4413 Cinnamon Ridge CirU
RESIDENT / OWNER
.
Name: e0c a f'c-- � ((' /f ,- s 0 >�— Phone: l 5 / - "/ ° "/3o /
,_-
Address / City / Zip: '7. / / 5 l .i it ri c, n- n r �l -, e (7,:,- L , r. Al 4/ 5:5
CONTRACTOR
Name: / a /rte, Coro, tnr'1 . ) S 7 S License #: ./l �- 3
� /
A d d r e s s : /Z (-de S f 3 _mil . t- Clty :.. / �r 5 r/ r S
y
State: /1 Zip: ' 5^ 0 .J) Phone: b5 / _ G 7— 0 - 3 3 fr3
// -, / I
/ � rh C
Contact: C. att rF lQ S o •-` � \ "1 o r` 1 P,L(C co--T r • 0 r~-
TYPE OF WORK
New Replacement Additional Alteration Demolition
Description of work: Pe o. —_e 0/ CC/ /2 a-r.k ( I/ hS° r , /
NOTE a and gro mt✓�untr�d
Code . ,« the 1Na
•lm ectianlcal a tiulpr� is Iii fo ; sere It 47 C(Ljf
t Inspector for infol ntattlon t>an patmit l si+reening
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
New Construction ., Interior Improvement
Air Condtffoner
install Piping Processed
Air Exchanger
_ _
Gas — Exterior H'VAC Unit
Heat Pump
Under / Above ground Tank ( Install / Remove)
— Other
4 _
**When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
555.00 Minimum Add-on
or alteration to an existing unit (includes
burned out appeances, ductwork, etc.) (includes
$5.00 State Surcharge)
$5.00 State Surcharge) $ 0 (3 TOTAL FEE
595.00 Fire repair (replace
COMMERCIAL FEES:
375.00 Underground tank
$55.O0 Minimum (includes
installation/removal OR
State Surcharge)
$1Q,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requites a$ 5.50 surcharge)
Contract Value $ x 1%
= $ Permit Fee
- If the Permit Est le ass then
Fee = $ Surcharge
- If the Permit Egg is > $10,010,
(i.e. a $1,0,010z411,0i0 Penult
TOTAL FEE
A City of Eatail
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
x
Applicant's Printed Name
PPOPI /FD
DEC 292010
2010 MECHANICAL PERMIT APPLICATION
Date: / / • 3/70 Site Address: -5////, 3 i /r n o
Tenant: P(v c j Aiic, /1 st
p #: 75 5
Per Fee: QV
mit
Date Received:
Staff:
Suite 5:
Use BLUE or BLACK Ink
CAi4i #1EFORE. YOU DIG. Can Gopher State One Cali at {651) 464 -0002 for protection againstundergrowid utility damage. Cali 48 hours
before you intend to 'dig to receive locates of underground utilities. www.eopherstateonecallorq
1 .hereby acknowledge that this information le 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 a proved plan in the case of work which requires a review and approval of plans.
Applicant's Signature
zz
Ground Rough In ,Air Test ; ;G Service Te
f=xt erior HVAC 9+ reen • im < • = ;
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4413 Cinnamon Ridge Cir
Lot: 111 Block: 04 Addition: Cinnamon Ridge 3rd
PID:10- 17402 - 111 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Window World AKA Probuilt America
2211 l lth Ave E, #130
N St. Paul MN 55109
(651) 770-5570
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Construction Type:
Occupancy:
Carbon monoxide detectors are required by law in ALL single family homes.
$88.50
$1.50
Total: $90.00
Owner:
James E Mollison
4413 Cinnamon Rd Cir
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
0801
9001
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
Issued By: Signature
Building
EA092398
12/23/2009
ePermit
CiTY OF EAGAN '
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
QUILDING PERMIT Rece;vt #
Address?
? W City
( hercby ocknowledge thct 1
the inlormolion is correct i
State of Minnesoto Stotute
Is
Erect i[J Occupancy a 3
Remodel T? Zoning 314
Repair ? Type of Const.
Enierge ? No. Stories
Move ? Length _24
Demolish ? Depth 4
Grade ? Sq. Ft.
Pem'+it -9.
fione Woter 8 Sew. Surchorye _
Police Plan Review_
F1ro SAC
Enq, Wcter Conn. _
' one Pianner Woter Meter _
Counci) Rood Unit _
read this opplicotion and state thet Bldg. Off--3`129/55 T.P.
gree to comply with oll upplicable APC Total ?
Ciry of Eagan Ordirwnces.
Var. Date
?n accordor+ce with
oll work
Buildinq
on ths sxp?est Corditlon liwl
jtes and Gty of Eopan Ordinonces.
r
Parmit No. Parmit Holder Data Telephono #
Plumbinp 5
H.VA.C. rl%? -% -95 ?3Y -QfU
ekictric I l.?p A.t f o Y 4.+ , pU
$Oft9Mf
Inspaction Data Insp. Other
Footinps a. ?
Foundation
Framinq
Roofing ?
Rouqh Pibp.
Rouph HVAC
Inwlation
Final Pibq. - ?
Final HVAC
Final ? ? '
CKt/OoC'
Waftr Deseribe Loeation:
VYsll
Sswer
Pr. -D'ap.
Rsasipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
FM
Fill in numbered spaces S/C
Type or Print JegiblY Tot
r '
1. Date - 2. Installation Cost
3. Job Address Lot ' Blk. ; Tract I`
4. Owner 4 5. Contractor Phone
6. Address
7. City ?State Zip
8. Building Type: Residential d Commercial ? Institutional ?
9. Work Description: New El Add ? Alter 0 Repair El
10. Describe
11
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
? Bath tubs
Septic Tank
Lavatory 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 : .? for
Rouqh Finsl
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Reaipt _ MECHANICAL PERM17 Permit No.
ciru oF Eacant
? FN ?
