1724 Bluebill DrCITY OF EAGAN Remarks
Addition 7,'OWNVSEW TOWNHOUSES Lot 6 Blk 6 Parcel 10 77100 060 06
Owner Kf'?? rakh Street 1724 Blueb9.11 Drive state EitQan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. S$ 1975 141.08 14.11 ZO ?.?
STREET RESTOR.
GRADING
Street 1009 1986 200_75 20.07 10
SAN SEW TRUNK
* SEWER LATERAL 1973 1,429.03 476.34 3
WATERMAIN
* WATER LATERAL I973 3
* WATER AREA 1973 3
* STORM SEV1k ; TRK_ 1973 3
* STORM SEW LAT 1973 1 3
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
13UILDING PER.
SAC
PARK
i
CITY OF EAGAN Remarks v
Addition TOWNVTEW TOWNHOUSES Lot 5 BIk 6 Parcel_ 10 77100 050 06
OwnerTE" ? S?Gd Street ?.726 Bluebill Dr?i.ve state E`'ag'?? M? 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1 Sg 19
75
141.08
14.11
10
j
STREET RESTOR.
GRADING
2treeL 1009 1986 200.75 20.07 10 06, 5 el-16l0911 /0-p-??
SAN SEW TRUNK
SEWER LATERAL 1973 1,429.03 476.34 3
WATERMAIN
* WATER LATERAL & !3tLib3 1973 3
* WATER AREA 1973 3
* STORM SEW: TRK Q 1973 3
3F STORM SEW LAT 19?3 3
CURB & GUTTER
SIDEWALK
STREET lIGHT
WATER CONN. ,
BUILDFNG PER.
SAC
PARK
CITY OF EAGAN Remarks
Additi Z'C)WNVIE?1 ''OWNHOUSES Lot 4 Bik 6 Par?l 10 77100 040 06
Owner?CLmArj. a. Les+FY" Street 1728 Bltlebill Dr3.ve scate Eagan' MN 55123
--D6wid P. ?,Sl?Gt,Y"w} ?- Srn4h 1Zp1 (X&t1 I.?.?' E'") iEU r, ?, 3??
Improvement Date Amaunt Annual Years Payment Receipt Date
STREETSURF, A,11 SB 1975 141w08 14.11 IO Qat CA
STREET RESTOR.
GRADING
Street 1009 1986 200.75 20.07 10
SAN SEW TRUNK
* SEWER LATERAL 1011 1973 1429.03 476.34 3
WATERMAIN
* WATER LATERAL+-,74,j Z??? 3
it WATER AREA 1973 3
t
* STORM SEU?: TRK 1973 3
* STORM SEW LAT 1 3
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BU(LDING PER.
SAC
' PARK
i
CITY OF 9AGAN Remarks
Addition `I'C)WDNIENI '.['OWNFiOUSES Lot 3 Blk 6 Parcel
Owner :L,v 6•`?(WeA Kka5S-6 street 1730 Bluebill Drive stace Eag?
Car()lGJh h??J_.v?kOsh
23
Improvement -
Date
Amount
Annual
Years
Paymem
Receipt
Date
STREE7SURF. •' S$ 1975 141.0$ 14.11 ],Q
STREE7 RESTOR.
GRADING
Street 1009 1986 200.75 20.07 10 pp. ,5- C'-16 p
SAN SEW TRUNK
* SEWER LATERAt (% 1973 1, 29.03 476.34 3 ?
WATERMA W
* WATER LATERAL & StLibS 1973 3
' * WATER AREA 1973 3
* STORM SEW4 ?? 1973 3
* STORM SEW LAT 1973 3
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUfLDING PER.
SAC
PARK
CITY OF EAGAN Remarks
Addition TOWNVIEW TOWNFiOUSES Loc 2 Bik 6 Parcel 10_ 77100 020 06
OwnerlaA?nL!S M. ?, ?1'(.t.{?U&,lOVd Street 1732 Bluebill ".Drive State Eaq?, MN 55122.°:
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF, Allt g,g, 1975 141.08 14.11 10 Rtei
STREET RESTOR. ,
GRADING
Street 1009 1986 200.75 20.07 10
SAN SEW TRUNK
+k SEWER LATERAL ? 1973 1 $29.03 476.34 3 6
1
WATERMAIN
* WATER LATERAL & 3tL1TJ 1973 3
* WATER AREA 1973 3
* STORM SEV1F". TRK 1973 3
iE STORM SEW LAT 1973 3
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
;
CITY OF EAGAN Remarks
addicio TQWNVTEW TOt?NHOUSE5 Lot 1 Blk 6 Parcel 1.0 77100 010 Ofi
Owner?Street 1734 Bluebill Dx1Ye State Eagan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 361 S$ 1975 141.08 1$.11 10
STREET RESTOR.
