4417 Clover LaneF0R SALE UNITS CITY OF EAGAN ?
•a 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121N_ 11656
BUILDING PERMIT PHONE: 454-8100 Receipt H i 1230
Tobeuaedfor 1 OF 4 PLEX Est.Value $48,000 oete MARCH 20 1986
SiteAddress 4419B CLOVER LN Erect 25 Occupancy R3
Lot 25 Block 3 Secjsub. EDEN ADDITION Remodel ? Zoning PD
Parcel No Repair U Type of Const V
. Addition ? No. Stories
a Name GOOD VALUE HOMES Move ? Length 44
3 1460 93RD LN Demolish ? Depth 24
a Address
BLAINE ph
Ci
780-5510 Int Impr. ?
? Sq. Ft.
ry o ne Install
a
a
.i..__ SAME APProvals Fees
OV
U Q
?
Phone
??
w W
Name
?
0 Address
.
z
i W City Phone
I hereby acknowledge that I have read this application and state that the
intormation is correct and agree to comply with all applicable State of
Minnesota Statutes and Ci n Ordi gnces. ?
Signature of Permittee?
A euilding Permit is issued to: GOOD VALUE HOMES
all work shall be done in accordance witla aILAolicable ate o inneso
Assessment Permit $ 274.OC
Water&Sew. Suroharge 24.0C
Police Plan Review 137.0C
Fire SAC 575.0[
Eng. WaterConn. 500.0(
Planner Water Meter 63.5(
Council Road Unit 290.0C
Bldg. off. 3/14/86 7r. PI. 156.0(
APC Parks
Var. Date Copies
2 019
5 C
7otal ,
.
on the express condition that
Statutes and City of Eagan Ordinances.
BuildingOtticial
?
ROR SXLE UNITS CITY OF EAGAN
- 11657
` 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N0
BUILDING PERMIT PHONE: 454-5700 Receipt s -23 -)
Tobeusedtor 1 OF 4 PLEX EsI.value $48,000 Date MARCH 20 ?y86
SiteAddress 4419 CLOVER LN Erect C3`; Occupancy R3
Lot 26 elock 3 Sec/Su6. EDEN ADDITION Remodel ? Zoning
Parcel No. Repair ? Type of Const V
Addition ? No Stories
c GOOD VALUE HOMES
Name Move ? Length 44
i
1460 93RD LN Demolish ? Depth 24
; Address
°
780-5510
ciry BLAINE ph
lnt. Pr. SQ
? ??
one Install
F Name SAME ApProvala Fees
i
$¢ Address Assessment P2rmit $ 274.00
? city Pnone water&Sew. Surcharge 24.00
?Q Police PlanReview 137.00
Fw Name
? Fire SAC 575.00
Address 500.00
Water Conn.
a W ciry pnone Planner Water Meter 63 . 50
Council Road Unit 290.00
Iherebyacknowledgethatlhavereatlthisapplicationandstatethatthe gldg.OH. 3/14/86 Tr
156.00
PI
informahon is correct and agree to comply with all applicable State of .
.
Minnesota StaNtes and City,gO en Orclii nces.
l APC Parks
?
?
? Var. Date Copies
Signature of Permitte y
??/ 70tal $2,019.50
A Building Permit is issued to. GOOD VALUE HOMES on the express condihon thet
all work shall be done in accortlance with all applic le State of M nnes Statutes and Ciry of Eagan Ordinances
Building Official Ai / ??
Pi
_
23
FOlt SALE UN ITS CITY OF EAGAN
' 3830 Pflot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 11658
BUILDING PERMIT PHONE: 454-8100 Receipt # ? 7 ? a-
J
To be used for 1 OF 4 PLEX Est Value $48,000 Date
MARCH 20
SiteAddress 4417 CLOVER LN
Lot 27 Block 3 Secisub. EDEN ADDITION
Parcel No.
W I Name GOOD VALUE HOMES
o Address 1460 93RD LN
ciryBLAINE phone 780-5510
o I Name SAME
? Q Address
`- CiN Phone
.?
F w
Name
? n Address
a W City Phone
I hereby acknowledge that I have read ihis application and state that the
mformation is correct and agre o cgmply wkh all applicable State ot
Minnesota Statutes and Ci ?an Or ' ances.
Signature of Permittee?s.?SG????
A Building Permit is issued to: GOOD VALUE HOMES
all work shall be tlone in accordance with all aoolicetrle? f Minneso
? ?-
Erect Occupency
Femodel ? Zoning
Repair ? Type of Canst. V
Addition ? No. Stories
Move ? Lengih 44
Demolish ? Depih 24
Int. Impr. ? Sq. Ft.
Install ?
Aoorovals Fees
Assessment
Water 8 Sew.
Police
Fire
Eng.
Planner
Council
Bidg. Off. 3/14/86
APC
Var. Date
Permit $ 274.00
Surcharg ? 0
Plan R
view
e ?_00
SAC
Water Conn. 500. 00
water Meter 63.50
Road Unii 290.00
Tr. PI. 156.00
Copies
Total 2.019.50
- on the express condition that
of Eagan Ordinances.
Building Oflicial l/ ?/GC-?-C ?l -1%L+
g
FOR• SALE UNTTS CITY OF EAGAN ?
N
11659
_ •: 3830 Pflot Knob Road, P.O. Box 21-199, Eagan, M N ss,2,
-
PHONE: 454-8100 ?C e?3
BUILDING PERMIT
Receipt p U
MARCH 20
$48,000
1 OF 4 PLEX 86
Tobeusedlor
EstValue
Date 19
Site Address 4417B CLOVER LN Erect Occupancy R3
Lot 28 Block 3 Sec/Sub. EDEN ADDITTON Remodel ? Zoning PL)
Repair ?
Parcel No Type of Const V
.
Addition ? No. Stories
W Name GOOD VALUE HOMES Move ? Length 44
; Address 1460 93RD LN Demolish ?
I
I
? Depth
S ?4
o nL
mpr.
Ciry BLAINE phone 780-5510 Install ? q. Ft
i
$ ? Address
? Ciry Phone
?a
W w
Name
?
z
?
E5 Address
z
a W o Name SAMF. Approvals Fees
Gry Phone
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all a plica le Siate of
Mmnesota Statutes and Cian rdihances.
Signature oi Permittee ' 1I/? - -
A euilding Permit is issued to: GOOD VAL
all work shall be done in accordance with II a pli
Building ONicial
Assessment Permit 274.00
Water & Sew. Surcharge 24.00
Police Plan Review, 137.00
Fire
Eng.
Planner
Council
Bidg. On. 3/ 14 / 8 6
Var. Date
SnC 575.00
Water Conn. 500 . 00
Water Mefer 63.50
Road Unit 290.00
Tr. PI. 156.00
Copies$??50
Total
on the express condition that
and Ciry of Eagan Ordinances.
Y
CITY OF EAGAN
,..- , 3830 Pqot Knob Read, P.B. Box 21-199, Eagan, FAN 55121 ?:- 116 5) a
PHONE: 454-8100
, BUILDING PERMIT Receipt #
$98 ,000 Date
SiteAddress 4417 CI+UVER
Lot 2 7 Block 3 Sec/Sub.
Parcet No.
Z o Name
? ? Address
?m
F W Name-
u ? Address
i z
W Citv -
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 Ci a Ordina es.
Signature of Permittee 2-???C1.,-!?-? '?L?
L
A Building Permit is issued to: GOOD VALUF HU:`iF:S
all work shall be done in accordance with all applicable Statp?7f Minneso
Erect ? X Occupancy xj
RemoCel ? Zoning
Repair ? Type qi Const V
Addition ? No. Stories
Move ? Length 44
Demolish ? Depth 24
Int Impr. ? Sq, Ft
Install O
Approvala Fees
Assessment Permit ? 274.00
Water &Sew. Surcharge 14 •0 0
Police
Fire
Eng.
Planner
Council
Bldg. Off. 3/14/81
Var.
Plan Review 137.00
SaC 575.00
Water Conn. 5 oU•00
Water Meter 63.50
Road Unit 290.00
Tr. Pi. 156.00 ;
Copies '
Total $[, 019 . 5 O
on the express condition that
of Eagan Ordinances.
Psrml! No. PermN Hddar Dwe Tal?phon? N
Plumbinq
H.Y.r?.C: f?')
E{ectric ?
Solfener
Inspoction Date Imp. Gommenh
Foodnys 1
Foorinqs II
Foundstion
Framing y/8 ? 6• ? ?G A. .
RoMlnq
Rouqh Plby.
Rouyh Nty. _F ,¢
Insul.
Fhoplsce
Ffnd Htq-
Ffnal Piby.
?-
3
Bldy. FMat
CKt. Occ.
Dock Ftq.
Oock Frmp.
YVall
Pr. Disp.
"' ?4 l l
PERMIT #
.. : MECHANICAL PERMIT RECEIPT #
CITIf OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE PHONE: 454-8100
Site Address BLDG
TYPE WORK DESCRIPTION
Lat Block ? Sec/Sub .
?
' "R
N
es.
ew
? Name ? t ' A
d
-on
Mul
d
?u Address sir
Comm
Re
c City Phone .
p
pm
er
Name FEES
?
c Address RES. HVAC 0-100 M BTU - $24.00
p City Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK 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 - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM BEYOND $1,000.00)
Gas Piping OuNets #
Other L?
FEE .4 u- = *
S/C: 51GNATURE OF PERMITTEE
TOTAL:
FOR: CITY OF EAGAN
PLUMBING PERMIT
' GTY OF EAGAN
3830 PILOT KNOB ROAQ, EAGAN, MN 55121
Site Address _,Zy / •
Lot ?2:Z Block
m
?o
?
c
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHARGE PER PERMIT
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
- $10.00
- 20.00
- .50
FOR: CITY OF EAGAN
PERMIT #
RECEIPT #
DATE:
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
NQ. FIXTURES TOTAL
? Water Closet - $3.00
T
' $ -
Bath Tubs - ?
,3.00
ZLavatory - $3.00
Shower - $3.00 _
/ Kitchen Sink - $3.00
Urinal/Bidet - $3.00
I Laundry Tray - $3.00
Floor Drains - $1.50 `
^
7 Water Heater - $1.50 ? ?
r
Whirlpool - $3.00
=Gas Piping OuUets - $1.50 -' r
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
t_
?Rough Openings - $1.50
` - '
FEE / L .- .
