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4247 Blackhawk Rd r z CITY OF EAGAN WATER SERVICE PERMIT 3830 rx,~rto Road - 5."f P. Q. B+bx"21199 PERMIT NO.: Eagan, MN 55121 DATE---- 7s' Zonings No. of Units. - F2 Owner FMC, Day Address: Site Address ~y , _ i; _ ,s: ,l Plumber. %f e 1 ` F° plum in.i, Meter No.. Connection Charge: ' Size: Account Deposit: Reader No.. Permit Fee: i egreo to com* wkly sire City of Eel oa Surcharge: orahmmeee. Misc. Charges: Total: .•A L~ F By Dote Paid: { Date of Insp.: insp.: CITY OF EAGAN SEWER SERVICE Ps "M 3830 Pilot KrQb Road (Ityi [~g, P. O. fox 21199 PERMIT NO.: 8,308 Eagan, MN 55121 DATE: .Zoning: 1 L No. of Units: TM:p enx Owner. BITC 12ev _ Ca p _ Address: {3~ Cliff ~ Site Address: 4147 .'ackbawk Roars I,2 Plumber. Valley Pluzbinq, v 1 some to eoarpy with the Ciy of 11""* Connection Charge: 42 5 30pd Ordinances. Account Deposit: I g L-Jadf Pemdt Fee: 1= L 03~ Surciwrge: 511PA BY Misc. Charger: Dote of Insp.: Total: Insp.: Dote Paid: ' CIT-~OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road X67 P. O. Box ¢'1s PERMIT NO.: Eagan, t 55f2l' DATE: 7-8-86 " Zoning: No. of Units- Ownor:.. FlIC Day _ Qpr'tT _ Address: - Site Address 4249 Bl ackh" mad. L2 B -Cun Cliff I Plumber: ale Plumbing ' Meter No.: Connection Charge: Size: Account Deposit: p 10. 00pd Reader No.: Permit Fee: 15 , 00pd E i esm to omq* w1a the city of &W" Surcharge; Or~norross. Misc. Chorges:'• ;~'P Total: 63.50pd rtet r - By Date Paid: I Dote of Insp.: insp.: CITY OF EAGAN SEWER SERVICE PERMR 3830 Pilot Knob Road 88-119 P. O. BOX41199 PERMIT NO.: Eagan, MN 55 J~,1 DATE: Zoning: ,,cc No. of Units: 1 Owner: P-MC DVY -00i M Address: - Site Address: 4249 B1ackhm 'c Four: L? 'V S-zm Cliff 1 Plumber. Valle Plumbin 6-30-86 64259 100.04d t e ae to soar with dw Cihr of Eegoa Connection Charge: 47 5.0022 Otdiwenea. Account Deposit: ..15. 0pd Permit Fee: - pa Surcharge: - BY Misc. Charges. Date of Insp.: Total: Insp.: Dote Paid: sus TY 01 SAGA Not { 4Cnvbiaad PERM ;Y. F-agan, M nnes( 55122-1897 Perm# Numb «tg44"" 4651) 6814675 Date [smiAo d_ ' s MAD DRESSY "COCK: APPUCANT-.~ L ~r OLACKHAWK P9, 1#+f CLIFF Ist CApi, a(N UAl~.: ' T SUBTYPE: TYPE OF WORK, INAU ru LAN MOVAC7YK. - x i Permit Holder Date Telephone # WATER PLUMBING RVAC Inspection Date Insp. Comments FOOTINGS FOUND FRAMING 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 CONDUCTNITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG(`~', DECK FINAL I I 'CITY OF CAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 pate limued: i ? 1 ! 9+ (651) 6$1=467 f SITE AI DRESS: 0 , * c: APPLICANT. (6164) 4954-0647 PERMIT SUBTYPE: TYPE OF WORK: t1 . CF "f INSPECTION FOOTINGS ' X At_ RFMARrSt PLAN REVIEW0 SY (RAIN NOVAC7YK. c .t I Permit Molder Dote Telephone # SEWER/ WATER PLUMBING KVAC. Inspection Date Insp. Comments FOOTINGS FOUND FRAMING 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 FrG DECK FINAL CITY OF EAGAN O W, . ' ' 3330 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 2210 PHONE: 454-8100 &q Z~ BUILDING PERMIT Receipt # To be used for 1/2 DUP & GAI:6. Value $71,000 Date JUNE 27 '1986_ 4247 BLACKHAWK RD R3 Site Address Erect ~ Occupancy Lot 2 Block 7 Sec/Sub. SUN CLIFF 1ST Remodel ❑ Zoning R2-PD Parcel No. Repair ❑ Type of Const. V13 Addition ❑ No. Stories W Name RMC DEVELOPMENT CORP Move C3 Length 49 Demolish ❑ Depth 28 o Address 3209 W 76TH ST., #205 Int.lmpr. ❑ Sq. t~II City EDINA Phone 835-3773 Install ❑ M SAME Approvals Fees 2i o Name U 4 Address Assessment Permit $ 3 4 3. 0 0 ~ City Phone Water & Sew. Surcharge 3 5 . 0 0 Police Plan Review 171.50 F W Name MINNETONKA DESIGN Fire SAC 575.00 x Address 337 WATER ST En Water Conn. 500-00 W city EXCELSIQFne 474-5991 Planner Water Meter 63.50 Council Road Unit 290.00 I hereby acknowledge that I have read this application and state that the Bldg. Off. 6/27/86 Tr. PI. 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and ity n OrM*-~ APC Parks Var. Date Copies Signature of Permittee Il 2 1 . 