GRADING
Street 1009 1986 200.75 20.07 10
SAN SEW TRUNK
I * SEWER LATERAL 1973 1N429.03 476.34 3
WATERMAIN
* WATER LATERAL & St1IbS 1973 3
* WATER AREA 1973 3
* STORM SEW.TRK 1973 3
jEISTORM SEW LAT 1973 3
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
?
INSPECTION RECORD C°ntr°'
I "°.
CITY OF EAGAN PERMIT TYPE:
' 3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date lssued: 04/28/92
(612) 881-4675
' SI'fiEADDRESS:
' 1734 SLuE"11.t. OR
. 'f` ?".??3#V 1t X ?" ?+1 1 ST
PE??
APPLICANT:
k4AW;F:' C't? NST INC. J 6
439-0189
TYPE OF WORK: FtLI,??lft
?, RIFHARVr:; RV-..#MOUT"a
PermR ido. PermR Hoider Date Telephone #
SMI
PLUMBING
HVAC
ELECTRIC '
ELECTRIC
inspectlon Date Insp. Comments
Footing5l
Foundation
Framing
Roofing
Rough Pibg,
Rough Htg.'
Isul.
Fireplace.
Final Htg.
Orsat Test
Final Plbg. Ptbg. inspector - Notify Plurnber
Const. Meter
Engr./Plan
Bldg. Final
Deck Ftg: ;
Deck Final
Well
Pr. Disp.
?? A A.* lr
?- ,
AMPAO 23-000 50 SHT. PAD
ffFICiENCYO 23-001 250 SHT. DISPENSER BOX
i
?
T
Dete Time
w"iLE vou WEFa
?
?
o
,,? ??l x-? Z l L?:-
K
Phone
Area Code Number Extension
TELEPHONED EASE CALL
CALIEO TD SEE YOU WtLL CALI AGAIN
WANTS TO SEE YOD URGEhlT
I RETURNED YOUR CAIL
? 2 ?
see a
p
b * (
tk I T ( Lr
nne
$n .
,
,
a2I 06'V>C.jv, ?r4 ?4 `io ? kz
a E ? ? -? t?,? - ? vti? ,?c C? ? I ff ? ?ri P,?
I, U1'Y?-
0 etator?
.?
?
.:• ;
. ,
CORRECTION NOTICE ?
:,?.....- ?.? DATE:
Address Site Name
Owner/Agent Telephone
Owner/Agent Address
Ordinance Nos. and Corrections - Correct By
`
. w ,
,
,
0
For reinspection
Eagan Dept. of Inspection InSpeCtOr:
3795 Pilot Knob Rd.
Eagan, Minnesota 55122
454•8100 Dept.:
Btd;Feb._18. 200$ 1:22PM Crest Exteriors
7197q
No.8400 P. 1
2006 MSIDENTIAL BUILDING PEftMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5575 FAX # 651-675-5694
N R
3 tepisiered site sunteys shorrinA sq. ft. of lot, sq. fl. of hou59; and W! I'oofed areds
(20gy max+mWn fat carerdge albwed)
2 copes of pkan Showin9 b8dm & window sizes; poured tound design, etc.
1 setaf EnergY Galwlanons '
3 cooe5 0( Tree PressrvatiOn Plan I lot PletWd after 711193
Rlm JeiSR DeWl Optlons seWtUon shesf {buWdirqs w+th 3 or less unlts}
Minnogasca mechanical ventilation £orm
COMP6ETE TNIS AREA P-MLY lF CONSRUCTING A NEM BUILDING
Minn sota ules 7 02
i sot ule5 70 te o 1 + . New EnergY Code Wor9csheet
Energy Code Category ?. Resiclenlial vgMiletion Ceteg°ry 1 W4rkSheet Submitled
(.? submisslon lype) Submltted
• Erergy Envelope Cdiculalions Subrnlned
In fihe tast 12 mOnlhs, has tne City of Eagan issued a permit tor a simifar plan based on a mastef plan?
y y N If y6s, date and address of masier plan:
Licensed Plumber
Mechan;cal Gontractor
Sewer/water Contractor
r ir
2 coes of plan showii+g kn6ngs, b9ams, l0ists
t set of Energy Cakuwions tor heated adftons
i sit& survey }or additials 8 decks
AdgflOa • irrrkC6fe!(on-* septiC sysfem
?--1?
Telephone # ( )
TelephQne # ( )Tetephone # ( and I hereby apply for a Residential Building Permit and ackr?owledge that the infarmation is co??l?he Statecofrat?e'
that the ve+ork will be in conformance with the ordinances and codes of the City of Eagan
Statutes; I understard this is not a permit, but only an applicat?an in the ca se of work which requ res a revi w? ar?d
permit; that the worlc will be in accardance with the appxoved P
appXOVaI of plar?s.
1 J ._ i it r_ r n, l.. .-, Q?C Y? ?/?5?4`?J 1? Y? ?} O?.?l.i V
6sco UW?
Gert Of Sune]t (?d
Tree`PresP?.?d -Y _N.