STATE 3/C: ?-?
'
GRAND TOTAL• " C
?
FOR bALE U.: t`r.,? CITY OF EAGAN 1259
3830 Piot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 j ,.
BUILDING PERMIT ??--
Receipt #
I ri:., eP r.).:-L 53ii . 000 _ MARCH 20 86
Parcel No.
W Name GOOD VALUE F30MES
; Address 1460 93RD LN
0 _ - . rwro- 9GA-GG1A
Z o Name SAMP -
? ? Address
~ Ciiy Phone
IU W Name-
E
v ? Address
i z
W Cih' -
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applic e State of
Minnesota Statutes :and: C
ity o a Ordina es.
Signature of Permitt
A Building Permit is issued to: ?'?D VALUE ?iUP??:S
all work shall be done in accordance with all applicahle State of Minnesa
Erect QP* Occupancy R3
Remodel ? Zoning PD
Repair ? Type of Const V
Addition ? No. Stories
Move ? Length 44
Demolish ? Depth '14
Int Impr. ? Sq. FL
Install ?
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Bldg.
Var.
Permit $ 274.00
Surcharge 24.00
Water Conn. 5uu •
Water Meter 63.
Road Unit^ 290.
Tr. PI:. 156.
ParkOg
Copie
Total ? on the express condition that
and City of Eagan Ordinances.
Building Official C i
I I PWmN No. I PermR Holder I Dale I TNMphom N I
-Y
Dat*
Plbq.
Kt9•
el Plby.
p. FMd
1. Oce.
:k Ftq.
;k Frmq
11
Dlap.
PERMIT # -' -l17 O
' ' MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
r
3630 PILOT KN08 ROAD, E11GAN, MN 55121 DATE C-
CONTRACT PRICE PHONE 4548100
Site Address - ' gLpG
npE WORK DESCRIPTION
Lot? BIoCk ..,? Sec/Sub ? - ,
?i
N
?
Name ' es.
ew
M
lt Add
?
Address -on
u
Comm
air
Re
c City • Phone - .
p
pther
Name FEES
?
3
Address
RES. HVAC 0-100 M BTU
-$24.00
p City Phone ADDITIONAL 50 M BTU - 6.00 I
ADD-ON AIR COND. 0-24 BTU - 12.00 I
ADDITIONAL 6 M BTU - 6.00 I
TYPE OF WORK GAS OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 146 OF CONTRACT FEE I
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50 '
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM BEYOND $1.000.00) I
Gas Piping Oudets #
Other
FEE
?GNATURE OF PERMITTEE I
S/C'
TOTAL•
FOR: CITY OF EAGAN
. PERMIT #
? ' • PLUMBING PERMIT RECEIPT # ?
CITY OF EA(iAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
IACT PRICE < PHONE 454-8100
d,eI`'- Z' 11 BIDG. TYPE WORK DESCRIPTION
? 81ock Sec/Sub ?
m Name
w Addre
..
c City ti!=
? Name
c Addre
O CnY-
FEES
COMM/IND FEE - 196 OF CONTRACT FEE
MINIMi1M - RESIDENTIAL FEE - 510.00
MINIMUM - COMM/IND FEE - 20.00
5TATE SURCHARGE PER PERMIT - .50
(ADD $.50 $/C IF PERMIT PRICE GOES
' BEYOND $1,000.00)
Res. New
M ult Add-on
Comm. Repair
Other
MO. FIXTURES
? Water Cioset - $3.00 TOTAL
$.
?Bath Tubs - $3.00
FLavatory - $3•00 -
Shower - $3.00
r Kitchen Sink - $3.00 - '
Urinal/Bidet - $3.00
? Laundry Tray - $3.00
?Floor Drains - $1.50
_LWater Heater - $1.50
Whirlpool - $3.00
ZGas Piping Outlets - $1.50 -
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
zP1
?Rough Openings - $1.50 17
-
FEE ? k= ? J
S (?
STATE S/C:
GRAND TOTAL•
FOR: CITY OF EAGAN
FQR ?iySALE ll;y:
BUILDING PERMIT
Eng.
Planner
Council
BIdg.Off. 311418!
APC
Var. Date
To be ueed for 1. OF 4 PLEYEst. value $48,000 Date t"IAKCH 2 d , 19 86
Site Address 4419 ,",• ` Erect ? XOccupancy R3
Lot 26 Block 3 Sec/Sub. EDEN A DDITION Remodel ? Zoning PD
Parcel No Repair ? Type of Const. ti
. Addition ? No. Stories
cc rOOD VALCIE HOMES Move ? length 44
= Name 14 64 9 3 RD LN Demolish ?
j
oepth 24
o Address Int Impr. ? Sq. Ft ?
City sj+A IN4hone 780-5510
- Instau ?
I;
Assessment
Water 8 Sew.
Police
Fire -
I hereby acknowledgethat I have read this application and state thatthe
information is correct and agree to compl with all applicable State of
Minnesota Statutes and Ciry- n inances.
Signature of Permitte
A Building Permit is issued ta: GnOD VALUE FIOHiES
all work shall be done in aCCOrdance with ali applicable State of Minnesc
Building
'i ;; CITY OF EAGAN
3830 Pibt Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
11V57
Receipt #
Permit
Plan Review jj/• UU
SAC 575.00
Water Conn.500• 00
Water Meter63• 50
Road Unit 290.00
Tr. PI. 156.00
Parks
Copies
Total $2.019.50
on the express condition that
and City of Eagan Ordinances.
J. PermR No. PermN Ndder Date TNephona M
Plumbiny
H.V4C.
Ekmlrlc U(o
sah«,.r
Inspectlon Date Insp. Comments
Foodnps 1
Footlnys II
Foundatlon
Framiny
Rooliny
RougA Plby
Rouyh Htq.
Insul.
Fireplaeo
Final Hty.
Flnal Plby. AIV
Final
Mclg.
6
;
/?,
[ E I
CaN. Oce.
Deck Ftp.
Dock Frmy.
WNI
Pr. Disp.
PERMIT # - 7 ? v
• *• MECHANICAL PERMIT RECEIPT # ? U ?-
CITY OF EAGAN
-?4 ? C
3830 PILO T KNOB ROAD, EACaAN, MN 55121 DATE: ?
CONTRACT PRICE PHONE.454-8100
Site A ress ?` BLDG. TYPE WORK DESCRIPTION
Lot? Block ?- Sec/Sub
Res. New
m Name f•, M
l
?
Addre
ss . u
t Add-on
C
R
i
omm.
r
epa
c City Phone ' Other
Name FEES
?
3 Address RES. HVAC 0-100 M BTU -$24.00
p Cityr Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
TYPE OF WORK ADDITIONAL 6 M BTU - 6.00
GA5 OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 146 OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM BEYOND $1,000.00)
Gas Piping Outlets # .
Other
FEE:
S/C: SIGNATURE OF PERMfTTEE
TOTAL• ?
FOR CITY OF EAGAN
PERMIT #
PLUMBING PERMIT RECEIPT #
CITY OF EAGAN
3830 PILOT KN08 ROAD, EACiAN, MN 55121 DATE: _
Site Address "Lot24,_ Block
d
?
U)
c
a?
c
3
O
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMiJM - RESIDENTIAL FEE
MINIMUM - COMM/IND FEE
STATE SURCHARGE PER PERMIT
(ADD $.50,$/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on _
Comm. Repair _
27 Other '
NO. FIXTURES
-L-Water Closet - $3.00
T_Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
1 Kitchen Sink - $3.00
UrinaUBidet - $3.00
$10 00 Laundry Tray - $3.00
Floor Drains - $1.50
20•00 -L Water Heater - $1.50
.50 Whirlpool - $3.00
":1 Gas Piping Outlets - $1.50
Softener - $5.00
Wetl - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
STATE S/C:
FOR CITY OF EAGAN
GRAND TOTAL:
TOTAL
$
?.
. ` .
?
?, ? ? ?
PERMIT #
PLUMBIN(3 PERMIT RECEIPT #
CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: ?-
CONTRACT PRICE: PHONE: 454-8100
Site Address
Lot ' Block
Name
c??o Address
c Ciry Phone
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-o?
Comm.
Other Repair
? Name _
3 Addres.s
p City _L
FEES
COMM/IND FEE - 1%OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUI31- COMM/IND FEE - 20.00
STATE SI,IRCHARGE PER PERMIT - .50
(ADD $.50'S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
OF PERMITTEE
FOR CITY OF EAGAN
NO. FIXTURES
Water Closet - $3.00
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whiripool - $3.00
Gas Piping Outlets - $1.50
=oftener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE
TOTAL
?
STATE S/C:
GRAND TOTAL:
CITY OF EAGAN
3830 Pilat Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?14 11656
:-
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used tor 1 Or' 4 PLLX Est Va1ue $48,V0n Date MARCH 20 19 86
SiteAddress 44198 CLOVEk LN Erect OX Occupancy R3
Lot2 Block 3 5eclSub. EaEN ADDITIQIV Remodel ? Zoning PD
Parcel No. Repair ? Type of Const V
Addition ? No. Stories
41 W Name G??OD Ve1L(lE IlOMES Move ? Length 44
1460 9 3 RD LN Demolish ? Depth 24
o Address Int Impr. ? Sq. Ft
Ci?, BLAIPJFphone 780-5510 Install ?
¢
F SA14E
Name aPProvais
Z
0 i Address ? Assessment
~ City Phone ^ r' Water 8 Sew.
? Q ? Police
w Name Fire
Z
? a Address Eng.
< W City Pnone Ptanner
I ncICuy acnnUw ieuyr ulau nava r eau uns appncacwn ana bcaie inai inC B?dg. Off, J11 4/?
information is correct and agree to comply wit II applicable Stat
Minnesota Statutes and C'}a+ of Ordin es. APC
' Var. Date
Signature of Permitte
Permit $ 274.00
Surcharge 24.00
Plan Review 137.00
sAC 575.40
Water Conn.504 • 0fl
Water Meter6? • 50
Road Unit 250.00
iTr, PI. 156.00
Parks
Copies
Total $2,019.50
A Building Permit is issued to: GOOD VALUE HOI-IE:i on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official '
I I " IPwn* No. I P.rm* Hom.r I Dr. I TN.phom x I
Htq.
Dlap.
PERMIT #
.
i MECHANICAL PERMR RECEIPT # v
CITY OF EAG/lN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
m Name _
? Address
c City
Name / 1%? ?
