3731 Brown Bear Tr
INSPECTION RECORD
' CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued;
(612) 681-4675
SITE ADDRESS: APPLICANT:
PERMIT SUBTYPE: _ TYPE OF WORK:
INSPECTION • TYPE DATE INSPTR.
..y g., t ilh'Ei"t4 is z FiER i 3 r;: si;(ti.ys 1 ntF
7-1
Permit Holder Date Telephone #
PLUMBING (r G~~'f-a ftAX
HVAC I0-0(o03
Inspection ate Insp. Comments
FOOTINGS % "&6 fD L17
FOUND
FRAMING
ROOFING
ROUGH
i PLUMBING
PLBG K
AIR TEST
ROUGH HEATING
GAS SVC
TEST
INSUL
GYP BOARD LL~Y
FIREPLACE
FIREPLACE /SJJ ~4~~t1
AIR TEST
FINAL PLBG
FINAL HTG/
ORSAT ~i
TEST
BLDG FINAL
~i l7
DOMESTIC GC+6
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC,
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
L
4
1
6'erd 'Cate of cCCuvancv
Wing of Wagan
Zga>ten# of Z>xit btS 4a64reMon
This Certificate issued pursuant to the requirements of the Uniform Building Code
certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
SF DWG 32159
Use CL=irmAdon: Bldg. Permit No.
0-PaType R-3 U-1 Zoning District R- Type Const. V n
OwnerotBuilding MAPLEWOOD DEVELOPU T 3030 GRANADA AVE N, OAKDALE MN j
BuiWingAddtess 3731 BROWN BEAR TR family L5, B3, B,LACKHAWK FOREST
Dale. , -
,
rBuilding Ofri iai ill
POST IN A CONSPICUOUS PLACE
i
i
Address'_ 3731 BRam BEAR TR Zip 55122
Lot 5 ' Blk 3 Sub XAaWWK F13PYSY
THESE ITEMS WE /WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: !c Yes No Inspector:
Final grade (6 from siding)
Permanent steps (garage) ✓
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch I L/
Basement finish t✓
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shutoff of water supply to
the outside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system.
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
PERMIT
CITY OF EAGAN
?830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
032159
Eagan, Nlinnesota55122-1897 Permit Number,
(612) 681-4675 Date Issued: 06/05/98
SITE ADDRESS:
3731 BROWN BEAR TR
LOT: 5 BLOCK: 3
BLACKHAWK FOREST
P.I.N.: 10-14325-050-03
DESCRIPTION:
Stillditrg Permit Type SF DWG
jBuilding Work Type NEW
("UBC Occupancy R-3, U-1
Construction hype V-N
Zoning R-1
Building Leng,th62
Building Width 48
8u IIdkhrq -s Co"r3es, ~ 2
r
S'y~.are FeL ° 2,267
G~s. st Ctbde', 101 1 - FAM. DETACH
e0..
xl jf r^s
4 i s j h , r L 1 fs i r` f 4 f l ( i F'"s."Is; s x. \
REMARKS:
PLAN REVIEWED BY MIKE BARCK
S&W PLUMBER: HUTTON & ROWE INC
FEE SUMMARY:
VALUATION $158,000
Base Fee $1,177.25 MISC. FEES $1,592.50
Plan Review $765.21 Total Fee $4,613.96
Surcharge $79.00
SAC $1,000.00
SAC % 100
SAC Units 1
Subtotal $3,021.46
CONTRACTOR: - Applicant - ST. LIC OWNER:
MAPLEW00D DEV/CONST INC 17776869 0001011 MAPLEWOOD DEVELOPMENT
3030 GRANADA AVE N A 3030 GRANADA AVE N A
QAKDALE MN 55128 OAKDALE MN 55128
(612) 777-6869 (612)777-6869
I hereby acknowledgOIthat I' have,lrea-d this«application and state that the
information is correct and agree„ to Comply wi-th all applacabie State of Mn.
Stat e_ and ity of Eagan Ordinances.
PPLICANT/PERMIT SIGNATURE ISSUED Y: SIG E
3Z 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAOAN PAP
3830 PILOT KNOB RD - 85122
i
681-4675 GK
New Construction Requirements RemodellReoair Requirements
# 3 registered site surveys # 2 copies of~plan
♦ 2 copies of plans (include beam & window saes; poured fnd. design; eta) # 2 site surveys (exterior additions &.de wil"
# 1 energy' calculations # 1 energy calculations for heated additions
# 3 copies of tree preservation plan if lot platted after 711193
required: _Yes _No
DATE: S- For- CONSTRUCTION COST; Oo
DESCRIPTION OF WORK:
STREET ADDRESS: 373 BLOCK: SUBD./P.I.D.
