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1885 Bear Path Tr7- 7_7 CASH RECEIPT .CITY OF EA N % ?? P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE // 19 RECEIVED l.? A ,caf??T ../"'?i_..._„"L"'? ..' ?+A"' _./ AMOUNT 1$ '27 li ? CASH -& -DOLLARS 1 00 CHECK FUND CODE AMOUNT Z-4 0 Thank You Fr'? ? f White-Payers Copy Yellow-Posting Copy Pink-Fite Copy CITY OF EAGAN96i l- 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 7 (.) 07 7 BUILDING PERMIT 10 Receipt .# To be used for SFr DWG /GAR Est. Value $69,900 Date OCTOBER 12 1984 Site Address 1885 BEAR PATH TR Erect C( Occupancy R3 Lot 6 Block Sec/Sub. SUN CLIFF ZN1) Remodel ? Zoning Ri Parcel No. Repair ? Type of Const. V Enlarge ? No. Stories of Name KEY LAND HOMES Move ? Length 4 5 Address 34/1 W 173RD ST Demolish 1 Depth 48- City Phone Grade ? Sq. Ft. JORDAN Zo Name CLA CONST CO INC 6451 E 190TH ST ou Address u PRIOR LK 447-6128 F City Phone Pw Name DENNIS HALLQUIST - xz Address 5001 W 80TH ST Go- City BLMTN Phone 831-1875 Approvals Fees Assessment Water & Sew. Police Fire Eng. Planner Council Permit ti' J`ZJ.VV ;Surcharge 35.00 Plan check 171.5 0 SAC 525.00 Water Conn. 470.00 Water Meter 63.00 Road Unit 260.00 Parks Total . J I hereby acknowledge that I have read this application and state that Bldg. Off. 10/5/84 the information is correct and agree to comply with all applicable APC State of Minnesota Statutes and Pity of Eagan Ordinances. Var. Date z t' . _ -1 Signature of Permittee cO S co INC A Building Permit Is issued to: on the express condition that all work shall be done in accordance wit,Jf lq applicable State -.Of. nesota Statutes and City of Eagan Ordinances. Building Official L '$ Permit No. Permit Holder Date Plumbing 3 ^Y?.? Lr « •-g ?Q? H.V.A.C. .5 I'L ( r?x'1 >'D 1 \'3 CS ' r I ?t -X ( 2 Electric P? (p (? a d C ?`1 3 C-Z) Softener Inspection Date Insp. Other Footings Foundation Framing Rough Plbg. ` Rough HVAC ?Z S' 13/ Insulation ^f/L J Final Plbg. Final HVAC Final Cert/Occ. Water Describe Location: Well Sewer Pr. Disp. Receipt MECHANICAL PERMIT Permit No. -7 CITY OF EAGAN Fee UO Fill in numbered spaces S/C ISO Type or Print legibly Tot. `U 1. Date 2. Installation Cost /706 GE 3. Job Address ?eo Lot t..' BIk. Tra t 4. Owner LG N CB t4O h\Q. S 5. Contractor`1e.-4ro Phone[?`7 -8la? 6. Address 1qL4 o k Q O r MO 4AC ru (e., k d 7. City ?C d r LAL. State i , ? _ Zip 2-- 8. Building Type: Residential Commercial ? Institutional ? 9. Work Description: New, Add ? Alter ? Repair ? 10. Describe i e.44 t (' Q j" Fuel Type 4 ("Q 11. No. Equipment BTU - M. Ea. Forced Air /OQ, (' No. Equipment CFM A H Mfg. Co r , c k ir andling: Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Other Air Cond. Mfg. Gas, Piping Outlets 12. 1 hereby certify that ve i formation is true and correct, and I agree to comp) ' h aa d desgoverning this type of work. Signed for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 Receipt q YF w PLUMBING PERMIT A CITY OF EAGAN Fill in numbered spaces - Type or Print legibly 1. Date 2. Installation Cost 3. Job Address of Blk. Permit No. Fee SIC --?-?--_-- Tot. ?/ 7 O Tract - 4. Owner t1 ?' If',l 4c2,'92 e.S 5. Contractor DC'. /9) - h4'Ai/Co9 L Phone 'V s o/ 6. Address, ? 7. City ? I^/CJ/L,?'31?"`c.' State Zip .j' ._e..' 8. Building Type: Residential t9 9. Work Description: New LX 10. Describe 11. Commercial ? Institutional ? Add ? Alter ? Repair ? No. Fixtures Water Closet No. Fixtures Cesspool/Drainfield / Bath tubs Septic Tank Lavatory Softner Shower Well Kitchen Sink Urinal/Bidet Other 1201 ti -c 5// 1 Laundry Tray Floor Drains crp 30 G't) Drinking Ftn. ! Slop Sink Gas Piping Outlets 12. 1 hereby certify that the above info oration is true and correct, and I agree to comply w'tl aliordinanc¢s and s gq ning this type of work. Signed : G? dt'' 1 for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 CASH RECEIPT CIT OF EAGAN P. O. BOX 21-199 EAGAN, MINNESOTA 55121 DATE - f I9e RECEIVED FROM ?'