0 0 Total , A Building Permit is issued to. RMC DEVA OPMENT CORP on the express condition that all work shall be done in accordance with all appl c State of Minn sofa atutes and City of Eagan Ordinances. Building Official p-41' 1 40 RENTAL UNITS CITY OF EAGAN ~ 38$0 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121N2 12211 -19 BUILDING PERMIT PHONE: 454-8100 Receipt# ~ L~2_57 Tobeusedfor 1/2 DUP & garEst.Value $71,000 Date JUNE 27, 19 86 Site Address 4249 BLACKHAWK RD Erect C Occupancy R3 Lot 2 Block 7 Sec/Sub. SUN CLIFF 1ST Remodel ❑ Zoning PD-R2 Parcel No. Repair ❑ Type of Const. Vn Addition ❑ No. Stories 2 Name RMC DEVELOPMENT CORP Move El Length i 3209 W 76TH ST., STE 205 Demolish C3 Depth 28 o Address -3209 Impr. ❑ Sq. Ft. City EDINA phone 835-3773 Install ❑ °C SAME Approvals Fees o Name ;i F_ Address Assessment Permit $ 343.00 city Phone Water & Sew. Surcharge 3 5 . 0 0 Police Plan Review 171.50 FZ Name MINNETONKA DESIGN Fire SAC 575.00 Address- 337 WATER ST 500.00 Eng. Water Conn. a W city EXCELSIPAne 474-5991 Planner Water Meter 63.50 Council Road Unit 290.00 Ihereby acknowledge that Ihave read this application andstate that the gldg.Off. 6/27/86 Tr. PI. 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and Ci y n Or a APC Parks Var. Date Copies Signature ofPermittee - - - Total $2,134.00 d A Building Permit is issued to: RMC DEVELOPMENT CORP on the express condition that all work shall be done in accordance with all applic I fate of Min esota tutes and City of Eagan Ordinances. Building Official r CITY f WAf`, MVI" Pte' t~?:- ik- PERMIT NO, 7657.. pagan, MN 55121 DATE: T-S -8 6. $2 No, of units: ex C?winar: AMC Aev. Corp. Addrew ac aw Road L2 IS7 un TMOTag t'er: a y Snet -SS73 i?a cfC + • to ow eby meter 613 t3a~ tic Dote of. t CITY OF EAG AN W/RM SMYKM PStW Kb React 7555 1199 PEWfT NQ.: 7-8-85 Eagan, MN 55121 DATE: zorargt: ' NO.bf Unit= Duplex Gma~s RM Dav. C.ctrp r►~,ess: Site Adi 41,47 b lac 8 un Cliff Ptvrr►ber: -Y Plumb Meter No.: l d gwrge: tidar tVo:CQ x"111 95;d~, 0 Op t or" to !b tom, OX~V,156. Mid T& 1El ~I 6 vpd meter Dote Paid: of tnop CITY OF EAGAN f t 12- 10 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ; PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for 1/ DUP dr OANtst. Value $71,000 Date g~ JUNE 27 Site Address 4247 File CKHA K RJ) Erect tJ Occupancy -3 Lot 2 Block 7 Sec/Sub. SUN CLIFF ISM' Remodel ❑ Zoning Parcel No. Repair ❑ Type of Const. Vn Addition ❑ No. Stories Z "C' I3_ -W FILOPPIEN T COR? Move 11 Length 4 2 Name i, ~,,,~r Demolish ❑ Depth 74 3 Address 3209 Int. Impr. ❑ Sq. Ft. O City 1a21-: Phone 835-3773 Install ❑ o Name - Approvals Fees Q, Q Address Assessment Permit ' d City Phone Water & Sew. Surcharge 735. 1.00 50 Police Plan Review 71' W W Name A3:'': ONKA Fire SAC 575.00 z Address 337 14,x`3 ER ST 500.00 v Eng. Water Conn. a City Pl A e 4 7 " 5 Planner Water Meter 50 Council Road Unit 290.00 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 Bldg. Off.6/27/86 Tr. PI. 156.00 Minnesota Statutes and City of Eagan Ordinances. APC Parks Var. Date Copies . 00 Signature of Permittee Total x:MC DEVELOPMENT CORP A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applic 1e State of Minnesota Statutes and City of Eagan Ordinances. Building Official Permit No. Permit Holder Date Telephone # Plumping H.V.A.(:. • r= f Electric Softener Inspection Date Insp. Comments Footings I Footings II Foundation r~ Framing / r 8' Roofing Rough Plbg. RAO Rough Htg. Insul. Fireplace Final Htg. Final Plbg. Bldg. Final a/ E ~QL(f Cert. Occ. Deck Fig. Deck Frmg. Describe Location: Well Pr. Disp. III CITY OF EAGAN Remarks ~-y SUN CLIFF 1ST 7 Parcel 113-72375-420-,07 Addition Owner adLV'7'I-CL-. Li `-f fi ff21 Street State EAGAN W SSS122 Improvement Date A Psi ment Receipt Date STREET SURF. 1985 3047.. r STREET RESTOR. GRADING - SAN SEW TRUNK 56,25 2,25 25 *SEWER LATERAL $ 6134-78L 4 8.99 WATERMAIN *WATER LATERAL trunk 1985 WATER AREA 3 y.3 1977 9S.00 6.33 *Services 1985 STORM SEW TRK 1971 322.29 11 * STORM SEW LAT 1985 " Storm Sewer Trunk qay 1985 4 X 00 2.47 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK ti This request void 18 months from f C, 6 2 0 5 9 RegaestfJB1111. Fire No. Rough-in Inspection Required? Ready Now Q Wil I Notify. Inspec- OYes ❑No for When Ready 9K,censed Electrical Contractor 1 hereby request inspection of above ❑ Owner electrical work installed at. Stree AcJdress, ox or Rou i~ C it ction No. Townshi Name or No. Range No. County 1 AF" Occup (PRINT) Phone No. 0I Power Supplier Address Electrical Contractor (Company Name) Contracto 's License No. iV~tf1~•~~c (Contractor or Owner Making Installation) j~ ~p11TjILL~~.LK,f rr T Author J11 ice, / r Making Installation) Phone Number APPLE L- v,4 i i - LikI1xxTE MINNESOTA STATE BOARD OF CE I t2 THtS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. -Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001-05 See instructions for completing this form on back of yellow copv• 2059 X"' Below Work Covered by This Request //UUUI OO~ Add'wep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other peMv Other (Specify) t er Specify Other Other Compute Inspection Fee Below M Fee Service Entrance Size tt Fee Feeders/Subteeders p Fee Circuits 0 to 200 Amps 0 to 30 Amps 0 to 30 Amps Above 200 Amps 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100-Amps Above 100_Amps Transformers Irrigation Booms Partial-'Other Fee Signs Special Inspection I ; amarks ~ TOTAL F4/E ~r Rough-in - - Date 1. the Electrical Inspector, hereby certify that the above Final ; Date inspection has been r✓ made. This request void 18 months from Bess void / / / 71 h3 4 7 8 9~~ Re st D e Fire No Rough-in nspection 77R'. Ready Now j2A*f1T'Notify. Inspec- le I es ❑ No for When Ready Licensed Electrical Contractor 1 hereby request inspection of above Owner electrical work installed at: St t Address, Box R ute No. City ecUO No. Township Name or No. Range No. -count V Occu IPRINT) Phone No. MIL . L) z Po we pplier Address Electrical Contractor Korn ntractor's License No. ELF o 2/6 fires 1 r stailation) 14 55124 Aut}p It(~ S c Owner Making Installation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612► 297-2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION Ea-ooaot.oa See instructions for completing this form on back of yellow copy. 4 789 "X" Below Work Covered by This Request . (o dd Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater ighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. urnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm other (Specify) - Other (Specify) t er Specify Other Other ompute Inspection Fee Below # Fee Service Entrance Size # Fee Feeders IS ubfeeders # Fee Circuits 0to200Am s AA 0 to 30 Amps Above 200 Amps 31 to 100 Amps 31 to 100 Amps Z} Swimming Pool Above 100- Amps Above 100-Amps Transformers Irrigation Booms PartiaL`Other Fee Signs Special Iris pection Remarks TOTAL E,7 _#G Rough-in Gate 1, the Ele Inspector, hereby y certify that the above Final Date inspection has been made. . This request void 18 months from This request void c^ tl ? , 18 -riths.from . J_. l T PC 34788 L Q, 'ILI Requ Date / Fire No. Rough-in Inspection Requrr ? C3Ready Now II Notify Inspec- (f/ es ❑No for When Ready icensed Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: Stree Add ess, Box or Route City n ) v 'T / V e uon No. I-Township Name or No. Range No. County Oc p nt (PRINT) Ph a No., R Pow r Syppfie, Address Electrical Contractor (Company Name) Contract iI License No. ut~tr1 ELECTRIC d ess Con~CJLV 1~ r!i[~~r ki g}►1~3i'ailation) tlV~ SLR Autf i a (190714 I Ilation) Phone Number MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT GriggsdJlidway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD ity Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS - ENCLOSED. J REQUEST FOR ELECTRICAL INSPECTION ///EB-00001.04 0 See instructions for completing this form on back of yellow copy. / J ` 