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3693 Ashbury Rd CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121b 12219 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SF OWG/GAR Est. Value $112,000 Date ,mot JULY 1 19 86 Site Address 3693 ASHBURY RD Erect C Occupancy R3 Lot 1 Block 3 Sec/Sub. BLACKHAWK GLEN Remodel ❑ Zoning R1 Parcel No. Repair ❑ Type of Const. Vn Addition ❑ No. Stories 44 LUNDGREN BROS CONSTRUCTION Move ❑ Length i Name Demolish El Depth o Address 9 5 E WAYZATA BLVD Int Impr. ❑ Sq. Ft City WAYZlZAPhone 473-1231 Install ❑ :1k o Name SAME Approvals Fees 04U Address Assessment Permit ' 0 I.- City Phone Water & Sew. Surcharge 56 . 0 Police Plan Review0 F z Name Fire SAC 500. czi z Address Eng. Water Conn.C c W City Phone Planner Water Meter 6 Council Road Unit 1 hereby acknowledge that I have read this application and state that the Bldg. Off. 6 0 8 Tr. PI.~ 0 information is correct and agree to c ply with all applicable State of Minnesota Statutes and City pf Eagan rdinances. APC Parks Var. Date Copies Signature of Permittee 4 Total • 0 A Building Permit is issued to: LUNDGREN BRO CONSTRUCTION on the express condition that all work shall be done in accordance with all applicable State gf Minnesota Statutj2~ra d.City of Eagan Ordinances. Building Official `5 _ i .1 e W Vi% -C z 0 v ~ TEL v u s n ~ x 1 ~ r I w ~,3 -j On PERMIT # ~23 (P f) • c MECHANICAL PERMIT RECEIPT # (L29 CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN $5121 DATE: I CONTRACT PRICE: ) Ci(;' PHONE: 454-8100 Site Address `t~ ,1 ` t' < < BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Su 4- Res. New X Name ' Mult Add-on Address ' Comm. Repair c City Phone Other Name + FEES c Address = ` r RES. HVAC 0-100 MBTU -$24.00 p City l I Phone -12,- 13 ADDITIONAL 50 M BTU - 6.00 ADD-ON AIR COND. 0-24 BTU - 12.00 TYPE OF WORK ADDITIONAL 6 M BTU - 6.00 GAS OUTLETS - 1.50 EA. Forced Air M BTU COMM/IND FEE - 1% OF CONTRACT FEE Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00 Unit Heater M BTU MINIMUM - COMMAND FEE - 20.00 = Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50 Vent CFM (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1 ,000.00) Gas Piping Outlets # Other FEE _;t S/C: SIGNATURE OF PERMITTEE TOTAL FOR: CITY OF EAGAN PERMIT # PLUMBING PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE CONTRACT PRICE: PHONE: 458-8100 Site Address BLDG. TYPE WORK DESCRIPTION Lot Block Sec/Sutr ' ! Res. New Name Mult Add-on ~a Address Comm. Repair C City Phone Other b0. FIXTURES TOTAL Name Water Closet - $3.00 $ Address Bath Tubs - $3.00 0 City Phone Lavatory - $3.00 Shower - $3.00 FEES Kitchen Sink - $3.00 COMM/IND FEE - 1% OF CONTRACT FEE Urinal/Bidet - $3.00 MINIMUM - RESIDENTIAL FEE _$10.00 Laundry Tray - $3.00 MINIMUM - COMM/IND FEE - 20,00 Floor Drains - $1.50 STATE SURCHARGE PER PERMIT - .50 Water Heater - $1.50 (ADD $.50 S/C IF PERMIT PRICE GOES Whirlpool - $3.00 BEYOND $1,000.00) Gas Piping Outlets - $1.50 Softener - $5.00 Well - $10.00 Private Disp. - $10.00 ' Rough Openings - $1.50 SIGNATURE OF PERMITTEE FEE: 4i STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL i : CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road P. O. Box 21.199 PERMIT NO.: Eagan, MN 55121 DATE: Zoning: No. of Units: Owner: Ltmdgren_ Address: Site Address: Ashburt Plumber. ,7*!eJ! T)-ro r ' opw h P1! with dw Ghr of sofa Connection Charps: ~')n onus mess. Account Deposit: Permit Fee: Surcharge: BY Doh of Inp: Misc. Chorpea Total: Insp.: Doh Paid: CITY OF EAGAN WATER SERVICE PERMIT 3830 Pilot Knob Road P. O. Box 21199 PERMIT NO.: Eagan„MN 55121 DATE: Zoning: No. of Units: Owner. Address: Site Address '93 !k.mhr c Plumber Lur'r,. er Meer No.: Connection Charge: Size: Acoourrt Deposit: Reader No.: Permit Fee: 1 some a aow oil wilts !w CRY of 1"em Surcharge: OrAwwwase. Misc. Charges: Total: BY Doe Paid: Date of Insp.: Insp.: CITY OF EAGAN 454-8100 DEPT. OF BUILDING INSPECTIONS Correction Notice (~~3 Located at I have this day inspected this structure and these premises and have found the following viol rions of city codes governing same: W L/ I ~I 8~ When co`frecti0 a e -be , please call 454-8100 for ins ection. Date " Auk Inspector City of Eagan DO NOT REMOVE THIS TAG CITY OF EAGAN Remarks 01 45t- /6-2 I~F Addition- Ble khawk Glen i t Lot } Blk ~ Parcel 10-143 50 -010--03 Owner Street 1 594 Ashhnr) P1 are State Eagan HN 55122 3693 Ashbur Road Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. 