?#, f ?/^-' ...d'Ii }'i,"' AMOUNT $ f CY 6 `? I 0 ? CASH f CHECK FOR FUND CODE AMOUNT (* 3 y 7 '4 V Sy/ 61 / +I 2,11111 , Q u 31 6 Q I Than You By & _DOLLARS ] 00 White-Payers Copy Yellow-Posting Copy Pink-Fite Copy Receipt PLUMBING PERMIT Permit No. CITY OF EAGAN Fee Fill in numbered spaces S/C Type or Print legibly Tot . 1. Date 2. Installation Cost 3. Job Address 4Lo W -- Blk. Tract 4. Owner J " f s 5. Contractor a 1H ?? Excelsiev An. E. 6. Address H rr ^A %3 ap'..'M8 ' ) 7. City State Zip 8. Building Type: Residential Commercial ? Institutional ? 9. Work Description: New, cl 10. Describe 11. Add ? Alter ? Repair ? No. Fixtures Water Closet No. Fixtures Cesspool/Drainfield Bath tubs Septic Tank Lavatory r Softner Shower Well Kitchen Sink Urinal/Bidet Other Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this type of work. Signed : i for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 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/Reaair Requirements 3 registered site surveys showing sq. ft of lot, sq. ft of house; and all roofed areas 2 copies of plan (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks I set of Energy Calculations Addition - indicate if on-site septic system 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 Office Use Only Cert of Survey Recd Y N Tree Pres Plan Recd Y N Tree Pres Required Y N On-site Septic System _ Y N Date ,? /12- / o ( Construction Cost \ C7 i Oo0. 00 Site Address ? 55 C3Q-O ( OAT v\ 2..L- . Unit/Ste # TA N 1 a a- Description of Work Multi-Family Bldg - Y - N Fireplace(s) )< 0 - 1 - 2 Property Owner Q, V t \0.y so \C., Telephone # {-fit j? l - Contractor c? 'z n c s W co I C r I0 1 Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (J 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 Sewer/Water Contractor Telephone #( Telephone # Telephone # ( is completed acc ate; I hereby apply for a Residential Building Permit and acknowledge that the informati ty., N-4 MN ,Ong,-"g41- LLAW" LJLftL' 81 that the work will be in conformance with the ordinances and codes of the City of 13-gm- -4 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. Applicant's Printed Name A cant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 08-plex 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 1 0-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or - N ? 25 Miscellaneous Work Types ? 31 New t 32 Addition ? 33 Alteration ? 34 Replacement Valuation 2?0" Census Code SAC Units # of Units # of Bldgs Type of Const Footings (new bldg) Footings (deck) Footings (addition) _ Foundation Drain Tile Roof _ Ice & Water _ Final Framing Fireplace _ R.I. - Air Test - Final Insulation Width z.. -, 11 ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. Siding Fire Repair Windows/Doors REQUIRED INSPECTIONS Final/C.O. 7k Final/No C.O. Plumbing HVAC Other Pool Ftgs _ Air/Gas Tests _ Final Siding Stucco _ Stone _ Brick Windows Retaining Wall Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ? 35 Int Improvement ? 38 Demolish Interior ? 44 ? 36 Move Building ? 42 Demolish Foundation ? 45 ? 37 Demolish Building* ? 43 Reroof ? 46 *Demolition (Entire Bld g) - GivePCA handout to applicant Occupancy MCES System - Zoning City Water - Stories Booster Pump Sq. Ft. PRV - Length Fire Sprinklered - For: Key-Land Homes Z ai N I''J L al)? NB9°3O'31"E r Jryvcro & ASSOCIATES, INC. LAND SURVEYORS T.l 945-3646 1381 EUSTIS ST., ' ST. PAUL, MINN. 53108 1 Scale: 1" = 30' (DDenotes Iron Monument NOTE: 0 Denotes Wooden Stake Proposed Garage Floor El 9OO 6 } (900.3) Denotes Proposed _ __" Finished Ground El. -IN,- Denotes Direction Of Surface Drainage Vertical Datum - N.G.V,D. 1929 Oc VilalSortK-. is s g v A Lot 6, Block 1, SUN CLIFF SECOND ADDITION, Dakota County, Minnesota WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES,OF THE LAND AII.O'VE'DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY THEREON, AND BALL VISIBLE E R)Ar HMENTS, IF :&NY, FROM OR ON SAID LAND Dated ?" doh 01 ??7`O1t_ ---?