Fil/ in numbered apeces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost ' .
i
3. JOb Addre8i LOt Blk. ; Tract
4. Owner
5. Coatractor Phone
B. Address •' ;•, ? ' ' , .: ., ? ° .
7. City State Zip
8. Building Type: Residential O Commercial O Institutional O
9. Work Description: New 0 Add ? Alter ? Repair ?
10. Describe Fuel Type ..: r, ..d S
11.
No. Eguipmanti 8TU - M. Ea.
Forced Air No. Ectuipment CFM
Ai
H
i
Mfg. r
andl
ng:
8pilers
Mfg, Mech. Exhaust
Unit Heater
Mfg. Oiher
Air Cond.
Mfg.
Gas. Piping Outlets
12. I hereby certify that the abave information is true and correct, and I ayree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rouyh Final
lnspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
?
Te Le umd fa? CITY QF EAGAN
eU1LDING PERMIT
3830 PNat Knob Road, P.O. Box 21-199, Eayan. MN 55121
!", t... 10010
.
PHONE: 4548100
ReceiDr #
N
q49
Site Address Erect 0 Dccupancy ?
Lot
Block Sec/Sub Remodel ? Zoning
_
. Repair ? Type of Const.
Percel No. Enlarge ? Na. Stories
Move ? Lenpth
ft
Na^e
Demoliah
?
Depth
Addres s Grade ? Sq. Ft.
City Phone Install ?
I hercby acknowledye thot I Fave reod this opplication and stote that
ths in4ormotion is oorrect and agree to comply with ell applicoble
Sroto of Minnesota Statutes ond City of Eogen Ordinonces.
Stpnaturo of Pem+itteo
;,.
N Buildinp Permit Is lssued to: oll work sholl be done in atw?dance with oll applicobla Stote of Mfm
Buildinp Officiol
Assessment
Woter b Sew.
Poliu
Fin
En0•
Plonner
Council
., ,
BIdg.Off. ,
APC
Var. Oete
Permit ,
Surchorpe - -
Plan Review -
SAC - --
Woter Corxi. =, ?? ?; - •.
Woter AAeter
Rood Unit
Psrla ' •
Total
an the sxpeets cor+ditlon thw
ond City of Eopon Ordinonoes.
Permit No. Pwmit Holder Date Telephone #
Wumbing
H.VA.C.
ENetHe
SohaNr
IMpsction Dats I?sp. Other
Footioqp
Foundation $ W ?
Framin9
Roofing
Rouoh Plbp.
Rouyh HVA
Inwlation ?f
Final Pltfa - / -
14
Final HVAC
v
Fieul ` • ?
CsrtlOac.
Wste? O+sc?ibe Loeation:
YYbll
Sawnr
Pr. Disp.
Reaipt , i: ' MECHANICAL PERMIT Pa?mit No.
. CITY OF EAGAN FN ~?- I
Fll/ in numbered spaces S/C I
TYpe or Prinr lepibly ToL II
1. Date 2. Installation Cost - I
- - - . i
.i
3. Job Address Lot B I k. Tract
4. Owner ileYries L..,
5. Contractor Phone t ?.?
6. Address 534. deS t i.1 t..`+
7. City ??ridT?hdSS?fi State 5: . Zlp .- = 1
8. Building Type: Residential 0 Commercial ? Institutional 0
9. Work De=cxiption: New El Add ? Alter 0 Repair ?
10. Oescxibe t?? t? i;u?: :• Fuel Type ?
11.
No• EquiAUl9nL BTU - M. Ea.
Foraed Air . .'
- No. Eauiament CFM
Ai
H
dli
•
Mfg. an
r
ng:
Boilera
Mfg. Mech. Exhauct
Unit Heater
Mfg. Other
Air Cond. - ;?? -
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I ayres to
comply with all ordinances and codes governing this type of work.
5ignad : for
Rough F inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and appro+red.
Approved CITY OP EAGAN 464$100
Recaipt ? -?
i ,
PLUMBING PERMIT
CITY OF EAGAN
Parmit No. "
FN !
?
Fi!l in numbered spaces S/C
Type or Print /egibJy T?
1. Date ' 2. Installation Cost
3. Job Address Lot ? Blk. Tract
?. .,
4. Owner
5.
Phone
6. Address
7. City State - Zip " " -
8. Building Type: Residential L`l Commercial O Institutional O
9. Work Description: New d Add ? Alter ? Repair ?
10. Describe
11.
No,
? Fixtures
Water Closet No. Fixtures
C
l/D
i
fi
ld
' Bath tubs esspoo
ra
e
n
S
ti
T
k
Lavatory ep
an
c
ft
S
Shower ner
o
d`J
' I
Kitchen Sink t.
I
Urinal/Bidet Q
h
Laundry Tray ?r
t
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify ihat the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : • ? ? ? r ? ? -
, for
Rough Final
Inspections: Date Insp. _ Date Insp.
This is Your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY UF EAGAN Remarks Addition CINNAMON. RIDGE 3RD ADDN Loc 11 sik 4 Parcel 10-17402-110-04
Owner street _4415 $ 4413 CINNAMON RIDGE C?te EAGAN MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. CrQ 925.44 c010 16 6-2 -$
STREET RESTOR. -
GRADING
SAN SEW TRUNK 1973 102.22 6.81 15 13.69
? SEWER LATERAL . 1985 31239-50
64 -90
$
2591.60
WATERMAIN
* WATER LATERAL X 1985
WATER AREA 1973 131.44 8.76 15 17.56 " "
* Services x 1985
STORM SEW TRK 1979 381.69 19.08 20 28.1
* STORM SEW LAT x 1985
CURB & GUTTER
51DEWALK
STREET LIGHT
RLk3 LTTl.lt 80.00
WATER CONN. 500.00
BUILDING PER. 10017,10018
SAC 595-00
PARK
.d . . i:F EAGAN waM sEWIO PEMrr
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: ' I
Ea98R M111-M721, DIITE: --1)7
Z0ning' No. af Units: _ 'i d u n lex
OwnNr: r x
/lddroas:
Site Addreas:
Plurnber. _
Metsr No.. _
Size;
Rsadw No.:
1 Nme te es?wlp rri1h !w Cilp of !e"¦
OdIMwoM.