3 A 788 "X" Below Work Covered by This Request f New d Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater je4ightinq Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. urnace Silo Unioader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other pec Y Other (St)ecify) t .r Speci y Other Other o ,jute Inspection Fee Below # F Service Entrance Size- if Fee Feeders/Subfeeders # Fee Circuits tTU 0to200Amps 0to30Amps 0tn30Am s Above 200 Amps 31 to 100 Amps !n ejo 31 to 100 Amps Swimming Pool Above 100 Amps Above 100_Am s Transformers Irrigation Booms PartiaL`Other Signs Special Inspection 3 AL F E rn p(1 Remarks :T I ~T;m ;1 Rough-in Date i, the Ele "'ca Inspector, ereby certify that the above Final / Date inspection has been made. This regpest void 18 months from PERMIT # /7 3 6 F PLUMBING PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 _ Site Add ss BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sub Res. New Name Mult Add-on BEC DR s :d Addres Comm. Repair EAGAN 452-1565 Phone Other C City NO. FIXTURES JOTAL Name -J-Water Closet - $3.00 X00 c Address -72 LO _ I Bath Tubs - $3.00 p City E£~ri - Phone S -_32 7 -2-Lavatory - $3.00 Shower - $3.00 O / Kitchen Sink - $3.00 '3. 0 FEES Urinal/Bidet - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE -LLaundry Tray - $3.00 340 MINIMUM - RESIDENTIAL FEE _$10.00 1 Floor Drains - $1.50 A S MINIMUM - COMM/IND FEE - 20.00 --L-Water Heater - $1.50 - STATE SURCHARGE PER PERMIT - .50 Whirlpool - $3.00 (ADD $.50 S/C IF PERMIT PRICE GOES _-Gas Piping Outlets - $1.50 BEYOND $1,000.00) Softener - $5.00 Well - $10.00 P % Private Disp. - $10.00 =Rough Openings - $1.60 5 r S j SI ATURE PERMITTEE FEE: STATE S/C: ' 29 FOR: CITY OF EAGAN GRAND TOTAL: - - RBi+t & UNITS CITY OF EAGAAI 3830 Plot Knob Road, P.O. Blot 21-199, Eagan, UN 88121 N* BUILDING PERMIT PHONE: ~L548100 Receipt To be'use r 1/2 DUlP & garEst. Value $71#000 Date ,;[JUNE 27 t~ 80 Site Address 4349 WACXMRD Erect 13X Occupancy R3 Lot Block 7' sec/Sub. SUN CLIP IST Remodel ❑ zoning V3"`S Parcel No. Repair ❑ Type of Const ' Addition ❑ No. Stories Name Im. i3E~V PI NT CO" Move CI Length Eltt 3209 W 76TH ST., STE 2a Demolish ❑ Depth Address Int. Impr. ❑ Aq. Ft. City PIS' Phone 835-3773 Install Approvals Fe" r Names E Address Assessment Permit ` City Phone Water & Sew. Surcharge ' Q Police Plan Review-' 5 F Name _ MINVIVIT N" DESIGN Fire SAC . if0 Address 337 -ST. * ~►R~V •~#f3 Eng. Water Conn.- a W City ?iXCMSI We 474--5991 i 63. 50 Planner Water Meter Council Road Vnit 290*100~ I hereby acknowledge that I have read this application-and state thatthe Bldg. Off, 6/27/06 Tr. 156.00 00 information Is correct and agree to comply with all applicable State of Minnesota, Statutes and City of Eagan Ordinances. APC Parks Var, Date Copies Signature bf Peti ittee , Total- A Building Permit is issued to: 1~ UH13~T~ on the express condition that 6 all work shall be done in accordance with all applicable ate of Minnmsota tutes and City of Eagan Ordinances. Building Official plormill Ma Pair" "Oklef Bala Toopt, ra $ 9- S& 3 %A.c. SoZ fucw `AL X10 palle Insp. Footings a ` Foundoftn Framing e cP' GsJ Rooftg Rovo p Rough MIp. mad. w d~ FNoplace F" Mfg. Fhrat fto. C Final Oce. Fig. Doak Frmg. Defer" Location: won W. Ohp. PERMIT # PLUMBING PERMIT RECEIPT # 7 `~Q CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: CONTRACT PRICE: PHONE: 454-8100 Site A ress °7J/ 7 ~ BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Su X Res. New `m Name ZEL MECH. Mult Add-on NNEBEC DRIVE Address Comm. Repair EAGAN 452-1565 Phone Other C City I NO. FIXTURES YT L Name J&fi e- 00 _ --L -Water Closet - $3.00 $ c Address 3 <f 76 ' Bath Tubs - $3.00 p City _ & L/1" lk - Phone :,2 Z-3 7 23 Lavatory - $3.00 Shower - $3.00 FEES J Kitchen Sink - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE Urinal/Bidet - $3.00 MINIMUM - RESIDENTIAL FEE _$10.00 -~Fundry Tray - $3.00 MINIMUM - COMM/IND FEE _ 20.00 Floor Drains - $1.50 /-1-40 MINIMUM