--A D. )9,FY C. R. WINDEN d ASSOCIATES, INC. levised is-io- Sq Svr???or M nn?? tooi?tro$,on No lz. by me' M C)' W I COMBUSTION EFFICIENCY TEST Site Name: Unit ID: 79- FPVAgO 30 Address: ?: 8 3 B ew .? RR -z. Natural Gas Test High Fire: 02 CO2_______ CO D Net Stack O manifold pressure rA) comb eff % 90- Low Fire: 02 CO2________ CO Net Stack manifold pressure comb eff % Fuel Oil Test High Fire: 02 CO2 CO Net Stack smoke test oil pressure Low Fire: 02 CO2 CO smoke test oil pressure oil filter comb eff % Net Stack comb eff % replaced Y or N nozzles replaced Y or N Comments: (r? ?? J 2.© Service Technician l?-/ .,QAW1 Date 7 `? 07/15/04 -PBP-> John Engelhart, Managed Services 9529256122 Pg 1/1 Professional Business Publications P.O. Box 3478, Mission Viejo, CA 92690 (800) 535-5795, Fax (949) 347-2576 To: John Engelhart From: Lisa Robins Company: Managed Services Inc Fax: 9529256122 Date: July 15,2004 Phone: 9529254111 Pages: 1 Re: National Builders Directory ? Urgent ? For Review ? Please Comment ? Please Reply ? Please Recycle Dear John Engelhart This notification is to let you know that we have just released the 2004 National Builders Directory. Below is a summary of the directory and what is covered. If you need further information or a sample, please don't hesitate to give me a call. The NEW 2004 National Builders Directory is Now Available Bigger and Better than Ever Before: Covering the 150 Largest Home Builders in the U.S. As always, The National Builders Directory lists All Corporate and Regional Offices of the leading Production Home Builders in the U.S. with Addresses, Phone & Fax, and E-mail Addresses We cover More than 800 Offices - With More than 3,500 Contacts The Directory Will Help You Reach The Decision Makers Presidents CEOs CFOs CODs Purchasing Managers and Executives Sales Managers and Executives Marketing Managers and Executives Land Development/Acquisition Execs We've also added more contacts including: Finance Managers, Head of Design, H.R. Managers and more Each Listing Includes Gross Revenue... Annual Sales Volume... and the Types of Homes Built Call if you would like more information or to Order Your Directory 800-535-5795. If you received this fax in error or would like to have your number removed, please call toll free 1-800-535-5795 and leave your fax number or fax back to us at 949-347-2576. ` T RESIDENTIAL BUILDING - Permit Application City Of Eagan (? 3 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq, ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cert of Survey Recd _ Y - N (20% maximum lot coverage allowed) I set of Energy Calculations for heated additions Tree Pres Plan Recd - Y - N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Reqd - Y - N 1 set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System _ Y - N 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date 2) / c . Site Address j; > / CD ? 5e Construction Costt$1 1 co - co Unit/Ste # Description of Work er •, c? ©? c?e e. ? v,, "; i 1p r qqe Y YIL, L?C? Multi-Family Bldg ? ` Y ? N Fireplace(s) s-0 1 2 Property Owner Jo e K . V r I C•v,SOKY- Telephone # ((9S t) 6,88- 0-7 P-G _ Contractor Joe K. V 1a., a( 0..,3,\e'r (Lov-e Address 1$R5 State P- a CA ccx \ INA N? City Zip s ) Telephone # (fps 1) ??eSQ,- G'1 a ?1 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 - Minnesota Rules 7672 Energy Code Category • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet (4 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 # ( Telephone # Telephone # Sewer/Water Contractor I hereby apply for a Residential Building Permit and acknowledge that the informatiy66QrL-?n°&C 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 e/?° f work which requires a review and permit; that the work will be in accordance with the approved plan i e/// approval of plans. A Applicant's Printed Name OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex K 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-piex ? 