By
Date of (nsp.:
...'I a uF .AUAn
3830 Pilot Knob Road
P. O. 3ox 21199
Eegan, MN E5121'
Zoniny: _
Owner:
Zft ran: _
/lddresc
;Plumber. _
Metar No,: ^
Size: ??
Reoder Plo,; ,
? MM to e009 wt16 tiN Cih ef EW¦
"eeaoa,
ay
D'nte of I nsp.: ?
Cannectia+ Chorpe: _ 500.00 nd
Aocounr Deposit: 15.00 pd
Parmit Fee: 1o 70 pd
Surchargs: .50 pd
Misc. Chorpes: _ 132.06 p d
Totol: 1; z -^ n r
Dote P'did:
Irnp.:
warER sfiftr*cE PEwur i
PERMIT NO.: ? - ?
DATE: 17 77 _
No. of Untts: ,
- ?? <3 u>>i1ex
?
; C,a+rlection Cho( pe: 500.00 V: i
/?bbounr-beposlt: p (1
Permlt Fee: 1 • P
Surchoryw: 7 ? a
Misc. Chorpes: - 132.00 pd
Totol: 2 nn -,??•r
DaM Pald:
i
"CITY OF EAGAN
3830 Pilot Knob Rcad sEWN 5ERVICE pEItMrr
P. O. Box 2109 PERMIT Np.: )' 250
Eagan, MN 55121 DATE:
Zonlrg: it2 No. of Units: _ '? dut?lex
Owner; DeVriea Rldra
llddreas:
5ite Addrcss: 4413 Cinnar„on Rid e Circle L1 ?. 34 Cinn Rics ?e 3
Plumber: IIlayloc?•;. P? ;)F,
4 -1-65 50595 ,
P
? '? ? ?' °f ?o Corn»ctton (horpo; _ 425,00 pc?
ilccount Depow _ 15 . DO n d
Punnlt Fee: 10.00 nd
By Surchoroe: -- 0 vd
Mtsc. p?orpss;
Dote oF I?up.: Tafol:
CiTY UF EE.•'-4o,
3830 Pilot Knob Road
P
O
B
i
21 i9 WATO SERYICE PERN[fT
6nO2
.
.
o
c
9 ? PERMIT NO.:
Eagan
MN- 55'121 -
'
, DATE: -
Zoninp: 7 '
No. of Units: l ciualex
-
Owner. -e C?T i rr a T:1 d 8
I1ddmss:
Si! AdArEii: 441 5 i
O 5
`
j` i -
Plumhsr. "iavloc? tIb
AAehr No.: Connection Chcrpe:
Size: /l
M D
i 15. 00 pd
coou
epos
r: -
Raadsr No.: Pormit Fee: 10.00 pd
1 Mr« eo e..py wm N. CiT ei hy.¦ Surd,o.ye: .50 pd
orm1O°0M'' Misc. phorpes;
Totol: - / l nn nA gmt
@]'
BY Date Roid:
Date of Irqp.:
Inap.:
CITY OF EAGAN 3EWER SERVIGE PERMR
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: "5 1
Eagan, MN 55121 p^TE:
ZO/ing: ILZ ? No. of Units: _ dL-)lex
Owner: -)zVries llldrs
/1ddr?c
Stte Addi
Plumbar,
I N" h eenplr wili Iw phr ei low,
Adhe.e...
ey
Dote of Insp.:
Co,,,,,dla, Chame: 425.00 pd
Acoourt Deposit; 19.OQ pd
Permit Fes: _ 1 n. 00 pd
Surchorpe; .50 -A
Mirc. Chorpes;
Totoh
Insp.: Doer PkYd:
i.dT f Of Ek..AN
3830 Pilot Knab Road
P. O. 8ox 21199
Eagaa, ;1N CS121
Zoninq:
vr?sr: F''•.'r i e
rea:
Stte Address: ?+41 ?
ianber.
r No.. -3
WATER SrRVICE FHtMIT
PERMIT NO.:
DATE: , ? .
No. of Units: - d u? 1 r K
Slze: c ?Cltyel Reoder No.: Ial?w te e'Pijr ?rNi? 1y Lm?e,
Orliaeeas.
By
Doh cf Insp.;
C,onnection Charpe: 00. 0 d
AcoouM Depoait: 15. 0 pd
Permit Fee: 10.00 p-:
Surcfiorpe: . ?'? ncl
Misc. Cho?oes; 132,00 ncj
TotaL• m?*er
Dote Poid:
- CITY OF EAGAN rJ° 10O'I H
3830 P'dot Knob Road, P.O. Boz 21-789, EagaM AM 55727
PHONE: 4548100 Sv
BUILDING PERMIT Recoivt *
h OF TWIN HOMR? $49,000 pm APRIL 2 lq85
Te M mad /a . Volue e -
4415 CINNAMON RIDGE CIR erect [B ocavancv R3
Site A4drm
RD
11
CINN RIDGE 3
4
R
e"'°de?
?
Z°"'"9 R4
?
gimk
cmisub. Repair ? Type of ConsL v
P8rcel No' Enlarge ? No. Storiec
DEVRIES BLDRS INC M°°e ? l.engeh 2¢
W Name
6 MARIN
ER DR Demolish ? Depth 64
?
Addre? s Grade ? Sq. Ft.
City MAPLE GRV phone 420-4685 mstall ?
SAME Apyrovah Fan
? Name
? AssessrneM Pemut . O
`
?? Addre7s
Water & Sew.
SurcMrye 2 4. S ?
City Phone Pdice Ran Review 139-? S
W parne GAGE Fire SAC 525 _ 00
_; naeres. soomF AvF Eng, wah,c«m, snn - no
,
wW ciri BROOKLYN ASone
Plonmr
WoterMeror 1;-4 - ?0
Council Rood Unir 2Q n_ n p
1 hereEy xkrowtedpe rtat 1 haw reod this cpplicotion cnd smte ti+af Bldg. Off. 3/ 2 9I $ S va)WT . P. 13 2.,;
comply with oll opplicable
IM inlormofion is cortect an APC Total ;' l
94 7'7 S
$rab o1 Minnetoto $tatu?es Eagan O in$ ?ncesyC???