Trte Pr1s Re4W?? ;'- Y -N
Of?SePtiCSy?+? ,Y' -k
-4 tn I
•
Appli nt's S+gna ure
Appli t's Printed Name
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
? City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694 ?-
_
New Construction Requirements Remodel/Repair Requirements Q?flce E?s? l7?ilu
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan C?rt ?at` ?rxite? Reed _ Y_?i
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pies P(an Recd ,.;'f ?J;
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks TreePres FZeqd
1 set of Energy Calculations Addition - indicate if on-site septic system fln-siEe;Ssplic Sysfem ,,:;:, X , N;
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 a? / ?6( Construction Cost
Site Address Z ! ,; --,? Unit/Ste #
(??
Description of Work
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner Telephone # ( 7'S-Z) 7Z Z°- .:E572 5?
Contractor
Address ? ZcJ t5L7 City ?? l ?
State Zip ,S_ .5 //!!;7 Telephone # (6/Z ) TK/
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categor? Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
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
Mechanical Contractor
Telephone # (
Sewer/Water Contractor
1 r- ??
eNlqV o
?
I hereby apply for a Residential Building Permit and acknowledge that the{'? b and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application far 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.
,
.?
pplicant's Printed Name Sig ure
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex [3 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex O 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
13 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea. ) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screeNgazebo) ? 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
? 31 New ? 35 Int Improvement ? 38 Demolish Interior 0 44 Siding
13 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
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Fina1 _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wa11
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Perrnit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
. 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomes/condos when permits are required for eaeh unit
Date / 1L-'
- I
.
r
Site Address Unit #
Property Owner v 1 `_- ?.(r o Telephone # I ) L-E? 0 -
Contractor
Burnsvilie Heating & A/C, LLC
Street Address 12481 Rhode Island Ave. So, City
State avage, N 55378-1122
Zi
Tele
(
hone # ci L
p p .
Bond #: Expires: ZS ? tC', `(-)q
The Applicant'is Owner ? Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace _Additional Replacement
air exchanger
? air conditi oner New ?Replacement
other
h
St
t
S $ .50
urc
a
e
arge D
Total sa,?
By
I hereby apply for a Residential Mechanical Fermit 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
pernut, but only an applicarion for a pernut, and work is not to start without a pernut; 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 7
L__j r'?C?, ? ??'Sr'll?C..r7 Yz La...
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 I
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 ? Instali Piping _ Processed Gas
Nature of Work:
**When installing/removing underground tank, call for inspection by Fire Marshal' and Plumbing /nspector
PeClrilt Fees: $70.50 Underground tank instal}ation/removal
$50 .51? Mir.iinum (includes State Surcharge)
or
ContractValue $ x 1% _ $ PernutFee
• If )i ermit fee is $1,000 or less, add $.50 ? $ State Surcharge
If permit fee is over $1,000, add $.50 for
every $1,000 nernut fee $ Total Fee
1 hereby apply ior a Lommercial Mechanical Permit and acknowledge that the information is complete and accurate; that'the work
will be in conformance with the ardinances 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 pernut, 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 pians.
Applicant's Printed Name Applicant's Signature
Approved By:
; Inspector Date:
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
/r3,75
New ConsUuction Requirements RemodeVReoair Reauirements €1J
3 registered site surveys showing sq. ft of lot, sq. ft of house; and all roofed areas
2 copies of plan _
Cerk o f $?l}?Ctl ?, :_ Y..._ ?1
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heafed additions T?'8e Pfps t?Rb6tl 0?' _Y;,N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks firee Pros Fkequired
1 set of Energy Calculations Addition - indicate if on-site septic system O"ite SeptPG Sotem
3 copies of Tree Preservation Plan if lot platted after 7/1I93
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
A j/.A_
Date 13
SiteAddress 7 3 y
, crmlv, 06
Construction Cost
13 /?re.k'I/ ZW ,Ak- Unit/Ste #
Description of Work 7°t? Rc "° koo 'F
Multi-Family Bldg ?!C Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner _/I'a/)G/Q ! zftn'-r"" Telephone # ( )
Contractor ?•? ?? ?h ? +'? ?'' /?,C ?.?
Address yd i "I G?. i'0
State AN? City
Zip ST?// 17 Telephone # (01 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Ru1es 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previousiy constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
IJA v) d J', ZA
Applicant's Printed Name Applicant' Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dweiling
? 03 01 of _ plex
0 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 07 05-plex ? 13 16-plex 0 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
0 09 07-plex ? 97 Garage ? 22 Porch/Addn. (4-sea.)
? 10 08-plex ? 18 Deck ? 23 Porch (screeNgazebo)
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building O 42 Demolish Foundation ? 45 Fire Repair
O 33 Alteration 0 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of B1dgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundarion 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:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
60,?L MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
0j6`.5-D
Date 7 / ;2,;t, / d F7
Site Address ? -7•2 6 -- r?C?.?t,l, ZW Unit #
Property Owner oln ?