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) ? 44 Siding C 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) - Give PCA handout to applicant Valuation 1,4042() 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. y 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 Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total For: Key-Land Homes 1*11 Z `1V Q.? L .1000 Scale: 1" = 30' 0 Denotes Iron Monument NOTE: o Denotes Wooden Stake Proposed Garage Floor E 900.6 (900.3) DEnotes Proposed Finished Ground El. mW - Denotes Direction Of Surface Drainage Vertical Datum - N.G.V.D. 1929 Lot 6, Block 1, SUN CLIFF SECOND ADDITION, Dakota County, Minnesota WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON, AND /ALL VISIBLE ENCROACHMENTS. IF ANY, FROM OR ON SAID LAND C. R. WINDEN & ASSOCIATES, INC. Dotal fkis_ ?'4_ do, •1'?L7'0bEJ.__ A.D, loE199d/ Revised /o-/O- 94 5.,.?ro. M!nn.? R.qu?roio? No __ E_7/ N 89°30' 3!"E C. R. WINDEN & ASSOCIATES, INC. LAND SURVEYORS Yet 645-3646 1381 EUSTIS ST., ST. PAUL, MINN. $5100 0 (G q f 3 RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 9-MOS- New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan _ Cert of Survey Recd (20% maximum lot coverage allowed) I set of Energy Calculations for heated additions - Tree Pres Plan Read 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks - Tree Pres Not Reqd 1 set of Energy Calculations Addition - indicate if on-site septic system _ On-site Septic System 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 / 0 5 Date / - ? c3C7 Construction Cost 1?L 1? T? p Site Address PM2 -VV*<\ L - Unit/Ste # Description of Work f i bf N 6 Or 47b'OSE /1\J L 60-ME Multi-Family Bldg _ Y - N Fireplace(s) - 0 - 1 - 2 b 6 V Property Owner ( T E- V L 1 S.JO - Telephone #09-) Contractor I V l? ? f l+v L? k0? M _ NS) Address O 7) city._/ WOM) 131 y - (/ C State Zip 20 Telephone # 17(?/ - s COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (? submission type) Submitted Submitted Energy Envelope Calculations Submitted Licensed plumber Telephone #( Mechanical Contractor rt Telephone # Sewer/Water Contractor 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. Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Work Types ? 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) - 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 Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total C ? y« J 1 3M Pibt 'Knob ROSA,Espa M* 55122 T Tekpkoft # 6514755677. VAX #,651.0 f' 23 ?' rIL- 1 l , - j.) ,Slokwftw? 77 Zak JOAY j!i ZV5:?N 04$ lrovkwoi? A25 , a$oD onto exktbg dweiiig unit o ,y ear www i? f ? } ' ' l or R'k . M foam dd ac w1ed a *At the is c is R C i "Li i the ardinwx" *w -tff the City of FAW and wit} „ c . piW br .sn t '3?r ?-?AY?o' fw * t It and work is not to.s t without-iw peaar tl*t llr0OV&w9l t, 4 in dui of wo* which re *AM a revww apprWAa of picas M C;iIE `if?.i6 R ??y.}},??fyt PrinW t?1y,,,,,?Ns nayaw e: AY * Uft - t1 I1tai } >? - '. 11 b'i 't' _ cam ? '.. ? - - .. - -.. ,... ..,- .. ?.. ....?_ .` ,. J I boreby y for a Comtoetti Mechanical Permit and acknowledge that the Mien is c kte and act: = .; watt De In COWOM&WO wtM ttie or bs and codes Of the City of Eagan and with i Chatc&t Codes, dw t ;;t t not a fwuA4 b only an application for a pennLt, aM work is not to start witho it a pan* tbat^the wart will be ih ace es[ . ritb RESIDENTIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 New Construction Requirements Remodel/Repair Requirements 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks 1 set of Energy Calculations Addition - indicate if on-site septic system 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 Office Use Only _ Cert of Survey Recd _ Tree Pres Plan Recd Tree Pres Not Reqd On-site Septic System Date -3 c ? Construction Cost / 3 6 Site Address ?O 0 ? t1 , ??Qyl Unit/Ste # Description of Work /z) / h d O COs , do 0 r a hG Q l /?YQ?