4235 Carlson Lake Lane NCiTY OF EAGAN
3795 PRof Knob Road Eogan, MN 55122 N2 6296
PHONE: 454-8100
BUILDING PERMIT
OU1
Site Address
Lot Blxk Sec/Sub.
Parcel #
W Name
;
b Address
ce Name _
??0
Address
? r...,
Name _
Address
I hereby acknowledge that I have rend this opplicotion ond state that
the information is correct ond agree to comply with all opplicable
State of Minnesota Statutes and City of Eagcn Ordinances.
Signature of Permittee
A Building Permit is issued to:
oll work shcll be done in accordance with oll
Building Official
i
Receipt #
Date , 19
Erect 0 Occuponcy
Alter ? Zoning
Repair ? Fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grode ? Depth ft.
Approvals Fees
Assessment Permit
Woter & Sew. Surcharge
Police Plan check
Fire SAC
Eng. Water Conn.
Plonner Woter Meter
Council Road Unit
Bidg
Off
.
.
APC
Total -
on tfie express condition thot
of Minnesota Statutes ond City of Eagon Ordinances.
remk # pste !eoW hrwMlM
Plumbing
hAechonical
INSPEGTIONS DATE INSP. Rough-In Final
Footings
Foundotion
Frome/ins.
Final
6 ?
Plumbing
Mechonirnl Date Insp. Dote Irnp.
Remarks: r• r,/ s/p?r A,: f L CtifA4vTfd1
.
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
P6one: 454-8100
H?ATII3 SOFTEM
PERMIT
3/18/,10
Date: Receipt No.:
Single
Site Address: 4235 No- Car?o= _ Residential
Lot Block ? Sub/Sec. 7? ?--
? _ Multi Res., C
No. _
1'202
33'l
x
? ?7i
Name
/Re
air
w/Alter
N
.
p
e
.
3
Address $Eimc-
tallation
t
f In
C
? os
o
s
City Phone: Permit Fee '
??f.lbert Co.
Nome
e
Surchor
?
'
g
? 1r! t-Alarie Ave. xo.
Address
Y T"-. . . r , -
City ' ?' Phone: Total
This Permit is issued on the express condition that all work shall be done in accordonte with ull opplicable State of
Minnesota Statutes ond City of Eogan Ordinances.
Building afficial
CITY OF EAGAN Remarks
Addition Wilderness Run 5th Addition Lot 11 Blk 3 Parce1 10 84354 110 03
?ner u?}` _? ? f-f%' t--' Street 4235 No. Carlson Lake Ln. State Eagan, MN 55123
,.
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
5AN 5EW 7RUNK ?a),/ 1973 $132.60 $6. 63 20
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA _Wd th W C?I onnect on 6 76
STORM SEW TRK 1981 237.36 15.82 j$
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. $320.00 Jib9 -
BUILDING PER. 3977
SAC 4 .00 3169 6-10-76
PARK
?
BUILDING PERMIT APPLICATION
N4 6296
Receipt # ':? ' VO? /
Te 6o uted fdi FIREPLACE Est Value $1 000 Date l n-l 7 19--80.
Site Address 4235 N. Carlson Lk. Lri. __ Erect ?j Occuponcy R3
Lot 11 Black 3 $ec/Sub. Wild. RUT1 5 Alter ? Zoning Rl
P 10-84354 110 03 Repoir ? Fire Zone
arcel #
l
E r
r
f C NA
n
arge ? ons
.
yPe o
a Nome Da.lAfi A . Johnson Move ? # Stories NA
; Address Same Demolish ? Front NA ft.
b Ci Phone 454 -3007 Grade p Depth NA k.
w N Approvals Feea
o ame _
r-
?U Address
f r:...
Name _
Address
I hereby acknowledge thot I hove read this application and stute thot
the information i rrect ond Cgree to cqmply with all applicable
Stote of Minnesota Statu and Ciri of Ehaan Ordinences.