PLof
? Ver. Dece _
Sipnoturo of Permittee ? 1
^^^"-
w eundirg Permir is iswed w: DEVRIES BLDRS INC ?? a? ?k? -?t
?
Igb?e St ? '
dl work zholl be done in aecordance with oll opplio "?
? atufes ard Ciry of Eopan Ordlrorr,ez
,
Builifinp OHidol I%?? ? r
- CITY OF EAGAId nJ° 10 01 7
3830 PiIM Knob Road, P.O. Boz 27-199, Eegsn, MN 55121
PNONE: 4548100
BUILDING PERMIT Receivt #
Te M aed Ier h OF TWIN HOM$st. Volue $49, 000 Date ApRTT. 2 19_$5.
4413 CINNAMON RIDGE CIR Erect E7 Occupency R3
SiteAddreu
Lot 11 CINN RIDGE 3RD
Block 4 %c/Suh Remodel ? Zoning ua
. Repair ? TVPe of Const. i?
Percel No. Enlarge ? No. Stories
Mwe ? Lergth 4
? Nme DEVRIES BLDRS Demolisn ? Oepth e}
? 7564 MARINER DR
Addrezs
Grade
?
Sq. Ft.
9 City MAPLE GRV phtme 420-4685 Instap ?
Name SAME
? Address
City
Name GAGE
AddmS BOONE AVE
City BROOKLYN Vffne
I hereby ackrowledge thaf I hova read this aOPliwtion ard stote that
Ihe inlormation Is Wrce[t onnnQQQ!!!ppp 9ree to comply wifh oll aOVlicable
Seate of Minrwwta Stotutas Gty of gon rdironces.
Sipnaturo of Permittee U_j a
? - - - -
A Building Parmif Is Issued to: DEVRIES BLDRS
all work shall be doro in acwrdonce with all icoble tota f ir
Buildfnp Official x
Atsessment
Woror 3 Sew.
Police
Firo
6q•
Plonner
Coundl
sids.on. 3/29/85
APC
var. oam _
Permit $ 278.5(
SurcFnrpa 24- 5 C
_
vlan ReMew 139.2E
SqC 525.0(
Woter Conn. 500.0(
Woter Meter 6'1 ..0 (
Rood Unlr 9 R 0 0(
T;,P. 132.0(
7ou1 $1,942_2`
_ on the eVm.as wditwn thol
urd Ciy of Eagan Ordironces.
Thus reques[ void ?p / ? / C"
18 months Irom ????? / ? ?
l? .?? l 2 ? 7 J, d ? t % V' v
r -
Requost Date ire No. Fough-in Inspacti
A
quired?
?Ready Nuw ill NoUfy InsPer
tq? ?
Ves u [or When Ready
&Licensed Elec[ncal ConVactnr 1 herebY requestinspection of ebove
n Owner electncei work installed at.
Street A re Box or Floule Na
/' ? ` 1 ? C ??°9/?`'? .•? City
-clw'"ee
ecLan o. Township Name ur No. Range No. Counry
Occupnnt (PRINT)
NuD W' Pbone No.
Power Supplier
y?''????I?./? Atldu???
EI tncal Contractor ICompan?Namel
e????h a--1 I c. ??l L ContraCi r's Licen?e Nn.
MaiLn7q/,,qdJress (COntrector or Owne MaknsIail?a?v/u?nl
..?, 1' 1+/?? , , ,1 Wai?.( P ? ?R
Authorired i na re(Con[r ctor/Owner Mnkiny In tallavonl Phc ?S 1!mDer, ?
V+\?? M q
v'! - 7H15 INSPECTION REQUE51 WILL NOT
MINN TA STATE 90AflD OF ELECTRICITY BE AGCEPTED BY THE STATE 80ARD
Gr? s-Midway Bltlg. - poom N•191 UNLESS PHOPER INSPECTION FEE IS
18 1 UniversitvAVe..St Peul. MN 55104
Phone (612) 642 0800 ENCLOSEO.
/VP REQUEST FOR ELECTRICAL WSPECTION ea-ooooi-os ill ? See mstructmns for :or.?pletung Ihis lorm on beck ol vellow mCV.
D 91277 "X'' Below Work Coveied by This Request
N.A Fdd Rep. Type ol BwlUing qppbancxa Wrted Equ,pmenl Wved
ine Range Temporary Service
Duplex Water Heater Liyhnny Fiztures
Apt. Bwlding Dryei Electric Heatin
Commernal 81dy Furnace Silo Unloader
Industnal Bldg Au Condi[ioner BWk Milk Tenk
Parm orne? oeci v o?ne. isi>????fvi
.,.
.......
,, i.._ iner Surcify
___..__ r .. , thee
Oth?r
b Fee SarviceEntrance$?xe H Fee Faeders/Sublextlers k Fea Cvcurts
00 to 200 qmps 0 to 30 qm 5 0 tn 30 Am s
Above 20D qmps 31 to 100 qmps 31 to 100 Am s
Swimming Pool Above 100_Amps Above 100_Amps
Transtormer5 Irngation Booms Partial. Other e
Signs SUemal Inspection 5
mT?k?.? TOTAL E
?
Nou h-?n Date
I,the Electncal
Insoector, hereby
Final arudy that the above
? spectwn has been
eea .. .
?
?
i
? „ _ ' _ . • '. - r ` r.i
This rnqu¢st wid
18 n h?f ' /
U 7 ?p ?
?? r(? ?? C
4U
Request Oate
_Vu_bb Rre No. qough-in Inspecifon
He4uiretl?
aIteatly Now Q Will NoLfy Inspec-
?Yes ?NO XX ?or Wl?n p??Y
Licertsed ElecVf cal ConVactor
? Owner I hereby rgquest inypecM1On of above
Street Atldress, Box or floute No.
