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1015 Blue Gentian Cir NSPIECTION RECORD s- OF -EAGAN PEnw. `'rYPc u ► x 3830 Pilot Knob Read Permit Number: 0,? 6 4 0 Eagan, Minnesota 55122-1897 Date issued: / ~~t2) €i81.675 R> t AWRESS; r t - t. 0 C t` vn APPLICANT: ~ fit-11E. OVNI (AN R0 S01" ON V OINIS1 1yx "Ir 1 ~yif 2 0 4- t PEF#I{TySUyBTYPE: TYPE OF WORK: g ' WA 1 i006H iN 141`0 IMAt F 6 ~~~~i~~~~~~~~€~a~~~~~~~~~~{~~ ~ e e i i 1 P f CITY OF . A Remarks Additi® ae • Ction 2 of 3 Bik 2 Parce WO r Owner IA r~ =1 ir, Street 1015 Bltae Gentian Rd. state Eagan,MN 55121 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK _ SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA 1977 STORM SEW TRK 4 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC not available 00.00 1OP05 6_10-74 PARK CITY OF E11GAN 3795 Pilot Knob Road Eagan, Minnesota 55122 PERMIT NO.: l9~ The City of Eagan hereby grants to Ryan Well Co. of Rosemount a WELL Permit for: (Owner) Herbert Polzin at 1015 Blue Bentian Road , pursuant to application dated 7/10/74 Fee Paid: $10.00 dated this 15th day of July , '19 74 .50 s/c Building Inspector Ma chaiiical Permits: Bid Total: T CITY of EAGAN N2 3312 BUILDING PERMIT 3795 Pilot Knob Road Owner'...:....... Eagan, Minnesota 55122 Address (Present) -440 '65 454-8100 Builder 7>/ Date Address DESCRIPTION Stories To Be Used For Front Depth I- Height Est. Cost Permit Fee Remarks LOCATION 2!0.,S-z) Street, Road or other Description of Location I Lot Block Addition or Tract Z- 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 ON HE PREMISE WHILE THE WORK IS IN PROG ESS. This is to certify, ................has permission to erect a._ ............upon the above described premise subject to tof all applicable Ordinances for the Ci of Eagan. " ~ . Per b`.'..` ` Mayor Building Inspector 07/15/2t. 1 15:01 FAX Q002 For Offio4'tIa 4 City of Eajan 1 Permit so 1 Permit Foe: i 3630 Pilot Knob Road I iI Eagan MN 55122 Date Received: I Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I L--_-------------- - 2008 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: ( -0 Site Address: I ©l I i► ~%'L~l C~ Tenant: Suite RESIDENT I OWNER Name: A4 A K a 69 Phone: Address / City! Zip:. CONTRACTOR Name: i E i rt it License q6 q q Address, (3 _4 Q O City: rI!,! 16 -1- State: ~ 1/t Zip: -5"F-0 Phone: 4t0 Contact Person: TYPE OF WORK -New _Replacement _Repair Rebuild _ Modlfy Space _ Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ / _ PVB) Main - Lower Level) Septic System Water Turnaround _ w Abandonment RESIDENTIAL FEE'S: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn Irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures, Septic System Abandonmenx, Water Turnaround' (includes $.50 State Surcharge) "Water Turnaround (add $136.00 if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES $ 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 It; that the work will be in accordance with the, approved-plan in the case of work which requires a review and approv I of plans. x /A-k/ X Applicant' Printed Na a Applicant's S ure FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground Rough-ln ,__Air Test -Gas Test -Final Municipal Notice of Well Permit Application Dakota County Environmental Management Department Water and Land Management Section 14955 Galaxie Avenue West Apple Valley, MN 55124 Tel (952) 891-7011 Fax (952) 891-7031 DATE: June 24, 2002 TO: Tom Colbert/Wayne Schwanz - EM Fax (651) 681-4694 FROM: Water and Land Management RE: Well Permit 02-H192269 Well Type: Sealed