T Phone
Name:
PROPERTY Last & CONST CTION, INC. -9 ifff
OWNER
Street Address: 3030 Granada Ave. N. Suite A
a a e, N 55128
city License #nnnjm state: Zip:
Company: MAPLFWAnn ne~~ e~cne 477 ~
CONTRACTOR & CONSTRUCTION, INC. License #
Street Address:
city Oakdale, 101466128 Zip:
License #0001011
ARCHITECT/ /
ENGINEER Company: Phone
Name: Registration
Street Address:
city State: Zip:
Sewer R water licensed plumber (new construction only): la4e ..'Penalty applies4hen address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the inform 'o I rrect a .a to compij~iith all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Yes - No
Tree Preservation Plan Received - Yes - No Not Required
. F
OFFICE USE ONLY '
BUILDING PERMIT TYPE
❑ 01 Foundation ❑ 06 Duplex 11 Apt./Lodging ❑ 16 Basement Finish
19,02 SF Dwelling ❑ 07 4-plex ❑ 12 Mufti.Repair/Rem. ❑ 17 Swim Pool
❑ 03 SF Addition ❑ 08 8-plex ❑ 13 Garage/Accessory ❑ 20 Public Facility
04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace ❑ 21 Miscellaneous
❑ 05 SF Misc. ❑ 10 _ plex ❑ 15 Deck
WORK TYPE
31 New ❑ 33 Alterations . ❑ 36 Move
❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition
GENERAL INFORMATION
Const. (Actual) V ,J Basement sq. ft. I q-7 5, MC/WS System
(Allowable) Vnl Main level sq. ft. 1u8 3 City Water
UBC Occupancy 1?- -3.u-1 2-d sq. ft. Gc(,. Fire Sprinklered
Zoning 12-1 n sq. ft. 7 1,:z PRV
# of Stories 2 sq. ft. Booster Pump
Length (s z ' sq. ft. Census Code. o
Depth 4 h `9 ' Footprint sq. ft. zz 1, -7 SAC Code o i
Census Bldg I
Census Unit - It
APPROVALS
Planning Building /kG1 Engineering Variance
Permit Fee Valuation:, $ i 5'S;ooo. -
Surcharge s a r '12
Plan Review ~•zr .uyZ ~az.s'
License. - 8 x t,-7
5
MC/WSSAC u.zs X y s9.r - 157 o&z.=
City SAC z x tg. S 37
Water Conn. 9.z K 4 • 7 s c,
Water Meter
Acct. Deposit N 8s'111_
S/W Permit zs•zs- x zci
S/W Surcharge „ X y.s X04
Treatment PI. a , 3 u4. s
Park Ded.-
Trails Ded. fL: ~s =".~t9v.-
Other ,so s ~d rte s ry tis'
Copies
~Ky 8
Total ,vs3rb~~k= e'er
?
% SAC suai X54
SAC Units B kz-o
~i mazer
_"T ~
SURVEY FOR: MAPLEWOOD DEVELOPMENT 61302-212 532/40
~ SCHOELL R MADSON. INC.
ovmma . tmwtl5iw . w,5mss
ae< xa55w . COMMUMonia Sa54C6x
10105 Wob" 80111.01100, Sun I
t512) 346-7m1 rbm+s-wo
N VACANT BY
DAT
c~ INSPECTIONS 6E~ DEPT.
ILDING ,
WEST q n
141.55 ?i . ' S08p ADDRESS:
sa1.5. m e5yge r n7. sop J 3731 Brown Bear Trail
DESCRIPTION.
Lot 5. Block 3. BLACKNAWK FOREST
~m
10
~50'00-nN`/ 13ENCHMARK:
I i i i t o +z.o 2.0 - li Top of iron monument as shown
_ L, i o Elevation = 847.30 (NGVD-1929 Datum)
T- 0 g I m ~'w R 10 1`, I n N GENERAL NOTES, 01 '
000 I eS o ax 01 t - 1. e - Denotes iron monument.
Z 0) tb _ 2. 2890.0 -Denote existing spot elevation.
