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4100 Blackhawk Rd
Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - I For Office Use I CPermit ity of Eall10H I Permit Fee: I 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 I Staff: 1 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: L0- s ' 3 Site Address: 41 U Unit --0 2 R 4, Name: S&O` L4 f, e l li e tgc lt,~ Phone: Resident/ p / Owner Address / City / Zip: 4/®c.> D flit k- h emu-, Applicant is: Owner Contractor Type of Work Description of work: K~ coo /VL7S L Sr d + /'t t u r» yi cq 5 Construction Cost: 85,1060 Multi-Family Building: (Yes / No Company: Uolu ki Hcv,< 3 ngf NLR y C Contact: IVAL, Contractor Address: City: 4r-c' State: /KAJ Zip: s`5p S3 Phone: 5~0-7" 5 6 VrC1 License 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: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gol)herstateonecall.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 ~of1permit issuance.. I x /yOi`' 'rG-n VoVt u x Applicant's Printed Name Applicant's Signature Page 1 of 3 o C'IN R WORD .,,jNSr c 44 Ot3W PIERMrr 1 Y v 3830 Pitt ~ ftTM Akaft0src 00e %sued: . t't i AWMSS: te: tort s 4~ 1K* Is APPLICA E: TYPE K: Allt C. rr ...r.. - ...rte _ ~ ~t 410 f CITY OF EAGAN Remarks f/L'n Addition SECTION 20 Lot 030 Blk 78 Parcell0 02000 030 78 4100 Blackhawk Road Eagan, MN 55122 Owner_ t-+i4.Ltir?~ a~ Street State Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1971 assessed der parcel 010- 9 STREET RESTOR. 1 1 assessed n er -parcel 010-Y9 GRADING SAN SEW TRUNK 1968 assessed mder parcel 010-19 SENM R,LATERAL 3138-63 627-73 513 A - 63 f Q062 74 WATERMAIN at 1531.80 153,18 10 Paid WATER LATERAL WATER AREA 1977 assessed inder parcel - waersub i971 200.'00 '10, 60 20 nai& STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN, 250.00 12166 10-26-78 BUI LDING PER. SAC 525.00 16282 10/15/80 PARK EAGAN TOWNSHIP BUILDING PERMIT N° 1836 Owner mac Eagan Township Address (present) __..._t1 Town Hall Builder ............................i I Date 1.-_/-6~ Address DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks LOCATION Street, Road or other Description of Location I, Lot Block Addition or Tract This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT O THE PREMISE WHILE THE WORK IS IN PROGRESS. . . ............__..............-upon This is to certify. that 7----- has permission to erect a_-.1 . the above described premise subject to the provisions of the Building Ordinance for Eagan Township adopted April 11, 1955. Per 10~ Chairm of nwn Board Building Inspector i ,.:sue0 EAGAN TOWNSHIP BUILDING PERMIT N 1352 Owner A~ . i` Eagan Township Address (present) i _ Town Hall Builder x - 1~4v U` Date Address DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks I ~ yw LOCATION Street, Road or other Description of Location I Lot Block Addition or Tract i This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent j the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. . 4. This is to certify, that__ k__ ...............has permission to erect a. . _ - _ yr_ upon the above described premise subject the provisions of the Building Ordinance for Ea Township ad ed April 11, 1955. fe7 - Per ---••-----•-•-d4 Chairman of Tnwn Board r Building Inspector q . ~S 2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 31 Telephone # 651-675-5675 Please complete for: single family dwellings & townhomes/condos when permits are required for each unit Date 01 / Site Address 60 AM19 Unit # Property Owner S Vg ~e llit V1 b6i Telephone # ( 149 Contractor ~o e Fint, kgeZ) Street Address I City ( ) State Zip Telephone # Bond Expires: The Applicant is V/ Owner Contractor Other Add-on or alteration to existing dwelling unit $ 30.00 furnace Additional Replacement air exchanger _ air conditioner _ ew _Replacement other