1076 198 253.48 50.70 STREET RESTOR. GRADING SAN SEW TRUNK 197 6.70 2 Pd prior to division SEWER LATERAL Bn1074 198 112.09 22.42 WATERMAIN Bn 1075 198 92.80 18.56 WATER LATERAL WATER AREA 1072 198 309.40 61.88 Storm Sew Trk 1073 198 110.91 22.18 STORM SEW TRK 732 19832.57 1 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK :ITY OF EAGAN WATER SERVICE PERMIT 330 Pilot Knob Road 7771 O. Box 21199 PERMIT NO.: Eagan, MN 55121 DATE: 8-6-86 loving: R1 No. of Units: 1 )caner: Lundgren Bros Wdress: fte Address: 3693 chbury Road L1 B3 Blackhawk Glen lumber: Lundgren Bros Plumbing Aeter No.: ,372 ~Sa 5' Connection Charge: SOO.OOud Ilze: " Roc Account Deposit: 15.00pd teade- No • IL-5 Al ~L 9a Permit Fee: 10.00ud _ esm ft aeestill wish tha Gtr of Ggaa Surcharge: . 50nd kdiaaaos~ Misc. Chorgew. 156.00gd TP ~ ' '-tea Total: Ai Sopd mAtP_l ly Doro Paid: )ate of Insp.: Insp.: i This request void Y~-2Y 18 months from tt ~v C 29212 I Request Date Fire No. Rough-in Inspection Regm red? Ready Nuw ❑ Will Notify Inspec- llyes No for When Heady Licensed Electrical Contractor I hereby request inspection of above Owner electrical work installed at: Street Address, Be. or Poute N Cit ec ion No. Township Name or NO. ange NO. C ty Oc ant (PRIN 1 Phone No. y7~/~3J Powe Suppli r Address Ele caI Contractor ompany el Contra/cc,t.,', License No. _ Mal ddress (Contractor a, Owner Making Installation) Auth ized Signature 1 tract Owner Making Insta ation) Phone Number r MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION PEG UEST WILL NOT Griggs-Midway Bldg. - Room N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 68104 UNLESS PROPER INSPECTION FEE IS Phone (612) 297-2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION Ee-00001-e4 Ii, See instructions for completim3 this form on back of yellow copy. /7, / C 2-9212 ""X"' Below Work Covered by This Request /f0 Add Rep. Type of 8uildin8 A.pplionces Wired Equipment Wired Home , Range Temporary Service DGplex Water Heater Lighting Fixtures ~IA Apt. Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm other peu V ,her lsporllyl Mimi ueu fy Other Other Compute Inspection Fee Below eders k Fee Circuits p Fee Servics Entrance Size a Fee IQ, 0 to 200 Amps 0 to 30 Am s Above 200 Amps s 31 to 100 Amps Swimming Pool Amps Above 100_Am s Transformers ns Partial Othe Signs ction s TO L FEE Remarks _ ' Rough-in . Date I th Electric ('f1 . Inspec reby certify the, the above Fi nal inspection has been medo. This request void 18 months from This request void 18 months from `Y Cc Poo,,~ 0 3 44 ~~,3i~Z«r ~s65'S Request Oat Fire No. Rough-in Inspectian i Re uiretl? ❑Ready Now Will Notify, Inspec- Yes ❑No for When Ready ,Licensed Electrical Contractor I hereby request inspection of above ❑ Owner electrical work installed at: Street Address, Box or R tG NO. ^ City 1+1 3 FIJ( ecvon e. Igo Name or Na. Range No, County tST-A4(k 41 31 pr N-46-tA Occupant (PRINT) pk Phone Nn. -(Z3 Power Suppli Address IF_I E. EI ctrical Contractor (Company Name) rmt,acior s License o. 4- L Eleova-f'( 4 88 Mailing dress IC ontraclor r Owner Making Installalio X, 2? c fY? sS~zs Au zed Sig a[ CO r tor/Owner Making Installation) Phone Number umberr ;j-7!5- -3q 0 MINNES TA STATE BOARD OF ELE TRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 56104 UNLESS PROPER INSPECTION FEE IS Phone (612) 297-2111 ENCLOSED. -uy6 REQUEST FOR ELECTRICAL INSPECTION EB-oocu, -04 ' See instructions for @ompletinb this form on back of yellow copy. '1 6 / _ sC0 063444 X'" Se/ow Work Coveted