Signature o4 Pertnitt
A Bullding Permit Is issued to:
all work shall be done in uccordance with
CITY OF EAGAN
3795 Pilo! Knob Road Eugen, MN 55122
PHONE: 4548100
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner -
Council _
Bldg. Off. -
APC
Permit 7. VV
Surchorge .50
Plan check
SAC
Water Conn.
Water Meter
Road Unit
Torol 5.50
A. Johnson on the express condition that
)le Styt@ of tvlinnemta $tututes and City of Eagan Ordinonces.
Building OFficial
t ??q'?q G
CITY OF EAGAN
BUILDING PERhIIT APPLICATION
'Ib Be Used For ?? Rre lAtZ Valuation
Site Pddress:
Lot Block :8_ Sec./Sub. 4Erect ?
Parcel #: zQ /?Ly ?ter
Repair
Runer: ?i Cl M • Enlarge _
hbve
Ptidress: cr,Yl$G'K Lk• (4A , Demolish
City/Zip Cocle: ? S:SIX7
Phone # : A5;i+- :7 '7
Contractor: V?Xyr.r,
Address:
City/Zip Cade:
Phone #:
Arch./En4• :
T
PdCZT255:
Grade
Include 2 sets of plans,
1 site plan w/elevations &
1 set of energy calculations.
Date )0?l7 ?SU
OFFICE USE ODII,Y
Occupancy
Zoning
Fire Zone
Type of Const.
# Stories
Fmnt ft.
Depth ft.
APPROUAI.S FEES
IO
Assessments ?? Permit
l,
?
?
Water/Se?r _
?Surcharge'
-
Police Plan Check
Fire SAC
Eng, Water Conn.
Plannes
Council Water Meter
Road Unit
Bldg. Off.
APC.
City/Zip Cade:
Phone #: 'IOTAL ir?
Ln7 11 $k 3? k/ Run 6?=
?
-.. °
ClTY OF Ee!,Gl1D1
3795 Pilot Knob Road
Eagan, Minnesota 5519-2
PERNLCT NO.: 866
The Cit3 of Eagan hereby grants to A. Bindar s Son Inc.
of 120 E. Butler
Glietafaon - Gold Msdnllion
a Heating Permit for: (Owner) Tils4n 8omee Inc
395?r.
at 4235 Carleon Iake Laneo , pursuant to apnlication dated 7/21/76
Fee Faid: $40.00 dated this 26 day o£ July . 19 76_,
1.00 s/c
Buildi^.g Inspe,tor
D"=2char.ical Permits:
Bid Total:
CITY OF EE1Gt917
3795 Pilot Knob F.oad
Eagan, Minnesota 55122
PERNiIT NO.: 704
The City of Eagan hereby grants to Louis A. Peter Coo
o£ 1854 Graad Ave.,
a PIAMBING Permit for: (Owner) Tilsen Homes
Lane (NOrth)
a 4235 s 4261 Carleon Lake , pursuant to zpplication dated __ 7/20/76 ?
Fee Paid: $40.00 dated this 21 day of JulY ?.19 76?
1.00 s/c
Euilding Inspector
Mechanical Permits:
Bid Total:
YILLAOE OF EAGAN WATER SERVICE PERMIT
3`s95 P-'at Knob Rood PERMIT NO.: _2426
Eagan. MN 55142 DA'I'E: 7/29/76
Zoning: RI2 No. of Units: 1
Owner: T9,Igen_flomas 7n -
Address:
Site Address: d-aS ('aUSOn Iak WR 5 h
Ptumher: B?Y-ROC - PeteY Plb4.
Meter No --
Connection Charge }.
: 160.00??
$ize: - Account Deposit:
R"kder No,; Permit Fee: 10.00
Iugr? l 'wi rhe Village of Eagan Surcharge: . 50
DI?111OIIC66. /
? Misc. Chazges: 6?10 p?