3 Address
O Ciry
TYPE OF WORK
Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping OuUESis #
Other
M BTU
M BTU
M BTU
M BTU
CFM
FEE
S/C:
TOTAL
BLDG.TYPE
Mult
Comm.
Other
WORK DESCRIPTION
New
Add-on
Repair
. FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL fi M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
SIGNATURE OF PERMITTEE
CITY OF EAGAN
p .
Site Address y`/ -"7
Lot Z,:? Block
m Name
?v Addre!
c City _
? Name
c Addre
o Ci1Y, ?
PLUMBING PERMIT
CiTI( OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121
FEES
COMM/IND FEE - 146 OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000.00)
FOR: CITY OF EAGAN
PERMIT #
RECEIPT #
DATE:
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult Add-on
Comm. Repair
Other
NrJ. FIXTURES
c
ci
w
c
3 TOTAI,
s
- $
a
er
ose
.00 T. ,
? Bath Tubs - $3.00 ,
`
Lavatory - $3.00
Shower - $3.00
?
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
T
=
- '
ray - $3.00
Laundry
? Floor Drains - $1.50
? Water Heater - $1.50
? - '
Whirlpool - $3.00
=Gas Piping Outlets - $1.50
"
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
j Rough Openings - $1.50 '
FEE STATE S/C:
GRANQ TOTAL• ' ?? ' ?'
i CITY OF EAGAN Remarks
I Additian E&n Addition Loc 27 eik 3 Parcel #10 22750 270 03
, Owner Street 4417 Clvver Lane stete Eagan NAi 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF, (D SQ 19$2 504.70 100.94 5
STREET RESTOR.
GRADING ^ 1982 232.99 46.60 5
SAN SEW TRUNK ?
* SEWER LATERAL 19 2 18 Y
WATERMAIN
?F WATER LATERAL
WATER AREA - I?77
i
1982
5
STORM SEW TRK
?F STORM SEW LAT 1982
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
5AC
PARK
CITY OF EAGAN Remarks
Additivn Ed--n Addition Lot 28 Bik 3
oWner street 4417B Clover Lane
#10 22750 280 03
Eagan hIN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 6,50 19$2 504.70 100.94 .r'?
STREET RESTOR.
GRADING ; 1982 232.99 46. (O
SAN SEW TRUNK a /
4
* SEWER LATERAL ,
2, 1$2 1896.46 372.2.2..
WATERMAIN
* WATER LATERAL 1982
WATER AREA
* Services 1982
STORM SEW TRK ' C? 1982 256.00 51.20
* STORM SEW LAT 1982 S
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN Remarks
Addition Eden Addition Lot 26 sik 3
Owner ? e' f\.1?...•. ._ street 4419 Clover Lane
#io 22750 Zbo 03
EaQan NW 55122
Improvement Oate Amaunt Annual Years Payment Receipt Date
STREETSURF. ' ?U 1-982 100.94 5
STREET RESTOR,
GRAOING 1982 2?? 46.6o
SAN SEW TRUNK y 1974 62. g3 4.20 15
# SEWER LATERAL ° ], '? ?8 6. !4E> 319.29
WATERMAI N
• WATER LATERAL 82
WATER AREA 977 62.93 4.20 15
* 3ervicea 1982
STORM SEW TRK 4 1982 2 6. 0o 1i.20
• STORM SEW LAT 1982 5
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PEFi.
SAC
PARK
CITY OF EAGAN
Addition F.dt-n Ac1c1iY_inn Lot 2 S Blk 3 Paresl # 0 790 .r,f1 03
Owner ' ' Street 4419B Clover Lane State EajZan AM1 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. ?'0 1982 504.7? 100.94 5
STREET RESTOR.
GRADING cID 1982 2 . 46.6o
SAN SEW TRUNK L, 1974 62.93 4.20
* SEWER LATERAL (Q 182 1896.46 319.29
WATERMAIN
* WATER LATERAL 1V
WATER AREA
* Services 1982
STORM SEW TRK i? 1982 256. oo 1.20
# STORM SEW LAT 1982 S
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
? - / o -- ? a--
.. .. ?
?
?
? .? . ?.?
?? adet;,? ?
?
?
l
v
g, ?
?? k- s
? 1/0,
/
?
?
.
:Z:-)Io ?i5
? ?? _? ?
?--------------INSPECTIUN RECORD - --
CITY OF EAGAN PERMIT TYPE: ""' "(t
3830 Pilot Knob Road Permit Number:
? Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
k . ,
SITE ADDRESS: , „ i . .1 1.1111111 APPLICANT:
? i ttV[!2 L HMk` ir? . ?iti! i
N t?> I:' 1 ti'??? -/,' ?Id
PERMIT SUBTYPE:
?
IL
TYPE OF WORK:
(!1 •,/ ?t I i' 1 ( (1tJ
? y?6`oC
---------------------------
r?'r I'A 114
t'f !'1 At'I
-1
?
Permit Holder Date Telephone ?
SEWE
WATER
PLUMBING
HVAC
Inspectlon Date Inap. Comments
FOOTINOS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
corvDucnwrv
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
7 - - - - :s- - - - - _- ^
INSPECTIOl`v RECORD
CITY OF EAGAN PERIIAIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued;
(651) 681-4675
SITE ADDRESS:
r ' , i nVf H 1 ANr
: .
I PERMIT SUBTYPE:
?
I;11! 1 (?! Nfi
N.;q:;4H
H 1 / N H /'i cl
s APPLICANT:
, ., . ? ',W,
l+,t:'? lt??:t
TYPE OF WORK:
1:1 . , i ; I E,ir:
Frrf>qtl:
RfPIAC'!` `;lh[NA
I N A I
I , r1Rt `; , IIN I 1 H
F- 7
1
L
PermR Holder Oate Telephone M
EWE
WATER
PLUMBING
HVAC
Inspectlon Date Inap. Comrnents
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUM8ING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP 80ARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METEF
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
7 --------------INSPECTIOI'? REC?RD
?
? CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number
' Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: ? " ? • ?' ' 4? :? ? ?? 9?? ? APPLICANT:
H t1) rr,
? i OVFR I.ANIF ??•J;!
I PERMIT SUBTYPE:
?
I ,,"?I4 F''?,; lfNl f 13
TYPE OF WORK:
, I i'A.th
?fi '•? I. 11, 1 iJiII I fP l AC(' S 1t1.iNti
Permit Holder Date Tslephone #
SEWER/
WATER
PLUMBING
HVAC
Inspecfion Date Insp. Comrtients
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AI R TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METEA
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
-----'--4 - INSPECTIOl`? RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: 1411 o i i + IiiVt (+ I 1 114i
C llf N
' PERMIT SUBTYPE:
?
APPLICANT:
tI I t I I tr 1 Nr,
43:tq`s44
Fi i/ N fl Iq9
TYPE OF WORK:
; I rA tu
i 1, i.i I i Eif A f' f
I Fa il I
F O1a ^ I? -
L 51?? 1
-- - - - - - - - - - - - - - - - - - - - - --- - - - - - - - - - - - -
r
I
I
SEWER/
WATER
PIUMBING
HVAC
Inspection Date In
FOOTINGS
FOUND
FRAMING
ROOFING
AOUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAI HTG
ORSAT
TEST
BLQG FINAI
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
coNOUCrrviTv
TEST
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
INSPECTI4N RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number.
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS: tQl r 2, oto` Ks ? APPLICANT:
44198 Cf.OVER lAME `?C.NlJILfI
Ft7EN (612) 681-0087
PERMIT SUBTYPE:
Ut C_ K
TYPE OF WORK:
k1 MA1tY.Ss RECF LPT •
Controi No. 0635
aut? aiMe
•#NTB6
06/ls/9x
SCOYT
m
? t
.
Psnnit No. Pannft Had.r oat. T.kpnon• t
S/IM1I
PLUMB{NG
HVAC
ELECTRIC
ELECTAIC
1nspectWn Date Insp. ComrtNnb
Footings I
Foundatfon
FrattNng
Rooling
Rough Plbp.
Rouqh H4p.
leul.
FlreplaCe
FkW Fiig.
Orsat Test
F'irnl Pibg. Plbg. inapedor - Notlly Plumber
Const_ Meter
Er?grJPlan
81dg. Fu181
oock Fig. ??GE
t-
Dedc Flnal lj LtJ
wan `
?
Fr. Diap.
CITY OF EAGAM
3830 Pjl`vt Knob Rgad
P:.O: Box 21199
Eagan, MN 551,1
WATER SERVICE? PERMIT
PERMIT r10.: , ,.
DATE' ?-nlex
? No. of Units:
Z01?Coo a tie orles
Qwr»r:
naaeess: 44 C over ,1ne T._ . c,den Adan.
Slh Addnss:
3c : ?cn u? i^F
PlurnMr. NO ? ? c?II I?1M? charge:
metis Reader No.: 1? C??!Tillli F .5Upd
c1
1 a/er 1e ao lif ? dw 91rufmow' ""sarawro•:
Orltw?00EL ?QutR?`?? -
By ?? Doft Pald:
Dote of Insp.: Irap.:
met
-1
CITY OF EAGAN SEWER SERVlCE PERMIT ;
3830 Pilot Knob Road p??T NO.•
P. O. Box 21199 DATE:
Esgan, MN 55121
No. of Units:
Zoninp: -
pwrnr.
Addre65:
Site /?ddi
Plun+ber.
I Mm te rh? wkb tM CIly ef EqNM Conrnctlan aorpt:
?eas. Account DeDoWt:
Pomnit fw:
SurcharOr
„ Misc. G+o?oas:
of Irop.: Totol: 'I
Dah Pald:
CITY OF EACiAN WATER SERVICE PERMIT
3830 Pl4ot Knob Road pERMIT NO.: ..--?
P. O. 84.x 21199 .
Eesae, MN 55721 pATE'
Zoninp: No. of Units:
Ownar;
?? 4417B Clot er
Sih /?ddress:
Pl
P1urr?ber: +ic'.?lson
µet.r No. ?/ cP 32 3-
sim: 4um
h emph rrllh 1w
?x &?? 1?'h.UU?u ir
Total: 6' • ??P?' ?^eier
f ??'? 7, z. 3- Zr?
pate Pnid:
Irap.:
CITY OF EAGAN SEINER SERVECE PERMR
3830 Pilot Knob Road p??T NO.:
P. O. Bcx 21199
Esgan, MN 55121 DATE: Zoninp:
..' No. of Units:
Owrnr:
Addross: ?