State Surcharge $ .50 Total $ I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; 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. bilitz lau& Applicant's Printed Name Applicant's Signature 2004 COMMERCIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit Date Site Street Address Unit # Tenant Name (if applicable) Previous Tenant Name Property Owner Telephone # ( ) Contractor Street Address City ( ) State Zip Telephone # Bond Expires: The Applicant is Owner Contractor Other Work Type New Construction ^ Underground Tank _ Install -Remove **see below Interior Improvement Install Piping Processed -Gas Nature of Work: "When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing Inspector Permit Fees: $70.511 Underground tank installation/removal $50.50 Minimum (includes State Surcharge) or Contract Value $ x 1% _ $ Permit Fee • If permit fee is $1,000 or less, add $.50 $ State Surcharge If ep rmit fee is over $1,000, add $.50 for every $1,000 permit fee $ Total Fee I hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; 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. Applicant's Printed Name Applicant's Signature Approved By: , Inspector Date: PERMIT I Control No. 0445 CITE( OF EAGAN PERMITTYPE: BUILDING 3830 Pilot Knob Road Eagan, Minnesota 55123 Permit Number: 000541- (612) 681-4675 Date Issued: 05/15/92 SITE ADDRESS: 4100 BLACKHAWK RD LOT: 3 BLOCK: 78 SECTION 20 DESCRIPTION: Building Permit Type DECK Building Work Type NEW UBC Occupancy R--3 Building Length 12 Building Width 12 REMARKS: FEE SUMMARY: Base Fee $25.00 Surcharge .50 Total Fee $25.50 CONTRACTOR: - Applicant - OWNER: RAHN, DAVE 14521978 RAHN ARTHUR 3879 WESTBURY OR 4100 BLACKHAWK RD EAGAN NN 55123 EAGAN NN (612) 452-1978 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 Mn. Statutes and Cit of Eagan Ordinances. S` APPLICANTlPERMITEE SIGNATURE ISSUED BIY, SIGNATURE PERMIT CITY OF EAGAN 1992 BUILDING PERMIT APPLICATION sill 681-4675 SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, I copy of energy calcs. COMMERCIAL 2 sets of architectural & structural plans, 1 set of specifications, 1 copy of energy calcs. Penalty applies when typing of permit is requested, but not picked up by last working day of month in which request is made or lot change is re guested once permit is issued. Date ,IValuation of work 6~0' Site Address:_ ' 100 ~ , ~ !7 STREET STE S Tenant Name: Al sJ~' LOT _ BLOCK SUBJ. P.I D. # Description of work: Ole- The applicant is: ❑ Owner Contractor ❑ Other (Describe) Name /('All1 ek 7-# 611; Phone Property LAST FIRST Owner Address ~/oC /'L - /~Q STREET STE S City State Zip * - G Phone , -Z 9 -7 Y Contractor Address _ -79 G, &,S'7-6 4 ilL 'y A l~ License # Exp. City State 1' Zip 1 2- Company Phone Architect/ s Engineer Name Registration # Address City State Zip Sewer & water licensed plumber Processing time for sewer & water permits is two days once area has been approved. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant; BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 05 Apt. Bldg ❑ 09 Basement Finish 1 Fac. ❑ 02 SF Dwg. ❑ 06 Garage/Accessory ❑ 10 Swim Pool IA r t u r a I ❑ 03 Two family ❑ 07 Fireplace ❑ 11 Res. Add./Porch lisomis"aneous ❑ 04 Multi-fam. T.H. 08 Deck ❑ 12 Comm./Ind. WORK TYPE JP 31 New ❑ 34 Repair ❑ 37 Demolish ❑ 32 Addition ❑ 35 Tenant Finish ❑ 99 Undefined ❑ 33 Alterations ❑ 36 Move GENERAL INFORMATION Const. (Actual) Basement sq. ft. MWCC System (Allowable) 1st F1. sq. ft. City Water UBC Occupancy 2nd Fl. sq. ft. PRV Required Zoning Sq. Ft. total Booster Pump # ,of Stories Footprint Sq. ft. Fire Sprinkler Length On-site well Census Code Depth On-site sewage SAC Code APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ❑ Site ❑ Footing ❑ Framing ❑ Insulation ❑ Wallboard ❑ Final ❑ Draintile ❑ Fireplace Permit Fee l