? Total:
BY Dare.Paid:
Date of Insp.: lnsp.:
YILLAOE AF E4ppN SEWER SERVICE PERMIT
3?. ? nob Road PERMIT NO.:
Eagon, MN 551I2 DATE: 7T29/7F
Zoning: RIi No. of Units: 1
Owner: milsen HomPa 7 r
Addresa:
Site Addrees: 4235 a on =ti r?n T.11 g3 WR h
Plumber: -Hev-R - p t r Pl F«
6/10/76 #3167 100.00 pd
I agree ro comply wieh ehe YIIMga oF Eagen Connection Chazee: 350.00 pd
Ordinanees.
SY:
Date of Insp.:
lnep.:
Account Deposit:
Permit Fee: 10.00
Surchazge: • 50 i
Misc. Charges:
Total:
Dare Paid:
sag4o
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EACAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
NewConatruction ReauiremeMs
• 3 regstered site surveys showing sq. R ot lol, sq. ft. of house; and all roafed areas
(20% mauimum lot coverege allowed)
• 2 copies ot qan showing beam & wirdow saes; poured found design, etcJ
• iselofEnergyCalalallans
•? 3 copies of Tree P2servatlon Plan if bl pladed after 1l1193
• Rim Jolsl Detail Options seledlon sheet (61dgs with 3 or less units)
DATE S -?6 -a
RemodeVReoair Reauirementa
. 2 copies of plan
• 7setMEreygyCalculationsforheatedadditiore
. 1 site survey for exterior additions 8 decks
• Indicate N home served by septic system for add'Nons
VALUATION 3 eA0 ??
Z-Q-M d
SITE ADDRESS u a35 CU-Isoa Uc '04 MULTI-FAMILY BLDG _ Y N
TYPE OF WORK _2Gf 09-- ? R2 ?IZpS FIREPLACE(S) _ 0 rk 1_ 2
APPLICANT /7/^f!`iLGN 000AiA/ Cd
STREETADDRESS I4-47 /Ji(OIkj A4 S, CITY AJf4V1I STATE-/-VziP1c1AM5533?
TELEPHONE #0jI09" CELL PHONE # FAX # 9 5o1=I07 -29 d5
9Sd )0?-6959
PROPERTYOWNER griW TELEPHONE# W-'6A`207
-----------------------------------------------°------------------------°--------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNFSOTA RiJI.FS 7670 CAI'EGORY 1
(4 submission type) . Residential Ventllation Category 1 Worksheet Submitted D
• Energy Envelope Calculations Submitted
Plumbing Contractor: Phone # B
Plumbing system includes: _ Water Softener _ Lawn Sprinkler
_ Water Heater No. of R.I. Baths
No. of Baths
Mechanical Contractor: Phone #
Mechaziical system includes: Air Conditioning
_ Heat Recovery System
Sewer/Water Contractor. Phone #
MAY 2 9 2002
P'ee: $70.00
---------------°------------------------------------°--------°-----------°-------°----°---------------.._......-----
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all appiicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant?/?/
-----------°----------°--------------------------------------__......--'---"--------'----•
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
RESIDENTIAL
s c?8??a
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
Naw ConsW Nion Reauirements
• 3 registered site surveys showiig sq. fl. of lot, sq. ft. of houu; and all roofed areas
(20% mmcimum lot coyewge allowed)
• 2 copies of plan showing 6eam & window sizes; poured found design, etc.)