by This Request Add Rep. Type of Building Appliances Wired Equipment Wired home- Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Omer pacify the, (Spocify) Lt er pacify Other Other - ompute Inspection Fee Below # Fae Servic2;( Entre nce Size tt Fee Feeders/Subfeeders # Fee Circuits / ' o to 0 Am s 0 to 30 Amps 5 l7RS 0 to 30 Awns Above 200 qm S 31 to 100 Amps / , as 31 to 100 q s Swimming Pool Above 100 Amps Above I00_Amps Transformers Irrigation Booms Partial/Other Fee Signs Special Inspection TOTA F flemarks g- o " Rough-in D/te I, the E [n lk Inspector, hereby ~l artily that the above Final Oete Inspection has been ads. This request vold 18 months from RESIDENTIAL BUILDING G,0r7 3 .gG,Jc%luAeVrt GLZ,v Permit Application (r3 1 City Of Eagan 3830 Pilot Knob Road, Eagan NIN 55122 'ryL~J° ok Telephone 4 651-675-5675 FAX # 651-675-5694 P64 New Construction Requirements Remodet(Reoair 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 Can of Survey Recd _ Y _ N (20% maximum lot coverage allowed) 1 set of Energy calculations for heated additions Tree Pres Plan Reed _ Y _ N 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Not Reqd _ Y _ N I set of Energy Calculations Addfion - indicate d on-site septic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan If lot platted after 7/1193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date Construction Cost Site Address 4A P Unit/Ste # Description of Work ~E CY Multi-Family Bldg - Y 7C N Fireplace(s) _ 0 K 1 - 2 g p Property Owner L ay JL/UL-' >dL %e Telephone # (/S-( Contractor Address 7/._~ 4~l4-Z- ~/O City al~,/ ~y State • Zip J Telephone # ( f, AA i b - n a COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 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 It so, 25% plan review fee applies. Licensed Plumber Telephone ) Mechanical Contractor al)G 0 8 2003 Telephone # ( ) Sewer/Water Contractor Telephone # ( ) By 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 cant's Signa 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 EM. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 EM. Alt - SF ❑ 04 02-plex ❑ 10 08-plex x 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 A 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 G?OO Occupancy R MC/ES System Census Code L/ y Zoning City Water SAC Units Stories - Booster Pump Nbr. of Units - SQ. Ft. PRV ` Nbr. of Bldgs - Length Fire Sprinklered ' Type of Const /L)- Width 7 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 p Approved By 1 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 E'YDRIS. CERTIFICATE SIENNR CORPORATION . gSHBURY _ _ Bz9.6 PLACE 3az R= 50T51 ~I °12b5AW 86. 11 I N89 g .;1..^Y S? e3aox 30 L~ l m m okkln 10 vy ' i.. ; 1,'y N P 4'kD': f,1 ::.,y Q e iv:il ~S}':'Y 4 Q I 831.8 tel.- 63a45 27.34_ _ ,g3L2 2T.0 p I 111 A R. ° ti' 1 y G / I 1 q 1 " r; i 1 t m~PROPOSED" b N 1 o 2 y. LOT HOUSE , 7 , o.o _ cn A 0 30. %831.6 ~ 4• 31.5 /yW 1 1 ' ~B31.BX b 4 a5.ee_ asLS ` J e31b p~A7NP~Gr 8117'7 Y EASENENT, 10 6 0 0 833 OX / $14.0 B]IA 1831.1 831.7X 127.77 - I 130 N 89°46'21 " W t L_ DENOTES PROPOSED SURFACE DRAINAGE 1 INCH 30 FEET O .DENOTES IRON MONUMENT SET SCALE: PROPOSED GARAGE FLOOR ° $3 0 FEET • DENOTES IRON MONUMENT FOUND X000.0 DENOTES EXISTING ELEVATION PROPOSED PROPOSED TOP OF LOWEST FLOOR BLOCK g3 PIS-1 FEET FEET (000.0) DENOTES PROPOSED ELEVATION WE HEREBY CERTIFY TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF TIIE BOUNDARIES OF: Lot I, Block 3, BLACKHAWK GLEN 15T AUDITION, according to the recorded plat thereof, Dakota County, Minnesota. AS SURVEYED BY DOES RIMPROVEMENTS TI11S 13TOIH DAY ENCROACHMENTS, OF CIIhi NaV. IF AN 1985. ME OR UNUER MY DIRECT SUPERVISION REVISED 6/12/e6 TO SHOW PROPOSED SIGNED: JAt-n. H LL, INC. HOUSE FOR LUNDGREN BROS. CONST. n r CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 12219 BUILDING PERMIT PHONE: 454-8100 ~13R b Receipt k l To be used for SF DWG/GAR Est. Value $112,000 Data JULY 1 , tg 86 Site Address 3693 ASHBURY RD Erect C$ Occupancy R3 Lot 1 Block 3 Sec/Sub. BLACKHAWK GLEN Remodel ❑ Zoning RI Parcel No. Repair ❑ Type of Oonst. VH Addition ❑ No. Stories 44 Name LUNDGREN BROS CONSTRUCTION Move ❑ Length 935 E WAYZATA BLVD Demolish ❑ Depth 56 c Address Int Impr. ❑ Sq. Ft city WAYZATAphone 473-1231 Install ❑ it Name SAME Approvals Fees o r°u¢. Address Assessment Permit $ 463.00 Ciry Phone Water &Sew. Surcharge 56.00 S Police Plan Review 231.50 F Name Fire SAC 575.00 Fa Address Eng. Water Conn. 500.00 aw City Phone Planner Water Meter 63.50 Council Road Unit 290.00 I hereby acknowledge that l have read this application and state that the Bldg. Off. 6/30/8 Tr. PI. 156.00 information is correct and dares to c fny with all 'cable State of Minnesota Statutes and C f aga nce s. APC Parks Signature of Perrr Al r-~ Var. Date Copies $2.335. 00 A Building Permit is issued to: LUNDGREN BR CONSTRUCTION Total on the express condition that all work shall be done in accordance with all applica to innesota S Ordinances. Building Official ueC > "17 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COMMERCIAL: j INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, V(~ 1 SET OF SPECIFICATIONS AND 1 SET OF va ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND 50-fl ~ar,icy ~~Z~v~ To Be Used For: Re J" Valuation: Date: G 2S $G Site Address 3cq /&4& ~y R. OFFICE USE ONLY ~ `J 2 Lot / Block 3 Erect Occupancy J Remodel Zoning Parcel/Sub JSc4cbclea,ik ro(s. Repair _ Type of Const-,-!~V p Addition # of Stories Owner l~iJ ~yrsa Rwof, epwx/. ,FYc. Move Length Demolish Depth Address 13s` W,¢+,taf4 (g Int.Impr. Sq Ft Install _ City/Zip Code G{lv¢y'24A , $2 Phone --q'7-T- /7 3/ APPROVALS FEES Contractor Assessments Permit Water/Sewer Surcharge_ Address 935 Lq~y Police Plan Review 23/.56 Fire SAC i City/Zip Code tAtw zo-4 Engr Water Conn Planner Water Meter Phone X173-/2-3/ Council Road Unit Bldg Offb 30 Tb Treatment Pl Arch./Engr. APC Parks Variance Copies Address TOTAL 3~s City/Zip Code Phone # 1/73-1-L31 NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. i5X 4/ 6 - S B = Z7/ W 141A yG/ /(o S 35~Zz ,f 5 85z- -SURVEYOR'S. CERTIFICATE* SIENNA CORPORATION `30.2 • A Sy - BUPLACE 830.2 R= 507.5/ of 830.5)_ e 1 M 86" 11 Na 012 b 029.6 I 5"W X830,7 2.89 g3o 0) rv'M 830.0% A/~ O 7 1 O 1,~ N 30 LI„I 10 0 co V I j m i N Q a, ` t 0310 483233; _ 27.34_ S.s.342.- 2T.0 ro ' 830.45 i /A fy 1 I W It w I NA GAR- J, a NO I I ~t N I ~ 3~ 11 mfPROPOSED b N { ~ `J 10 /LOT /HOUSE 7.67 o.o _ fn 30 X83L5 ✓ ~em.ex o 44.0 ~g37,5) 31.5 1 45.68 ((g1L5 T J 831.6 ';'-PER PLAT d 1/71Ll7Y EASFMENT~ to .iN• I \ 831.7% 833.6% 1 l$3y~34.0 ~C ` r/ P(8 834.1 I / 1 1 127.77 I N 89°46'21 " W 30 t DENOTES PROPOSED SURFACE DRAINAGE SCALE: 1 INCH 30 FEET O DENOTES IRON MONUMENT SET = ~ FEET • DENOTES IRON MONUMENT FOUND PROPOSED GARAGE FLOOR 83l.; - XOOO.O DENOTES EXISTING ELEVATION PROPOSED PROPOSED TOP LOWEST F FLOLOOR OR 8 8,3S- FEET 1 FEET (000.0) DENOTES PROPOSED ELEVATION WE HEREBY CERTIFY TO SIENNA CORPORATION THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF.THE BOUNDARIES OF: Lot I, Block 3, BLACKHAWK GLEN IST ADDITION, according to the recorded plat thereof, Dakota County, Minnesota. ME DOES MY DIRECT SUPERVISION THIS UAYIIpFCHh1~N~TV. IF ANY. 85 S SURVE.Y~E1D BY REVISED 6/12/86 TO SHOW PROPOSED SIGNED: JAMES--R; H LL, INC. ~r ~~y_8L HOUSE FOR LUNDGREN BROS. CONS? ; n BY: HAROLD C. PETERSON, LAND SURVEYOR MINNESOTA LICENSE NUMBER 12294 PROJECT NO. BOOK / PAGE JAMES R. HILL, INC. 85618(1,(,'7111) 173 / 64 Planners / Engineers / Surveyors FILE NO. 4200 Humboldt Avenue soulh FOLDER Bloomington, Mn. 55431 012-004-3028 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY y 1 SET OF ENERGY CALCULATIONS To Be Used For: ~eDJ " zT Valuation:Aee~ QO Date: Site Address:,j( 3 OFFICE USE ONLY Lot: Block 3 Sect/Sub Erect Occupancy Remodel Zoning Parcel 0 Repair Type of Const Enlarge 1l of Stories Owner Lundgren Bros. Construction, Inc. Move _ Length Demolish Depth Address 935 East Wayzata Boulevard