„
$it! Add?em ' . .ye i„ cat,nP h" jP^ r,c'i;:t.
F.
? ;f?; ?.LLL•t`,?1:,.
w Plumber. - ` ,
c - ?-, ^ ? 1Lt: '•,llr:
11 Mw te wIlf wrb fM Ckf? +f iqpm Cort.we,Non Q+oW:
+OrdiMweM. Accow+t Deposit:
? Pemnlt Fes:
Surdhorpe:
By
DaM of Irmp.:
Misc. CMrpes:
Total: _
Dab Pbid:
3830 PJ.Ityt Krwh Road
P.'J. Bax 21199
Eagan, MN 55121
Zoninp:
Owrnr: ' 4 „ I ; "a
/1ddnw. - -
SI» /lddresa:
plumber. _?---
MOtw No..
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
. No. of Units: . y
liociss
m
RlOdef NO.:v V ' ?"• - _ ,? ?`?'? ' r. _
?arr 10 Mmpay M101, ?` ffip• YfChG?g@: ?
OrllMaer. Mlsc. ChoMes:
Total:
By Date Pold: -
Dote of InsP•. Imp.:
CITY OF EAGAN WATER SERVICE PERMIT
f 3839 P.ilbt Knob Road
; P. O. Box"21199 PERMIT NO.:
Eagan, MN 551 ?1 DATE: ZW1I11p: ?J 1 BX
of Units: P
?oo ti'a se -!,
Ownsr: _ ,
Add?sw
i}? LiP r?
sft Aea?es.: ..+
?a .
PiYI1tbOr T: ?i •- _ ,^ ? n„ . O
Meftr N,.:3 o !?9
; ?, ,?,
_? S ?' o[?I1.. ?,?j •
Size:
? -
^
. ? ):
j
? Reoder No. 19 S't V
Pe?mit Fae: 7
'
/
'
•
a
s wMh tiw?A . Su„d,c.
e; ?
p ;
G; .. .tc ordbwnom
r AAisc. Chorpe,;
. . ?;,;,., .
Totol:
61
. ,()I); meter
BY Dote Pcid:
Dote of Insp.: lrwip,;
7- g- k6
P. O. B.,ic 21199 PERMIT NO.:
- Eagan, MN 55121 DATE:
Zoninp: ^- No. of Units:
' -
OWfNr .. l)ns} V3ltE' rfCL2(`o
I'Addrew
Sitr Addron: % ?1?? ?'r iane L27 ?•? ?,???, ?a i
-.Pl11Rbef:
?I MM to esewhi wob IIM p1T oF VNw Connwcfian Chorps:
O?i1MeeM. Acaount Ceposit:
CITY OF EAGAN SEWER SERVlCE PERMR
3830 Pilot Knab Rcad
Pomdt FN:
SurrJ+arpe:
eY Misc. Cltot+pm
Dote of Imp.: Total:
? ?,,... • Dote PoW:
CITY OF EAGAN SEWER SERVlCE PERMIT
3830 Pilot Knob Rosd -
P. O. Box 21189 PERMIT NO.:
Eagan, MN 55121 pATE; ?
ZO^i^g: No. of Units:
Owrnr. .. . , _.;,?<. .. .._.
Add.ess-
Slte /lddi
Plumber.
I agrN to ee- plyr wMh tW CJ1y oi lNeD
Ordl"neN.
8y
Dote of Irop.:
Connection Charge: - n 00.p:?
Aooount CepOSif:
Pom"lt Fea:
Surchorps:
Misc. Chonpes:
Totol:
Doft Poaid: -
This request wid 5??,^ 1
,8 mon ,h, fram
C 18084 1? :z, FJ n_ .
L.• 3 0 6 6
xl?_01
flequest Dc:e ' Fire No. qouph-m InspecLOn
flepuireA?
E]Ready Nuw?ill Nmdy Inspec-
I
I
? lp ?
j$Yes No
o
r When fleady
U Licensed Electncal Contractor I hereby request inspecLOn ot above
? Owner elactrical work installed et:
S dress, Boz or Rou No. Ciry
E
It,?,r
ecWO Cz-?
Township Name or No. ange No. Cn ty A' r
Occupant IPflINT)
a
-
d
- Phone No.
(
)n
V(
Aut
Pa.,,,r S?upgher Adtlress
?L ?/
Ele;ncal ConVac[or ICompanv Name)
Lt.n
I
C.ntrar,to - r's Lm?se No.
? "'-7 -
Meiling Address ICOntracror?or Owner Makine?t?latwN
??1 1
l1
A thonzgtl Signawre (ConhaclodOwner Mabng Installation)
Lniu' lYMs ._T' Phone Number
S(? - 8 c' o o
MINNESOTA STATE BOAFD OF ELECTNICITY
Gri99s-Mi 91de. - Aoom N-181
1621 University Ave., St. Paul, MN 55104
Phone (612) 297-2111
THIS INSPECTION REQUEST WIIL NOT
BE ACCEPTED BY THE STATE BOAND
UNLESS PPOPEfl INSPECTION FEE IS
ENCLOSED.
57,?7 Jkl REQUEST FOR ELECTRICAi INSPECTION ea-oucwi-o4
? 1 See inatracbans for com0lehng this form on hack ot y011ow coOV.
f 18084 "x" seloW Work Covered by Ihis Request
AEd flev. TyDe of Bwltling AOOLnnces Wired Eqmumenl Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt Bwlding Dryer EleCtnc HeaLn
Commercial Bldg. Fumace Silo Unloader
Industnal BIAg. Av Corxirtioner Bulk Milk Tank
Farm otne. v",fv otn,•, tsucn,fy7
t er Sue, (y [he, Oth.r
l.OmpUtB /nSpeCtlon hee HelaW
N Fee ServiceEntmnce5.ze tt Fee fexeers/5ubteeders M Fee C?rcwts
0 to 2 0 to 30 Am s 0 to 30 Am s
_A,,,,
A6ove 31 to 100 qmps
E
Swimml Above 100_Am
Transi Irnyation Booms Pattial.'Other Fee
Signs Speciallnspection n
S
Hemarks TOTAL / ??)
1 [
t
Noueh-in ) Date ?, the Ele
?nspector, hereby
certrty that the abave
F?nal Oa[e inspection hes been
r Z mada.
thbreQuestvoldl8monlhslrom ?1r. ,
REQUEST FOR ELEC7RICAL INSPECTION ee-oocwi.oa?
1 See instructaons lor completing this form on baek f '? '
a ve„ow ?oa? ?ao ) b
78 ,'rj F), "X" Be/ow Work Covered by Thfs Reauesr
Add Rep. Type ol BuilUrng Apolaancea Wiretl Eqmyment Wired
Home Range Temporary Service
Duplex
Apt. Bu?ldmg
Commercial Bldy. Water H e a t e r
?ryer
Furnace
liyhtiny Fixtures
Electnc Heatin
Silo Unloader
industnal BIAy, Av Conditioner Bulk Mrlk Tank
Ferm Other pea y Othcr fSOCnfyl
t r.r Syceify thee
O?hur
erviceEniranceSize p Fee Fanders/Subfeeders Fee Cvcurts
0 to 200 qm 5 0 to 30 Am s t? 3p
Ai?, S
M Above
200 qinps in J 31 to 10
Swimming Pool ove 100_Amps Above 100_Amys
ransiormers Irrigation Boon?s PartialOther Fee
S
igns Speuai hispect(on
n
Rema.ks
/17 ?, /
? TOTAL
L-? rrll
flaugh-m ? " - -
. o.,te
?. ?na ei vi
/a4 Inspeclor, heraby
Final pA e cerh}y [hxt ihe above
! ? ?r inspection has baen
aV meda.
tNs repuest voi018 montiia irom
/_ZL 0 71.
Thig request vmA 5-/-gy
18 months /rom
C ? 7 8 5 8 L..?. 7, A?.
Re.quest Date Fire No. qouPh-in InsVecLOn
^
}3- ?' R qwretl. ?fleatlv Now ?II NoUfY Ins0ec
J.?
- l1 es ?NO 1 r When Ready
LJ Ucensetl Eleclncal ConVactor I hereby request inspecrion ot ebove
? Owner electncal work mstalled at
Sveet Atldress, Box or Pou e o. bty /-?
ection o. Townshi0 Name or No. qange No.
?
OccuOa fPqINT) Phone No.
Powe $upPher ? Atltlress
El,ectncal Con'T^ractorA ICOmDanv Nnmel
? N V\ ? & C??nhuctor's Licenqs¢.N'. ?
??q -77 V
Matli BAddresslConiractoror,,p?erMakin0lnstailauon)
r ??
?- 1
y
17zed ignaIDre ICOmfactod0 ner Makmg In [allafionl Pho Number
MINNESOTA STATE BOARD OF ELECTRICIiV THIS INSPECTION flEQUEST WIIL NOT
Gnggs-MnOwav Rldg. - flaam N491 BE ACCEPTED BY TME STqTE BOAND
1821 UniversitY Ava., S[. Yaul, MN 55104 UNLESS PPOPEN INSPECTION FEE IS
Phone 1612) 297.2111 ENCLOSED.
This .equest void ?C, 7C, 3
18 monffis fmm ?
C 18061. y7-
flP.quest Oate Fre No, Rouph-in InsDecbon
Required?
Aeady NowQWlII Nolrty InsDer
?
? Yes ? No tor When Ready
? Licensetl Electncal Contrector I hgreby request insPection ot ahava
? Owner electrical work inslalled et'
Sveet Addres, Bax or Raute No. CilV
ectron o. Township Name or o. Range No. County
Occupant (PpINT) Phone No.