Municipality: Eagan Environmental Specialist: Olsen The Water and Land Management Section of the Dakota County Environmental Management Department has received the following permit application for the well described. If you require further review of the application or if you have any questions or concerns about it, contact the Environmental Specialist listed above or our office at (952) 891-7011. If there is no response from your office within 24 HOURS (excluding weekends and holidays), we will assume that you have no objections to the issuance of the permit. Please note that permit issuance is always conditioned on the permit applicant's observance of and compliance with all applicable state, county, and municipal laws and codes. Well Contractor: E.H. Renner & Sons Date application received: June 24, 2002 Anticipated Drilling Date: Time: Anticipated Grouting Date: Time: Property Owner: McGough Development Well Owner: McGough Development WELL LOCATION: PLS Coordinates: sw 1/4, nw 1/4, ne 1/4, nw 1/4, Sec 02, Town 027, Range 23 Street address: 1015 BLUE GENTIAN RD PIN Number: 10-00200-030-25 WELL INFORMATION: Diameter: 4 Casing depth: 205 Total depth: 209 Static Water Level: Aquifer: COMMENTS: TO-NB- 135E - - - - I INHANDL GEORGE E TO EB 1494 BLUE GB( 1015 BLUE GENTIAN CIR EAGAN MN 55121 BLUE GENTIAN CIR INHANDL GERALDINE BLUE GENTIAN R© ONAVES i BLUE WAIL ~ 1015 BLUE GENTIAN CIR N I PERMIT City of Eagan Permit Type: Building 3830 PILOT KNOB RD Permit Number: EA054267 EAGAN, MN 55122 Date Issued: 08/12/2002 (651) 681-4675 Site Address: 1015 BLUE GENTIAN CIR Lot: 3 Block: 25 Addition: Section 2 PID: 10-00200-030-25 Use: Description: Sub Type: Single Fain UBC Occupancy: Work Type: Move Building Construction Type: Description: Zoning: Census Code: 9999 Square Feet: Remarks: Call for final inspection. (ld) BL -Base Fee 75.00 9001.4085 Fee Summary: Financial Guarantee 2.000.00 9001.2257 Surcharge - Fixed 0.50 9001.2195 $2.075.50 Contractor: - Applicant - Owner: Otting House Movers St. Lic.: GEORGE WEINHANDL 11640 275th Street 1015 BLUE GENTIAN CIR Lakeville, MN 550440000 9524613265 EAGAN, MN 55121 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. Applicant/Permitee: Signature Issued By: Signature b~ - RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN KNOB RD, N MN 56122 3830 PILOT 651-681-4675 Nov CoU)rMction Reauhmenis ftmodelRteaair iteuuitaments • 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed area • 2 copies of plan (20% maximum lot coverage allowed) . 1 set of Energy calculations for heated additions • 2 copies of plan showing beam & window saes; poured found design, etc.) . 1 site survey for exterior additions & decks • 1 set of Energy calculations . Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan if lot platted after 711193 • Rkn Joist Detail options selection sheet (bldgs with 3 or less units) C) C DATE VALUATION 61 7i r SITE ADDRESS 0(~'_ 2d MULTI-FAMILY BLDG -Y N TYPE OF WORK FIREPLACE(S) _ 0 _ 1 _ 2 APPLICANT r STREET ADDRESS CITY c STATE ZIP TELEPHONE 3ZCrCELL PHONE #0 FAX # .IF o~,TO CIZ- 46 /6 PROPERTY OWNER 611" TELEPHONE # COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 _ MINNESOTA RULES 7672 (d submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: - Phone # Plumbing system includes: Y Water Softener Lawn Sprinkler Fee: $90.00 Water Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning Fee: $70.00 Heat Recovery System ~ M P_ Sewer /Water Contractor: Phone # LandA 0 F~ I hereby acknowledge that I have read this application, state that the information