vslustion: s Surcharge Plan Review License MWCC SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment P1. Road Unit Park Ded. Trails Ded. Copies Other Total: SAC % SAC Units stotb ` 1~ ZXiz c,,) A) 3~~ r r ~aus~ ~ I I j PERMIT CITY OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: Eagan, Minnesota 55122-1897 Permit Number: (651) 681-4675 Date Issued: SITE ADDRESS: I DESCRIPTION: "WJ I I REMARKS: 'I FEE SUMMARY- "".j' } J I II it ~ CONTRACTOR: OWNER: T 'I'wformal':a'on J's APPLICANT/PERMITEE SIGNATURE ti SSUED BY: SIGNATURE 1998 ML G'; : ,APPLICATTIDN (RFAMZNTL ) crrr or Z►catr 3830 FILOT,KMM RD 55122 ",146TS ~r Ruauitts ~ ~ ' ~ 4 3 pond 3ibe swvop i 2 WON of Akan 2 topi" of pbs WAkift beam d Md. : air.) i ~ aat sar"M f+ r d argr. s +i 9 a for h+railed' MATE: CONSTRUCTMN COG L4~ DOCRIPTION OF WORK: SMEET ADDRESS: P! low DMT Witt,, OWNM City Stec: w Company: Phone CONUAMR Ste. Lice~rea # City - Zip: ARCHt' T=/ EMPMM Company: ROOM Name: Rrghioa # City S+w w & r VMWd Phan r # r «"&tam ~ . PMM* appo" w Stad lot awwwg We is f" is i I hweby 2dMw ete t t #t aft Sir of NW40ft Sti*08 and C *Of > 642PLI OF M : & Su W" ftecenrtd , YO $ T"* P Wn Pmt iftd Y+ft No Not R"Wfed f OFFICE USE ONLY BUIL O PER11AT TYPE Q 01 Foundation 0 06 duplex 13 11 Apt.A odging C3 15 Basement Finish' Q 02 . SF Dwelling D 07 4-plex 0 12 MuW ftepair/Rem. 0 17 Swim Pool U 03 SF addition d 48 8=p x 0 13 G e(Accemiory 0 0 Public Facility 0 04 SF Porch 0-109 -12-plex 014 Sept. ` 13 21 Miscellaneous 0 05 SF if:. Q 10 -Tftx Cl 15 Dedc %fCRK TYPE 0 31 New 0 33 AfteraWns Q 36 More 0 32 Addition, Ci 34 Repair Cl 37 Derroli n GENE4L FORk:' CwW. (Actual) Basement sq. ft. MCNVS Sys (AffowaWe) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered " Zoning . ft. PRV # of Stories _ sq. ft. Boaster Purrp Length sq. ft, Census Cam: Depth Footprint sq. ft. SAC Cady Census Bldg Census LIM , Planning 8u ling Engine Variance PertFeef t Valuation: Surcharge • $1 Plan Review License MCANS SAC Vie' Conn. water Mow. k Acct, Deposit SfW Perm SNV Surcharge Tmatmert Pl. Park Ded. Trails Chi. Other Tow: % SAC; SAC units PERMIT CITY OF EAGAN ` 3830 Pilot Knob Road PERMIT TYPE. . B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 0 2 7 7 2 0 (612) 681-4675 Date Issued: 05/31/96 SITE ADDRESS: 4100 BLACKHAWK RD LOT: 3 BLOCK: 78 SECTION 20 P.I.N.: 10-02000-030-78 DESCRIPTION:,, X . (ROOFING) a. Building Permit Type ~S (MISC.) Building Work Type REPAIR Census Code 434 ALT. RESIDENTIAL REMARKS: FE8 SUMMARY: CONTRACTOR: OWNER: - Applicant - LECLAIR SCOTT 4100 BLACKHAWK RD EAGAN MN 55122 (612)686--6401 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 Mn. Statutes and City of Eagan Ordinances. f , APPLICANT/PERMITEE SIGNATURE ISS I ATURE jqq10 CITY OF EAGAN 3830 PILOT KNOB RD - 55122 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 New Construction Requirements Remodel/Repairquirements ♦ 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) 1 energy calculations ♦ 1 energy calculations for heated additions ♦ 3 copies of tree preservation plan if lot platted after 711193 required: _Yes _ No DATE: & CONSTRUCTION COST- 13?-7o- jy~ r ( DESCRIPTION OF WORK: *Vin STREET ADDRESS: LOT BLOCK _ SUBD./P.I.D. 10 PROPERTY Name: Phone OWNER uB,, OU g"AA)MIT Street Address- V- City: 611o, State:_ Zip: CONTRACTOR Company: a Phone Street Address: License City: State: Zip: ARCHITECTI Company: Phone ENGINEER Name: Registration Street Address- City: State: Zip: Sewer & water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. _ Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 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 ❑ 04 SF Porch o 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 _ plex ❑ 15 Deck WORK TYPE ❑ 31 New ❑ 33 Alterations ❑ 36 Move 0 32 Addition ❑ 34 Repair ❑ 