Po r SvuP?mr Adtlress
/ l W
Ele?yc ,i/calpCoyn'h?actor ((Cnmpany( Name?l ^ Cmhacto 's l.icense N.o.4-
Mai1mB AtlJress (Contractor ;r?qwner
? ki Insta?lauon)
`
?:
" l 3
?544
ized Signawre Contraclor/Owner MakinB Install vonI Phone Number
?
r L
MINNESOTA STqTE BOARD OFELECTHICITY
Gnggs-Mitlway Bldg. - Faom N•191
1821 Univarsitv Ave.. 5t Prul. MN 55104
Phone (612) 297.2111
1MI5 IrvSYECIION HEpUE51 WILL NOT
BE ACCEPTEO BY THE STATE BOAND
UNLESS PflOPEN INSPECTION FEE IS
ENCLOSEO.
j- (ci- ?56 REQUEST FOR ELECTRICAL INSPECTION Ee-o°°"'-°°
1 See inalrucboris lor comoleting this Iwm on 6ack ol Vellow copy.
AAM "X'- Be/ow Work Covered by 7his Request u &?) 7C3
tl Ae0• 7yoe ot emltlme Appliancea Wved Eqmpment Wved
Home Range Temporary Service
Duplex Water Heater Lightiny F?xtures
Ap[. Bwlding Dryer Electne HeaLn
Commercial Bldy. Pumace Silo Unloader
Indusinal BIAg. Air Conditioner Bulk MiIk Tank
Farm otnnr pec? v 01nerlsuec,tyl
t er Syecify Other Other
Cmmr,utalncnarNnn Faa Hnfnw
p Fea ServiceEntrence5ize H Fee Feeders/5ubfeetles 9 Fne Cvcurtg
U to 200 Am s 0 to 30 qm s 0 tn 30 Am
A6ove 200 qmps 31 to 100 qmps C 31 to 100 Amps
Swimming Pool Above 100_Amps Above 100_Am '
Transtormers rngation Booms PartiaL Other Fee
Signs SUecialinspecUOn
$
TOTAL'FEE ?
Rercyrks 4. / J / 7-cc?'
?
Rough-m D`?e ? I,the lacal
? nspeclor, heraby
Fnal I//?/},?, ? nT'. ? rI?1e7? x,.-(?Imspection has been
//"! I ?iIM I? U'? ?l mede.
Thw repuest voiA 18 mon[ha from
???lJ?il REQUEST FOR ELECTRICAL INSPECTlON Oft Es-ooooi.a
1 See inslracbans for compleong this horm on back of yellow copy.
(C 18083 "X" Below Wwk Covered by 7his Reques!
da .R 7ype ol Buiiaing Aoul?a..sa Wirod EquiUmanl Wire]
Home Range iemporary Service
Duplex Water Heater Lighnny Fixtures
Apt. BwlAmg Dryei Electnc Heatin
Commercial Bldy. Fumace Silu Unloader
Industrial BIAg. Au CondiLOner Bulk Milk Tdnk
-
Farm oiner pe?itv 7
1 ner 15neuryl
t er peci y Other Other
(;OI!!DlIIB lnSpBCt10n feQ (J@JOW
p Fee ServiceEnbenceS¢e N Fee feeders/5ubfeeders N Fee Cirwrts
/ 0 to200qm s 0 to30qm s Otn30Am
Above 200 qmpy 31 to 100 Amps 31 to 100 A s
4
ming Pool Above 10D-Amps Above 100_Am s
siormers Irngation 6ooms Partia6 Other Fee
gn
s Special Inspechon 5
4
TOT
Hevirks 0 ?' FE? ? ?
HouBh-in , ? D?te ?. The al
spectar, hereby
certify thx' the abova
Final ingpection hes been
Tbia reeuest voi01B montha irom
This request vmd
a
18 months fmm
? 1808
?-?5 ? .?, +
??
b3UU 6
Feques: Date Fire No. Rouph-i ?InsV
e?i??n
eq W retl ?
qeady Now
Will Notity InsDec-
?^-
v, ?-??
u ?Y ?NO r When Peatlv
E] LicenseC Electncal Conhactor I hereby request insoection of aEave
wnrk mstalled aY
LJ VWn¢r
Sve)et ?Address, Box or Poute No/. ? /?? ? ?/?
???v ?j /? /'?
l.?lii I
?`??
{ ? LJ V ll`iif
? -
ecliori a• wnshi Tme or No. RanBe o. Cou
Y
?
?
Ocwpant (PRINT)
? Phune No.
Power Suppher Address
fa
??
'
ractocV Name)
al
Elec s License No.
Conuar,tor
???? -
?r?,n??
MailinB /?ddress ICOntractor or wner Making InstailaLOnl
Sli q
? J
Aulhorized Signature (COntractor/ Owner Ma4?ng Iretallauo^) umber
Pho
` coc
ru?n . nu R[n11iST w111 N(lT
NNESOTA STATE BOARD OF ELEGTNICIiY BE ACGEPTED BY THE STqTE BOARO
Tiggs-Midway gldg. - Roam N-191 UNLESS PNOPEft INSPECTION FEE IS
1 821 UniversrtY Ava., SL Paul. MN 55100 ENCLOSED.
PMna (612) 297-2111
RESIDENTIAL
BUILDING PERMIT APPLICA710N
? ??013 CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
Naw Construction Reauiremenis RemodeUReoah Reaulrameats
• 3 registered site surveys shawing sq. R of lot, sq. fl. of Muse; and all roofed areas • 2 copies of Dlan
(20% mauimum bt coverage allowed) • t sel of Energy Calculations for healed additions
. 2 copies o( plan showirg beam 8 window sizes; poured tound design, etc.) • i site survey for exterior additlons 8 decks
. 1 set of Eneqy Caltulalions • Indicate if hane served 6y septic system for addifions
• 3 copies of Tree Preservation Plan'rf lot platted after 711193
. Rim Joat Detsil Optians selection sheet (bldgs with 3 or less units)
DATE VALUATION
JOB SITE ADDRESS AT ?fLO
IF MULTI-PAMILY BUILDING, HOW MANY UNITS? ?
4RQPERTYOWNER geVFh) /{an+,r (31,J XA-Ye-f
TYPE OF REPLACE(S) _ 0_ 1_ 2
APPLICA PHONE#C '^??°2
ADDRESS 73C. 151 A(f /L)G,/ AIC-1,1 ,?lbe-17a^? ZIPCODE S?57/o2
PAGER #
CELL PHONE #
FAX #
NEW RESIDENTIAL BUIIDING ONLY - FILL OUT COMPLETELY
Energy Code Category MINNESOTA RLTI.ES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNESOTA RULFS 7672
New Energy Code Worksheet Submitted
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Contractor:
Mechanical System includes:
Sewer/Water Contractor:
_ Air CondiUOning
_ Heat Recovery System
All above infortnation must be submitted prior to processing of application.
Phone #
Phone #
Fee: $90.00
Fee: $70.00
I hereby acknowledge that I hove read this application, state that the information is dg?ec qgreQso_....?PN
with all applicable State of Minnesota Statutes and City of Eagan OrdincTMes-
Signnture ot Applicant
Certificates of Survey Received _ Tree Preservation Plan Received _ C -
? Water Softener ?
_ Water Heater _
_ No, of Baths
Phone #:
Lawn Sprinkler
No. of R.I. Baths
RESIDENTIAL
BUILDING PERMIT APPUCATION l\ 3.-1 ?
t} I,}?O-(I CITY OF EAGAN
? 1/ 3830 PILOT KNOB RD - 55122
651-6814675
New Conatruetion ReaulremeMs RemodeUReoair Reaulrements
• 3 registeretl sfle surveys showiy sq. fl. of lot, sq. R ot house; aid all raafed areas • 2 aDies of plan
(20% manimum bt coverage allowed) • t sel ol Energy Calculations kr heated addNOns
• 2 copies of plan showirg beam 8 window s¢es; poured found design, etc.) • 1 sile survey for ezterior edditbns 6 decks
• 1 set of Eneyy Calculatioiu . Indicete i( home served by septic system tw additions
• 3 copies of Tree Preservation Plan il IM plaHed after 717/93
• R'un Joisl Detail Options selection sheet (bidgs wilh 3 or less uniGS)
DATE VALUATION ?'5,1)na Ob
JOB SITE ADDRESS Yy/ 3 A R?Iy??1P ??? AV»
IF MULTI-FAMILY BUILDING, HOW MANY UNITS? ?
PROPERTY OWNER8220J ?n9.GozdnJ?S 6?"S?Z?
TYPE OF WORK /kCU)ir_0Z> 1- ,p ?//-
APPLICANT NUTZ/yt A-nJru F'.est 4
ADDRESS 'I ? C? /s-"- 'Ad A14/ ,
PAGER # CELL PHONE #
PHONE#
_ZIPCODE 5_j5")Z-R
FAX #
NEN' RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check one)
Plumbing Conhactor: _
Plumbing System Includes:
Mechanical Conhcctor: _
Mechanical System Includes:
Sewer/Water Conhactor:
All above infortnation must be submitted prior to processing of application.
FIREPLACE(S) _ 0 _ 1 _ 2
Phone fk
Fee: $90.00
Fee: $70.00
? ,'P f;
l'
IRv
I hereby acknowledge that I have read this application, state that the information is correCt>?nd agree to coinpry
with all applicable State of Minnesota Statutes and City of Eagan OrdinFnces.
Slgnafure of Applicont
?
,?•?,
CeRifcates of Survey Received _ Tree Preservation Plan Receive _ -Plot Requi
. Updated 1/01
MINNESOTA RULES 7670 CATEGORY 1
- ResidenUal Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Phone #:
Water Softener _ Lawn Sprinkler
Water Heater _ No. of R.I. Baths
No. of Baths
Phone #
Air Conditioning
Heat Recovery System
1986 BOII,DING PEHlIIY 9PPLICATI09 - CITY OF E9G9N
NOTS: ALL CONTHACTORS HQST BE LICSNSSD iiITH THS CITY OF EAG9N
COlMERCI9L SINGLS FAMffLY DiiS[.LINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE HOND
To Be Used For: LoA??-w- naluation:
Erect _
Remodel ?
Repair _
Addition _
Move _
Demolish `
Int. 2mpr . .?
Install _
Site Address OFFICS QSE ONLY
?
Lot alZ Block ff
Parcel/Sub
Owner
Address
City/23p Code
Phone
Contraetor
Address
City/Zip Code
Phone
Areh./Engr. _
Address
City/Zip Code
Phone 0
APPROVALS
Date: ?-J,2- s'6
Oceupancy _
Zoning
Type of Const
# of Stories
Length
Depth
Sq Ft
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Couneil Road Unit
Bldg Off3.3 14 e?x$Treatment Pl
APC Parks
Variance Copies
10T9L
NOTS: ADDEESS&S FOR COBHSR IATS - COPTRAC?Oa/HOMSOANSR MUST DFSZGHATE iiHICH
9DDRFSS IS DESIRHD. NO CHANGSS iiILL BE ALLOW6D ONCE BDILDING PERMIT
IS ISSOED.