is co agr cowith all applicable State of Minnesota Statutes and City of Eagan Ordinances.. Signature of Appiican . OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required updated 4JD2 OFFICE USE ONLY Y- ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-piex ❑ 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-piex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi ❑ 05 03-plex ❑ 11 10-piex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-piex Plbg_Y or _ N ❑ 25 Miscellaneous ❑ 31 New, ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)* ❑ 43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C.O. - Footings (addition) _ Plumbing _ Foundation _ HVAC _ Drain Tile Other Roof _ Ice & Water _ Final _ Pool - Ftgs _ Air/Gas Tests -Final Framing - Siding _ Stucco _ Stone Fireplace _ R.I. -Air Test -Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector - - - - - - - - - - - - - - Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total OWNER'S PERMIT APPLICATION (FOR BUILDING MOVE) 0 Date of Application: 0 Address & legal description of building being moved: 0 Address & legal description of proposed destination:~ ~P ~ ~J 0 Building owner's name: ("Z address : l 7 phone T-b -1 0 Landowner's name: address: / phone If landowner is different from building owner, provide approval Arom landowner to operate on the property. 0 Indicate if structure is connected to: City sewer City water Septic 1~// Well Electric service Gas service Other (list) 0 Indicate party responsible for utilities disconnect: Owner Mover 61 Other OFFICE USE ONLY Real estate taxes/assessments on building Real estate taxes/assessments on land Utility disconnect: Electric Gas Sewer/water Landowner approval 2 1 1 RE: HOUSE/GARAGE MOVE I guarantee I will repair any and all damage to local roadways, utilities, and public right-of-way that may be damaged by this moving operation. Date By: t' ~r A .r ~ ws C I ,r 0 E re F 6 r.e . M 1 .~o J ii r K r L - VEND Tq 1 E/6NTS - , - LETeEd9¢ ~ t 994 • ;I s. wr= I - f ~~-."."x~~ %~'Y • r' ^+:•'.~yy r ■ ~ ~ J r'r ~ ~ tp ♦ . ~ mot. w 100 s wit " `w {{r w w 3 6 w ~ ~ ~ •~tl. !4 • w rte,;... r w r IS, ,17 i N {Y 1 Z d t 1+,r r ~4 n , APPLE YALLEI' I AOSE QW rs .J~o a► Y ~ .~M •r ~w r' i ~ wr A [ 0 i a i N 1 K A' L A' MOVER'S PERMIT APPLICATION (FOR BUILDING MOVE) 0 Date of Application: ~ 0 Address & legal description of building being moved: 0 Address~& legal description of proposed destination: r .r+ 1 61 0 Check situation that applies: Building presently located in Eagan - to be moved out of Eagan _ Building presently located in Eagan - to be relocated in Eagan (Requires Council approval) Building located outside of Eagan - to be relocated in Eagan (Requires Council approval) Building located outside of Eagan - to be moved through Eagan to another City. 0 Mover's Name: Address: Phone # 7_~/ (d Mn. Mover's License (submit a copy of license) 0 Highlight origin, route, & destination on current City map. If County or State roads are used, provide copy of those permits. 0 Proposed date & time of move (notify Eagan Police Department). NOTES Eagan Police rill not accompany move until time ooordination has been made with neighboring municipality. 