413 Cinnamon RIdge Circle .•Vtl•C??y•.
Eayan
cUOn o. TownsA.p Name or No. Pangr Nn.
COUOty
ayan Dakota
Occupant (PpINT)
eVries Builders ?? N.
424-2611
Fowe, suppl.e.
akota Electric am.ess
3U0 - 220th St. W. Farmington, MN
Electncal Cnn[rar.tor ICOmpany Name)
ontemporary Electric
Inc
c°^?????%sLicenseNo.
,
.
Mailmg qdJress [Canhac[or or Owner Making Insiailatfon) ?419167
810 Hemlock Lane Maple Grove, MN 55309
AuM ized S?gnaWre (Contractor1Owrier Making Inslallation)
Phone Nwnp¢r
.424-4232
Grigys-MidwaY6ldg -RoUTN-l91 •?•???•
1827 UniversiryAve., SL Paul, MN 55106
vnoia (812) zs7a1ti
Wnartc ? ?un R[uVeST WILL NOT
9E ACCEPiED BY iHE STA/E 90ARD
UNLESS PpOPER INSPECTION FEE IS
ENCIp$ED_
REQUEST FOR ELECTRICAL INSPECTION ?
Q14'?+Q?7c3 ' See inseruetions tor completing this form pn 4eek of yalhse cepY.
"X" Be/ow Wurk Cove:rd hv Th;? Ro....e?.
Add ilEfn9 APOlia?es WireU ' ?-
. Evuiomeni Wired
? ??? T-POrary Service
Water Heater Lighting Fixtures
ng
N Dry¢r Etectric HeaUn
l Bidg. }?' Furnace Silo Unloader
ldg. Au Corxlftioner
om
s Bulk Mfik Tank
e,
oe?? Dish sher °ih?? Is???tv)
?rv OSAJ
m.;,
s
a ane.
om put e
lns
pectron Fee Below
-pi
M Pee ServiceEn[ranceSiz e q Fee Pcetlers/Subfeaders k p¢e
Cf¢uiis
0 to 200 Amps
Above 200 01030A 5 30 Am
uy-
-Am 31 to 100 q? o 100 q
E
Swimming Pool
Transiom?er A6ove t W_ Abovr,
100_A?Us
Si?s Inigatin Boort.s
• iab'Other Fee
xema.ts Speciai Inspec!fon
S 47
JrO /
Wirinu of
dnuhia hiinn.l??.? . ?
TOTAL,FEE
r;? LIfY
xouan-or -- -- '-- l '4
,
Electncal
%? ?Yactw. M1erebY
final certify Ihat tM aboVe
-nsPectim Aas Eeen
11llinre0u?twidl6monllnlrom . , . ? ?de.
qw
This request void d 5
U
??a? ?{ /•
/8
o7?b?4 le :,4M_ ? y-7 jl?)
Reyuest Da?e
_L_UG
O OJ Fire No. Rouph-in laspectio`
ed>
Yes ?No
? IicadY Naw Will Noliry.lnspec-
Wr Wh¢n fleatlY
JU Llcensetl Electncal ConVactor I hg'ebY rqpuest inspection ot ahove
? Uvner elecVical wark insU11eA at:
Stteet Address, Boi or Ibute No. C ilY
415 r;In amon Ri
d e Circle Ea an
cuon Name
iovrnship or No. flange No. County
E an Dakota
Occupnm (Ri1NT) Phonc No.
UeVI:jes uil er 424-2611
Power Sapplia Adtlress
akota Electric 4300 - 22Uth St. W. Farmington, MN
Elecnical Contractor 1Conpany Name] Conlractor"s L.cense No.
ontemporary Electric, Inc. 0415167
Maillnp qCJrrss (CoMracror or Owerer MakiW Ira,tailaiion)
610 Hemlock Lane Maple Grove. MN 55369
Au wized Sig?[ure ICOntractw?Ow?e Alaking Irefallalion) Phone Numb¢r
424-4232
/YINNESOTA yTp7E 9pARD O C7RICITY
GrismirsalidwsY Bld9- - _191
7821 Univergiry Ave_. St. Paul. NN 55106
Phww 16121 2972111
TMIS INSPECTION NEQUEST WILL NOT
eE ACCEVIED By THE STA7E BppRp
VNLESS PROPER INSPECTION FEE I$
EMCLOSEU.
REQUEST FDR ELECTRICAI. I.NSPECTION EB-000011-04
, See ir?sinctipns for completing this form pn Wck of yellaw wpy.
14964 "x" Below Work Covered by This Request M 7?
• Fea ServiceEntranceSiie k Fea Feeders/Subfeeders M Fee Grcwts
um 200 0 to 30 qm 0 ro 30 Am rs
Above 200 Amus 31 to 100 Amps 1 4 00 31 to 100 A
Swimmirg Pool Ahove 100_Amps Above 100_A
Tra?siormers Irtigation Booms Partial.'Other Fee
°•a^? ayec?a? ?nspecoon s 47.50 TOTRL FEE ?
Bmarks
Wirina of douhle hunralnw .. ) ? /, / L'I7-?
Rouph-in D:.te
I Ne Elec
? u>2-Fj
???.. ?.ea.
?-
Final ? Da1e ?rti1V tAe? tbe abpve
. . ?ROQCt
?M MS AlQ?1
/,7
1985 BUILDING PERNIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
'/Z oF TW tN (-IothE 1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: 49P?t7- ? Date: 3/y
Site Address: -?1g c,N„g.,,ou R,666L? ctoeSt-E OFFICE USE ONLY
[P,ST 'FZ nF G.r.,,..m, :-, ?R-ev?
Lot: // Block ? Sect/Sub Erect
Remodel
Parcel # Repair
Enlarge
Owner Q[-' vRirS Ot?p,E+. Move
Demolish
Address 7c','6(4 Grade
City/Zip Code VflrancLF e.QavA-r 5-5-3& 9 -------
Phone `fa-o y6 ?.S' APPROYALS
Contractor S iq rp C'
Address
City/Zip Code
Phone
Arch./Engr.