14'0 - rJ it 6 Z 3. x(890.0) - Denotes proposed spot elevation.
01 n 7i~ 13: 4.r- - Denotes direction of surface drainage
+ n
EGRESS ~ ' WFLL - 2a.o N 111 s.zs ~%9$ O 5. Proposed garage floor elevation- 846.0
2 S. Proposed basement floor elevation= 838.3
20. LL 7. Proposed top of foundation elevation= 846.3
Six-, m g~ m
- I FIRFPUICL 20A I
L
46.09 m 119.54 -28.00-
.1 0
e55.2+
149.94 ~a3.eo vi 6.30`a was
Drainage k utility Eosemed, % WEST `der Ifl~fecertify that this survey and 1 `~"prepored under my supervision and that
1am a Licensed Land Surveyor under the
VACANT lows'of the State of Minnesota.
Theodore D. Kemno
This droorm has been checked and Dote: MAY 26. 1998 License No. 17006
reek ed the day of
, io-M. 30 0 30 60 90 Feet
by
m
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL: DATE OF SURVEY:
LATEST REVISION:
w
s DOCUMENT STANDARDS
❑ Registered Land Surveyor signature and company
C>---❑ ❑ • Building Permit Applicant
0--'0 ❑ • Legal description
I:r' ❑ ❑ • Address
0~ ❑ ❑ • North arrow and scale
Er- ❑ ❑ • House type (rambler, walkout, split w/o, split entry, lookout, etc.)
Q--'❑ ❑ • Directional drainage arrows with slopelgradient %
I~ ❑ • Proposed/existing sewer and water services & invert elevation
of ❑ ❑ • Street name
❑ • Driveway
ELEVATIONS
Existino
W'~❑ ❑ • Sewer service (or Proposed)
❑ ❑ • Property comers
❑ • Top of curb at the driveway
O ❑ • Elevations of any existing adjacent homes
Proposed
o • Garage floor
Er ❑ ❑ • First floor
i7 ❑ ❑ • Lowest exposed elevation (walkout/window)
❑ • Property corners
@' ❑ ❑ • Front and rear of home at the foundation
PONDING AREA (if aoolicable)
❑ CO" ❑ • Easement line
❑ cr' ❑ NWL
❑ ❑ • HWL
❑ ❑ Pond # designation
❑ p ❑ • Emergency Overflow Elevation
DIMENSIONS
cy, ❑ ❑ Lot IineslBearings & dimensions
¢r ❑ ❑ Right-of-way and street width (to back of curb)
❑ ❑ Proposed home dimensions including any proposed decks, overhangs greater than 2',
porches, etc. (i.e. all structures requiring permanent footings)
;b ❑ ❑ • Show all easements of record and any City utilities within those easements
ff' ❑ ~1 Setbacks of proposed structure and sideyard setback of adjacent existing structures
n
❑ ~ ❑ • Retaining wall r7ame
Reviewed: ~ D t
January 1986
CM1619Bfl9L0GPRMT.FM
_7j
OWNER G \J ~Pr/~GGr¢/✓~i¢
SITE ADDRESS i
Z~ pA~P- L-
S 73
CONTRACTOR DATE PHONE?-
I
i
Determine working square footage of each.
1. Total expose 'wall area 7-h : 1 sq. ft. X ~1 4 5ry
2. Total roof/cc area 1'>3fi Be. ft. X . a2.r:. '7
i
A. Total wall !window area 6..............
8. Total doo urea......... e
C. Total slid ng glass door area D. Total fir lace wall area E. Total wal framing area (average 10%)...........
r. Total Rim oist area I i3'1_
0. Total Net *all area above floor............... ' 1'7 d.
Total exposed foundation area - 174>
f~
H. Total fou ation window area
1. Total net oundation area above grade..........., 1?Q_
Determine nUn valuer of each wall segment.
X null
b X nu.. {73 lv
c ( X nU"
i
ai x•un~
2a.
ei Z2'y x"un {l
f X "U" 4
h~ X..u.. `
i
x nun 1 - ZZ
...Total 4 .
If item N3 is th 1 same as, or less than item q1, you have met the intent Of
SBC 6006(c)2.
j
i
RECEIVED FROM 612 780 2746 04.07.1993 10:11 F. 1
. i
' I
I
I
Total exposed roof/ceiling area
J. Total s ylight area
k. Total r f/ceiling framing area (average 101)..... & 4
1, Total n t insulated roof/ceiling area.............. l oI
j Determine "u" value for each roof/ceiling segment.