/O h L? Multi-Family Bldg _ Y N Fireplace(s) _ 0 - 1 _ 2 &,e- Property Owner V !/L71/SO(,c.k, Telephone # 6S/) D? Contractor CUSTOM REMODELERR, I Address 474 APOLLO DR. City State 2648 OR (800) 2 Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Energy Code Category Minnesota Rules 7670 Category 1 • Residential Ventilation Category 1 Worksheet (4 submission type) Submitted • Energy Envelope Calculations Submitted _ i Licensed Plumber Mechanical Contractor L,7 L2 Sewer/Water Contractor By Minnesota Rules 7672 • New Energy Code Worksheet Submitted 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. Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 02 SF Dwelling ? 03 01 of, ilex ? 04 02-plex ? 05 03-plex ? 06 04-plex Work Types ? 31 New ? 32 Addition ? 33 Alteration ? 34 Replacement Valuation Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext, Alt - SF ? 36 Multi Misc. ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors *Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy MC/ES System Zoning City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width Footings (new bldg) - Footings (deck) Footings (addition) _ Foundation Drain Tile Roof _ Ice & Water _ Final Framing Fireplace _ R.I. -Air Test -Final Insulation REQUIRED INSPECTIONS Final/C.O. _ Final/No C.O. Plumbing HVAC Other Pool _ Ftgs _ Air/Gas Tests -Final Siding Stucco - Stone Windows (new/replacement) 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 ? 07 05-plex ? 13 16-plex ? 20 Pool ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 09 07-plex 0 17 Garage 0 22 Porch!Addn. (4-sea.) ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Building Inspector This request void j /(J(°?T ^ \ _?_ 1.? 18 months from ( C!J / Cl 7 A 09946Q,- L( I .t..Y, 3t4.do Request D t ?. Fire No. Rough-in Inspect+on Required?_ 0Ready Now 0*itt•Netrerilnspec- When Ready }-'f6s ' ? No tor icensed Electrical Contractor I hereby request inspection of above ? Owner electrical work installed at: Street A dress, Box or Route No. City d Section No. Township Name or No. Range No. County . "- Occupant (PRINT) Phone No. Power Supplier Address Electrical Contractor (Company Name) , itractor's License=Np. Mailing Address (Contractor or Owner akin, In ailation) Aut?forize Signature. Contractor/Owner Making Ins Ilation) o e Number MI E TA STATE OARD OF ECTRICITY THIS INSPECTION REQUEST WILL NOT Grig -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. ( (L REQUEST FOR ELECTRICAL INSPECTION EB-000O1 O4 (l/ LA / See instructions for completing this form on back of yellow copy. A Of 9 9 4 0 "X" Below Work Covered by This Request fJ Now Add Rep. Type of Building Appliances Wired Equipment*tred 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 Specify) Other {Specify) ter Specify Other Other Compute Inspection Fee Below # ,Fee Service Entrance Size # Fee Feeders/Subfeeders # Fee Circuits 1<'' _ 0 to 200 Amps 0 to 30 Amps -' G 0 to 30 Am us Above 200 Amps 31 to 100 Amps 31 to 100 A Swimming Pool Above 100_Amps Above 00-Amps Transformers Irrigation Booms Partial.'Other Fee Signs Special Inspection TOTA F Remarks ?.? / r // L FE{r is /1 _l fi Rough-in Date 1" the real 7-4"` Inspector, hereby certify that the above Final }epection has been made. This renuest void 18 months from CITY OF EAGAN Remarks t/iS r on/?G3? ??y Addition SUN CLIFF 2nd Lot 6 Blk 1 Parcel 10 72976 060 01 Owner Street 1885 Bear Path Trail State Ragan, MN 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1985 369.37 24.62 15 344.75 C010214 4-19--85 STREET RESTOR. , p7g 1986 -2+5117 431.51 5 5 C - 010,5 I O ` -J GRADING SAN SEW TRUNK 1970 48.64 1.95 25 17.60 C010214 4-19- 5 SEWER LATERAL * 212-51 C010214 4-19-85 SEWER LATERAL 999 1986 829.62 165.92 5 a 6 -/0. Iv` 5 WATERMAIN WATER LATERAL 1000 1986 942.60 188.52 5 . (p o WATER AREA 40 ; 73 62.34 4.16 8.39 C010214 4-19--85 HAT LAT BEN 4964-071 1986 57.88 11.58 5 57- 9F -/U39?. /O-,F- 25 STORM SEW TRK 0.