SURCHARGE PER PERMIT - .50 Water Heater . $1.50 (ADD $.50 S/C IF PERMIT PRICE GOES-Vllhirlpool - $3.00 BEYOND $1,000.00 Gas Piping Outlets - $1.50 Softener - $5.00 Well - $10.00 Private Disp. - $10.00 -A -Rough _ Rough Openings - $1.50 Si NATURE PERMITTEE FEE: STATE S/C: FOR CITY OF EAGAN GRAND TOTAL: CITY GAN RECEIPT # 3830 PILOT KNOIIE ROAD, EAGAN, MN $5131 DATE: -Jut CONTRACT PRICE: PHONE: 454.8100 19 Site ' DG. TYPE WORK PES T CIRIP Lcrt 49 Block Sec/Sub / /1 1 11,121- ~d? Res. New $ Name #if it Mutt Add-on as Addre Comm. Repair C City 11 Phone Other IF /Z /n Name FEES Address RES. HVAC 0-100 M BTU .00 0 Ph = ADDITIONAL 50-M BTiJ_- - _ ADD-ON AIR COAiD. 0-2 -eT# ; - 12DO 'TYPE OF _ ADDITIONAL 6 M BTU - 6.00 Forced Ai WORK D j NIL GAS OUTLETS - 1.50 COMMAND FEE - 1% OF CONTRACT FEE Holler M BTU MINIMUM RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMMAND FEE 20.00 Air Cond. G M BTU STATE SURCHARGE PER PERMIT - .50 t Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets # BEYOND $1,000.00) Other FEE: Sf I t MATURE C3F PERMtTT E TOTAL: FOR: CITY OF EAGAN r i r For Office Use//~ "t l City of T E I Permit#: I I Ct I Permit Fee: 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I 1 I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Tenant: Suite M RESIDENT / OWNER Name: Phone: li%=' %`•~-'''•3~ Address / City / Zip: ' z2 WAI J Applicant is: Owner Contractor TYPE OF WORK Description of work: 22-Z,9 zz- Construction Cost: 1.500.j--_e- Multi-Family Building: (Yes / No s ) CONTRACTOR Name:w License Address:97e~o City: J)/ Y r 1 ZZI State: Zip: a r'~ r✓ r Contact Person: ,~'`E COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 Minnesota Rules 7672 Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted submission type) Energy Envelope Calculations Submitted 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 the are trade secrets. 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. c x/~ 1 Applicants Printed Name ----''Applicant's ignature Page 1 of 3 1247 gla~k wk 'I C. R. WINDEN 3 ASSOCIATES, INC. V LAND SURVEYORS Tet $45-3640 1351 EUSTIS ST.. ST. PAUL, MINN. 55106 R.M.C. DEVELOPMENT CORP. NOTE: Scale: 1`=30' o Denotes Wooden Stake. ODenotes Iron Proposed Garage Floor E1. 9os•3 Monument (9a8.o) Denotes Proposed Bearings Are Assumed Finished Ground E1. __4 Denotes Direction of Surface Drainage. Vertical Datam - N.G.V.D. 1929 ~Dra:n4ye £aseMEn7' I N84'I9,le"E a .n 9O/..o1 10 OVe~hony { ' l0 O 30.3 3 Prow 0 e d w 30 Y o r a ~ Doable Rt 4~v c ~ fa. ENO 4 Bung 410w e' C~ c ~1 d Z m (4x249) N o°.~ i- 30.3 v m _3- J 13..2_. h'b8°~5 E A;P Lot 2, Block 7, SUN CLIFF FIRST ADDI ON, Dakota County, Minnesota. WE HERESY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND AlOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON, AND All VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. Doted this / 3 t/1 der J,nP A D 19 gL C. R. W DEN t ASSOCIATES, INC. toy Ll N rm 19 Svrvoxor, AAinwoNto Rspistrotiee No 777 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS, t $2,000 LANDSCAPE BOND To Be Used For. Valuation: Date: Vv MP Site Address f!Z; T 7 OFFICE IISE ONLY Lot a Block 2` Erect Occupancy CIS / Remodel Zoning -fz 2 Parcel/Sub Repair Type of Const :a/ n J Addition # of Stories Owner ~1zo Move Length Demolish Depth Address ,3Z~ f GC/ ~?ps- Int.Impr. Sq Ft Install City/Zip Code .Ewa. Phone ~'3a'' -3 773 APPROVALS FEES Contractor 3.~,e~jpr.e Assessments Permit 54/3 Water/Sewer Surcharge 3 S- Address Police Plan Review Fire SAC City/Zip Code Engr Water Conn Planner Water Meter CS - b Phone Council Road Unit 2 l.5 Bldg Off d_ Z Z- Treatment Pl Arch./Engr.jyr,~r,E APC Parks Variance Copies Address OT df/ City/Zip Code Phone # 7/,! 9Z NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. 77, i t - Y 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET OF SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS,. $2,000 LANDSCAPE BOND 071000 To Be Used For,:., Valuation: 071 Date: L/yAte Site Address ~.