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code Census Bldg Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trails Ded. Other Copies Total: % SAC SAC Units /v - oaooo -o WELL PERMIT DAKOTA COUNTY Permit No. ENVIRONMENTAL MANAGEMENT DEPARTMENT WATER AND LAND MANAGEMENT SECTION 93-9254 Unique # 14955 Galaxie Avenue, Apple Valley, MN 55124 H36942 (612) 891-7011 WHEREAS, the NON-TRANSFERABLE PERMITTEE/DBA: Hartmann Well Company ISSUED TO: 40174 ADDRESS: 308 E. Main St. REVIEWED BY:Luehrs New Prague, MN 56071 has submitted a permit application, has paid the sum of $108.00 dollars to the County of Dakota as required by Ordinance Number 114 and has complied with all of the requirements of said Ordinance necessary for obtaining this permit to seal the Well described herein: An abandoned well with a casing diameter of 4 inches, depth of 168 feet, and completed in St. Peter Sandstone, will be permanently sealed. The well shall be cleaned of equipment and debris, disinfected, neat cement pressure grouted and terminated at least two feet below grade. THE WELL IS LOCATED IN THE MUNICIPALITY OF EAGAN AS FOLLOWS: WELL LOCATION PROPERTY OWNER & ADDRESS WELL OWNER & ADDRESS 4100 Blackhawk Road Clara Rahn Clara Rahn 4100 Blackhawk Road 4100 Blackhawk Road Eagan, MN Eagan, MN NOW, THEREFORE, Hartmann Well Company is hereby permitted and authorized to seal the well described and located above for a period of one year from the date of this permit. Sealing of this well is subject to all provisions of Dakota County Ordinance 114, the Minnesota Wells and Borings Code and any conditions attached on the reverse side of this permit. Given under my hand Wednesday, September 8, 1993 ATTES 11nvi ~me~tal Supervisor Environm tal Management Director ~ 1 - 1 93 rN. i i q f r~ i I Permit Number REScheck Compliance Certificate Checked By/Date 2000 Minnesota Energy Code REScheckSoftware Version 3.6 Release 1 Data filename: C:\Program Files\Check\REScheck\House Addition.rck PROJECT TITLE: Garage/House Addition COUNTY: Dakota STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family WINDOW/ WALL RATIO: 0.11 DATE: 06/18/04 DATE OF PLANS: June 12, 2004 PROJECT DESCRIP ION: Scott & Kellie LeClair 4100 Blackhalw Road Eagan, MN 55122 651-686-6401 DESIGNER/CONTRACTOR: John McNamara-Designer Contractor-Homeowner PROJECT NOTES: Demo existing tuck-under garage and construct 2-stall garage addition with dwelling addition above to shell stage, including completed D exterior JUN 2 8 zoo4 COMPLIANCE: Passes Maximum UA = 120 By Your Home UA = 78 35.0% Better Than Code (UA) Gross Glazing Area or Cavity Cont. or Door Perimeter R-Value R-Value -F ctor 11A Ceiling 1: Flat Ceiling or Scissor Truss 660 44.0 44.0 8 Wall 1: Wood Frame, 16" o.c. 529 19.0 19.0 15 Window: Street North: Above-Grade:Vinyl Frame:Double Pane with Low-E 20 0.310 6 Window: Street South: Above-Grade:Vinyl Frame:Double Pane with Low-E 19 0.310 6 Window: South: i Above-Grade:Vinyl Frame:Double Pane with Low-E 11 0.310 3 Window: East: Above-Grade:Vinyl Frame:Double Pane with Low-E 11 0.310 3 Door: East bedroom: Glass 20 0.310 6 Wall 2: Masonry Block with Empty Cells:Interior Insulation 220 5.0 5.0 20 Floor 1: All-Wood Joist/Truss:Over Unconditioned Space 660 30.0 30.0 11 Proposed and Maximum U-Factor Averages Proposed Maximum Average U-Factor Allowed U-Factor Above-Grade Windows and Glass Doors 0.310 0.370 Includes Foundation Windows > 5.6 ft2 Floors Over Unconditioned Space 0.016 0.033 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in RES checkVersion 3.6 Release 1 (formerly MECcheci~ and to comply with the mandatgry requirements listed in the RES checkInspection Checklist. Builder/Designer Date' 2004 RESIDENTIAL BUILDING PERMIT APPLICATION ' City Of Eagan + 3830 Pilot Knob Road, Eagan MN 55122 g 30 , J I~ Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Reguirements