? Telephone #
Contractor J p 4, 7 ?Get2
Street Address /o go ? " ???1- pp! ?? 6 ? ,/lt°- City ?lD?'? ?
State ? rl, Zip Telephone # (95:rL
The Applicant is Owner ? Contractar Oth er
Add-on, modification or aiteration to existing dwelling unit $ 30.00
? furnace replacement
_ air exchanger
air conditioner
other
State Surcharge $ .50
Total $ 50. Sr-b
I hereby apply for a Residential Mechanical Pernut 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
pernut, but only an application for a permit, and work is not to start without a pernut; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
R0 be. rr 6? S1 Cf . P,r"t K 2A4j
Applicant's Printed Name Applicant's Signature
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date / /
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner ':;,,eph:,ne
Contractor
Street Address City
State Zip Telephone # ( )
The Applicant is Owner Contractor Other
Work Type
New construction Underground Tank Insta
;; . Rer p 't
,
_ Interior Improvement ,
,
Call for inspection-during ins4aliition/romoval 0 j nk
_ Processed Piping
Nature of Work:
NV`
Permit Fee $50.50 Minrmum Fee (includes State Surcharge)
?
Contract Value $ x 1% _ $ Permit Fee
• If pernut fee is $1,000 or less, add $.50 =:I $ State Surcharge
If pernv.t fee is over $1,000, add $.50 per
$1,000 Pernut 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 pernut, but only an application for a pernut, and work is not to start without a pernut; 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:
?
MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
Date '7
Sit
Add
? C ?
` ? ?
e
ress
. Unit #
?
Property Owner
Telephone # (g?a, )
? 9 t ' ?? / I
Contractor
24260 Gi•eenn aiy Ave, Siaite F
Street Address Fpi'est Lalhe, MN 55025 City
Phone #: 651-982-2626
State Telephone # ( )
The Applicant is Owner _KContractar
\ Other
Add-on, modification or alteration to existing dwelling unit $ 30.00
/
r? furnace replacement
air xchanger
air conditioner
other
State Surcharge $ .50
Total R? ? -
I hereby apply for a Residential Mechanical Permit and acknowledge that the informatic
be in conformance with the ordinances and codes of the City of Eagan and with the Me
pernut, but only an application for a permit, and work is not to start without a permit;
approved plan in the case of work which requires a review and approval of plans.
0 ? ? r
HvU U 5 LUU3 I? II ?I
complete and accuraat the work will
ical Codes; that I under and this is not a
i?rdance with the
Applicant's Printed N-a-me
MECHANICAL (COMMERCIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: commercial/industrial buildings
multi-family buildings when separate pernuts are not required for each dwelling unit
Date
Site Address Unit #
Tenant Name (if appiicable) Previous Tenant Name
Properfy [?wner Telepiione # ( )
Contractor
Street Address City
State Zip Telephone # ( )
The Applicant is Owner Contractor Other
Work Type
Newconstruction UndergroundTank _Install _Remove
Interior Improvement Call for inspection during installation/removal of tank
Processed Piping
Nature of Work:
Permit Fee $50.50 Minimum Fee (indudes State Surcharge)
Contract Value $ x 1% _ $ Perxnit Fee
• If pernut fee is $1,000 or less, add $.50 ? $ State Surcharge
If permit fee is over $1,000, add $.50 per
$1,000 Pernut Fee
$ Total Fee
I hereby apply for a Commercial Mechanical Pernut and aclrnowledge 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 pemut, but only an application for a perxnit, and wark is not to start without a perxnit; that the work will be in accardance 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:
AGGRESS L
OCCJPANT
HEA T
, LOSS
SOLD BY .5?4 a
Etectricol Work By
TYPE OF HEAT
DA;E?
t
GA?FA
HCUSc
?.. `.?
,
TG ; ST.
et orofoo, I
HW
H EATING i ESi RECORD
' x
APT. FLCOR CiTv SUBURBC?'??
D'NN E R
'? -
lNS7ALLED BY C???..?-?-
STEAAA
Gas Lino Sy
SPAC: HT;1. UNIT HTR. OT}1ER
GAS DESIGN CONVERSION ?MAKE MAKF OF?BURNER Mod. f
lulodel ? O
so.ioi ? 5 ' i13n? Max. aTU Ratin9
!NPlJT f:zt L?- . MAKE OF FURNACF
Model
CONTROLS ?t . . -_. _.
?HERYOSTA Mw: Pt.g Ywt 51&* ?
Vatw KIND OF
L:mts
` Drafs 9iood
a
t.imi: s.ttma -
? Ftt:.rs
?
Faa SRttfap ?I&<-? GaLwy L"as"
?..K G+isws
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eIbe s„p•
Pl1at IIQb mJ
Ptlat 14o"
Ptiat Tlwtos
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9
o
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?-- ? EAGAN TOWN S H I P
BUILDING PERMIT
Owne: ----1!L.[r-/t°(.e-q*i -------- Ak-Op-...... C71P -•-•----•---•--------•
..