~9 OFFICE USE ONLY Lot Block Erect Occupancy 'es Parcel/Sub Sow (A r7F~Pt f"IGp a) Repairl ning PD_,~ ~jf Type of Const yt/ Addition # of Stories Owner C e Move Length 40Z Demolish Depth ~ Address Int.Impr. Sq Ft Install City/Zip Code A 44r ,~S•y3 Phone APPROVALS FEES Contractor Assessments Permit 35~. Water/Sewer Surcharge Address Police Plan Review 171, - Fire SAC 7 City/Zip Code Engr Water Conn SUS Planner Water Meter Phone Council Road Unit Z; 1r, 6 Bldg Off 6 `Z. . Treatment Pl Arch. /Engr.APC Parks Variance Copies Address 3„3 7 G(1t„r,~ TOTAL City/Zip Code Phone # 1y17J~ 1-5'99V NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR /HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. Z=~J~X~C ,77 n C7"t`- t 71ov vele-= /oz 7oJ77, 00 ~I ` I.X I( H I Ql I NVi I ON AVI r AGI "rr~ ~.~:(~~1r( I A I I ON t a l c %-t t ~/f// i f Jed OWNI_I{ 111{( 5 1TE. ADDRESS: T`(IOW ~i``'(~ r✓Z~.\~LC= =j CONTRACTOR: r ~ Determine working square footage of each 1. Total exposed wall area ....'.y54 --Sq. fr.. x .ll 2. Total roof/ceiling area.... 1 sq. ft. x .026 = yf<.C~~ Total exposed wall area above floor= a. Total wall window area t 1S b. Total door area . t~•,G_~ c. Total sliding glass door area r d. Total fireplace wall area e. Total wall framing area (average 10"11 f. Total rim joist area :::2n -7 g. net wall area above floor........ fi 4 h. wall area above floor i. wall area above floor j. frame wall area at foundation Total exposed foundation area= ~512j k. Total foundation window area 1. Total net foundation area hove grade Determine "u" value of each wall segment (e.g. window, door, each separate wail section) 7 b. X 'lull X Hull d . _ X 11 11 -50 A lJ 11 11 1 1 g. 4( h. X 'suit = X 40 ,,11 j X 11 U 11 If item 13 is the same k. X /lull = as, or less than item You have met the X Lr►11..:.:. int.cnt of S{IC 6006 (c'a 3. .................................Total ~,1• ~.X 1 iVl.' ia►Vglbtlll "U.. t.t411t-111.11 6,14 ~i(loe n m. Total nhyli.ght area -n. Total roof/ceiling t.rilnl.i,llti itr(ia {:ivvrit't.' lU'+) -1!/~.] o. Total net insulated roof/cciling ai va.......... • s Uetormille "U" value for each )lu)f/cci i i1Nt ::1'~pnuill. 111.` x .full n . mot- a U.. 7 ^ _ Z 4 Zi,t-a1 - - If total. oc 0'1 i.:1 t1w ;u1mw .c;, (1; 1• a:: t il.ul liL. } 'u 11•,v'. 1,1, t_ i:fa 11111:111. of SHC 6006 (c) 1. Alternate Builda11q l?nvc_11, t~l:c.i.ttn To utilize the total envelope 'system method, the values established by the ssnl of items iii iind 44 shall not be greater than the stun of items IL-•LL1d 02. 3. + 4. _ F' A t~d `l` 1 ~ LwE.AL_ rT. F-XPOSE D WALL "i t 1 1-3 (o ~:U L L. C~ - IF! WALL AR-'EA 1 X , 1yI x 6 r,.. r ~PULL I x 6 L. W DVJS ' ] oath-5 t~ ~Aa Z t 1 7:7 ?A-Tio DRS b ` ~ CJ lnt..ri„t :dr rilm = 0.61 ` 1 l + p 1 4 - 0 . 61 Total r'` i(r,- pO . , EO, • 1. Int-e-lor nit 0.61 inted heat f 1p~r 2_ ~n _ 7 CC c L 3 Fla. 05 - C !tire it t T i .r I••~ • _..,.t.,., , 1 0.61 .+.-~t ly ~~~s1•1111 ~~'~~.~_~t••. _~••+r- - . 1. ~11'.~ ~t: 1 : to - 3. _ "I Irv, L 1_ 7;~sidc :air. Cilia 0.61 Y.ect ilou vp j vtnteu 3• • t?~t s:dc i it : -ltn _ 0.17 Total a~ % u rnsid^t air fi.]n ti. 17 iot!~i i r film Total 7~ b C~J - 1 >;,-.t•! Ucoiliti.onal ~hcets if more LpaCO S: ~t~:,1ct+ for ,Ictail^. and calcu?atlans. t"ent Fin. f7 I C unt, 151 or ep.JmW W.411 Alt A 1..1• 1rnim~~ 'ct+m.rruci tun i YZI, At P.i j.> 4a UL r•rc. Tcjt'~•.!:,r of ; • FItN1E t:ALI. 1. Intrr!or ',a - 16 Eff { , 4, t,•j f ~ ~ ZZ t`i ~ I;. tt , -v u t:_ o. G!l 30 1 Jl~ ~.~i __,.1 tt. }.\~f•:!or tkic 11:'l l~. .1,.2 .-1.C1~ A ? l 12" all \ .8 -CO 0_17 -'r •n, -~.:~•j"°` G. !:xt, 1,t•~ _ Total • ' , ' ' ;tit) r ~ „ ~ it i 77 ~ t .t , l , f lam, • 13 I~ •o 1• • •T .l lljt' t1~: 1•+1..II nn(I c ' PERMIT ~Cli"t OF EAGAN 3830 Pilot Knob Road PERMIT TYPE: B IJ .I L, D :I` N G Eagan, Minnesota 55122-1897 Permit Number: 033754 (651) 681-4675 Date Issued: 10 .i 21 f' 9 S SITE ADDRESS: 4247 PLACKHAWK RD 4,J N C L. I F F 1. 