• 1 set of Energy Calculatians
• 3 copies of Tree Preservation Plan if lot platted afler 711/93
• Rim Joist Detail Options selection sheet (61dgs with 3 or less units)
DATE 5 ? ds- oa
Remodel/Reoair ReouiremeMs
• 2 copies ot plan
• 1 set of Energy Calculations tor heaied additions
. 1 site survey tor exterior additions 8 decks
. Indicate if home served by septic system for add'Nons
VALUATION
SITEADDRESS ? 4d35 G4-ISad 0,' LIJ /i MULTI-PAMILYBLDG _Y XN
TYPE OF WORK_ Qcl" ?ff '?C 4v-Sh FIREPLACE(S) _ 0X 1_ 2
APPLICANT
SiREETADDRESS IaP47 Ai(j&J CITYSTATE,?Od ZIP"AAT
TELEPHONE # 95d')7 )-6959 CELL PHONE # FAX #
PROPERTYOWNER(xgPSYWI TELEPHONE# 65f - ?$8-7y)2 -
COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RiJI.ES 7670 CATEGORY 1 MINNFSOTA
(J submission type) . ResidenEal Ventilation Category 1 Worksheet Submitted • New ? rC
• Energy Envelope Calculations Submitted
MAY 2 9 20OZ
Plumbing Contractor: __
Plumbing system includes:
Mechanical Contractor:
Mechanical system includes:
Water Softener _
Water Heater _
No. of Baths
Air Conditioning
Heat Recovery Sys[em
_ Phone #
Lawn Spiinkler
No. of R.I. Baths
Phone #
Sewer/Water Contractor: Phone #
-----------------------°--°------°^----------------°-°--------°--------------------
Fee: $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicabfe State of Minnesota Statutes and City of Eagan Or 'nances.
Signature of ApplfcanT \Ij
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
?
' J CITY of EAGAN
BUILDING PERMIT
owR.: .:-.1..-?. n. ........................
Addsesc (P=esan!) .........
Huilder .....
Addrau
N0- 3977
3795 Pilo! Kaob Road
Eagan, Mianesof8 55122
454•8100
Da3s W..-7? .......................
Sforias To Be Used For Fson! De°!h Heig6! Eel. Coe! Permi! Fsa Rameske
? ,???
`7:.00
This permit does aot aulhorise the use of siree2s, roada, alleys or sidewalks aos does it give !6e owna[ oi h[a ayen!
the righ! !o creaie any situation which is a auisance or whieh presenls a hesard to the health, safety, convenienee aad
genezal welfaxe !a anyone in the eommunily.
THIS PEAMIT MUST BE EPT ON TH£ PREMISE WHILE THE WOAK IS IN PROGRESS.?? o
This ia !o cerlifp, ihat.,,2......................................... has parmission !o areet a._? . ,npon
the above described premise subjecY io the pravisions of all appliaable Ordinances for the CiYy of Eagan.
....../V........i ...:.. .. : . . ................................- . par . ...D......---
ayor Sutlding Impeclo?,?
DA'!'L:
E'JI1TJ:NG MMIIP &Pr^rSr,A;Ir,pl CIiECK
? / Blcox-2 Ad::? tion
Lot_ rt'7?
Parcel and soctiari nw;:oer
Streot
X
Ou,*ner tld3ress_
Develope.r 1 ,4::, Ac3: ees
-, 4
Zcne-Ordin2nce #52
Lot Size Z Totzl area
Platted Unplatted
Bu11dir_g 3ize
Ocoupax?.cy
Typo of cczstniction
Setbacks: Stres+ eides
'r Sicles
Parlrir_ec Total area
I NW
mbcr '.?; c?•,?? .._?_.._
Total area
T..le
Ts l o
Rear
Total d3C_.._.???.._ .
,._. ?.<.
Parkipo area setbae3:s:
Street side
jt dscaa appr
ci Assess
Jer areai /
Asspssed
if assessed:
If 1li1F156u8::°.d:
?
F{ear :iIae5 .ra.?..-...?.?d ?._
?
Bond requ3rod__.??7.._.a._._..
ge ? @ $450.00
°' . ,?.? :? ?? -
6 Lo
Ut:assessad
Comz-00t:i.o?z chsrga
Connectiun cha:ge
Lot di??.;.sion:
Additional assessmenta needed
Later.als:
Assessed
Wai,*er of hearing:
Need.e3
Assessm;-nt clk
Police Dept
Nob riesded 1-
)/J Net a:;ses:,ed
Watar & Sewer Dept__^^ 33uilding Dept
Fire Uept, (Caumt G Ind only)
Not n.aedod ?