Grade Sq Ft City/Zip Code Wayzata, Minnesota 55391 Phone 473-1231 APPROVALS Contractor Lundgren Bros. Construction, IncAssessments _ Permit Water/Sewer Surcharge Address 935 East Wayzata Boulevard Police Plan Review Fire SAC City/Zip Code Wayzata, Minnesota 55391 Engr Water Conn Planner Water Meter Phone 473-1231 Council Road Unit Bldg Off Parks Arch./Engr. PC Treatment Pl Variance Address i1~-62i/ ( if Rio TOTAL City/Zip Code ~~rJ~j/,~~p ~fJ~ s~ 3f~ Phone # Cities Digital Quality Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. LWIDGR k 0 ca,61RUCION a INC. ESUI/ jS39t " (612) 47s-t23t \4hYZP,Th„ IJJFJId 935 EAS Z/+i BOULE"P'D Ex1ER10". Ei1VELOPE AVERAGE U 0'; PUTAT10N Lou Block Site Address R U R 8t0rs .D58 opaque Walls 117 Wall Framing Areas .023 Ceiling Insulation Area „ - .027 Ceiling-Framing Area .04 Rim Joist - .14 1•1jasonry Wall - .26 ?dindows Double Hung 46 Casements - .18 Doors - .46 Patio Doors 47 Sidelites - 1) Lower Level (Basement) Total exposed wall area ~8 D x (U) .058 = Opaque Wall Area x (U) .117 = Wood Frame Area - = x (U) .04 Rim Joist. - 78,~Dx (U) ,14 = I10 / Exposed block Casement X (U) .46 = Window Area -x (U) .26 = Double Hung x (U) .46 = Sliding Glass Door - Door Area - Total 0 CCONSIRUC110N i VJAYZATA. I✓~IN14 ES0TA 5S391 (612) 4731'231 B35 El;ST \':/-.YZk.T pOULEIARD 2) 1st or main floor Total ezocsed '0all area 7al•8ox (U) .058 = opaque V211 area 9=- yp,l9x {U} .117, _ Wood frame area 9a x (U) 04 Rim joist Casements /3, x (U) .46 = 5 5a l?indow Area ~~s x (U) .26. Double Hung 33.35x (U) .46 = Sliding Glass Door 3.78 x (U) .18 = $ Door area 13,y~ x (U) .47 = a - Sidelites Total -In/ ;3) 2nd floor if 2 Story V6 Total exposed wall area ~BS~x (U) .058 = e99 Opaque wall area _ 76•!/ x (U) .117 = Wood frame area 3,55x U) .46 Window area Casements ax ~U) 26 = 73.3 Double Hung 5L~ j x (U) :46 = Sliding glass door r x (U) .18 = Door area Total /O ~~D 4) Total ceiling area a 3a 8(I x (U) .027 = Wood frame area -I 7 x (U) .023 = /780 Opaque ceiling area . x (U) .55 = Skylight - Total aO /a - MD AD)CH L . 0 CCONSI RUCI ION - IJiI I.1 IJE SO TA 553 91 (6, ) 14 73-1231 935 EAST 1VAYZATA BOULEVAPD • 1.AYZP.TA. iSinn. U Factors Total exposed wall area Total exposed ceiling area 026 I inn. U Factors ag.7 (A) Total + Item 4 ao•I2, ~9 Item 1 ! bl + Item 2 !01'I + Item 3 (3-~D If total of Items 1 - 4 is less than Item (A), building complies with SBC 6006 (C)s C J L I BL 7) CITY USE ONLY RECEIPT C' I U SSS C s SUED. Gk C I~. CL W 1 -C RECEIPT DATE: U ~~3 1999 PLUMBING PERMIT (MIDENTIAL) CITY OF EAGAN 3630 PILOT KNOB EW EAGAN, IAN 5514E (651) 691-4675 Please complete for: D 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 = 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/Spa 3.00 x = Water Healer 3.00 x = 30, rti Floor Drain 3.00 x = Gas Piping Outlet ' minimum-1 3.00 x = Rough Openings 1.50 x = Water Softener for dwellings under construction 5.00 x Water Softener ' for existing dwelling 30.00 x U.G. Sprinkler for dwelling under const. 3.00 = U.G. Sprinkler for existing dwelling 30.00 = Alterations to existing residence 30.00 = Water Turn Around 30.00 = Private Disposal System MPC lic. 75.00 = (new and refurbished systems) Private Disposal Systems Abandonment 30.00 RPZ (new installationlrepalr) 30.00 STATE SURCHARGE .50 Reminder, Call 681-4675 for inspections of water heaters, water softeners, alterations, etc. 30. SO TOTAL I hereby acknowledge that have reatl this appllcedon, slate that the information is correct, and agree to comply with all applicable Cityof Eagan ordinances. It is the appiicanrs responsibility to notify the property owner that the C'- - -w ^ +^m~^ -sed by the City during its normal operational and maintenance activilles to the facilities constructed w CRAVEN, KIM nent. SITE ADDRESS: 3693 ASHBURY ROAD EAGAN, MN 55122 OWNER NAME: (651) 681-1599 INSTALLER NAME: L6WL Om 6/i(4 TELEPHONE STREET ADDRESS: Z`30 y,¢PF/AFt-C> S j CITY' lj STATE: ZIP: S OFD SIGN R F PERMITTEE CD/PERMIT FORMS/RPLBG