ffi e Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan ert of Survey Recd (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd Y _ GJ 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required 1 set of Energy Calculations Addition - indicate if on-site septic system s~tc Septic:~yst~.m _ IJ 3 copies of Tree Preservation Plan if lot platted after 7/1/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date 14100 Construction Cost pb Site Address Unit/Ste # Description of Work '-/t a afNM 1 r 74~" Multi-Family Bldg _ Y ✓ N Fireplace(s) ✓ 0 ^ 1 _ 2 e Property Owner '51,V A ~`-e~~) V1L11 Telephone # (~~j~) 1~~b - b u Contractor "G D mI N Address ,c nRnFR OF City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Categorv 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet 0 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 Telephone ) Mechanical Contractor Telephone # Sewer/Water Contractor Telephone # 604 I hereby apply for a Residential Building Permit and acknowledge that the informati ate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. GC4 Ve Glat~l Applicant's Printed Name Applicant's Signature OFFICE USE ONLY r 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 X 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 (7-0 I a o-Al lf- 0/0 -1-5 o rh-' ❑ 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 *Demolition (Entire Bldg) - Give PCA handout to applicant - 1 Valuation Occupancy MCES System Census Code Zoning I,/-/, City Water (Ir SAC Units Stories Booster Pump # of Units Sq. Ft. 0 PRV # of Bldgs Length Fire Sprinklered Type of Const Width i REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) Final/No C.O. ff- It C3W Iy 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: L Building Inspector Base Fee -I Surcharge 64~v" Plan Review A ~/9a MC/ES SAC City SAC ~ Utility Connection Charge CJ S&W Permit & Surcharge Treatment Plant V. License Search Copies Other Total ~S.~O 71 e (of (o --p4lo, 0e, 2007 RESIDENTIAL BUILDING PERMIT APPT_.ICATION City Or Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New f:onstnialen RoGeMements RemodellReeair RenuirernonIS dace. lJse brily 3 registered sic surveys showing sq. H. of lot, sq- ft. of houso. -mid all roofed areas 2 copies of show (20'16 maximum !at coverage al plan mg fWirtgs, boams. lasts Cett4SWV. olk Read " _ Y N b'"Od1 1 am of roargy Calwlamm. for heated addtians Sofa Report,; " i Y';7n t4 1 Soils Report if proposed budding is to be plamd on disturbed sus 1 rile survey for addilions 8 decks Tree, Prw Phm:Aecd;; ' ° ; _ Y, ° "'N 2 copies of plan showing boom d wkxbwsize--, poured found dw4n. sic. Adoilion - indicate if on-Aire 'Nc kern I sM of Energy Calculations Y" Zri el3ir Rmqurait; ; l" .r hi 3 copios of Tree Rvaervalion Plan if bt pbttod after 711183 r+ Re i eailc SY : i Y; _ N Ran Jod DeW options selection sheet (buildings with 3 or 1es9 units) MinnegAepp machUical + "Islion Wrn Flans are considered ublic information unless you state the are trade secret and the reason. Date_ Construction Cost t ~C~ afl Site Address _ unit/ste # Description of W ork~~, hp~ _ Multi-Fatally Bldg _ X V N Pirepiace(s) _LX _ 1 _ 2 Property Owner 1 V AN tLt V L Telephnne l#,) t~.. `3• Contractor e, ~'C v V'\ ru Address city state Zips Telephone # -(J ~1 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Code Category - Mul,tesiiti, $uIcs 7670 Category 1 _ Miumesota ?;tole. 7672, t~ submission type} • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Submfteert Submattod • Energy Envelope Calculations Submitted in the last 12 months, he City of Eogon issued a permll for a similar plan based on a master plan? Y N if yes, dote and address of master plan: Licensed Plumber Telephone # Mechanical Contractor Telephone ) Sewer/Waiter Contractor