4 0 ,? - --- ?
I?
? I
'
II
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D
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L1
+1
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?J- _Ho?sE
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i
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?.
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??PEk 7'Y
LINE
(
E7j
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a
M11
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ztt??r
LJNE'?
? Q
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1
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L oT / / BLQC K M
s£ vya y rtiOrW I ?
?ROPFrLTY ..LINE
-PLC]T 1 L AN
??,.-, J . ;? •.? ?.
? , ? ... ? .
MTERIOR ENVELOPE SPACE "b" COMPITPAP= (To be subaittad with building permit application)
laa or tvo family dwelling jL_
111 other
Oaner
Site Addrem
1 L/
:ontractor i`t 1 _%:).-? f•-45,-5 Date Phoae '
, INEAL FT, OF
OCPOSED WALL + + + xM- ft, above gsade-
?q L04P
TOTAL ERPOSED iIALL AREA SQ, FT,
IPAQUE iiALL CONSTRUCTION: "U" velue R area
"U" a sq.
!K..w.2.}44n?..41„? ? "U" ,1.3-? z sq.
iuil referenae z sy,
from sq.
tached eheete ? ????.ta-?.• S?. ?3,?, .4 p = eq
.
touli . : eq.
"Q" x sq.
•wllVASi , V" vlflaVli A {00a
ft. ? (t)
fL. 1 fa Iq . (U)
ft. ? (D)
ft. ? (i)
ft. ?S?w:.? ' A 'I.«?.. (U)
ft. ? (U)
ft. ? (II)
(A)'
(A)?
(A)'
(A),
(A)i
(A)
(A),
RS i M`11z.? .?i.dN ?
. .?--L?
sq. ft.
eq, ft,
? eq.ft,
sq.ft,
to. 0 sq.ft,
eq.ft,
? eq.ft,
ke 6 type
„
n
„
ft. 4•?,.? (U) (A
ft. (U) (A)
fc, (U) (A)
ft. (u) (A)
OORS: "U" velue E area
ake & tqpe x sq. f[. ka!rCJ (U) (A) ?
x sq. ft.
? (U
) (A),
4 Z sq. ?
ft. -S ! ., ,?=i eee /
.4 5. ? ?..b (U) (A);
er
'v" . ?.?:
sq.
fc.
(v)
i
(A)
t
OTAL (U) (A) pALUES .44
I1IDED BY TOTAi. WAI,L AREA j` ?,}?, G. "U"
RRACB "RT" ,17 or less for 1 fi 2 family dvellinga
,22 or less for all other buildings
OOF/CEILING:
(YfAL AREA: _ ?C) sq: ft.
*tail referenee . ?A.?-,x sq,
frm x sq.
ttachod sheeta x sq.
@scriba openinsa "U" a sq.
n roof "U" x sq.
TOTALS (S_Q4., aq, ft, 2,17, U) (k
f t. 1 t7 a a ? 45, A,- (U) (A)
ft. (U) (A)
ft. ' (lJ) (A)
ft, ? (U) (A)
ft, (U) (A)
DTAL (11) (A) VALUES 4?: 'A
' ??.? TALS sq. ft. A•?, 4. (U) (A)
CVID? BY TOTAL ROOF/ ? ° ?,
an,nNc Aaaa
C St,, '-r's !t! l y?aF>,h•^..? "?"-Q--,z sq.
. fluit = eQ
.
:J i 6"f3.N:cS "U" a a sq.
ll-1 d^,G X sq.
%?- ?y
.OS for wntialitod roofs
• .10 for all other constru¢tion
ROOF/CEII.IIaGs B- valne
2.
3. ,..,?iR?.l ..A.?
4. !5...l? a??'-. Aqa »le? 4
5.
6.
CUS?RUCTIOP PRA)[ING: R- value
1.