1,;°4` P < I , N e < 10-72975--022....0./. DESCRIPTION: i I1 i. 1 d ne t•rit.xt Type 17E~r:.K Eui 1.di.nca I,Jc) t•k Tv r)e, NEW erlC;Ilt )ti 434 AL.-E o RESIDENTIAL. I REMARKS: PLAN REVIEWED By GRA:TG NOVA(.7YK. FEE SUMMARY B,)se f"ee $1-0 00 Surcharge Total Fee $ 50 0 CONTRACTOR: OWNER: A r .).p L J, c a n t - CAPLS)ON DALE I 4247 BI_ACKHAWK furl f EAGAN SIN 551.22 (651)454-0597 heI yC4`.nU JI. Cj ? .31'. [ have 3(~ th1°: aopllisat4ni1 of"I C1 tIlo. i1 i°(TI .1. ?n curr'e? a lij Sgt T-o i°:oI'llp,Ly wi,t: i 3l?4 tacab1e tat-e? C?f Hn df~Lli,p = ild -I 1oarl 0' c 11i!i.'.~; e PLICA ERMI SIGNATURE IS UED B K SIGNAT s` 1998 BUILDING PERMIT APPLICATION (RESMENTLALL) !CITY OF EAGAN PVAYr XW RD - 5512 "1-4613 tr e; Qmtnxfign 5 nuirs m'm R~arnodaU terra c ft9t2Ments tc ♦ 3 registered t surreys # 2 copies of plan 2 Copies of plans (i OA# beam $ wk%dow sizes: poured fml. des4n; eta.) ♦ 2 site surveys (exterior arddit ons & decks) # t ever calcufatlans # 1 aftergy oaWations for heated ads 3 cam of bee preservation plan f lot p slyer 7/17$3 "Wed. YJ No 7 rDATE" t Fi +M"fRtJC"tiQt±i Cca,, 4 a © SCRlMON OF WORK: STREEI'ADDRESS: Z o ~2 BLOCK: DoT: .,.L..,_..., SuBO./P.M.0: ti Name: l` l/ 1-- Ph e # : k ? L 6~ 7 PROPERTY OW-MA Street Address: Cv City - r.~' - - zip: Conipany: Phone CONTRACTOR Street Address: License # City 'Stow: Zip: ARCHICT7 ENGMER co parry: ~tj, j. J,, - Phone Name: Registr'a on #s Street Address: City State: Zip: SWAW & water tensed *Mber (now construction oroy): Penakty appWS whets:aft"s dvmV td,t ttttrsitige i8 request ed once perrrtrt is issued. I hereby admowledge than i hew neat this aippkation md- $tot#> ir~rrrtsrt' is a ale Wo VA ax*CW state of Minnesota State ASS and CRY of Eagan Ord tr . Signature of Apps' ni OFFICE USE C}ULy _ Lertiticat of Survey Received yes OCT 19 1998 NO BY: Tree Pr rullltion Pn Remived Yes No Not Required OFFICE USE ONLY BUILDING PERMIT TYPE ❑ 01 Foundation ❑ 06 Duplex. ❑ 11 Apt./Lodging, 0 16 Basement Finish 0 02 SF Dwelling ❑ 07 4-plex ❑ 12 Mull Repair/Rom. Q 17 Scrim Pool ❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20,NblicFactlity' 0 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace C 21 Miscelianeous 0 05 SF Misc. 0 10 ~ plex 15 Deck WORK TYPE 31 New C3 33 Alterations ❑ 3fi Move ❑ 2 Addition ❑ 34 Repair ❑ 37 Demolition Conan. (Actual) Basernint sq. ft. *CN Smarm (Allowable) Maio le4el sq. ft city water. USG 0ccu ancy. 12 -21 aq* ft. Pls ..r Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census.Code. Depth Footprint sq. ft. SACC;ode ► Ce Btdg t Census Unit ' APPROVALS Planning Building Engineering 'Variance Permit Fee Valuation: 8 F Surcharge Plan Review Uoense MC/VVS SAC City SAC Water Conn, water meter Acct. Depose SAN Permit SPIN Surcharge Treatment l Park Ded. Trails Ded. , + C?ther ° _ , Copies Total: X96 SAC SAC Unlts _ . 1247 glcck wk wkw *e ' ~fI C. R. WINDEN b ASSOCIATES, INC. CJ LAND SURVIVORS TOL 643-3648 1 PAUL MINK »1 EUSTIS iT., ST. , 65106 R.M.C. DEVELOPMENT CORP. BY DATE ;,:4 ; s Cale: 1'=30' NOTE. UIL~. iN nv uL . o Denotes Wooden Stake. ODenotes Iron Proposed Garage Floor E1. 908.3 Monument (9o5.o) Denotes Proposed Bearings Are Assumed Finished Ground El. --4 Denotes Direction of Surface Drainage. Vertical Datam - N.G.V.D. 1929 Demo;n4ye 41Y/1,Yy Ecr5emE177 Iv 84' IS' IG` F 130.3 y0~ , CE o✓«hanq (4247) /Z 3 P~'oposed N 3a o r Double 44 z m (4249) a v °30.3 Lot 2, Block 7, SUN CLIFF FIRST ADDITION, Dakota County, Minnesota. WE HERESY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND A1OVE DFSCIIIED AND OF THE LOCATION OF All BUILDINGS, IF ANY, THEREON, AND All VISIILE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND Doted phis / 3 r~ dar Of june IL_D. 19S6 C. R. W DEN i ASSOCIATES. INC. boy Svr.eyer, Mins%*sete Repistret4n No 771 ` • CITY O F E A G A * PAYM~ OF M AT TIME OF APPLICATION DOES NOT CONSTITUTE APPROVAL OF PERMIT. APPLICATION FOR PERMIT INSPECTION OF SEWER AND/OR WATER * INSTMI.ATIONS WILL NOT BE SCIE- SEWER AND/OR WATER CONNECTION vLID UNTIL PST HAS BEEN ' * APPROVED. (Please Print) 1) PROPERTY ADDRESS: 44z-/1GC ~7a LEGAL DESCRIPTION: -e z Lot Block Subdivision or Tax Parcel ID ) IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: (Mon Year} PRESENT ZONING/PROPOSED USE: -CO4+JERCIAL/RETAIL/OFFICE R-1 SINGLE FAMILY INDUSTRIAL R-2 DUPLEX (Two Units) INSTITUTIONAL/GOV NMENT R-3 TOWNHOUSE (Three + Units) ( Units) p R-•4 APARTMENT/CONDOMINIUM ( Units) 2) v NAME: C / ADDRESS: a Q C.v ~A CITY, STATE ZIP: SE- -35-- PHONE: 2--, -7 -7 3) u NAME: For City Use Plumbers License: ADDRESS : Active Expired CITY, STATE, ZIP:17-r-1 1-C( o f - Not recorded PHONE: o7 J9 MASTER LICENSE # Staff Initial 4) 119i-Ksj NAME: _ ADDRESS: CITY, STATE, ZIP: PHONE: ED CONNECTION TO'CITY SEWER CONNECTION TO CITY WATER OTHER 6) f PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPR PERMIT TO 1, 2, 3, 4, ABOVE (Circle one) .4j e/ ~.4 A! ' 1~ 1 ! • ;r M-I • t1A! 1 l 1 1 di f 1 ..FOR CITY USE ONLY ' PERMIT # ISSUED L Pd w/Bldg. Permit FEES: $ SEWER PERMIT (INCLUDE SURCHARGE) $ $ 16-~ WATER PERMIT (INCLUDE SURCHARGE) $ $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ /6-, X71 ACCOUNT DEPOSIT - SEWER $ - $ ACCOUNT DEPOSIT - WATER $ V O O, ~a $ WAC $ 575-1 1 71 $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ 41 7 $ er--o TOTAL _ go? c.,,zVV 7 RECEIPT # RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: C . ~rr~,cJ-may TITLE: p / DATE : < 1 ~ C I TY O F E A G A I~ * inn: PAYmgT OF FF~E AT TIME OF APPLICATION DOES NOT CON,STITUI7E APPROVAL OF PERMIT. APPLICATION FOR PERMIT * INSPECTION OF SLIM AND/OR WAS niSTAr LATIONS WILL NOT BE SCE - SEWER AND/OR WATER CONNECTION ULED UNTIL PERMIT HAS BEEN APPROVED. > Please Print) p 1) PROPERTY ADDRESS: dill 13/4 c A/- 017 z, Z U LEGAL DESCRIPTION: (Lot/Block/Subdivision or Tax Parcel ID IF EXISTING STRT-M7URE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: • PRESENT ZONING/PROPOSED USE: (Month/Year) Cav ERCIAL/RETAIL/OFFICE R-1 SINGLE FAMILY Q INDUSTRIAL R-2 DUPLEX (Two Units) INSTITUTIONAL/GOVERNMENT CD R-3 TOWNHOUSE (Three + Units) ( Units) R-4 APARTMENT/CONDOMINILTM ( Units) NAME: :f7 ADDRESS: / (rte C-',,jCCs?\~- 3~~✓'~ .~C~/ C o7 CITY, STATE, ZIP: PHONE:_ 13 5-,3? Z:3 3) u / For City Use NAME: - Plumbers License: ADDRESS: d e h Active CITY, STATE, ZIP. f Expired ~-je) r Not recorded PHONE: _4-('/ - (9 /o MASTER LICENSE# Staff Initial 4) NAME: _ ADDRESS:-7fT~ Y CITY, STATE, ZIP: _ PHONE: CONNECTION TO CITY SEWER CONNECTION TO CITY WATER OTHER 6) 1 _ • PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE (Circle one) 7) N7Tg&7r;,qkjI A i } I .FOR CITY USE ONLY PERMIT # ISSUED -7 Pd w/Bldg. Permit FEES: ~I $ $ O -S-0 SEWER PERMIT (INCLUDE SURCHARGE) $ $ ~b S~ WATER PERMIT (INCLUDE SURCHARGE) $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ ACCOUNT DEPOSIT - SEWER $ $ ACCOUNT DEPOSIT - WATER $ $ WAC $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SURCHARGE $ a, $ OTHER: $ A;7- / Y $ 4 Al TOTAL RECEIPT RECEIPT # DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: I DATE: I City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink r For Office Use Permit #: 1lyy37 Permit Fee: I Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit #: Resident/ Owner Type of Work Name: N e I d ! k©r rAct S Phone: C=11-8)2-- '-t l l L Address / City / Zip: LI 2241 BlcAC K t O V Rd . Applicant is: Owner X Contractor Description of work: Roo 't �►'� .4- Si c7ll NZ Construction Cost: 2.0 1 o oc Multi -Family Building: (Yes / Non ) Contractor Company: MCr'rt �� RC',$1-or1 Or\ Contact: RC -o Her re d Address: 2.011 Ess Od CT State: 1'1 N Zip: 55 3- 3 Phone: License #: 1C'- (LI 18 \ C� City: 12oC-1-Lcc) r'cl C.12- 2A-2.-99-79 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: 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.gopherstateonecail.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 Code must be completed within 180 days of permit issuance. Applicant's Printed Name x ro..d.. 14e rre i GL Applicant's Signature Page 1 of 3