Address (Present) .e..,,?.1 ------- -4-...... nL!?..-••ZIOrD
Builder --.............................................................................
Address ..............................................................................................
DESCRIPTION
N° 2933
?
Eaqan Township
Town Hall
Da3e..1A-_Z.,9."..7k . .............
53ories To Be Used For
Tow'R,I flocls-? Fron! Depth Heigh Es Cos! 'Permi! F e
r?,?r 77 Remarks
S v
?
'?SL? 7 7
This permi2 does not auihoriae the use of streels, :oads, alleys oz sidewalks nor does it give the owaes or his agant
the sigh! 3o create any situa2ion which is a nuisance or which presen3s a haaard !o the heallh, safety, coavehience aad
general welfare !o anyone in the communily.
THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IDd PROGRE /
This is 2o ceriify, ihai..,tjrl.e..i-:.,a_b,..... i!¢o?•-•---. Gr.a.•-•--...has permission !o erect..e..??.91;???LQ. .eI.................. ..upoa
the above described premise subject !o the provisions of the Building Ordinance for Eagan Township adopled April 11,
1955.
, ? /,
?. .... ._...?t... _.__.?•---•...•-••-•••--.._..:...•--. Per <\`71r??•-- :J .• •-- - . ........................
- --
Chairman of Tnwn Board BuildinQ Iasp?etor
' PERMIT : ?I,,'',,,,,,.` ?o trol No. 0312
-?
?
CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: BUILDING
Permit Number: 000351
Eagan, Minnesota 55123
(612) 681-4675 Date Issued: 8 4 j 2 8 j 9 2
SITE ADDRESS:
1734 B1.UEBILL oR
L.OT s 1 BLOGK : 6
TpWIV VIEW 1ST
DESCRIPTION:
wzscELLaNEous
REPAIR
R-3
p
, e• ? m
E ? ve r ? _
40,
A-TH
? ree a?`? Iw e?m m? HE,
, m
REMARKS:
RE-ROOFxNG
INCLUDES 1732, 1730, 1728, 1726, & 1724 BT.trF3IL.L. DR
FEE SUMMARY:
easg Fes $90.00
5urcharge $.58
Total Fee $90.50
CONTRACTOR: - Applicant - S7. I.IC. OWNER:
HAUSf CONST INC, J G 24390189 0005350 TOWN VIEW ASSOC
1034 EAC,LE RID6E CIR 1771 FLAMIN60 DR
STILLWATER MN 55082 EAGAN MN 55122
(612) 439-8189 (612)688-6247
APPLICANT/PERMITEE SIGNATURE IBSUED BY: tIeG UR u
INSPECTION RECORD Control No. 0312
CITY OF EAGAN PERMIT TYPE: sUILDINCa.
3830 Pilot Knob Road Permit Number: 098351
Eagan, Minnesota 55123 Date Issued: e 4 I 2 8/92
(612) 681-4675
SITEADDRESS: LOT: 1 BLOCK: s APPLICANT:
1734 BLUEBILL DR HAUSE CQNST IhtG, J G
TOWN VIEW iST (612) 439-8189
PERMIT SUBTYPE: TYPE OF WORK:
MISCELLANEOUS REPAIR
INSPECTION .. . DA
REMARKS: RE-RQOFING
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site turveys, l copy of energy
. ' calcs.
COMMERCIAL 2 sets of architectural & structural plans, l set of
specifications, 1 copy of energy calcs.
Penalty.applies when typing of permit is requested, but not picked up by.last aorking day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date Ou not„? Yaluation of work
Site Address: i2 -1 L). Cl? U?
STREET STE #
Tenant Name:
Lot sLaK ? s?c. TOWN V7EW IST P.I.D. #
A-DT)t Tt0
Descri tion of work:
The appl i cant i s t ? Owner ,?Contractar O Othar cDoscribe)'
- Z y`1
. Pt?one L?t _ C?
Name ?C 7 2 ]1?? t 1 '? ? ?L? ?C
Property ,
LAST FzRST . ?
. Owner ?
Address ? ? ?\4,M i &tan 71k
STREET fTE #
?
C i ty F ic:44Ki State M!? Zi p
Company c? c V\4h ?NGPhone L}??=b 1?°1
C011t1'BCtOt' , -.
Address Wii-s?rp 'e,:VO-6ticense #r Exp :1 311
Ci ty cy? 151E S?._ State Zi P
Company Phone
Architect/
E11git1Ee1' Name Registration f
Address
City State Zip
Sewer & water licensed plumber : Processing time far
sewer & water permits is two days once area as been approved.
I hereby'acknow1edge that I have read this application and ?state that the infarmation is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan OrdinaRCes. _
Siqnature of APPlicant: . .. •
*Aorr;vrm 4wac vnti.;•
BUILDING PERMIT TYPE
D Ol foundation C] 05 Apt. 81dg D Q9 8asem*ent finish :D ? &c.
- 13 02 SF Dwg.