Address (3oaNe- Au?
City/Zip Code A3.e«,Kl-y,v PK.
Phone ll
? Oecupancy IZ-3
_ Zoning R-4
_ Type of Const
_ /J of Stories
_ Length
_ Depth ?
Sq Ft
Assessments Permit
Water/5ewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Couneil Road Unit
BZdg Off.?T Parks
APC Treatment P1
Variance
TOTAL
ZIA. so
sv
Z¢.
SZS.°?
S? • ?
2&?. °=
132."?
e?
n
.'
?o
?
??
. . ..?j???
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS lIUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
%ZoF rwiN (-IqnE 1 SET OF ENERGY CALCULATZONS
-
To Be Used For: AL,.-<1t Valuation: 49,[Xno. ? Date: 3 is/rs'
4415 11
Site Address: .m onJ (2?nc4f--G?r"- OFFICE USE ONLY
W EST Iiz oF
Lot: Block ?f Sect/Sub Erect X Occupancy 9-3
Remodel _ Zoning ?-?
Parcel p Repair _ Type of Const
Enlarge II of Stories
Owner Move _ Length 24
Demolish Depth (fl¢
Address •7 S'[,U Grade Sq Ft
City/Zip Code 2Lt«,.& ? )w-5"f369 -----------------------------------
Phone 6PPROVALS
Contractor SA ?hf-
Address
City/Zip Code
Phone
Arch./Engr. G`rn6z-?-
Address ???4?- RLC
Assessments Permit 2ls.50
Water/Sewer Surcharge 24.so
Police Plan Review 139-Zs
Fire SAC 525. =
Engr Water Conn -soo.°-`
Planner Water Meter 63.'-
Council Road Unit Zop.=
Bldg Off z9 s Parks
APC Treatment Pl ? 3 Z°=
Varianee
TOTAL
City/Zip Code 6 90-1 («y,v P°K.
Phone /1
j C A L v s?V H. H E D L U N D 772e Moroan Avenue sou,n
} ? Richfield,Minnesota 55423
7 Land Surveyor Civil Enqineer Phone 866-2523
smalevar`? ???tifi?Id?
.w `;. JOB N0,
SURVEY FQR: John Devries
DESCRIBED A5: Lot 11, Elock 4, CI;•:IQAI10:; P,IDG;: 3rd ADU. 1;cVI;LOI'ML:Ni, City of Lagan,
llakota County, :iinnesota xnd reserving easements of recvrd.
1y
i ?
i O I
? S
,3
0
N
00
N
ego
Z
?
/.
?
N
p q5•65 a=
..-
s
I? 8??2 ?z w
?98• ?
?
?
??.? _SC ?' 4 ?a ?o •a
ti A Q
C. Z0
O
37.p 1-5 0?
?
9ig ^?8y. .
\? $9?
?
?
\
Top of Foundorion - 920,3
.BwsaMent Tlool'= '9f7.Z
Caraqe Fldor= 919.9
Prcposed Elevntions ?
Ex?stin9 Elevat?ons
srnires Drntnaye Diree-t?ons -+
Dencrtes Lot Cornei' O
, ' , i -,
L_! , I : a_
,
oGNtA Np.MO N
?-- -_, e
? c,
?C4.
1- o
0 M
2
CERTIFICATE OF SURVEY
I hereby certify that on 3/19-/85 I surveyed the property described above and ihat
ihe obove plot is a correct represenrotion of said wrveT-.
??.?-?=.?-?! ??-4?-.?-??
Calvin H. Hedlund, Minn. Req. No. 5942
1
2/84
CITY Or EAGAN
?
AP°LICATION FOR PERiMIT
• SEWER AND/OR WATER CONNECTIODi
(PLEASE PfiINT)
1) PROPII7i1' ADDRESS: (_6 l 4j/vic)1'n c)t7) t4H i L
T_FP3J7• DE..CRIPTIC:V: „2tr ?L &_,q '
(Io t/Block/Subdivision or Tax Parcel I.D. Nisnber)
IIF r`:IS7=:G ST^CCTL^:'?E, DA'IE Oz' Oi2TGi T11L 'ciiI?.DLI:G PE:P_!I; ISSUANG.:
?.,_=_";
p°F'SL'= ::'?•71iir/p?OFOS'?J C'SE: O R-1 SLiGL: FPYJLY
? R-2 DU= ('Ititi? LTIITS)
R-3 ZC[,1T7CUSE ('?HIP...F". + Li:]ITS) Wi ITS)
? R-4 A^r?R'!'_TTM
'
`IT/
CC.
MCi-ff`Ir?i ? Wl ZTJi
/
?
T
??t
0 CQ?'1?'?CL?i/ aw?ty/QF?.ICE
Q P.'Dti51.TAL
Q NSTI'SC,'TIODLAL/GGVM1^A.E_'\'T
2) APpLIQ?.NT (PlEASE PRIHi)
rAME: L)c./ Io(
r? _Z/L[ rr1hir16 Co.
ADDRESS: SC.
CTTY, STATE, ZIP: /(/ 3
PxoiNE:
3) PLli4BER NAr'tE
: PLEASE PRINT) FOR CIiY I15E ONLY
ADD.RESS: PLUH?EAS LICE4SE:
Active
CITY, STATE, ZIP: Q Expired
PHONE:
PLUMBEF LICENSE N L N°tiPf gecord
? ?J
at nttia
4) OCC[JpANT/a,IDIER NF1ME' /? n (PLEASE/P IN/1)
' f?Lt ?Z)e4, !?