PERMIT (RES) - 1999 CITY OF E A G A iV * ''10~= PAYMENT OF FEE AT TIME OF s APPLICATION DOES NOT CONSTITUTE APPROVAL OF PERMIT. * APPLICATION FOR PERMIT * INSPECTION OF SEWER AND/OR WATER x* SEWER AND/OR WATER CONNECTION + ~ PERMIT HAS BEEN * APPROVED. * * =9=== tit * * P ease Print 1) PROPERTY ADDRESS: LEGAL DESCRIPTION: Ld f ~ZirZ~C~ ,gwr-'eh~f AJ. Lot Block Subdivision or Tax Parcel ID IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE: p PRESENT ZONING/PROPOSED USE: (Mn Year) ❑ C'QM!VERCIAL/RETAIL/OFFICE Cy R-1 SINGLE FAMILY ❑ INDUSTRIAL ❑ R-2 DUPLEX (Twn Units) ❑ INSTITUTIONAL/GOVERMENT ❑ R-3 TOWNHOUSE (Three + Units) ( Units) ❑ R-4 APARTMENT/CONDOMINIUM ( Units) 2) ADDRESS: CITY, STATE, ZIP: PHONE: 3) I: p For City Use _ Plumbers License: ADDRESS: ~3j / / 2~~ ~r~✓ Active i CITY, STATE, ZIP:_~_ Not recorded PHONE• / - / 2 f MASTER LICENSE# Staff-Intial 4) as •',i ...uT~ NAME: LsLj✓,s, b s L~►+53"G ADDRESS: CITY, STATE, ZIP: PHONE: 5) ! v I t a• ::1 • a~ a! CONNECTION TO CITY SEWER CONNECTION TO CITY WATER ❑ OTHER 6) PLEASE HOLD APPR`OVED' PERMIT FOR PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVED P T TO 1, 2, 3, 4, ABOVE (Circle one) 7) r r. p• . ' • 7C ~ K V'I' ~ • ~ ~ I' t1 • ~ • IP' i! F Y71• • y 1 • ~ D1 1• •11 Y a~'• i:r. 1 ! :;f aa• Iy S! 1 1 1 ";r' ~ • 1 h FOR CITY USE ONLY PERMIT # ISSUED 27 -7/ Pd w/Bldg. Permit FEES: $ $ Id, 56) SEWER PERMIT (INCLUDE SURCHARGE) $ $ /Q Jr O WATER PERMIT (INCLUDE SURCHARGE) $ 5v $ WATER METER/COPPERHORN/OUTSIDE READER $ $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP $ $ / 5. ~JZJ ACCOUNT DEPOSIT - SEWER $ $ /S. QL7 ACCOUNT DEPOSIT - WATER $ 5o-b • C~ C ) $ WAC $ S 7S 0~) $ SAC $ $ TRUNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER ~J~~•~ U $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ /9 ~5o $ 5I•V~ TOTAL RECEIPT RECEIPT DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? Q YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. Q SUBJECT TO THE FOLLOWING CbNDITIONS: APPROVED BY: TITLE: DATE : L I eD`-:1) ~o~ Cyr ~ hki6n F q` e I o-!•- 3 HEAT LOSS CALCULATION J~L-° TEMP. DIFF.. tmtam« Name t 4 ~1'~_ aY~$ Tyw Cerotruction City - Windows Storm Sash Dealer Name. Walk . Ina. Street Coiling Ina. City Floor FI. RoomlLen th Width 7 Nei t FLIF- RoomlLen h 13 Width 1;;' Nal t Q -jo Windows and Doors-Crackapa and Arm Windows and Doors-Cradupa and Arm No W Nrh «ayl.r Nn. N L~ 11. raa wrrh Nayln No. N L~ N. a"M's nr Zoo." L r N o i, h. - Nn• N N Coef. Btu Cod. Btu Infiltration Infihration i Glass Glar _ Exp. wan ;1, )cQ p Exp.wall 35X4' 280 Net exp. wail a?0 „ Niel exp• will 2W 4l Z,O Int. wall IM. well Ceiling 0 X (S:S Z Ceiling IT )cIz- 20 t O! Floor 3 y Floor so `f 3 I L Total Btu. I S Total Btu. zl`fo B FI.I J{;I' Room l L h Width l ~ S alaid Ar K I'LI .F?y.ev Rooml Lan h l - S7 Width ,S leaipht Windows grid Doors-Crat#apeOld Arr Windom and Doors-Craekapaand Arm Nn aw.eth W ~M th. „ r h. ar~x. Na. NwMM NaV~t La. N LNInaN h. Am of me" W 1. Dgav Zo rt 1 3 fo poov Zo Lo 7- 6d 3 3-f Coef. Btu - Coief. Btu Infihratlon Zo 00 Infiltration $ r{O Z/100 Gim Zo 92 000 GIM S 2 00 Exp. wall 220 Eats. wall • S x fi` ri l. Net exp. wall lw 90 ,0 - Net exp. wall 2 2 Int. wall Int. wall Ceilug fy)c 3. V, 1 L 11.5 Ceiling 15 x 110 2 ZLo 1, low Floor Ir0 2' 22o Total Btu. 35Y Total Btu. - 3 $ 13 FI.I 2r~. RoomtLargth 3: Width jy Naipltt 8 15`FLI irw«dreRoornllelt h 10 Width 12- Height Windows and Door-Cra6a a and A►r windows and Dtwn-Cradcapa and Arm wmh wyr.r ft.. hr LhOW N. arIr.Nh «arahr m. N LYnar h. Am Nn N N. hr" nr rrr n1 "he L N N aW 0.7:. ~5/ 8' 30 ~ L 1 la I $ ov t°I 18 CDO. Btu cot 11111 Infiltration 3 $!92 / ZU IrfiltrNion y0 Gla:s 3o U0 Glass 2. 