Telephone # [ ) I hereby apply- for a Residential Building Permit and acknovdedge that the information is cornplete and accurate: that the %vork wall be in conformance with the ordinances and codes of the Cih. of Pagan and the State of MN Statutes: I understand this is not a permit, but only an application for a permit. and '%vod'l: is not to start without a permit; that the work will be in accordance with the approved plan in the case of vvork which requires a retiie v and approval of plaxis. Applicant's Printed ame Applicant s Signature T00/T0013j lualulsanui S2Tnba 1DaTOS TL00 095' C9L IVA VV:9I QaM LOOZ/ZT/60 TL00 099 29L I SHEET INDEX GARAGE/ A1.0 51TE PLAN HOLE ; AM DEMOLITION PLANS ADDITION A1.2 LONER LEVEL FLOOR PLAN A1.3 MAIN LEVEL ROOF PLAN FOR: A1.4 ROOF PLAN A1.5 ELEVATION5 j Mr, d Ms. Scott A1.6 ELEVATIONS A1.7 ELEVATIONS . ~ : ; Laclair 4100 Blackhonk Rd. A1.8 5EGTION A Eagan, MN 55122 A1.9 SECTION B 51.1 FOUNDATION PLAN 51.2 FIRST FLOOR FRAMING 51.3 ROOF FRAMING / JohnMcNamara,Archted 51.4 FOUNDATION DETAILS 139.42' 8845 Old Cedar Ave. S. `80d 40' Bloomington, MN 55425 Tel: (952) 87G9318 00, +01V EXIST. A5PHALT w DRIVEWAY n : y EXI5TING.':f I~ HOUSE of 1 CO ;t»:y PROPO5E12 UPPER LEVEL ADDITION : 3 i I006 PROP05ED LOWER LE L ADDITION (2 5TORY) ~!01 GAR h f, Revisions Date No. 377.00' 5 89d 40' 22" E m Dra.............................._..... 04 JM Drawn: JM North Check. JM l SITE PLAN SITE PLAN I hereby cx8fythat this plan, specification or report wasprepared bymeorunder mydirect supervision Scale: V" 30"-0" a d that l am a duly registered Architect under the Sheet laws'nnesarl John McNamara A1.0 Registration Number: 24281 Date: DV.EGLAIIgAi-0DWfi MST o 6/13/1004 0 206,15 0 JOn Fem. _ INSPECTION RECORD CITY OF EAOAN PERMIT TYPE:, a 't 3830 Pilot Knob Road Permit Number: 7 0 Eagan, Minnesota 55122-1897 Date issued: ot~ /'I 1 9 (612) 681-4675 p -N. 10-02000 03" 78 SITE ADDRESS: 1, OT 3 ff t. Of, K; 70 APPLICANT: 4100 8t._ACJ 14AW 00 i.VC 1, A'1H r`.0v Sf C't t ()N ~eO t ~ ;4 t4i - 6401. PERMIT SUBTYPE: TYPE OF WORK: ~5b RiPiy yyR [ A-l. !NSPUCTION TYPE RDATE INSPTR. INSPECTION TYPE DATL ' l~ 67 Ei # i7 Permit No. Permit Mohler . Date Telephone # ELECTRIC PLL W&NG HVAC w"peallork Date IMP. Commerna FOOTINGS FOUND f FRAMING 't ROOFING . 06- P AO ROUGH PLUMBING AIR TEST ROUGH HEATING GAS SVC TEST r INSUL i GYPBOARD I 4 FIREPLACE FIREPLACE AIR TEST i FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FIG DECK FINAL cic m 4 WATER SERVICE PERMIT 3745 Pilot. Knob Road - PERMIT NO.: 2601 Eagan, MN 55122 DATE: 10/ Zoning: so No. of Units: _x Owner: ~k'~3}3.-,'dlR _ Address: -Site Address: •---4100 13 tss ~er~ ~Gt~c~ !B -1d0~ Plumber: Meter No,: _ F 1 Connection Charge: 00 P f Size: Account Deposit: -1-5.00 Pd !d3 t' Reader No.: in, 7~~?--'0730088 Permit Fee: i[ agree to with the City of Eagan comply Surcharge:. _.r! 3d Ordinances. Misc. Chorges• 00 12-d Total: Rv bate Paid: Date-of Insp.: - Insp.: C1TY Q€ ALAN >.,.:.;t. tR WvtC9 PERM 5T9S POof -Ku* Pood PERMIT NO.: 3746 - EogQn, MN 55122 DATE: 1115 79, Zoning: No. of Units: - . Own": Address: ^-6,206 _7 Site Address: Plumber: iq, 1 agre coM~p r wrt fie City of Eagan Connection Charge: Ordinonces. Account Deposit: Permit Feet 11 Surcharge: „asp By Misc. Charges: Date of insp.: Totot: Insp.: Date Paid: INSPECTION REC-ORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: ,./tagan, Minnesota 55122-1897 Date Issued: o <<:;st (651) 681-4675 SITE ADDRESS: APPLICANT: ~I ~ sf t4~ ~ti ; sI 4 ION PERMIT SUBTYPE: TYPE OF WORK: i t 4 a_ 1 4,~ # V A 1 1k I'- V, I A I- I f) f 14 (,1 INSPECTION • TYPE DATE INSP'rf1, F] NA! i 5~ Permit Holder Date Telephone # SEWER/ WATER PLUMBING HVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING I ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL Use BLUE or