? O 06 6aragefAccessory Li 10 Swim Paol E3 14 Asricuitural
C] 03 TWO family O 07 Fireplace E3 12 Res. Add.JParch ? i3-Misceiaaneous
t3 04 Mul ti-fam. ' T. H. D 08 Deck 12 Com. JInd. M " -
woRK rrPE
D 31 New 34 Repair D 37 Demoi ish
D 32 Addition ' D 35 Tenant Finish D 99 Undefined
? 33 Alterations L'I 36 Move -
GENERAL iNFORMATiQN ?
Const. (Actual) 6asement sq. ft. 14WCC 5ystem
(A1l owable) lst fl. sq. ft. ? City Mater
UBC Occupancy 2nd F] . sq. ft. . PRV Requi.red
Zoning Sq. ft. total Booster Pump
# of Stories Footprint Sq. ft. . Fire Sprinkler
Length On-site we1l Census Code
Depth On-site sewage SAC Code
I, APPROVALS
:
.
_
Planning 6uiTding Assessments
fngineering Yariance
.
REQUIRED INSPECTIONS R?J?I?RKS: *Rr-_:R00
F:1 NCt
? Site ? Faoting ? framing . E3 insulation
? Mallboard O final [3 Orai-ntiie ? fireplace
Permit Fee
Surcharge
Plan Review '
license
MWCC SAC
City SAC
Water Conn`. `
Water Meter
Acct. Deposit
S/W Permit
SjW Surcharge
Treatment Pl.
Road Unit
Park-Ded.
Trails 0ed.
Copies
Other
Total:
SAC %
SAC Units'
? CITY OF EAG,AN
- 3795 Pilot Kno'o Road
EaE,an, IVIinnc.-ota, 55122
PEFT NOo > 437
The City of Eagan hereby grGnts to Summit Plumbinq & Heatinq Co., Inc.
of 712 No. 21ing Avenue, S.':. 1 55104
a PLCM331'? ? Permit for: (Owner)
24 Perini*s
ac _ srr .-1TTA?7;17-71pursuant to af,plication dated ^/?'
Fee Paido $13';. dated this = da,y of , 19 74 ,
12.00 s/c ,
STJMMjT PLUNiBI*1G CO. - PLI7P4BI^1G PF:RI'"ITS
r
Bluebill Drive - 172E 20,50
1728> 20.50
]_730 20.50
1732 20.50
1734 ?_0.50
Flamingo Drive - 1740 20,50
1739 20.50
1741 20.50
1743 20.50
1745 20.50
1752 20.50
1754 2.0.50
1751 20.50
1753 ?_C1.50
1755 7n.50
1757 20.50
1760 20.50
1762 ;?p.5n
1764 ?0.50
1766 2n.,n
Golden Hill Terrace
3762 20.50
37ti4 20.50
3768 ?n.50
3782 20.50
Total --------------------------------- ???._?
----------- . 00
LJ( , ?;
?
(! ? ( (
?
?
t / L41?
n
_._._-... . . ... L' (??'
? ?i<
l b
CITY OF EI?irAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PM1IT N0. a 1132
The City of Eagan hereby grants to nonal ,? son -rlcConr,ick ro.
of _ Fr"t T•.,-,rlhIr *ve ^r 1' n^t»- 12207 Mp1s. 55419
a P:6f?F Peri7;it for: (Owner) MA1?TT?? r?Yl.+?..?.C1T-a??, ..?*
- - '?3??VG :
174o c 1?5n F1.aiei.ru,o, 172?:•-7_7,3?-1l?n._1_7?1''--17??i
-tt P1*4.e1q-j. 1-1 , pursuant to application dated 3Zr,f74
Fee ?jj* , 0p.0-- 7 p * e dated this 5th day of March ? 19 74.
?BILLED 3.50 s.c TOTAL AMOUNT DUE $,z3.ii1 '
13uilding Insbectvr
:%iechar_ical Per:nits;
iiia '1'of;al;
_ . ?
, _.r.
CI'IY OF EAGATQ
3795 P11.Ot KTi01"3 ROad
Eagari, IvIirnesota 55122
PERi,iIT NO a c 48o
The City of Ea,gan hereby grants t?Q, ??nrE=r t5or 1nc
of
Permit. far: (Owner) M?,ni oToo??',o?,:s c -
a _^^n ? T_:: ?
at Ao }tarhar? ,L??ting , Pursuant to application dated 4/4/`-r21_
Fee Paide dated tY1isl7th day of pa,? i"; 19 7`?