2,
3,
4.
s.
6.
?
S? i? c!?1 I_? . I? 1
4.. ?. e-, ?'•,@,.'S's?.? ?
kt
' '? • ??? a?' I
? 1 N.? n ?!.
14 , q-1
?=-
gO !
?-
HOTE: If average "U" value• as oalculated abv?a do not mat the Boetgy Code reqnireMista,
the "Altarnate Emelope Design" ae wtlinad in SBC 6006 (g) aar be ussd. Additioaal
rheate msy be used to ehw caleulations.
MASTER CARD
LOCATION & (7e.0?7
OWNER
AND
D AS
Permit
No. ?
Issued Issued To
Coniractor Owner
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK 39 7 ?
?J?/f /-? ? ?/J'J ??/I
?z/•7G ?@A7
1 ? oa,T?
V?ELL
ELECTRICAL
HEATING
GAS INSTALLING
SANI7ARY SEWER I
OTHER I
OTHER
Ifems Approved
(Initial)
Date
Remarks
Distance From Well
FGOTING ? SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HEATING
7 ??76 DEPTH
OP WELL
GAS WSTALLATION I
SEPTIC 7ANK J
CESSPOOL
DRAINHELD
PLUMBING
WEIL
? ? .
SANITARY SEWER
?
Violations Noted
on 8ack
COMMENTS:
-1 ?)41 co
2006 RESIDENTIAL BUILDING PERMIT At'PLICAT[ON
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Caehuctlon Reauirerands
3 regislaed si0e surveys shoM"vg sq. R oF W1. sQ-ft d hwae: and aA roMeE areas
(20%mmdmum lot caveraqe allowo
2 copies af plai shwwiig beam & wkidwv sizes: Pwretl faund design, dc.
1 set of Enetgy CaladaGOra
3 copies of Tree P2servatian Poan'rf lot platted afler 711/93
Pom Joist Detail Optians selecdpn sheet (bWdings witlh 3 or less uni@)
Minnegasco mechenical ventilation form
RemodellReoair Reauremenls
2 capies of plan showm9 froUngs, beems. jdsls
7 set of Energy Calculetians for heated addiGans
1 sife suneyfor adtlitions & dedcs
Adfton - irc6cate A oo-sda septic system
Low
?
affice usa omv
CerlofSurveYRed _Y _N
TreePreSPIan Recd _Y _N.
TreePresRequted _Y _N
On-sileSepScSystem _Y _N
tp,ca _ ?t-" S \k
51 ,-)A _ CaDa ?3V<
D
? ?'? i ?y i ?
qIG ,
?,on C? ?-I
C
t
a ao 9
ti
?
Site Address
?Ci? la eb
I?'/
Y?
o?t-'
Unit/Ste #
.tu, , ?L/' l7Za i?
Description of Work C( 4( Gf ? // 0,1 /A YC. ?/l
Multi-Family Bldg _ Y? N Fireplace(s) ? 0 _ 1 _ 2
PropertyOwner a-4I ?l ?4go e'? Telephone#( 4"lJ'h 0kk--7q1 1
Coulractor M{`I 196 lI 6 )6GL{lC? ?yh:L )C'Y? t• i C Ric ' 2 L Y-5 2-7 /S-t
Address City ?`ev/ /1 L?it-IN
State Zip S=;g Tdep6one # (%3)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category - Minnesoh Rules 7670 Category 1 _ Minnesota Rules 7672
(? submission type) • Residentiat VerNlation Category 1 Worksheet • New Fsergy Code Worksl?eet
Submitted Submittetl
• Erreiyy Ernelope Calculations Submitted
In The last 72 months, has the Ci1y of Eagan issued a permit for a similar plan based on a mastei plan?
_ Y _ N If yes, date and address of masTer plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone # (
I hereby apply for a Residenti IjEuilding-Eermit and acknowledge that the information is complete aod 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
app ova , of plans.
?