?
1986 BQII.DING PERMIT APPLICATI0N - CITY OF EAGAN
HIORS: ALL CONTBACTOHS MQST BE LICSRSED WITH THS CITY OF EAGAB
COHIMERCIAL 3INGLS F9lfII.Y DiiSLLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND
To Be Used For: 40-6y?? Valuation: Date:
Site Address T y[76 ?"v-,L, A OFFIC6 QSE ONLY
Lot U Block c3 Ereet _ Occupancy -
Remodel Zoning
?
Parcel/Sub
? Repair _ Type of Const
Addition 0 of Stories
Owner Move . Length
Demolish Depth
Address Int.Impr. Sq Ft
n
City/2ip Code Install
----------
-----°----°---------
Phone APPROVALS FF.FS
Contraetor S ?j?Q
Address
City/Zip Code
Phone
Arch./Engr. _
Address
Citq/Zip Code
Phone #
Assessments Permit
Water/Sewer Sureharge
Po13ce Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off314-86?Xreatment Pl
APC Parks
Variance Copies
TOTAL
NOTE: ADDRESSES FOA CORNSR LOYS - COATRACTOH/HOMSOfiflSR MQST DFSIGHATE iiHICH
ADDRESS IS DfiSIRBD. HO CHANG&S WILL HE ALLOiiSD ONCE BOILDING PERMTT
IS ISSOED.
?7
1986 HQILDING PERlIIS APPLICATIOH - C11R OF EAGAN
NOTL: ALL COATRACTpRS Mp3T BE LICSRSED HIT$ THE CITY OF EAGA6
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL
& STRUCTURAL PLANS, 1 SET OF
SPECIFICATIONS AND 1 9ET OF
ENERGY CALCULATIONSJ
$2,000 LANDSCAPE BOND
SINGLS F9PIILY DiiSLLINGS
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
t SET OF ENERGY CALCULATIONS
To Be Used For:
Vol Valuation: Date: ? j-Ja-??
'
Site Address y ?-( JCJ 4 OFFICE IISE OALY
Lot ?WL Block Ereet _ Oecupaney _-
Remodel Zoning
Parcel/Sub Repair _ Type of Const
Addition ik of Stories
Owner 11, Move Length
Demolish Depth
Address Int.Impr. ? Sq Ft
Ciby/Zip Code r??,? y,3y
Phone
Contractor
Address
City/Zip Code
Phone
Areh./Engr. _
Address
City/Zip Code
Phone #
Install
9PPROVALS FEES
Assessments Permit
Water/Sewer Surcharge
Police _
Fire
Engr _
Planner
Couneil
Hldg Off
APC
Variance
Plan Review
SAC
Water Conn
Water Meter
Road Unit
314b6b6 Treatment Pl
Parks
Copies
TOT9L
NOTS: ADD9FSSHS POH COEPER LOTS - COATRACTOB/HOMHOiiNEB MOST DESIGNATS iiHICH
ADDRESS IS Dfi.4IRED. HO CHANGES iiILL HE ALLOiiSD ONCE BUILDING PERMI?
IS ISSIIED.
: T
1986 BQILDING PERlIIT APPLICATIOA - CITY OF EAGAH
AOTS: ALL CONTR6CfORS MOST BE LICSNSED AITH THS CITY OF 6AG98
CDMfl+16RCIAL SINGLS FAMILY DWfiLLINGS
INCLUDE 2 SETS OF ARCHITECT[TRAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF
f 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2v000 LANDSCAPE BOND
To Be Used For: Valuation: ?4 ra-0 Date:'3 -/o2-"n?
Site Address
y? y
OFFIC6 IISS OPLY
Lot tq,5 Block _3_ Erect X Oecupancy 23
Remodel _ Zoning Pp
Pareel/Sub Repair
Type oP Const ?
_
Addition # of Stories
Owner Move Length 4-4
Demolish Depth 2-4-
Address 7`/?0 ??z,?G.A- Int.Impr. . Sq Ft
Install
City/Zip Code .63-Lc 3 2? ---------- ------------°--------
Phone APPR099I.S FEBS
Contraetor S?-?Q
Address
City/Zip Code
Phone
Areh./Engr. _
Address
City/Zip Code
Phone #
Assessments Permit 2.?
Water/Sewer Sureharge 2
Police Plan Review ( 3"1
Fire SAC ?7751
Engr Water Conn 500.
Planner Water Meter = ?5
Council Road Unit 290
Bldg Off 3 t4& 5(hTreatment Pl f S?
APC Parks
Variance Copies
TOTAI.
NOTE: ADDRFSSES FOR C09AER IAi3 - COHTBACTOR/HOMEOWAEB lIOST DS3IGHATE WHICH
9DDRESS IS DSSIRED. HO CH9AGES TiILL BB ALLOWSD ONCE BQILDING PERMIT
IS ISSOSD.
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 68,.' -4675
PERMITTYPE: suzLuiNs
Permit Number. 034350
Date Issued: a l/08 r 9 9
SITE ADDRESS:
44198 CLOVEft LANB
LOT; 25 BLGCK: .,
EOEN
P.t.Ne; 141-22750-250-03
DESCRIPTION:
REPLNCE SIDIPiG
Bildina, Permit Tvpe STORM DAhiAGE
B/u u-3ldinq Wo.rk 'ryPe REPRIR
,Census Codc? 434 FlL7. RESIOENTIAL
r4
J ?/ \
l
? _... . . ' ?. -.` _ .
REMARKS:
UNJT ?.
FEE SUMMARY:
CONTRACTOR: - A pP 1 i c a n t-ST. 1. I (o p{p/NER:
CUSTOM CONCEPI'S CONSI' 18987290 20142417 SCHULI"Z 5COTT
15540 KENRICK L00P/S'iE B 4419B CLOV[R LAPIE
LIIKEVTLLG PIN b6044 LFiGAN IhN 55122
(612) 898-7290
I herebv acknowledqe that I have read t:his application and sr,ate t.hat the
j,nYormation ls correct a n d a4rae tp comply -A th aLl applionbLe St.?j te of Mn.
5tatutes and Cit.v oT Eaqan Urdinanncs.
?
(2Q-,t- a? -.
APPLICANT/PERMITEE SIGNATURE OSSUED BY SIGNA l?i
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
^ (6511681-4675 ?
..
New Construction Renuvemen[s
? 3 registered sde surveys
? 2 copies of plans (include beam & window s¢es; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preserva[ion plan if lot platted after 7l1/93
required: _ Yes _ No
DATE:
DESCRIPTION OF WORK:
RemodeUReoair Reauirements
? 2 copies of plan
? 1 site surveys (exterior additions & decks)
? 1 energy calculations for heated additions
_?? .9(
CONSTRUCTION COST;
STREET ADDRESS: !"f N 13 L ta/Q c LC..ln e- v
LOT: ?-S BLOCK: SUBD./P.I.D. #:
Phone #:
PROPERTY Firsi
0?AV F. R
Strect
Ci[v
S[ate:
"/..ip:
`7Z
Ccxnp:ury: l--Q![D ?/? --- - -- Yhouc
---- -- - -- - -
C0\"1'RLCI'0R / ?r ?
Street Address:_F?? ?J ?`_?11?",C? Liceiise # Z-oLJ 2 -w ---ExP' ----- -
?--- -
Cuy ---
ARCHITECT/
EtiGNEER ComPain':
Naine:_
Strcet !1d<
City --
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applica6le
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received , Yes _ No
Tree Preservation Plan Received _ Yes _ No _ Not Required
S4ite: ? ?---- ZiP' - - -----------
Phone #:
_____ Registntion #:
------------------
State: ---------? Zip:
PERMIT #? a7(?s
REA6:i?'ATE'
--?
v?
1 ~(^j?
- ov9 ? ?Z_
SINGLE & MULTI-FAMILY 2 s ts of plans, 3 registered site surveys, 1 copy of energy
_cwl
COMMERCIAL 2 sets of architectural & structural plans, i set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date ?/ Yaluation of work
Site Address: q4/g6 avPr L-Ai
e??c?t al1ITc A
Tenant Name: (commercial only)
T ""'I'L- 1 BIACR 5 SUBD.? P.I.D. #
Descri tion of work: bee-K GdG{ji?"/OVl 6ai&A;n
The applicant is: K Owner ? Contractor ? Other (oesen )
Name sC h o $'eo "7t Phone fo?l '606 7
Property LAST FIRST
Owner ?v
q41913 ?
(
DVS2 (
qddress
-
.
-
STREET STE #
City F-AState Zip
Campany Phone
Contractor Address License q Exp.
City _ State _ Zio
Company Phone
Architect/
Engineer Name Registration N
Address
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area as been approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply ?rith all applicable Sta'te of Minnesota Statutes and City of
Eagan Ordinances.
?
/v/I? ..Q-. ` •
Signature of Applicant:
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
OFFICE USE ONLY
BUILDING PERMIT TYPE
11 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
O 04 SF Porch
? 05 SF Misc.
WORK TYPE
? 06 Duplex
? 01 4-Plex
? OS 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? l?ew ? 33 Alterations
2 Additio O 34 Repair
\
GENERAi !MFciRMeriON
? 11 Apt./Lodging
? 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
15 Deck
? 35 Tenant Finish
? 36 Move
Const. (Actual) Basement sq. ft.
(Allowable) lst F1. sq. ft.
UBC Occupancy K-3 2nd F1. sq. ft.
Zoning ? Sq. Ft. total
_
?1 of Stories Footprin t Sq. ft.
Length to' On-site well
Uepth 6 On-site sewage
APPROVALS
Planning Building
Engineering Yariance
.92t%U1RED iNSPECTIONiS
? Site Footing &?'f+J}'1? ? Framing
? Wallboard ,QFinal ? Draintile
? Insulation
? Fireplace
Permi t Fee o25 , C? a v,imt;,,,:
Surcharge , <-r,
"lan ^eviE::
License
MWCC SAC
City SAC
Water Conn.
Water Meter .
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
CoPies ?
o
Other -
Total:
SAC %
SAC Units
S
s-
? 16 Basement finish
? 17 Swim Pool
0 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
O 21 Miscellaneous
? 37 Demolish
e ?
. .