BLACK Ink r I I For Office Use//~~// -7 / Permit City of Eaob~n ; ! fJ(!l ! LG' I'~. ` G~~ 3830 Pilot Knob Road I Permit Fee: Eagan MN 55122 I I Phone: (651) 675-5675 Date Received: Fax: (651) 675-5694 I Staff: L -----------------I 2012 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial pkpli'catio s. Date: bq~ l l 112 Site Address: ®b IQ~~~ 6ilily bZ1G ~y! Tenant: Suite Name: Phone: 6b b RESIDENT / OWNER Address / City / Zip: Db I ~G~C►lu+~K 1~ G1/1~1 7 ~Z' Name: License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: New Replacement Additional Alteration Demolition TYPE OF WORK 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. RESIDENTIAL COMMERCIAL i/ Furnace New Construction Interior Improvement PERMIT TYPE V Air Conditioner Install Piping Processed Air Exchanger Gas Exterior HVAC Unit Heat Pump Under / Above ground Tank Install Remove) Other RESIDENTIAL FEES: $60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge) $100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) _ $ TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x1% $60.00 Minimum (includes State Surcharge) Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 Surcharge - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (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.caopherstateonecall.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. x (ilia ~ x Applicant's Printed Name Applicant's Signature FOR OFFICE USE Required Inspections: Reviewed By: Date: Underground Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening Use BLUE or BLACK Ink r For Office Use Permit I City of EI Permit Fee: I 3830 Pilot Knob Road l( Eagan MN 55122 / I Date Received: t Phone: (651) 675-5675 51'X, S l W I I Fax: (651) 675-5694 I ti n 6~. ~ I Staff: I - C~ 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ('L- Site Address: 41 `t~1L4eC-~4~ Pa Unit Name: Cam, &.a 4"e- Phone: Gg01 RESIDENT / OWNER Address / City / Zip: 4ivnin ( Ar w i r W Applicant is: Owner Contractor Description of work: L TYPE OF WORK Nzu U,S co",,k ,~tL Construction Cost: Multi-Family Building: (Yes No ) Company: c~ G Contact: CONTRACTOR Address: City: State: Zip: Phone: License Lead Certificate If the project is exempt from lead certific ti n, please explain why: (see Page 3 for additional information) 1-01617 Zo, Cc~& , (21 A COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.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 mu be ompleted within 18,1.. days f permit issuance. x Q-J i1 ba"~- x Applicant's Printed Name App icant's ignatur Page 1 of 3 LV DO NOT WRITE BELOW THIS LINE k" k SUB TYPES Foundation - Fireplace _ Porch (3-Season) Storm Damage Single Family _ Garage _ Porch (4-Season) Exterior Alteration (Single Family) Multi - Deck Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi) 01 of - Plex _ Lower Level _ Pool Miscellaneous Accessory Building WORK TYPES - New Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100% ) Zoning City Water Y AV V - Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: -Stucco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test -Final Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By:/ , Building Inspector RESIDENTIAL FEES Base Fee Surcharge" Plan Review V , MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 Use BLUE or BLACK Ink - - - - For Office Use l~ 7 I ~ Permit [ U I City of Ea ~a~ I Permit Fee: (1 I 3830 Pilot Knob Road j O I Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I) Fax: (651) 675-5694 L Staff: - - - - _ - - - 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION ~~~~lrlC~`-i ► Date: Site Address: Tenant: Suite RESIDENT / OWNER Name: Phone: Address / City / Zip: tt0 Name: License CONTRACTOR Address: City: State: Zip: Phone: j Contact: Email TYPE OF WORK - New - Replacement _ Repair _Rebuild _ Modify Space - Work in R.O.W. Description of work: Wki tm' V41 Lv r t RESIDENTIAL Water Heater Water Softener PERMIT TYPE Lawn Irrigation RPZ PVB) V Add Plumbing Fixtures Main Lower Level) Septic System New Water Turnaround _ Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.oM 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 wor i not to st wit out a permit; that the work will be in actor ance with the a [proved plan in the case of work which requires a review and approval f lans. X ~1~f,o x Appli ant's Printed Name Applica is Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final 40/1. CityofEa�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: Permit Fee: E77'/ Date'Received: 9 Iasi 1 Staff: 5 z r 41,E 2013 RESIDENTIAL BUILDING PERMIT APPLICATIOTz 343 _373 44 14) Unit #: Date: 6PQ''-^1 Site Address: Li,too 3(A -3k Name: ' kid Phone: (A' (41i(0"COLVet� Address / City / Zip: ' 1 OD Z.(Af�C4 t q•�sk— (Z11- 64-G y"k, 505 z Applicant is: Owner Contractor Description of work: CC>r-• 2u <A' Construction Cost: Ace- fa4T Multi -Family Building: (Yes / No )& ) Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) /Var A 444/ L/i (Wyritie2TOR15‘ 6(11 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: 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 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 Cod days of permit issuance. Applicant's Printed Name x be completed within 180 Appli " . nt's Signature Page 1 of 3 glob ISkc h c1.fri . DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation Fireplace Single Family Garage Multi t Deck 01 of _ Plex Lower Level WORK TYPES New ` Addition Alteration Replace Retaining Wall Interior Improvement Move Building Fire Repair Repair DESCRIPTION Valuation /3 Plan Review (25% 100% Census Code # of Units # of Buildings Type of Construction 17'31/ Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Square Feet Length Width REQUIRED INSPECTIONS Footings (New Building) )t Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: Ice & Water Final Framing Fireplace: Rough In Air Test Final Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies 136` /53 lig- TOTAL Siding Reroof Windows Egress Window flr��i�Z Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Accessory Building Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant XRo .2.002 A MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: Footings _Air/Gas Tests _ Siding: Stucco Lath _Stone Lath Windows Retaining Wall: Footings Backfill Final Radon Control Erosion Control , Building Inspector Final Brick 7X/1Once /33jI6/5 jr /ot X 3e' ace 3 je',?/1/4e /I '-"4' ,/ac. 841 @ oQJry0 /qx 631'0 /2, 13 Page 2 of 3 SHEET INDEX \ \ N., e, / „ „ , „ \ \ / 3, A._ . 4 \ \ .e \ 1 Zt AO. VA 1 SITE PLAN Scak: 1":.30"-0" 0 T"" 1 < 1 1 VI 2 j,,,; • ,..;;:-.... e s. As6.'","..‘• s -k) . ,, z 1-1, y i—.111 "".....,.d. i'.....';•0:,...1. \ .: .,: , / kb 1 Z.( < • ±-n z„z 1-4 06p ‹ LLI.L.‹ zo, o .o LLU <<<<<<<<<< SSSTi .. ", -••• • 5 89d 40 22" E 0N m .S\ 0 ID R 0 0 Use BLUE or BLACK Ink r For Office Use ) I 40b Permit City of Ea Ed~ I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: II I Site Address: 4100 Unit Name: Scc ~T } ~f2 l l ~C d-PuG tG 1 - Phone: Resident/ ( Owner Address / City / Zip: ~00 9IwCLh << 2~ ~ Applicant is: Owner Contractor Description of work: h-~ c)- (,tJ ✓t JoS Type of Work Construction Cost: ®U. Multi-Family Building: (Yes / No Company: V6)4 ~ S -JQ C, Contact: /Vk T~~n U© l1g gf- Address: 4!a4q City: Contractor r State:M /A/ Zip: 55 Phone: License CT 7 Lead Certificate .......w_ 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: , ,..u a. . NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.or-Q 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 per it jissuance. x 1Iith OX App icant's Printed Name App cant's Signature Page 1 of 3