( 1971 161.72 8.09 20 40-52 0010214 4-19--85 STORM SEW LAT S S/W SERVICE 1005 1986 808.77 161.75 5 909,77 103 2 !0 A-T CURB & GUTTER SIDEWALK STREET LIGHT STORM SEW LAT 1006 1986 610.14 122.03 5 /O./ Road Unit 260.00 #47027 -10- 17-84 WATER CONN. 470.00 'r U BUILDING PER. SAC 525 00 PARK , *aIe o/ 99u2cey For: Key-Land Homes C. R. WINDEN & ASSOCIATES, INC. LAND SURVEYORS T+t 645-3646 1381 EUSTIS ST., ST. PAUL, MINN. $510• ?1 NB9?3o'?!' E z? q ??.OC 9?g Q' I ?? I ?897r) Scale: l" = 30' 0 Denotes Iron (V , 44 { Monument LJI - - 1 ti propcsey lDS L_1 N U) House NOTE: e N _ /5 Ln a Denotes Wooden Stake (.A ~ ' (9Gp3) 7 ?r p sed Garage Floor E 6900.6 (9 3) Denotes Proposed Finished Ground El. ?? -f --- Denotes Direction 22 Of Surface Drainage -+---33---- Vertical Datum - N.G.V.D. 1929 L96, 65.0 O 1998 Lot 6, Block 1, SUN CLIFF SECOND ADDITION, Dakota County, Minnesota WE HERESY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF All BUILDINGS, IF ANY, THEREON, AND ALL VISIBLE ENCROACHMENTS. IF ANY, FROM OR ON SAID LAND Doted flti??i ?<" day ol?c7`-ObC?- A.D. )994/ C. R. WINDEN & ASSOCIATES, INC. Revised /o-/G- 84 O 4 6r 7_/ Svrv*yo'. MIONA&S04 Reputrot'on No N -M 11 CITY OF EAGAN N? 9601 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE:454-8100 47 -"7 BUILDING PERMIT Receipt .# ! To be used for SF DWG/GAR Est.Volue $69,900 Date OCTOBER 12 ` 984 Site Address 1 885 BEAR PATH TR Erect CX Occupancy R3 Lot 6 Block 1 Sec/Sub. SUN CLIFF 2ND Remodel ? Zoning R1 Parcel No. Repair ? Type of Const. V Enlarge ? No. Stories fie Name KEY LAND HOMES Move ? Length 4 5 z a Address 3 4 71 W 17 3RD ST Demolish El Depth 48 6 JORDAN Phone 492 6646 Grade El Sq. Ft. CLA CONST CO INC Approvals fees s o Name U Address 6451 E 190TH ST ? City PRIOR LK Phone 447-6128 WW Name DENNIS HALLO UIST 19 Address 5001 W 80TH ST <W City BTMTN Phone 831-1875 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 onr ty of Eagan Ordinapc/s. A_ Signature of Permittee A Building Permit is issued to: all work shall be done in accordance CONST CO INC icoble Assessment Water & Sew. Police Fire Eng. Planner Council Bldg. Off. 10/5/84 APC Var. Date Permit 343.00 Surcharge 35.00 Plan check 171.50 SAC 525.00 Water Conn. 470.00 Water Meter 63.00 Rood Unit 260.00 Parks Total $1,867.50 on the express condition that Statutes and City of Eagan Ordinances. Building Official BUILDING PERMIT APPLICATION - CITY OF EAGAN ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN INCLUDE © SETS OF PLANS, © CERTIFICATES OF SURVEY SET OF ENERGY CALCULATIONS Date: 0& /?!/` To Be Used For: __ Valuation: 6-?70D Site Address: f5 x= PI7I Lot : _.L Block : ( Sec t/Sub : SUS eL,FI S tect : Parcel #: Remodel: Repair: Phone #: Occupancy: Owner: kLxy Enlarge: Move: Address: e/' Li Demolish: City/Zip Code: ??,(,gh,, f7fj.? 0' 7- Grade: Zoning: Type Of Const: # Stories: Length: Depth: Sq. Ft.: Contractor: / 'p ??c, • Address: x z j /9b 5t Assessments: City/Zip Code: p/t,'p , ?-'g 'A <j trap Water/Sewer: Police: Phone #: Fire: Engr.: Arch. /Eng : Nrs _ (L f/ $7`' Planner: Address: Council: Bldg. Off.: City/Zip Code: YN N /yJ?,d l87 APC: Phone # : ¢93 r _ / ?S Variance: Permit: ?)43 Surcharge: Plan Rev.: 11 ?. SAC : 5, Water Conn: 0 Water Meter (e7 , Road Unit: ?fParks: EXTERIOR ENVELOPI AVI-HM.; "u" (it' 1AiI(lt OWNER • i SITE ADDRESS: -/SS , Gyrz mfn ?/"ICUt I !ION[: CONTRACTOR: 77? - 5 Z€ ' ate. ,3 Sk. z-t F ct. our. Determine workiro of oo, h 1. Total exposed wall area ..... ____z/5 sq. tt . Y 1 i - ,23 _$3 ? 2. .Total, roof/ceiling area ....880_sq. ft. Y .026 ___ ,Z 3 0.3(0, Total exposed wall area ahovt' *lonr _ gyp } a.' Total wall window area ....................................... . . . . b. c. Total door area ............................... Total sliding glass door area ........ .. ... . . .. . d. e. ............ ...... Total fireplace wall area ...................... Total wall framing area (average 10T) ........... .................. 39 yp??_ f. 9• .......... Total rim: joist area. ....................... e t?wall area above floor n ............ .. .................. 01(96 h. ................... ..,, - wall area above floor . . ....... . . . . . . . j4sj: .04( i. j, . .. .............. wall area above floor ................... frame wall area at foundation ............ ........... .................. _ Total exposed foundation area= 7? k. Total "foundation window area ................... ... ----? I.. Total net foundation area above grade .......... _ ... .. ry _ - Determine "u" value of' eact, w:;ll segiert (e.g. window, door, each sepJrote wall section) X X "" U" C. q-1717 X "ul; e. ZC f3 X flu" f. /,50 X flu" 9• 1474.011 x „u" h. X 'u$# X fluff 3. X ?u„ _ k X "u" If item #3 is the same ' . __ as, or less than item -??_ X 'lull /O.2, j #1, you have met the;,' intent of SBC 644 0) 3. ?•'?.r,,..?...:......... .............Total =?? ? 4'-i?-aT 4 ,•(Y leave 3c ,c( Avitrrtg° "W' 0111l)r(11.(1 I'm • Total exi>oucc3 Woof/c ii.il(c? ill:('" - _eg____ in. 'Ntal takylight aro ............................ n. Total roof/ceiling framing arc,I (iv(-1'.I'1(' 101) ... o. Total not insulated roof/coiling ar.c'a........... UOtert ine '?U" vulut' fu1" t',."('l1 l ((UI /C(; 1 .1 llrl ;;(:OIUUIit 1'(1(x(. 2 of 4 n. d!2 x lull Z-1Z.,474 C22 , __ 124 o. 7V7. f x "U(( , OZ 4 ........................... Total = 1?4.C? 7 ? if total of #4 is the same as, or less than 1l2, you have "net the intent of ShC 6006 (C) 1. Alternate Building ilnveloPe De_=i.gn To utilize the total envelope 'system method, the values establI ;hed by the stun of items #3 and #4 shall not be greater than the sum of items 1!i and #2. 1. 3Cp • 8 3 + 2. s_7-?,• 03(_ ,Z?R- BlPfo 3. + 4. -- .0 744- « .'?• 4 f..+'?I covlstr111-t (nn A-VaIUC (1 ?. Interior ii r film 0.6]. try -?"` /i ?" '? ? . -?, /( •f h•' fJ]'{{.`..?? j JA ,.? total vzrr r _?w. ?. 2` 4s 80 2 Znted heat f )-ov 3 _ Zt?; r, or P. L t i t.m 0.61 4. n`_c c.ic? sir 1' !n { t';Ti t Total. ts• • •• COIL. Srer- A/CTI .p) '.it film 0.61 5. Out :iOc .ir film 0.17 ( t l'I Total In- #,lc air rilin 0.61 • Lear flog up • t•vez?ted ?__ _ - ' • 4 ut ,idc :•it lelm S. 0.17 • .]MG. /6? Total J n 3-. air film 0.61 .•?.'1• •?'irr?f G+.i t` ^ic??'' r 1 i?im __ 0.17 Total • bCI-VI?.'hu7. °:.?te: U_.e additional sheets if more space is jceded for details and calculations. Beat • ', • • flaw up . • ,'. •4 ,!7 f• !! I M,UmEAL F-7-T. EX PosE cO - PULL'p;'? ?s o I S ?T k?aL.C?Gk:? ?-?? X , S WEE!, X. 5- LL l , ?C g P u L F,o P-1 PLA tit 4* 4 - 3 o WALL .;.,-./. - / ,'> WALL AREA v •I 7 -ro -rA L - - ?? ?!Z zo/3G? ?X?OS?D o po e-.s 6 J t?l7? ' 4i•? Pt\Ti o DR,,S .iti3 CITY OFEAGAN- WATER SERVICE PERMIT 3830 Pilot Knob Road 5848 P. O. Box 2 PERMIT NO.: Eegin, MM 9512 7 DATE: 11 / 30 / 81k ?-On'7, R1 No. of Units: Key Land C .w" \,Site Address: 1885 ra i?, ? i6rt i ip€un Cliff 2 No. $ agree to Haply with the City of Eagan Ordnenaes. By Date of Insp.: 4 ' io rge 470.40 pd bur Al? e t: 1-5.00 pd Permit Fee: p Surcharge: pd Misc. Charges: 63.00 pd meter Total: Date Paid: Insp,: CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot KnalrRoad ' 5848 P. O. Box 21199, PERMIT NO.: Eagan, MN" 18121 DATE: 111 30184 Zoning, R1 - No. of Units: Owner: Key Land Const Address: Site Address: 1885 Bear Path Trail L6 B1 Sun Cliff 2 Plumber. C ' Meehan i i Meter No.: Connection Charge: 4 0»00 p Size: Account Deposit: P Reader No.: 10.00 Permit Fee: P 1 agn a to comply with the City of Eagan .50 Surcharge: PC! Ordinances. Misc. Charges: 63.00 1?d meter By Total: Date Paid: Dote of Insp.: Insp.: CITY OF EGN 3830 Pilot Knob Road 7037 P. O. Box 21199 PERMIT NO.: 11 Eagan, MN 55121 DATE: Zoning: 81 No. of Units: Owner: Key Land Domes Address: Site Address: 1885 Benz Path Trail L6 B1 Sun Cliff ,2 Plumber: 1) C n cal. 10-12-84 47027 100.00 Od i agree to comply with the City of Began Connection Charge: 425.00 pd Ordinance.. Account Deposit: 15.00 Rd Permit Fee: 10.00 Std Surcharge: .50 gd By Misc. Charges: Date of Insp.