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
PERMIT
CITY OF EAGAN
3830 Pilol Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: Bur.LorNG
Permit Number: ? 3 ZI 3 4 g
Date Issued: a 1/ 0 8/ S7 y
SITE ADDRESS:
P.l. 14.: l.P--?"i 5Fi-240-F3
441? cl-ovFh GAtvF
I-07: 26 Ci t7CK: 3
EDEiV
DESCRIPTION:
S1:0 7P1C,
STORPh C1AMf15E
ftC-FAIR
A54 ALT, 12E551)CN7SAL
:
•- ` _ _ , ?* 1 - . .
. ? REALIiCE
8 vi3din?Permi.i: 'Tv??
' BUlldinq at"r'k 7ypc
;-E:eiTsuS Cor}e
i
1
\
? _ •;,
REMARKS:
FEE SUMMARY:
CONTRACTOR: - H p o l i o a n e- s t'. t T c. pWNER:
CWSTOM CIJnICEPI'S CONS7 18987290 201?24Il7 PfsLMITES5b1 MARY
166A0 KrNftI(:K LU[)F>/STL. li 441q CIO`JER LFlNE
I_AiCFV.[LLE f4tJ 135044 EA(;RIN MN 55222
(612] 898-%290
L-
I haraby ackhpwledqe ChaY: C have read th.is applicata.oti an€7 gCate tttat the
irti'qrma'tion is correct arid agree to c+amaiy,wir_h mll appl.icat7le StaLe oY' hln.
5tatu'tos aMtl City o6 Eaclan 4i^tiinances.
APPLICANT/PERMITEE SIGNATURE
b-? I&Q/ ?'J
SSUED BY SIGNATUFiE
I
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
.. CITY OF EAGAN
9 3830 PI' S1) 680 BRD - 55122
New Construclion Requirements
? 3 registered site surveys
? 2 wpies of plans (inGude 6eam 8 window sizes: poured fnd. design; etc.)
? 1 energy calculatlons
? 3 copies of tree preservation plan if lot platted after 711193
required: _ Yes _ No
DATE:
' -
DESCRIPTION OF WORK:
Remodel/Reoair Requirements
? 2 copies of pian
? 1 site surveys (exterior addihons & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; `737 S
?
STREETADDRESS: t'I "I II C(UUC(- Lan e- a
LOT: BLOCK: J SUBD./P.I.D. G?:Q-?^-
\.mic: Vg15_MD?pL_?Yhone k:
PROPERTY L= F?? I
W,VvLa
Sircci Address:--------- ----------- --
Citv
SGUe:
Zip:
Comp:uiy:- ?_Z A ----- Ylione ------
CONTI2ACC012 // f??r-n /?
Sh'ectAddres's:?it?l`'?s?_L1'_?1__?lGK -_----&- ---- Licensc#j--Lxp'----
City
ARCHITECT/
ENGINEER Comr
Nuue
Strcct
City
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
State: 4A&I ------- Zip: _6 6 e/7_`L
------- Yhone k: -------
----- __ Regis'tr.IIion #:
S[ate: ------ Zip:
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes - No _ Not Required
PERMIT
CITY OF EAGAN
3830 Pilot Knob Road
-Eagan,-Minnesota 55122-1897
(651) 681-4675
PERMITTYPE: BurL°ING
PermilNumber: 0 34347
Date Issued: 0 1/ 0 a / 9 9
SITE ADDRESS:
4A17 I;l ()VER LANt:
LO7? 27 t3LOCK: 3
EDLN
P. I .IV. : 7.0-22%50-Z?0-?-03
DESCRIPTION:
REF'LA CE SIpINO
Builldiriq-_PermS r Type STORM DAMi1GE
hl'uildxnq Wo,rk Tyrye REPAIR
,Zensus Code--'\, 434 FlI_7. RESIUEN7TFlL
?
i i
?
?
., ? .
'
?? -
REMARKS:
FEE SUMMARY:
CONTRACTOR: -- Aopl.i.cant - sT. L1C. OWNER:
CUS701h CUNCIcPTS CONGT 98987290 241.L42417 RUI:.C'KCR KA7HLEEN
16540 KEiVRICK LOOPlSTE B 4A7.7 CLOVER IRNE
LAKEVILLE MN 55044 EflGAN MN 55122
(G12') 898-7290
IL
7 hprebv acknowLedqa tha'? I have i°ead this 'trpplication and st;rate that; tl-ie
inTormaL"ion is cort-ect ar7d aqree to complv wiY.t7 aIl applicable 5tate ot Mn.
;tatutes and City Qt Eaq&n QrdinanceE.
APPLICANT/PERMITEE SIGNATURE
_zl? -
IS D BY: SIGNATURE
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 C? Q]
T (651) 681-4675
New Construchon Reawrements
? 3 registered site surveys
? 2 copies of plans (inGude beam & window sizes; poured fnd. design; etc.)
? t energy calculations
? 3 copies of tree preservation plan if bt platted aker 711/93
required: _Yes _ No
DATE: I'7 - ?cl
RemodellRepair Requirements
? 2 copies of plan
? 1 site surveys (exterior addilions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; '--? 3-75
DESCRIPTION OF WORK:
'l u ?
STREET ADDRESS: `"I q 1-7 Z(i/?.4_
LOT: a'? BLOCK: ? SUBD./P.I.D. #:
N?une:_ R U'Q-Lu(' _G?? I L L?1------- Phone
PROPERTY
OWVI•:R
Streot :lddress: ----- --------
City
Sta[e:
Zip:
)
/?' ?
C'omp:iuy:----- Qu6?*L_.------ -Phone?:
COV1'LZACl'(>R r ,
? e `C 1-icense #Z&?/ZeP/(7 Lsp.
Strcet Address:?'l 0 c.QR ,
G
ty -------?? -------------------- Stalc: ??------- Zi?'' -"----7 ??-----
ARCHITECT/
EVGINEER Coinp:ury':--------- -------- Phone
Registra[iou #:
Street Address:--------- ----------------- ---
Ciry ------- --------------- State: ---------- 7ip:
Sewer & water ficensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances. ?i
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received - Yes _ No - Not Required
PERMIT
CITY OF EAGAN
,3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
P.i.N.: l.O-22750-280-03
4411e ci oveR LAivt.
Lor: 28 sLOr.K: s
eDtN
PERMITTYPE: eulL D zNG
Permit Number: 0' 4 3 4 8
Date Issued: 01/08/4 9
DESCRIPTION: R E P i.wr,e SIDING
?
6ui 1 tfi7try Pei°mit l'vGO ?TC)RP1 DAM(dGE
Bu,.ldinq T.ko,rk Tvpe RFPAIR
,-Ceneus Code`"'\ 434 Al_T. RFBIUENTTAL
?
<
?.l
._ ?
:
--
- - ,.
??
„ . . -?
REMARICS: R
FEE SUMMARY:
CONTRACTOR: - µPPl,icant - s'r. i_IC. OWNER:
CUSTOM CONCENT5 C6NST 18987290 2014241% ,70FINSCJN SlINOY
16540 KENRICK LOOP/STG 8 4417R CI.qt1ER LANE
I.AKEV.fLLE MN 55O4q EA(iAN MPI 55122
f6121 '698-7290
I hereby acknowledqe that i have raarJ this apolicaY.ion and sCate that the
in'Yarmation is correct and aqrae co complv w?th all aoplicable Stata ot I1111.
Statutes and C,itv ot Enqan Orainance5.
I
APPLICANT/PERMITEE SIGNATURE
I
? Q4 /-e?
IS ED BY: SIGNATUF
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
?C (651) 681-4675
New Construction Requirements
? 3 registered site surveys ?
? 2 copies of plans (indude beam 8 window sizes; poured fnd design; elc.)
? t energy calculations
? 3 copies of tree preservation Olan if lot plattetl after 711193
required: _ Yes _ No
DATE: / 7 - 9 ?
?
DESCRIPTION OF WORK:
Remodel/Repair Requirements
? 2 copies of plan
? 7 site surveys (exterior additions 8 decks)
? 1 energy calculations for heated additions
CONSTRUCTION C05T; L43-7S
STREET ADDRESS: q 9 I-7 E ( Ir9i/CY' ZC?1 -P o
LOT: D ??- BLOCK: a_ SUBDJP.I.D. #:
Y?LSqv\ ----? Phoue g:
Vaznc: ?o
PROPERTY ?-"c °°s`" `
ObVNL''12
tilrect
Ct[y
SL1[e:
%lp:
Comp?ury,-- ?p ? ? ?__ --- Phonc 4: (g??? / L /%?!---
`'1- ---------- --- ------
CO\'1'RACI'O11 ?ehr c' License # ?1? ?-
Street Address:/G --- ?,??----a--------?-??_--- _L`p . _____
_.
? ??----
ciLS - // st:,te:
_.?-? --- ip: --? -
-----------?-----
ARCHITECT/
E\GINEER Comp:ui}':------- -------- - Plione --------------------
Rea str.ition #:
Strccl Address:--------- ----------- ------------- --------- --
City --------- ------------ ----- - Stare: ----------- Z'P'
Sewer & water licensed plumber (new construction only): _
change and lot change is requested once permit is issued.
Penalty applies when address
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable
State of Minnesota Statutes and Ciry of Eagan Ordinances.
Signature of Applicant:
?-
?i
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received - Yes - No - Not Required
"_ 65i3?o -
L ae CITY USE ONLY
BL RECEIPT #: ?2L?5
SUBD. _(Q'4? DATE:
1996 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
New construction Add-on furnace
? Add-on air conditioning Add-on airexchanger, i.e. Vanee system, etc.
Date:
? Minimum Fee: Add-on/Remodel (existing residence only $ 2.
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each)
¦ State Surcharge .C5 '
TOTAL ?10
S I T E ADDRESS: _N//??
OWNER NAME: ??y PHONE #: j?
INSTALLER NAME: A2tPLuL ???
STREET ADDRESS:ZaL Ap"I
CITY: G5;STATE: ?`? ZIP:
PHONE #: (
? /C7
??
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*****#***t#*****i+***#3***********
y?. *A1'F': PAYMM OF k'EM AT TIME OF
* ArrLxcATIorr noFS wr oorsri=
APPROVAL OF PERMIIT.
nasencriota oF sEWM Arm/oR MzEa
INSLAr.raTIpNS WTf7• NCYf gE SQ-gg-
OLID UNTSS, PII2MIT HAS BFEN
APPROVID.