17-60 Exp• wall 8k Exp. well 12 >er to Net exp. wall 3" q 1q; (0 Me exp. well 1 7- Z88, Int. wan Int. wan Ceiling ?3. S r 1 ea9 2 b5T tailing 6x 17- Floor 3aq j Floor ? L (r1/ Total Btu. 0 Total Btu. ocu For office use rte'' j Permit j City of Eapi~ I Permit Fee. / 3830 Pilot Knob Road I I Eagan MN 55122 r j Date Received: Phone: (651) 675=5675 Ao~'A Fax: (651) 675-5694 1 1 Staff: I I 2~009 RESIDENTIAL BU.I. - = .ERMIT APPLICATION Date: j oG I Site Address: Tenant: Suite RESIDENT/ OWNER Name: :~JY_, 4- C___aCisIn-e, aini fh _ Phone: (90~-] ` -1c" Address / City / Zip: `alb)( ca (\d rwn V., NW , SSA Applicant is: Owner Contractor TYPE OF WORK Description of work: 1-car- t~ C- YC C Construction Cost?7 Multi-Gamily Building: (Yes No CONTRACTOR Name: Pd+ nG License Address: S 1- City: _ 1 U t'M' j rl r 4'1 Sfate: AA kJ Zip: 5509q Phone: f'oS Contact Person: L~ -f A.A 1 COMPLETE THIS AREA ONLY IF CONSTRU01ING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code + Residential Ventilation Category I Worksheet New Energy Code Worksheet Category Submitted Submitted (q submission type) Energy Envelope Calculations Submitted In the last 12 months, has the Citikof Eagan issued a pern for a similar plan based on a master plan? -Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer $ Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicant's P inted Name Applicants $ig ature Page 1 of 3 PERMIT City of Eagan Permit Type: Mechanical 3830 Pilot Knob Rd Permit Number: EA088421 Eagan, MN 55122 . Date Issued: 03/10/2009 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 3693 Ashbury Rd Lot: 1 Block: 3 Addition: Blackhawk Glen PID 10-14350-010-03 Use Description: Sub Type: e - Furnace Work Type: New Description: Furnace Comments: Quesetions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, 952-445-2840 Ashley Orman 410 W Lake St Fee Summary: ME - Permit Fee (Replacements) $50.00 0801.4088 Surcharge-Fixed $0.50 9001.2195 Total: $50.50 Contractor: -Applicant - Owner: Standard Heating & Air Conditioning Jon M Smithberg 130 Plymouth Ave. N 3693 Ashbury Rd Minneapolis MN 55411 Eagan MN 55122 (612) 824-2656 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA108733 Date Issued:01/07/2013 Permit Category:ePermit Site Address: 3693 Ashbury Rd Lot:1 Block: 3 Addition: Blackhawk Glen PID:10-14350-03-010 Use: Description: Sub Type:e-Windows/Doors Work Type:Windows/Doors Description:House Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . 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 - Kelly M Zemaitis 3693 Ashbury Rd Eagan MN 55122 Home Depot At Home Services 656 Mendelssohn Ave. N Golden Valley MN 55427 (763) 542-8826 Applicant/Permitee: Signature Issued By: Signature City of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit* I ` Permit Fee: f �� Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit #: Resident/ Owner Name: K.e.,1\y ?tea S Phone: Address / City / Zip: 210/ 3k bye\� . CL A-6 Applicant is: Owner Contractor Type of Work Description of work: Re ?._D0 -s' $400-C Construction Cost: R S OC Multi -Family Building: (Yes / No X ) Contractor Company: C S ►1 k e_'S \D\CS a "Contact: 7-1'c $ Address: ) � �O0.V\V\C I--� City: i./4 v\ - c K� State: /1417\ Zip: SS j q 3 Phone: CO )D,--3 ° —ack f License #: 1SC-570S-091( Lead Certificate #: er 34!) � e) 1 C Celi If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) In the last 12 months, Yes _No 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: Licensed Plumber: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.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 issuance. x Applicant's Printed Name •Nr W(3-S\'\el< x Applicant's Signature Page 1 of 3 City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 FEB 2 4 2014 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2014 MECHANICAL PERMIT APPLICATION ❑ Please s bmi wo 2) sets of plans with all commerci ppl'ca ions. Date: .�) Site Address: 3 6q 3 fishhcip". Tenant: f3 Suite #: Phon :63 Of 01 07 SS Name: License #: Standard Heating & Air Conditioning Address: 130 Plymouth Avenue North Minneapolis, MN 55411-3445 State: 602_874-2656 Phone: Contact: Email: New Replacement Additional Alteration Demolition Type of Work Description of work: NOTE: Roof mounted g q red by Gitj Code.