9 /n/~ 0 0 Size & weight of structure: ki ;74 OFFICE USE ONLY Mover's permit fee Permit # Guarantee to repair 3 PERMIT L~Zo~7~o~ .161TY OF EAGAN 9~~fA5 3830 Pilot Knob Road PERMIT TYPE: B U I L D N Eagan, Minnesota 55122-1897 Permit Number: 0 2 6 3 4 8 (612) 681-4675 Date Issued: 09/07/95 SITE ADDRESS: 1015 BLUE GENTIAN RD LOT: 3 BLOCK: 25 SECTION 2 P . I . N . a 10--00200--030--25 DESCRIPTION: MAC SOUND INSULATION Building Permit Type SF (MISC.) Building Work Type ALTERATION REMARKS: FEE SUMMARY: VALUATION $15,000 Base Fee $224.75 Plan Review $78.66 Surcharge X7.50 Total Fee $310.91 ~~NNTR~CT (NT _ Applicant - ST. LIC. OWNER: O 'ON S~" INC 17846910 0008934 WEINHANDL GEORGE 9901 XYLITE ST NE 1015 BLUE GENTIAN RD BLAINE MN 55449 EAGAN MN 55121 (612) 784-6910 (612)683-0517 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, 449444-- AAPPI-MAT? /PER ITEE SIGNATURE ISSUED BY: IG TURE7~ CITY OF EAGAN 3830 PILOT KNOB RD - 55122 191 BUILDING PERMITAPPLICATION (RESIDENTIAL) sMd ♦ 2 copin of plan ;a€ _ sums; poured Add. +R 2 site sump O add &-O ft) S apt" of 0 Y"...~., DATE: CONSTRUCTION COST: -DESCRIFMON Of WORK STAMET ADMSS: LOT BLS, SUBD p.I.D. t: PROPERW Phone OWWER Afteet'Address. Mr. State: zip Y/Y~M~-II#~Rr~r ~~~I I Pt .,.i,# 1+~1~Rp ~1 ~i ~ fl~l1111#il► Comfy: Phone * lo Aiia- Street Address: Ste: ARC ' TI i - _ Nam; `hil't . eet Address' City. Stsft: zip -poor S~ ► water' #CWMd. olumber Penatty miss when a n dWiP;o'►d W d we regd anoe pe"M Is issued. j I hWeby *dm0 Abdq* 1 have ' is apploOm and soft4W + R*wmation is erect to ampy. `a# $too of Card M. Sow*" of Appftft I c4rofcat" mwy fto~ivsd Yes .,....r, No SEP Q 1995 Tree Pmwv&Wn Plan RoeWe d Yes No $ RDM P a el Foundation 0 06 DUPWX ct .11 AptJttwlg a 03 SF P, 08 519ex a 13 GarageAcogmeory, fa 26' Pubk Facs#ty a a 12-p c • a 14 Fib o 27 MWcel laneous ,0-05 8VMimc a 10 , -pleat a 15 Q _ WORK TYPE D 31 _ New a elrvitkx a 36 Move- a n o° 34 Repsir O 37 Demolition Cc (Actual) Sawmwt sq. ft. i s sy4ftm (A.Uowa#ste)Nan kvvel eq. ft. City War # raC1~ ...........Y..., + ft Fire Sptvk*W zarft sq. ft.PR'V of Stories r.y..,~,..... sq. ft. 8omter Pump i + r~th ...„w,,..... spy: ft. Ceps Gods. DWh Fo rird sq. L SAC COde APPROVALS Vsftnce Permit Fee 'Vss#u"on Surcturrge FUn Roves ms Cat SAC r WxW Conn. -wow mew sw Sure Trea►a~t Ttasffa DW. Mer Copes `Ts: z; %,SAC S Unft CITY USE ONLY (1 2 LOT i_ BL PERMIT JJ J SUBD. 9CO h RECEIPT RECEIPT DATE: lo - f 1 2000 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 651-681-4675 Date: Complete this section Alyy if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner/occupied. • HVAC: 0-100 M B T U $ 30.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets (minimum of one required @ $3.00 ea.) State Surcharge .50 Total $ Complete this section omy if you are remodeling, adding to, or reairin an existing single-family dwelling, townhome, or condo. Please indicate if it is a new item, alteration, or repair. New ✓Alteration _ Repair _ Other Furnace Air conditioning Air exchanger Other Fee $ 30.00 State Surcharge .50 Total $ 30.50 Reminder: Call for inspections SITE ADDRESS: ) 01 5 6) ~eYl ~ f Q yl ~ r• ue- OWNER NAME: e i ✓i N rd }ePHONE L51 INSTALLER NAME: - - - - - (AREA CODE) PHONE Expert Sheet Metal, Inc. (AR A CODE) STREET ADDRESS: 30 West Main St. FO Sox 90 Bethel, MN 55005 CITY: STATE: ZIP: SIGNATURE OF P RM1 1BY: CITY USE ONLY L BL PERMIT* SUED. RECEIPT* APPROVED BY: , INSPECTOR RECEIPT DATE: 2000 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 651-681-4675 Please complete for all commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit DATE: WORK TYPE: New construction Install U.G. Tank Interior Improvement Remove U.G. Tank Processed Piping When installing/removing underground tank, call 651-681-4675 for inspection by fire marshal and plumbing inspector. Description of work: Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater. Underground