' X .,V" + ~J h
. ld2
~y154' X SUN . Z- IN
' (?.1✓1 X NUS + ozz- a
. Total za ' Z d
v
If total of #4 s the same as, or less than #2, you have met the intent of
SBC 6006(c)l.
• Alternate Building Envelope Design
To utilize the tal envelope system method, the values established by the
sum of items 43 hand #4 shall not be greater than the sum of items 11 and #2.
1. + 2.
I
3. + 4.
I
I
I
i
i
RECEIVED FROM 612 780 2746 A4.A7.+OOT tu,++ ° '
Construction (use for Item Q R-yalua
1. Interior air film 0.61
2 -f
4. Extcxior air film (still) 0.61
vW l4 0 2 2 Total
CGU. M44ING (Use for Item 1Q
Vented ideate: flow
up 1. Interior Air film.' 0.61
2. 5l8 w Y P°t~ t~ r'3 C7 ~(v
f
3. Inches soft wood 3 Y Q
FIG. 95 4. Inches insul above framing 1 • d
5. Air Film 0.61
U =,C~Zly _,t~l ,Z
1. Interior air film 0.61
2.
3.
4. >;xterior air film (still) 0.61
Total
1 2 3 4-
11nat flov up vented
FIG. II
3._.- 0.61
1~ 1. Insido air lilm
SS'•'~'w. 2.
4.
~••~.v=T?~j•~~('~~'~~ Outside oir film 0•
5.
1 Z ~
N _VMrM Neste: UFO a3ditional shouts if mar:: space is
1;ocdcd for dotails and calculution-4•
E Near '
flow up
RECEIVED FROM 612 780 2746 04.07.1993 10:13 P. 4
y
NW-1: ' WgM 15% uuf' apaq a wall area for
' frame construct on Construction. RR-V~ue
IC r3r
3, r•., i'cheS ft oo~
1z -7 4-j
5, r
9ASIC G. 8xter or ai ti 0.17
WALL Total Ct , 1 C,..
TOM ER OF 68
FTG. M1
FRAt WALL 1. Into r a . fil 0.68
[nY d
2
3. G" t't= i v4 y lci.ao
6. Exterior air film 9 0.17
FIG. #2 47
. a
Int rior air film !0.6
I L ~,Oq 16,T7 11 1
Spheral r? 6. Exterior air f lm 0.17
T 4 a total ~Z., 7 l
0.68
k 1. Interior air film
•
R I . a
.7i 1TION 0,. 2
A . 3.
!ALI. ! ' tl' . •p 4. C3i t+ ca1~ r wa cu
h 1! f
sndC 5. 0.17
• ` 6. Exterior air film
•n i•` Total
SLAS ON GRADE
S ~ t<
\ u ~ rr1 y
• lit
% %
• ! PIG. 44 ~
i ' Kt r /
(G.-03
/it
Illdep h, a
d
o NOTE: ln4fca ccacc type...~•
i placeMe~t of ins A
n.. . ...n 0a P~ ~OQt 101 f9 ~ 4 . P t
i/ CITY USE ONLY
LOT S BLI 3 RECEIPT 7 7 0/
SUBD. a( ,6 eQ e,l I O~ RECEIPT DATE: 6
NC-3~1 1998 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IWOB RD
EAGAN HN 55122
(612) 681-4675
Date: Complete this section only if you are installing HVAC in single family, townhomes or condos under
construction and not owner /occupied
• HVAC: 0-100 M B T U $ 24.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets (Fiinimum of one required @ $3.00 ea.) -6,00
• State Surcharge: .50
• TOTAL:3 3 • so
Complete this section only if you are remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Note: Mechanical permit is not required for alteration/add-on to ductwork in
existing residential units; but is required for the following:
Install furnace Install air conditioning
Install air exchanger, i.e. Vanee system, etc. Other
Minimum fee applies to all remodel or add-ons of existing residences $ 20.00
State Surcharge .50
Total: $ 20.50
SITE ADDRESS: 3-731 &-Kpw tJ
OWNER NAIME:N---VEL-0Pnn.6Av'r " 9- PHONE#: TJ-68(o`l
INSTALLERNAME: APoL-LJG\T'. & 6 Q PHONE -2-70-0"03
STREET ADDRESS: (oSl b t i 4LV Y 3 L 6 L-y b
CITY: 0~KDAU E. STATE: ~N ZIP: SS
SIG OF ERMITTEE
IS/FORMS BLD/MECH PERMIT (RES) - 1999
} CITY USE ONLY
L S BL 3 RECEIPT / T
SUED. ` RECEIPT DAT/~ 9
1998 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, HN 55122
(612) 681-4675
Please complete for: ➢ single family dwellings