1t3.5C) s/c
Building Inspector
BINDER SHEET METAL - HEATIPdG PFRMTTS
Flamingo Drive - 1728 20.50
1730 20.50
1732 20.50
1736 20050
1740 20.50
1739 20.50
1741 ?_(7.50
1743 20.50
1745 20.50
1750 20.50
1752 20.50
1754 20.50
1756 20.50
1749 20.50
1751 20.50
1753 20.50
1755 20.50
1757 20.50
1759 20.50
1760 2.7.50
1762 20.50
1764 20.50
1766 20.50
Golden Hill Terrace
3762
3764
3766
3768
3778
3780
20.50
20.50
20.50
20.50
20.50
20.50
? 20.50
20.50
TOTAL ------------------------------- $758.50
C;?TY tJF EAGl?l1
3795 Palot Knab Raad
Eagan, 14inncsota 55122
PET1,:I`I' NO o > 4 9 G
''i?he City of Ea:;an hereby brants to e';7n,.:;truction Co.
Of 1710 r^laininefa ?r_ive, "a.ga.n, 55122
a l;f-'ATIr-r, Permit for: (Owner) Manita
at _ igt , pursuant to appiication dated 4/1'74 .
Fee Paid; nn _ dateci this 17th da,y of Api: i.l , 1g %4
6. 50, s/c
.,w 1`4v
MANITO - DIMENSION CONSTRUCTION CO. - HEATING PEFtMImS
Golden Hi`11 Terrace
3760 20.50
3770 20.50
3776 20.50
3784 20.50
3786 20.50
Flamingo nrive - 1726 20.50
1738 20.50
1.742 20.50
1737 20.50
1747 20.50
Bluebill Drive - 1724 20,50
1740 20.50
1742- 20.50
Total ------------------------------------------ $266.50
w
a
-AVhGE oF EAGAN ._.._?,.? . _
WATER SERVICE PERMIT
3795 Pilot Io8 Rood PERMIT NO.: - 1426
Eagon. MN 55122 DATE: ___ 4 5?4
Zoning: No. of Units: 2
Owner: Manito
.
'Address:
Site Address: -1734-1732 Bluebill Drive_
Plumber: DgRjkik -St1mit__P_1uIIlY.tirig__
? Meter No.: Connection Charge?40.00 pd 12/314
Size: AccounC Deposit: ?
Reader No.: Permit Fee: _-1(?,4-Q-Pa._414
I agree to comply with the Yilluge of Eagon Surcharge: _ .50 pd 4/4
Ordinances. Misc:. Charges:
Total: _._
gy _ Date Paid:
Date of Insp.: Insp.:
-1?L11k oF EaoaN SEWER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.: 2185
Eagon, MN 55122 DATE: _ 415174
Zoning: R'4 No. of Units: _- 2_tOWrihOUS2S
Owner: Townv].ew
Address:
? Sice nddress: 1734-1732 Bluebill Drive
.Plumber:
1 agew to eompir wlth tba Vlllage of Eogon Connection Charge520.00 pd 12f
Ordinanees. Account Deposi?:
Permit Fee: ? p
Surcharge: ' p
BY: Misc
Char
es:
.
g
Date of Insp.: Total:
Tnsp.: Date Paid:
cI oF EacAtr ,
WATER SERVICE PERMIT
3795 Pibt Knob Road PERMIT NU.: _1413 .
Eagon, MM 55122 DAT'E;
`
Zoning: -_-.R-4.------___ -.-- No. of Unitsi .?2
? .
Owner: Mdnit o-- ---.?._
jelt?/77-
N
Ad
ress:
1724-{172 Blueb
i 1 Drive
Site Address: _
Pluinber: ? ?nd1dS MCCOY'itllCk
Nteter No.:2,3261157 (1724) Cminechon Chargg.40.0"d 12/31
Sire: -- -5/8 R[lClt _ Acc'ount Ueposit:
He.ider No.: --532090------- - f'c>rmit Fee:bi11@d-$1Q_.04
1 agree to eomply with the Villoge of Eayen Surchargc: blll@Sl $___ - 50
o.dana?? .
? J? naba.ltL?daMetez_560,00_ _._______
?^?Pg?perhQrn.?.•_50billed
BY t.t.?-!!`l2
-_ _ -- f?4?ute t'aid:
?
1)ate of Insp.:
_ Insp.; -
....... , a,.,.
?
V41'•? flF EaGAN
WATER SERVICE PERMIT
3'I , r'i ot Knob Rood' PERMIT NO.: _ 1425
Eagan, MN 55122 DATE: ___ -}f 5174
Zonings R-4 No. of Units: 2
Owner:
Address: L ;
Site Address: --172-$-173S1 $luebill--D.rive--__-
Plumber: ' u-Inm'lt__Pltunbing
Meter No.: Connection Charge: 240 s.00 pd 17.13;
Size: Account Deposit: -
Reader No.: E'ermit Fee:
1 ogref to comply with the Village of Eagan Surcharge; . 50 Ad 4/4
Ordinonces. Misc. Charges:
TotaL•
gy Date Paid:
Date of Insp.: Insp.:
vILCaROM 0 AoAN SEWER SERVICE PERMIT
3795 dot Knob Road PERMIT NO.: _ 2184
Eagan, MN 55122 DATE; 4/5/74
Zoning: R-4 No. of Units: 2 tflWrihOL1SeS
Owner. TOWYIVIG'W
Address
site Address: 1728-1730 Bluebill prive
12&; surnm].t Plumbing
Plumber:
I agroe to comply with the Village of Eogon Connection Chazge520. 00 pd 12/31/2
Ordinances. Account Deposi :
? 0-,,," -3?To-yo977D
Insp.: Pernut Fee: ? p
By:
Date of Insp.:
Surcharge: _ p -----
Misc. Charges:
Totai: _
Date Paid:
13 <
nuaoE oF E?oAN SEWER SERVICE PERMIT
3795 Pilot Knob Roud PERMIT NO.: _____'?167?
Eo9on. MN 55122 DATE: 3/Sj74
Zoning: No. of Units: 2 tOW2'1hOUa989
Owner: __T4myi eW
Address:
site Address: 1 2 1 26 :.Bluebill DY'iVe
Plumber. _ Dori81d8ori MCC02IItfCk
1 ogr" to complr with tfie Vfllo" oi levn Connection Chazgt520nn nA 1/?1/3
Ordinonus. ACCOUnt De
posis.0. 0
Permit Fee: ? P W72
1 Surchazge: • _0 Pd
?y? ------ - ------ ---? Misa Charges:
Date of Insp.: Total:
Insp.: ---------- _--- - Date Paid: ?
0
i
?
CITY USE ONLY
L ? BL ? RECEIPT#: SIS6 2
SlJ6D. DATE: / o? .?
1995 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unif
FIXTURES
EACH NO. TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
Kitchen Sink 3.00 x =
Laundry Tray 3.00 x -
Hot Tub a 3.00 x =
a er ti"ea er 3.00 x =
3:00 x -
Gas Piping Outlet * minimum - 1 3.00 x =
Rough Openings 1.50 x =
Water Softener 5.00 x =
Private Disposal * Dakota Cty. license 20.00 =
U.G. Sprinkler * home under const. 3.00 =
Alterations * to existing 20.00
Water Turn Around 20.00
STATE SURCHARGE .50
. TOTAL 7L 50
LUNC? DAVE
SITE ADDRESS:_ 172?, Pi_saEBELl_, ORi 4aE
EAGAN , a? i??
OWNER NAME:- ? 688?26120 w
INSTALLER NAME
STREET ADDRES
CITY: STATE: Z1P: -
PHONE #: (
f ' 2'2 "91(7r? E OF PERMITTEE
??
CITY USE ONLY
L BL
SUBD.
RfCEIPT #:
DATE`
1995 PLUMBING PERMIT (GOMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? all commercial/industrial buildings.
? multi-family buildings when separate permits are J]o# required
for each dwelling unit.
DATE: CONTRACT PF21CE:
WORK TYPE: NEW CONSTRUCTION ADD ON REPAtR
DESCRIPTION OF WORK:
FEE: $25.00 minimum fee or 1°l0 of contract price, whichever is greater. State surcharge of $.50 per
$1,000 of Rermit fee due on all permits.
CONTRACT PRICE x 1%
STATE SURCHARGE
TOTAL
SfTE ADDRESS:
TENANT NAME: STE. #
OWNER NAME:
INSTALLER:
ADDRESS:
CITY. STATE: ZIP:
r . . .??V0AuA Wl ?9ROW
PHONE #: J3*Ar!%%WT%W iaStt
r+7tfOR AV11 liS W"
40" NM . HIAIk!
SlGNATURE:
APPLICANT C1TY OF EAGAN
Use BLUE or BLACK Ink
For € ffic a Use 1
~ Permit I
City of Ea
qI4 ~S '
{ Permit Fee: I
3830 Pilot Knob Road I
I Date Received: 2
Eagan MN 55122 l I
Phone: (651) 675-5675 Staff:~ I
Fax: (651) 675-5694 I 1
L-----------
42 a
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
31JR`O~ r~J
pate: lC3 'a2°i -1 3 Site Address: 17a_ ~I~ 1701( 17 a 7 304 1 3a1, 17 3'~ - unit ~M
Name: Phone:
Resident/
? Owner Address (City /Zip:
I I
I Applicant is: Owner Contractor
F ~ of Work ;Description of work: ~ cGrca~
V,& Type ;
t Construction Cost -75l,' ad Multi-Famiiy Building: (Yes /'ttiio )
Company: ~~1~~1®rn+e\~Qrva-~~ Contact Or✓Q~~ _
i Address: (9o '1 'v:rc + a nn~ ~rkem•
Contractor q ~t
State: Zip: ~2<23`4~ Phone: l Ja~° `~G,' C O
License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes ____No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Por#!an$ of i
the Information maybe classified as non-public if you provide specific reasons that would permit the City to
w_conclude that the we trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 tnr h,ol(. clion against underground utility damage. Catl4s hours
before you intend to dig to receive locates of underground utilities.
I hereby acknowledge that this information is complete and accurate; that the work will be to conformance withthe ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, wid 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 Applicant's Signature
Page 1 of 3