- Please con,`", and round motnted mechanical equipment is required to be screened tact the: Mechanical.Inspector for information on permitted screening methods:; RESIDENTIAL Furnace Air Conditioner Air Exchanger Heat Pump jCtokkr Other tC4 COMMERCIAL New Construction Interior Improvement Install Piping Processed Gas Exterior HVAC Unit Under/Above ground Tank ( Install / Remove) ............ RESIDENTIAL FEES 3 n%A.% Sctego ) c5 .2- revs/ Pais !ng •aS•ern i I $60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge) $100.00 Residential New (includes $5.00 State Surcharge) I, COMMERCIAL FEES $55.00 Permit Fee Minimum 1 $70.00 Underground tank installation/removal *If contract value is LESS than $10,010, Surcharge = $5.00 **If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005 ***If the project valuation is over $1 million, please call for Surcharge .$ _66 TOTAL FEE Contract Value $ x .01 _$ _$ I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the o Eagan; that I understand this is nota permit, but only an application for a permit, and work i _tart without a pe, with the approved plan ninth case �T�prk(which requires a review and approval of plans x Applicant's Printed Name FOR OFFICE USE Required inspections: Underground Rough In Permit Fee Surcharge* TOTAL FEE inances and codes of the City of t the work will be in accordance Applicant's Signatur Date:, - Gas Service Test ate:Gas;Service'Test In -floor Heat Final HVAC Screening' PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA123053 Date Issued:05/28/2014 Permit Category:ePermit Site Address: 3693 Ashbury Rd Lot:1 Block: 3 Addition: Blackhawk Glen PID:10-14350-03-010 Use: Description: Sub Type:Residential Work Type:Replace Description:Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Ashley Orman 130 Plymouth Ave N Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 $60.00 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 - Kelly M Zemaitis 3693 Ashbury Rd Eagan MN 55122 (763) 232-3013 Standard Heating & Air Conditioning 130 Plymouth Ave. N Minneapolis MN 55411 (612) 824-2656 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink . �________________� I For Office Use � I ' � Permit#: �� Clty of �a�� .�s � iPermit Fee: �� 3830 Pilot Knob Road Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I i Fax: (651)675-5694 i Staff: i 2015 RESIDENTIAL BUILDING PERNIIT APPLICATION Date: y�'v2�" � S Site Address: Unit#: v� rt �� ` "�� Name: �e- i L1 -f-V�� Lc� Z-P�W�G.;��S Phone: �� , e�iiden�/ �� 7 � c� S�v� � d � Ow�er� �- address i city i z�p:_ _ � �.�� = " �`P. Applicant is: Owner �Contractor �� , �. , f � ,� �� ° � ' �� ' Description of work: c � 1(^l! t�-�i — �� '��C(� If� �� Ty�e of Work� ' �`�� =�� , ; �� ,, Construction Cost: Multi-Family Building: (Yes /No )� �f,(� �� , � l�� ) � • � `�� Company: �s Y 1�liC ��X�lCN'S Contact: � f0.,�\,S (y. �.� ��. � ' � � Address �01 I I.�R SC"�V�Y\e G-�v�-�. _City: M�vlV�e--Tt�� " ;Contractor� ��. ��`� �,�_ ��l��/ . � ,,�� , State:LL _I�ip: 55��3 Phone: C��a'3iD� EmaiL (�'�I��.0 ��'t�'nr�or� C� ei,.r't��lV�Ir, , vl.r�T- ,��*�� ; �'�' '"� "��; License#: g��sbp� Lead Certificate#: �� 3��S� l� U r7,r�,CQ� 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: �``�NQTE�Plans and supporf�ng tlocurrier�ts�th��yau�subm�t,`are�cons�tlerE�d to e j�ub/��nfo�rrrratiar��Port►�an'�ot" v: �°� �� .�.�� .��'� �.. �� , �,,, � �;�, � ��r � :. the�nformat�on may be classified as,�on putil��f�,y�u�prov�de� ec��aso�r ��at woulal ertr►�+ t e Cit�r to > �� ,�� y � �conclutle,�t�hat;�hey.:are i`rade se�re�tsr �, � ��`� �� .��f ��` ;< � CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection a�gainst underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. vwvw.qoaherstateonecall.orq I hereby acknowledge that this information is complete and accurate;that the work will be in coriformance 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 i:� 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'��'o��S W�S v�� X �.LJ ApplicanYs Printed Name Appl� Signature Page 1 of 3