1388 Lakeside CirCity of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date Received:
Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: (l " l %" Site Address: /3 0 8 /-4- 4e -s i de_
Tenant:
Suite #:
RESIDENT / OWNER
Name: mr ,--'- l P - re- & r
Phone: /AI
Address / City / Zip: /3 es C; Eelet" S7-5—/ P-3
Applicant is: Owner /` Contractor
TYPE OF WORK
Description of work: Re -4. c
Construction Cost: CP 0-00 12)
Multi -Family Building: (Yes
/No )
CONTRACTOR
Name: Lc..c,y [ oSfsuc.—E: 0
Address: 1 q c 1 Co
City:
License #: a-0 (Q
Phone: (0S7 - a-)9— qc$ Contact Person:
State: YLI PO Zip: SSS)
%r,
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(J submission type) • Energy Envelope Calculations Submitted
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:
Mechanical Contractor: Phone:
Phone:
Sewer & Water Contractor:
and.
an
uman� flat yous�u.
d as non-- 'rblic if;y
conclude that tf
Phone:
1 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 plan
X 1 1 0 G✓ 1- ,4 1475o "y
Applicant's Printed Name
X
App icant's Signature
Page 1 of 3
City of bpi'
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675 staff:
Fax: (651) 675-5694
ort lse /
Permit #: /6 0 6" t<_,
Permit Fee:
Date Received:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: & —d -c
Tenant:
Site Address: /3 Se L �., , c /e C ," c)
J
Suite #:
V lP
RESIDENT / OWNER
Name: ( R.t„loc` cr.
Address/City/Zip: )388 2--6.-k j
f,
Applicant is: Owner ` Contractor
Phone: 1057 3?'
rel_ &t4 S-S2a-3
TYPE OF WORK
Description of work: lrLi++ovr 490 c` >atiC._ „Sd1A-4"16" P vv, ,Ilectr0014,.
Construction Costa t
Multi -Family Building: (Yes ,C / No )
CONTRACTOR
Name: Lel ° `-/ 64a S'/f✓ c f� v License #: rW g C ( to 3
Address: /, (L' /�
j (� r / v t
City: �?+3-k. �y
Phone: &',�% -% L / u8' i Contact Person:
State: nil A) Zip: S$ 0 '7
Ad -,2_,-.56 c�
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1
Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(.I submission type) • Energy Envelope Calculations Submitted
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:
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.
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 Af pl - ns
AidQr30.-.
Applicant's Printed Name
i/
JUN 2 9 2009
J
x
Applicant's Signature
Page 1 of 3
s
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Fireplace_ Porch (3 -Season) _ Storm Damage
Single Family Garage_ Porch (4 -Season) _ Exterior Alteration (Single Family)
Multi Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool _ Miscellaneous
_ Accessory Building
WORK TYPES
New
Addition
Alteration Fire Repair
Replace _ Repair
Retaining Wall
_ Interior Improvement _ Siding _ Demolish Building*
Move Building_ Reroof _ Demolish Interior
Windows Demolish Foundation
Egress Window _ Water Damage
*Demolition of entire building — give PCA handout to applicant
DESCRIPTION
Valuation
Plan Review
(25%_ 100%_Z
Census Code
# of Units
# of Buildings
Type of Construction
3m m:'
y?�
J
Occupancy .1.L/k-2. MCES System —
Code Edition Aa9? SAC Units
Zoning City Water
Stories Booster Pump
Square Feet PRV
Length Fire Sprinklers
Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) „le' Final / No C.O. Required
Foundation HVAC
Drain Tile Other:
Roof: _Ice & Water _Final Pool: Footings Air/Gas Tests _Final
Framing Siding: Stucco Lath _Stone Lath _Brick
Fireplace: _Rough In Air Test _Final Windows
9/ Insulation Retaining Wall
Meter Size: Erosion Control
Reviewed By:
Y`�
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
, Building Inspector
57y
373
Page 2 of 3
%IF EAGAN WATER SERVICE PERMIT
379 Pilot 3Knob Road PERMIT NO.: r�• ,'.
at`gan, MN 55122 DATE:
Zoning `. # No of Units-
her:
nits
iter:
Aldi ess
Site Add
Plumber
Meter Nq, Connection Charge:
Size:'.
_ Account Deposit:
Reader No.. Permit Fee:
1 agree to comply %ith the City of Eagan Surcharge:
Ordinances. Misc. Charges
Total:
Date Paid:
Insp.
By w
Date of Insp.:
CITTittOF EAGAN
3795` Pilot ICeo°bRead
Eagen,. MN 55122
Zoning: _
Owner
Address -
,z .. , •m. f .
Site Address,;
,Plumber
'.:SEWER SERVICE 'PERMIT.
PERMIT NO '
DATE: "
No. of Units: s
1 agree to comply with the -City of organ
Ordinances
onnectir;Charge rb
Ace unt Degas,
ermit : Fee:
St rcharge _ }
MIse Charges:
_
Date of Insp.: Tota"
Insp.: Date Paid;
iolac:uuo 3?Lldmr? ?ac.
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7;V /e:
C'. 10915 - ,-.
M;-34
F. C. JACKSON
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Lot 3,Block 4,Chea Iier,Firet Addi[ion,
Dakata Cauncy,Minneaota.
At SURV[YCD !'/ M[ THIB-9ch
Revised Feb. 7tn.1979
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. . .. .? - _ .. . ??... -:,-a ?-t. .
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit It: /`' 76779
Permit Fee:
Date Received:
Staff:
L
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:
Site Address:
13F?' err
Tenant: Suite #:
Itde =
�0h Arlo
Name -Phone:
/'
Address / City / Zip:
Contractor
.,1 7
Name:/44 19--p-, ?L.4 r Z9,-' e License #: 0 , 61
Address: /7 e c i
City: ril)
State: _ Zip: d
9dig;:;-- 0�Phone:
Contact- Email: S 44t fa1,41 e,Zerf'%'
Work
New Replacement Repair Rebuild Modify Space _ Work in R.O.W.
_ _ —
— — ///n{` /j /(/�J�
Description of work:
® t d
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation (_ RPZ / PVB)
-
Add Plumbing Fixtures ( Main / Lower Level)
Septic System
_
Water Turnaround
New
—
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
*Water Turnaround
$115.00 Septic System
Water Softener, or Water Heater and Softener
(includes State Surcharge)
Turnaround* (includes State Surcharge)
p�7
(includes State Surcharge)
Fixtures, Septic System Abandonment, Water
(add $280.00 if a 3/4" meter is required)
New (includes County fee and State Surcharge)
TOTAL FEES
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
accordanceth the approved plan in the case of work which requires a review and approval of plans.
s Printed Name
7sa
Applic Signature