ApplicanPs Printed Name ApplicanYs Signature
DO NOT WRTl'E BELOW THIS LINE
Sub Tvues
O 07 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
X, 02 SF Dwelling ? 08 06-plex ? 16 Fireptace * 21 Porch (3-sea.) ? 31 Ext Ak - MuNi
? 03 Ot of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext.Alt - SF
? 04 02-plex ? 10 08-pleu ? 18 Dedc ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Stortn Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvoes 1-P -Pc? K
? 31 New ? 35 Int improvement ? 38 Demolish Interior ? 44 Siding
?' 32 Addition ? 36 Move Buildirg ? 42 Demolish Foundation ? 45 Fi2 Repair
? 33 Atteration ? 37 Demolish Building' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolition (EiMire Bldg) - Give PCA hendoutto applkant
DESCriDti00: VYaterDamage`Yes
rZ
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code 1' L Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft PRV
# of Bldgs Length Fire Sprinklered
Type of Const V 1 Width
REQUIItED INSPECTIONS
_ Footings (new bldg) Sheetrcek
Footings (deck) _
Final/C.O.
P Footings (additio ) T:?
? S d FOO q Z°. Final/No C.O.
-Fem[daEiea- HVAC
Drain Tile Other
Roaf Ice & Water Final Pool Ftgs A'v/Gas Tests Final
)0 Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
Fireplace R.I. Air Test Final Windows
_ Insulation ? /)) I Retaining Wall
Approved By: (R//!`9!L' tv 7/J"'/ffMoilding Inspector
Base Fee
Surcharge
Plan Review a
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge l
Treatment Plant
license Search
Copies
Other
Total
EAGAN
REVIEW
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ADDRE93 ; 4135 CARL9pN LCKE LANE N.
CITY / STATE / ZIP : EACsAN, MN 55173
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DR4WING DATE : 3129106
REVI510N pATE : 0
Al
411'
C!tyofEaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: (y0
Tenant:
Use BLUE or BLACK Ink
For Office Use
/Ma
Permit #:
Permit Fee:
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
0,I(3 Site Address: Lia 35 Car tsmr, Ln 14v5ta3
Tyr:tc,LA/A 4 S\flial N
Suite #:
1
J
Name: sir a- Sri t• -sq 5-k Phone(4p57) Cage- 77-y1
Address / City / Zip: d;35 CGx-r l ` 1-1;0 2-1- CO C:attduvel,
Name: ,k0.x:( License #:
Address: !
4,1111.
City of Eapll
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use ,----:i
Permit #: /z/ zyj
Permit Fee: yv
Date Received: -3—z/ J/
Staff: 46)
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
36-11 1`1 Site Address: '4&35 efiuV l6hrk. Laik L- J Unit #:
Resident/
Owner
Name: YJ CI (�Y\ A S 1\t,L ii. t N 5T04 Phone: LCI) - -1 Li)
Address / City / Zip: Lia. -.-s- C A r fr (Yr L,-oJL.e_ L 1 i-) ►^ 1 /� 5-5-/(33
i '
Applicant is: Owner Contractor
Type of Work
Description of work:
Construction Cost: Multi -Family Building: (Yes / No )
Contractor
Company: 6 {-4-An el -v‘ Ex po5a(4 44Uk)(5Contact: rrtA ' CCi1wet.
williNiellirm '
Address: City: - gli.oNmayeAa:.-- (1'
State: iAll Zip: Phone: ((ICJ 1 �-1 62 —1(i3 9
License #: 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 _No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING ANEW 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:
N0T_E Planc and
the information
suiting -documents -that you-submit-arm-considered-afo--be /blie-iniar-nnatisn. Portions-of—
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.gooherstateonecall.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 au orized by a building permit issued in accordance with the Minnesota State Buildi g Code must be completed within 180
days of per t '- . uanc
x
Applica is rinte Name
�0ir. 1 v�
x
Applicant's Signature
Atui, 4 -Wad
Page 1 of 3