tank removal/installation = minimum fee. Contract price: $ x l% = $ (Base Fee) State surcharge calculate at $.50 for each $1,000 Base Fee TOTAL $ SITE ADDRESS: OWNER NAME: PHONE - (AREA CODE) TENANT NAME (IMPROVEMENTS ONLY): WAS THERE A PREVIOUS TENANT IN THIS SPACE? _ Y _ N. NAME: INSTALLER: ADDRESS: PHONE - (AREA CODE) CITY: STATE: ZIP: SIGNATURE OF PERMITTEE l~'rJ WELL RECORD Wall Owne.. and ddress VILLAGE OF E.t.GAN Well Location Section Lot Block State Licence No. Permit No. Date Dr'. ling Compaay Address Telephone Size of Well Inches 1~ Water Level / Feet t Well Depth _ 7- Feet Draw Down r - Feet apt C~G~ C=PM i Casing Depths f Feet Capacity Gallons Per/ti?.. Thickness Started Ended of Kind of Formation Color Depth Depth Formation Remarks 0C Extern Space Around Casing Sealed With: Cement Grout Puddled Clay t3 Other c~ - Disin ~r ant Used \ eft in Well i~ Driller's STLLmi at-i e RETUM THIS RECORD AFTER COMPLETION _ MASTER CARD LOCATION ' OWNER dw~ STRUCTURE AND y~ . LAND USED AS Issued To Permit No. Issued Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING s' - )-A GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION • CESSPOOL FRAMING /~~I' ( C~ TILE FIELD FT. FINAL ELECTRICAL - DEPTH HEATING OF WELL GAS INSTALLATION SEPTIC TANK ~ CESSPOOL DRAINFIELD PLUMBING a WELL SANITARY SEWER Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION OBSERVED. EVIDENCE OF NON-COMPLIANCE NON-COMPLIANCE. BUILDER DOES NOT OBSERVED. F INTEND TO COMPLY. a ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS FOLLOWS: ❑ REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTIFICATION-1 certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected. ❑ ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: 23 - /0 _ c5 o a o©- 4 30 'z ~ftceL- ~0 5 I~ u~ QAgtAn/ RCA-10 MEMO TO: RICH HEFTI FROM: CITY ADMINISTRATOR HEDGES DATE: AUGUST 12, 1983 SUBJECT: AGNES POLZIN Rich, Mrs. Agnes Polzin is the wife of the late Herb Polzin, mayor of our City from about 1971 through 1977. Agnes lives on Blue Gentian Road and is concerned about 1) dust control and 2) would like to know who owns her old farmstead, across the street from which the Johnson Brothers are providing fill for that property. I would like for you to check with Bill Branch to determine whether Blue Gentian will be given an application for dust control and secondly, research the current ownership of her farmstead through Special Assessment or some other means of property description and I will get back to Agnes with the information. QV4 City A ministrator TLH/kf For Office 7 Use 1 Cit of Eapn I Permit I I Permit Fee: I Y I i 3830 Pilot Knob Road Eagan MN 55122 d I Date Received: Phone: (651) 675-5675 -6 1 1 Fax: (651) 675-5694 staff: 2008 RESIDENTIAL BUILDING PERMIT APPLICATION a - og s Date: Site Address; Tenant: V GAt rt,. - Suite RESIDENT/OWNER Name: /'/C ~ov~~t On'I,GL^~nn°.S Phone: f~ 5 6 3y- ~7'I Address / City / Zip: d ? 3 Applicant is: caner contractor TYPE OF WORK Description of work: DF%~Ial ~iQ/t Construction Cost: Multi-Family Building: (Yes - / No ) CONTRACTOR Name: T'r /`t fit- r` License Address: _ 3LlUl 140y SS City: 4 ')State: Ma Zip: 5 467* Phone: & 3-/ --/V 73 $-a Contact Person: / r 0 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 (4 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 subriit are considered to be public"inforrriation. 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. 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. Applicant's Printed Name Applicant's Signa Page 1 of 3 i