ADDRESS: <S p r l?& E'
CITY, STATE, ZIP: I?}?})?JIf_' G?OUF `????/U ?r53?7
PHONE:
5} IIZIC11TE W[iICH PERMIT IS BEING RFQ[JESTID:
?CONNECfION '1`O CITY SEWER
? CONN=Q.1 'LO CZTY FIATL?2
? 071ER (PITA.,E DESCFtiBE)
67 IfdDI= C:+E:
PLF-:%SE HOID APPRCIVED PERMIT FOR PZCI;-UP BY ONE OF ABC)VE
?J PI.EASE 1iAiL APPR(}Vm PER.?LIT T"J 1, 2,1 3, 4 ABOVE
(Ci e one)
7) SI?1T 1V'RE: _X?L'bFi7j ??(-(iyt(.?•?12C/1?.? DATE:
? R o1:R?lfRJS i i s? Erg? ?! s r?r?-sas:aa+? : rs I?.sa ,?:? a a.t ft?Fl?a?lia?! ??G" tiw es'.?iac=ar ?
F O R
PERMIT °- ISSUED
I T Y U S E O N L Y
FEES: $ /m • .,??°
$ A . ?.Sd
$
$
$
$
$
S
$
$
$
SEi^iER ?'EBMT_T (I`ICLU?E SU°CT.iaRGE)
W-ATER PERPIIT (INCL'JDE SliRCYARGE)
WATER NIETER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SE:JER TAP
:'?' =-=OSi=
AC('OUNT DEPOSIT - 47ATER
tiV[iC
SAC
TRCiNK WATz'R ASSESSME\TT
TRU:1K SEjQER ASScSSME:iT
LATERAL BENEFIT/TRUNK SE:4ER
LATERr;L BENEFIT/TRUNK WAT°R
$ /_3a?- a'--? OTHER
$ TOTAL
$ ?
AA?OU:vT PAIDjRECEI?T $?- a> 91
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGi-IT OF WAY?
? YES IF YES, THEN A"PERMIT FOR W0RK WITHIN
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERZNG DIVISIO[V. LIST AS A CONDZ-
TION. "
SUBJECT TO THE FOLLOWING CONDITIONS:
I
APPROVED BY:
TITLE: ...??,? e-e 41
DAT°:
ma wl=m
,
•
C.
?
C
{ ' ? 2/84
3 CITY Or EAGAN
N?
/
1111 APPLICATION FOR PERMIT
• SEWER AND/OR WATER CONNECTION
(PLEASE PRINT)
1) PROPIIYPY PIJDRESS: /-s- (41 rYl QFu L
r.Frnr DESCRIpI'ICV: /
(Lot/Block/SulDdivision or Tax Parcel I.D. Nturber)
I I'r' E:;IS:'=:G S'?'PL'CP'RE, DAT? OL' GRIG^dAL uiILDI::G PZF:-1IT ISS?;?NG:
eaz;
PPES= Z^`Iliry'P?OPpSED C'S: ? R-1 SitiGL;, cPYSLY
R-2 DUPLEY (710 1JPIITS )
R-3 TC[v?II?Ci?GE (`!'Fp= + U:1ITS) f LNI"'S)
[I R-4 EicAR'_T'=+T/C'':':DCi1TT1IL?1 ( INI`TJ)
Q CCIi`?`g,T'.CI]U/RETAII,/CrFIC::
? INDliSTRLAL
? INSTI'I'GTIO:IAL/GGVERrME.'\'T
2) APp?C.;?.NT (PLEj SE PRiNi)
?
I
'
NAME: Iql/
DC_n(l ?"IGvn Kl'
/16 l"o
ADDRESS: ?'?I.3/-- zi t?- q tie
CITY, sTATE, zzP:
PHOiNE:
3) PLU.,BEIR, PLEASE PRINi) FOR CITY I1SE ONLY
NAME: ?
ADDRESS: PUJF}9ERS LICE4SE:
Active
CITY, STATG, ZIP: Q Expired
PHONE: MAsiLm
PLUflBER LICENSE N ol y / ot f ReCOrd
?
a nitta
R1flIJ
4 OCCUpAId'P/CI.vTIQ2 ?. ' ?
J??/LYLtAt P
ADoREss:
CITY, STATr-, ZIP: SSJ(o7
PFIONE :
S) INDIG'1TE WFIICH PERI4iT IS SEING REQUESTEp:
CbNNECTION 'it7 CITY SEY7ER
corNECrsev TO czTY wr.TM
diHER (PT.FASE DESCF2ISE)
6) INDIG,'T C.+'E:
7) SIG:;A'IL'RE:
,??/ PI.EASE fSOID APPR(JVm PEFL'N.IT FOR PICi:-UP BY ONE OF ABWE
A!] PLFIISE h'AIL APPR(7?IED PFR?LLT 'Id 1, 2 3, 4 ABWE
z? /i (Circle one)
DATE:
?F ?l p:ilMf?s.is i? s? se la:aa?c! a? t/Y?aaEr.s+? a? s?.s?i:? a aR !!wli4.+?a?!-??.}? rt ?=acsar r
FO R C I T Y U S E ON;,Y
PERMIT °- ISSUED
FEES: $_ ! d • s-°
$ /n S`O
$ S
S
$ /S. °-e
$ e'-e
$
vc-e`-fl e--d
$
5
$
S
$
SE:^iER PE?tMT_T (I`1CL::D? SURC::aRGc.)
WATER PERr4IT (INCL'JDE SliRC;IARGz)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SESJER TAP
ACCOUNT DFpnSIT - WAT°R
WAC
SP.C
TRG'NK WATER ASSESSi4E:QT
TRliNK SEWER ASSESSMEPIT
LtlTERAL BENEFIT/TRUNK SE;•IER
LATERAL BENEFIT/TRUNK WATER
OTHER
$ TOTAL
o-d
$ __ -•-La? AI•lOU:VT PAID/RECEIPT
DOES UTILITY CONNECTZON REQUIRE EXCAVATION IN PUBLIC RIGcIT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGZNEERING DIV:SION. LZST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DAT° : -r,l
Me stMwi ? ? MA&URzft E&MMe =-w wsg w*+ pkWw Wo@ OR" vtAww*= Ie WJIGwCr IcWia sjo w ?
