_ 23S "6,
CITY, STATE, ZIP: vV,qrf 3'f? ...?
PH4NE: 42j / z 3 I " .._. ,,. _?_........_
3) ' ic ?• . -
NAME. /p* C,- . ?_?,.....?..,,_.._
ALIDRESS: .
CITY, STATE, 2IP:
PHONE: MASTER LICENSE#
xior caty C.Tse .
Plumbers License:
Active
Expised
Not recorded
St n?.tza1.
4) •• ` ` • Ea?- - -- .
_ IVAME: ??++`c?rrj•r ?yya S ? ?1'? ,.?_
_ ADDRFSB: r-. . '
CITY. STATE, ZIP: '
PHONE: .
-5} i? N• • a?• c a - r??
7` OONNECTION 70 CITY SEW.M ? CON[tiID=ION M CITY WP,TER ? 0'IiM ' .- - . • '
6) ?? _ • i ? PLEA.SE HULD APPROVED FERMIT FOR PICK-UP BY ONE OF ABWE
? Q PLEASE MAIL APPRdVF.D PERMIT TO 1. 2. 3, 4, ABOVE •
(Cixcle one) . ?
:.FOR ,CITY USE ONLY
PERMIT # ISSUED
Pd w/B1dg. Permit FEES:
$
$
$
$
$
$
$
$
$
$
$ ?f,'? .• ? ? ?,
?.
0
SEWER PERMIT (INCLLDE SiIRCHARGE)
WATER PERMIT (INCLLDE SLRCHARGE)
$ WATER METER/COPPERHORN/OUTSII7E READER
? WATER TAP (INCLUDE CORPORATION STOP)
$ SEWER TAP
$
?
$ ?
?
Z) 1
$
$
$
$
$
$ $
'l r
RECEIPT RECEIPT
ACCOUNT DEPOSIT - SEWER
ACCOLNT DEP05IT -- WATER
WAC
5AC
TRLNK WATER ASSESSMENT
TRLNK SEWER ASSESSMENT
LATERAL BENEFIT/TRLNK SEWER
LATERAL BENEFIT'/TRLATIi WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
TOTAL
D4ES UTILITY CONNECTI4N REQUIRE EXCAVATION IN PiJBLIC RIGHT OF WAY?
? YES `IF YES, THEN A"FERMIT FOR WORIi WITHIN PUBLIC
? ROADWAY" MUST BE ISSLED BY THE ENGINEERING
NQ DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLQWING CaNDITIONS:
APPRQVED BY:
TITLE:
DATE :
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
St6s Permit #:/JJC~_~2 1
City of Ea Permit Fee:
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: ~1~
Phone: (651) 675-5675 1 I
Fax: (651) 675-5694 i Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: -2& ` 13 Site Address: 1J 41 ^7 ~I C~C/trCcJ f 1-1-67 Unit#:
Name: v c) Phone: 6951- 33V (13(o
Resident/ / /
Owner Address / City / Zip: 15 l0 7 X131 oti GjC &4,,j
iC /~I e1 J' ~l
Applicant is: Owner V contractor
Type of Work Description of work: I v 0-4 c<,J Rrt ~ F --t ~aCt I'~U coj
i Construction Cost~~ CCU C~~ Multi-Family Building: (Yes / No
Company: `re ihlln -o eyC' n)- yvc v~ Contact: X y~1 a r-
Contractor Address: City: 4AMkL44
i State: 4 Zip: 5 ~ ~0 Phone: I 2-(o o
License (0 3~ 9 2'(P Lead 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:
i
Licensed Plumber: Phone:
i
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
i the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
I
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.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 ~iY~cYiZ~LZQ~° x
Applicant's Printed Name Applicant's Signature
Page 1 of 3