➢ townhomes and condos when permits are required for each unit
➢ backflow preventer for underground sprinkler system
FIXTURES EACH # TOTAL
Shower 3.00 x I = 3,°O
Water Closet 3.00 x 3
Bath Tub 3.00 x 3 = 9. '0
Lavatory 3.00 x y = r 2 00
Kitchen Sink 3.00 x I = 3eO
Laundry Tray 3.00 x f = 3,eo
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x 3..0O
Floor Drain 3.00 x 3• V
Gas Piping Outlet *minimum- 1 3.00 x = °o
Rough Openings 1.50 x 3 = /4. 5V
Water Softener `for dwellings under construction 5.00 X =
Water Softener ' for existing dwelling 20.00 x
U.G. Sprinkler ' for dwelling under const. 3.00 =
U.G. Sprinkler ' for existing dwelling 20.00 =
Alterations ' to existing residence 20.00
Water Turn Around 20.00 =
Private Disposal System " MPC ric. 75.00 =
(new and refurbished systems)
Private Disposal Systems' Abandonment 20.00 =
RPZ (new installation only) 20.00 =
STATE SURCHARGE 50
TOTAL Jr 3.0 0
---t - --l - applicable C -----ily o ----f Eagan ord----------- inances-. -
Ihereby acknowledge tha I have read this applica8on, state that the infonna8on is correct, and agree to compy wfth al
It Is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its
normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement.
SITE ADDRESS: 3731 - wl-a-K (3P4r
OWNER NAME: ^lldD/ evei dot D VaIn rrey
INSTALLER NAME: 4t, - Tan aac// /C°we //t&. TELEPHONE 7 L 7 - Z.3 2-
STREET ADDRESS: 2- 12 (o - •a A ✓e , A ,r/v /
3d3
CITY: A STATE: lv ZIP:
SIGNATURE OF PERMITTEE
CD/PERMIT FORMS/RPLBG PERMIT (RES) - 1998
Use BLUE or BLACK Ink
_
For Office Use
C1
I Permit#: I
City of Evn
I Permit Fee:
3830 Pilot Knob Road I C L
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 i Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit M
Name: 1 /!~tlx,7 ! NSE? r`i Phone: (~~Z 7 ,?b i 7G l
Resident/
> l~ti~Z t2 L
Owner Address/ City /Zip:
Applicant is: Owner l~ Contractor
Description of work: (P- Q o l T? S-T
Type of Work
Construction Cost: Multi-Family Building: (Yes r i No
Company: 6°I-V~'~~'~ ~ ycix I Contact: Mi16c=
Contractor Address: )(6 &7 I( ~'A ~ City: PC 5~ moo;A T
State: Zip: o C^ Phone: 61 License E CnS~ 948 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x ll c' Z°Z6 x
Applicant's Printed Name A is is Signature
Page 1 of 3
City a[EaQau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ,'2 . /7-00)3 Site Address: 37'3 1 2 rc7wh Rear IYI. Unit #:
Resident/
Owner # �
Name: .60-V &flSc9ll Phone: t7/2— -so-0-x 7
Address / City / Zip: _ e
Applicant is: Owner /Contractor
y ;
Type of Work,:
,ryE
Description of work: Pen, n, 0 a--/ re ) e vni v/ s rd o-La1'0G
% toms__
(� /
Construction Coy;._ 9690 Multi -Family Building: (Yes / No )
Contractort.
Company: ! C J( r G n L4 CCS n Contact: tom. tie ( PcLsk'Ar
Address: 06p2. i'lct S T (1(t/`/ City: C®41�1 Cjo%oi S
L.2 Q
State: p/ q Zip: ---S-4 4 Cl
Phone: 5/2- c2Q ). c)2 7Z
License #:. 647'17, Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NATE ;Plans and supporting documents that you submit are considered to bye public info ` atlon Port ans of,
the information maybe classified as noyo
n public rf u provide Specific reasons tha Aya ermit the City to
desets
conclude'that they are trre
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 issua e.
x e/ iI CkSkOr ✓
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3