PERMIT#
RECEIPT DATE:
RESSIDENT1AL f'LUMBINfi PERMIT A#"PLICAT[(DN
crrY oF F-Asm
3$30 PILOT KNOB iiD ' EAHAIY, MN 5518E
651-6$1-4645
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
TELEPHONE #:
TELEPHONE #:
STREET ADDRESS: ^-1 -5Piq NO'Arh ?i-- W ? vV
CITY: n-?A-e? pSTATE: ? ZIP: ?i ?CJI? G_
Place a check mark nert te the eermit work tvee
New residential dwelling unit under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existina dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repair/rebuild of RPZ
• lawn irrigation system
• waterturnaround /
Nature of work??Lr
Septic System, new/refurbished - $ 225,00
. inaudes c:ounty & Consulting Inspector fees
• requires MPC license
Water tumaround - existing dwelling unit, including: $ 50.00
• 5/8" meter 115.00
$ 165.00
State Surcharge $ .50
Total $ SG ?
Reminder. Schedule inspections of alterations, i.e. water heaters, water sotteners, water turnarouna, ecc.
I hereby acknowledge that I have read this application, state thatthe informaHon is cortect, and agree to complywith all applicable City of Eagan ordinances It
is the applicanPs responsibility to no6fy lhe property owner that the City of Eagan assumes no liabilityfor any damages cau d by,tlte City during its normal
operational and maintenance actlvides to the §cilitles constructed under this p ie n?City property/ri?f-way?n/n ^
SIGNATURE OF PEFjMITTEE (J Updated 9/01
? 7-3CO ? RESIDENTIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Kuob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
413 -11s
New ConsWdion Reauiremants RemodeVReoair ReauiremenLS Offm Use Onlv
3 registered site surveys showing sq. ft. of lot, sq. R. o( house; and all roofed areas 2 copies ot plan Cert of Survey Recd _ Y_ N
(20% maximum lot coverage allowed) 1 sel af Energy Calculatlons tor heated additions Tree Pres Plan Recd _Y _ N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey foraddNons & decks Tree Pres Reqd _Y _ N
lsetofEnergyCalculations Addition-indicefeilon-sftesepticsystem On-sile5epticSystem _Y _N
3 copies W Tree Preservation Plan i( lot platted after 711 193
Rim Joist Depil Ophons selection sheet (bltlgs with 3 or less units
Date /10 Construction Cost 00
SiteAddress yy/3^`r?f/S ?:vn?AYYJoy? ?i ?Qa? ct?CQFUnit/Ste#
Description of Work ?r?0
Multi-Family Bldg ? Y_ N Fireplace(s) _ 0_ 1 _ 2
Property Owner M /4ou S S",? Telephone #( )
Contractor 62nCA^ ?? ,-C?
Address ° ,?'?? /`f}-^J° 51'- l.kx -;?J- City 244el< ua.
?
State (}m tiJ Zip
Telephone # (58?) ?-Y) ' 3 3 -7
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv I _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
('Jsubmissiantype) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously consiructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies. ??-
Licensed Plumber I II IT?7??? 1 II II Telephone #( ?
Mechanical Contractor t ?j NOV 14 2003 A Telephone #(
Sewer/Water Contractor 1.,., 1 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.
?"2yryTC?
Applicant's Printed Name Applicant's Signatuy6
Oct-18. 2013 8:58AM Crest Exteriors 651-463-8095 P. 10
Use BLUE or BLACK Ink
-
For Office Use
I
i
Permit
City of Baran Permit Fee:
I
3830 Pilot Knob Road l
Eagan MN 66122 Dale Received: 1
i I
Phone; (661) 676-5676 1 staff:
Fax: (661)676-5694 1 I
- --___J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; J 0" 1-1 '6 Bite Address: ~jL4 n- Unlt ,
Name- v I ► Phone:
"O 'gr Address I City! Zip: "T
.c__
Applicant Is: Owner V Contractor
of Description of work: R~ r
`•'r' Construction Cost: r lsw Multi-Family Building: (Yes ^ I No
Company: Contact \
_n;ci~;~;~%:r:,-•c~'.- qty, C
_ Address, e
0
2
= 9 State: Zip- i~; , L1 1 Qom- Phone: 9 1
`f> License #;BC- Z Zq_O_Lead CartiHcate
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 Fagan Issued a permit for a simllar plan based on a master plan?
Yes ZNo If yes, dale and address of master plan:
Licensed Plumber; Phone:
Mechanical Contractor: Phone:
Sewer a Water Contractor: Phone:
s of
ort Ifi s ` :y u sr -1>xa Cons/ "ed t'"bye pt/c inform to
E' Pls~ Oc
sN0 s a ' d supp
'~~.9/tea to .R►~,1, e:c/ass ~u o aso s:t~at_,~N►ould6 ifs L~
CALL BEFORE YOU DIG, Call Gopher State One Call at (661) 464.0002 for prolecOon against underground utility damage. Cap 48 hours
before you Intend to dig to receive locales of underground utilities. www n9 harp s(ateonecall.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 permll, but only an application for a permit, and work Is not to start without a permit; that the work vdll be in
accordance with the approved plan In the case of work which requires a review and approval of piano.
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 x
Appllcant's Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
I For OfFice Use I
I 1 I
Permit
City of EaRan
1 ( ~ '
Permit Fee: 1
3830 Pilot Knob Road
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Pe-Kg Unit
Name: Phone: opResident!
Owner Address / City / Zip: 1010/2
Applicant is: Owner X Contractor
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Description of work:
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Type of Work
Construction Cost: 2- d Multi-Family Building: (Yes / No )
Company: "tL►tci1-6 tK,r/e'eT ontact: ® o +tn f
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Contractor Address: ~y° -r~ 51 ;itro city:~
State: fv Zip: °y' '"f Phone:
License ~ 6 ~ -V0 Lead Certificate IVA-7-
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 i
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
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Applicant's Printed Name Applicant' ignature
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