- Total: Insp.: Dote Paid: 2/84 CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPERTY ADDRESS : LEGAL DESCRIPTION: vv(Lot/Block/Subdivision or Tax Parcel I- ..i Nurber) IF ST UC'I?T:'<E, DATE. OF ORIGINAL i ILDING _ ?_ IT ISSU C,: /() - ' I , PRES= 2^`Irvt;/PaOP0S USE: R-1 SING - FAMILY 13 R-2 DUPT r ('IWO UNITS) ? R-3 TC;v ?OUSE (TITS + U' IITS) ( UNITS) p R-4 Ar AR'F T/CC.I)Ci•SIIU I ( UNITS ) p Ca-, 1ERCLLL/REI'AIL,/OFFICE ? ?'DC ST` IAL p INSTITUTIONAL/GOVERr r T 2) APPLICA..'7r (PLEASE PRINT) NAME : k i,-1 ) i11 ADDRESS: ,/ - ,,.i / 73 p> 5 / CITY, STATE, ZIP: 70 0 'D A-t- X ,,.? PHONE : 3) PLU^:SB NAND- (PLEASE PRINT) - 7 C ? C y FOR CITY USE ONLY _ u 9-L ADDRESS:r e 7r3 ?f` f ,SC' . c? PLUMBERS LICENSE: Active CITY, STATE, ZIP: Expired pit PHONE: 9 / f u J PLUMBER LICENSE 3 [?] Not of Record ,-_ aJt tT Initia 4) OCCLjPpNT/a,? NA (PLEASE PRINT) ME:: ? ?l'!7 ?' ? / < t? ? ??,?L i f' /; ADDRESS: CITY, STATE, ZIP: PHONE: 5) INDICATE WHICH PERMIT IS BEING REQUESTED: CONNECTION TO CITY SEWER CONNECTION TO CITY WATER Q ariR (PLEASE DESCRIBE) 6) INDICATE ONE: ? PLEASE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE RAIL APPROVED PERMIT TO 1, 2, 3, 4 ABOVE 7) (Circle one) SICZaTUM: ? DATE: p',/ - MR E! 4lAPL-A+tAW-04 m sat It m_wj-m Nw sm s r+s .a? ?s as rs mss a :ar ?t mare r??? ?r f! rs ?t a?i p? a? FOR C I T Y USE ONLY PERMIT u ISSUED F__ FEES: $ SEWER PERMIT (INlCL . D SURCHARGE) $ WATER PERMIT (INCLUDE SURCHARGE) $ ?°- WATER METER/COPPERHORN/OUTSIDE READER $ WATER TAP (INCLUDE CORPORATION STOP) $ SEWER TAP $ '.000,i;::T ??OS' - ER $ ACCOUNT DEPOSIT - WATER $ < ;r? WAC $ 1 ?; SAC $ TRUNK WATER ASSESS-TENT $ TRUNK SEWER ASSESSMENT $ LATERAL BENEFIT/TRUNK SEWER $ LATERAL BENEFIT/TRUNK WATER $ OTHER $ TOTAL $ AMOUNT PAID/RECEIPT 6 DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YE S IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : •? s? w? ?. tam -- nook" ¦ =00 NOW M s-.sE -H§ R+0 MUO M ININ sip - ¦%= M wig - /!I. - WJW PERMIT City of Eagan Permit Type:Building Permit Number:EA113683 Date Issued:09/06/2013 Permit Category:ePermit Site Address: 1885 Bear Path Tr Lot:6 Block: 1 Addition: Sun Cliff 2nd PID:10-72976-01-060 Use: Description: Sub Type:Reroof Work Type:Replace Description: Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes . Danielle Merritt Valuation: 4,000.00 Fee Summary:BL - Base Fee $4K $103.25 0801.4085 Surcharge - Based on Valuation $4K $2.00 9001.2195 $105.25 Total: 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. Contractor:Owner:- Applicant - Khamphao Vilaysouk 1885 Bear Path Tr Eagan MN 55122 Merritt Restoration 2031 Basswood Ct Rockford MN 55373 (612) 282-9979 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink r For Office Use I I I City of EaRan ; Permit ~ gas a s I Permit Fee: 3830 Pilot Knob Road I Eagan MN 55122 Date Received: 9_1_2-43 Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: /!t I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: a - l3 Site Address: l ~~5 lea. Y, Unit Name: K h OLWO a Q V I I0,Q f (,t JL Phone: Resident/ Owner Address / City / Zip: Applicant is: Owner Contractor Type of Work Description of work: Construction Cost: Multi-Family Building: (Yes / No Company: m Q f(~ 1+ ( 4-b-10-~ 1 Contact: Contractor Address: do,)) B"/~~ ~ City: /C~fJcl~~iC~ /y//V State: Zip: sS~ 3 Phone: l d - r~ Y01- License Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A .NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE; Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.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 Minnesot tat ild' Code mu a corn leted within 180 days of p rmit issuance. X Appl ca s Printed Name pp cant's ig ture Page 1 of 3