- x,r,r,rxxyr,e:xxrrxxx,c.,ruxx.x:,e?x:ayezxy.P ease Print
? 1) PROPERTY ADDRESS: '2W/ 7 ?? Z19?? 19 LEGAL DESCRIPTION: -
_ Lot Block Sub ivision or Tax Parce ID )
IF EXISTING STRL'CIL,IRE, DATE OF ORIGINAL Bi!ILDING PE[2MIT ISS(.'ANCE: -, '7
PRFSENP ZONING/pI20POSID YISE: (1%,bn ear1
Q aZMMCIALAIETAIL/OFFICE ? R-1 SINGLE FAMILY
0 IPIDL'STRIAI, ? R-2 DL'PLEX (7wa C?nits)
n INSTITL'TIONAL/GpVERNMr ? R-3 4UWNhiOL?SE (Three + Units) ( t?nits)
• ? R-4 APARnopp/COAIDOMIDIILTM Units)
2) ?
NAME:
ADDRESS:
CITY, STAT'E, ZIP:
73
PHONE:
3) • u?: ?'• NAME. For City Use
Plumbers License:
ADDRFSS: Active
CITY. STATE, ZIP: ;.' ?pired
Not recorded
PHONE: MASTER I,ICENSE#
Sta? tial
4) ••• • ?
NAPIE:
ADDRESS:
CITYo STATE, ZIP:
a PHONE:?;ffO
•5) t'? v a: • a?• : at • ao - 013
? CONNECTION TO CITY SEWFI2 0 CpNNECTION TO CZTY WATER pTHEtt . .
6) '? •? '?• ? PLEASE HOI,D APPROVID PERMIT EC)R PICK-UP BY ONE OF ABOVE --•- --
? PLFASE MAII, APPROVID PERMIT TO 1.2 3, 4. ABOVE
p? (Circle one) '
7) r, r• u• - . ?r`9 GG??ayt?. , ? ?? ???..
FOR -CITY USE ONLY
PERMIT # ISSUED
P i `// /r(l
Pd w/Bldg. Permit
$
$
$
(?3 .550
$ S
$
$
S .,?d U. Ls 7J
$ v 7S ?? ?
$
$
....
FEES:
$ /O -1S 0 SEWER PERMIT (INCLUDE SURCHARGE)
$ WATER PERMIT (INCLUDE SORCHARGE)
$ WATER METER/COPPERHORN/Of.'TSIDE READER
$ WATER TAP (INCLUDE CORPORATION STOP)
$ SEWER TAP
$ ACCOUNT DEPOSIT - SEWER
$ / el ACCOCNT DEPOSIT - WATER
$ ??-J-9-?-- ? WAC .
$ SAC
$ TRUNK WATER ASSESSMENT
$ TRONK SEWER ASSESSMENT
$ $ ' LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ A5 $ WATER TREATMENT PLANT SORCHARGE
$ $ OTHER:
S $ 5A TOTAL
? e . 736 RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUSLIC RIGHT OF WAY?
ED YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q ROADWAY" MOST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SDBJECT TO THE FOLLOWING CDNDITIONS:
APPROVED BY;
TITLE:
DATE :
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*RYt'6: PAYMh?TP OF FFE AT 71161E OF
APPISCATION DOFS NOT CONSTIZLTfE
APPROVAL OF PIIiPII'p.
INSPDGTION OF SEWM ADID/OR [MFS2
rnsTu=oNS wIM Nar BE scHEn-
ULID UNiZL PERMLT HAS BEQ9
APPROVFD.
;?***??,r**+r,r**?*****?**:+?*?*?****P ease Print
1) E'ROPERTY ADDRESS: ' G?'U u?? ?? ? G, •.
LEGAL DESCRIPTION:
. Lot Block Subdivision or Tax Parce ID
TF° EXISTING STRCLMME, DATE OF ORIGINAL BLILDING•PIIZMIT ISSCANCE:
? . •
- PRESEW 20NIf1G/pROPOSID LSE: ('7on Year
Q COAg1ERCYAL/REPAIL/OFFICE
[] IPIDC?STRIAI,
n INSTIIS,TIONAL/GdVERMIJENT
2) ?
rrAME;
ADDRESS:
CITY, S'PATE. 2IP:
PHONE:
0 R-1 SINGLE FAMILY
? R-2 DUPLEX (1wv Lfiits)
j? R-3 20WNHOUSE (Ttsee + Units) ( Onits)
R-4 APARTMEN'p/CQNIpMINILqy ( Units)
??. d-
.5-:
3) ?
NAME:
ADDR£SS:
CI`I'Y, STATE, ZIP:
PHONEa
MASTER LICENSE#
4) •?r • • ?,i?i? +
NAI?IE: ?
. ADDRESS c ??
CITY, STATEo ZZP:
PHONEe ? ?p _ rJ- ?/?'I
?
Active
Expired
Not recorded
St?Initial
•5) ? n v t a; •?•
CONNECTION 1C) CITY SEWIIt ?- CpMBCTION RO CITY WATER
6)
n •' •?" ?
?
PLF.ASE HOLD APpROVID PERP'IIT FOR PICK-L?P SY ONE OF ABOVE
PLEASE MAIL APPROVED PERMIT TO 1,20 3, 4, AHOVE
, .
FOR CITY USE ONLY ?
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ $ /? •?b SEWER PERMIT (INCLLDE SURCHARGE)
$ $ /D•J D WATER PERMIT (INCLDDE SURCHARGE)
$ $ WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLC'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ U ?j ACCOONT DEPOSIT - WATER
$ J Od - f-Z) $ WAC .
$ SAC .
$ $ TRL?NK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ • LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ $ WATER TREATMENT PLANT SLRCHARGE
$ $ OTHER:
$ /`'717' `'S 0 $
v? er-r/
TOTAL
61133
RECEIPT RECEIPT
DOES LTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
? YES IF YES, THEN A" PERMIT FOR WORK fVITHIN PCBLIC
Q ROADWAY" MLST BE ISSUED BY TfiE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CbNDITI0N5:
AP PROVED BY;
TITLE:
DATE : ???' ??
CITI° OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
*KYP?': PAYMMF.:W' QF M AT TIIM OE
APPI,ICA7ZOD7 DOE:S NC7P CONSTIT[TI'E
APPROVAL OF PEEibIIT.
xNsrFx.'riorr oF saM Avn/ox WATM
IN,Tnr.r.AmrpT7S WILL NOT SE SC[EED-
UI,ID UNTIL PII2MIT AAS BEF2I
APPR(7VID.
-?***? ??* **? ** **,r *?,r*** *,e**** *,e # ?* .
Please Print
l) PROPERTY ADDRESS: t?ll?jc'? C??G,?2 ?A?t/? ..•
LEGAL DESCRIPTION: -
_ Lot Block Subdivision or Tax Parcel ID
TF EXISTII`1G STRC'CIS]RE, DATE OF ORIGINAL BI.'ILDING PII2MIT ISS[;ANCE: .
;
PRFSENI.' ZONING/pROPOSID LSE: (Mon Year
? CONMCIAI./RE'PAIL/OFFICE ? R-1 SINGLE FAMILY
? INIDL'STRZAL ? R-2 DLPLEX (ltao Cfiits)
C] INSTin'TIONAi+/GOVERn`=7.' ?i R-3 'lOWN[3I0LISE (Three + Units) ( Onits)
• ? R-4 APARTRjENT/CODIDOMIDTICT7 ( Units )
NAMEe?
2'
ADDxess: ? a -
CITYs STATE. ZIP: ?,tf?_.C_e?
Pxo?: 3 3 ?-
• 3) • u i: ?• NAME. For City Use
P1LUnbers License:
ive
ADDRESS: Eired
CITY, STATE, ZIP: recorded
PHONE: MASTEEt LZCa7SE#
Sta?f'Yit1a1
4) •?r • i?• , ?)
NAME:????
_ r.DDREss:
CITY. STATd', ZIP:
? PHONE: ?. ) - 5S m
.5) ?'? YI 1 W' • 71' :? • 9• ' ?li
?'.ANNEC.TION 1q CITY SEWER CR CpT7TIFXTION RO CITY WATER ? OZ'IIER '.
6) ? u- • r ? PLE7ISE FiOLD APPROVID PERPIIT FOR PICF{-UP BY ONE OF A&JVE --
? PLEASE MAIL APPROVID PFRNIIT 'It7 1,2 3, ¢r pWVE
(Circle one)
7) r.?i: ?U: z
r
FOR CITY USE ONLY -
PERMIT # ISSUED
rI?9 i ?13 :? ?
Pd w/Bldg. Permit FEES:
$ $_ /21-,S O SEWER PERMIT (INCLUDE SURCHARGE)
$ $ / D• S ? WATER PERMIT (INCLUDE SDRCHARGE)
$ $ WATER METER/COPPERHORN/OL'TSIDE READER
$ $ WATER TAP (INCLLDE CORPORATION STOP)
$ $ SEWER TAP
$ $_ /S UZS ACCOUNT DEPOSIT - SEWER
$ $ /,5?` Cr D ACCOONT DEPOSIT - WATER
$ $ WAC $ $ SAC .
$ $ TRfJNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMEIVT
$ $ • LATERAL BENEFIT/TRDNK SEWER
$ $ LATERAL BENEFIT/TRLNK WATER
$ $ WATER TREATMENT PLANT SURCHARGE
$ $ ' OTHER:
TOTAL
k/.3
RECEIPT RECEIPT
DOES LTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j YES IF YES, THEN A"PERMIT FOR WORK SVITHIN PUBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SDBJECT TO THE FOLLOWING CbNDITIONS:
APPROVED BY;
TITLE:
DATE :
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
NOTS: PAYNff="OF FEE AT TIME OE
arrLscATzON DOES Nar CONSTITUTE
APPROVAL OF PII2FffT,
nasrncizoN oF sEWER Arm/Ux wnxEa
7I1S'f'ATT.ATTQT]S IV= NQ'j` $E $QHED-
ULID UNPIL PIItMIT HAS BEFS]
APPROVID.
-:r*+r,rf *?*+rt«??*?**?*?***?*+***f *,r* P ease Print
1) PROPERTY ADDRESS: 113 lel . „ ?v e-- ,.
LEGAL DESCRIPTION; •-
. Lot Block Subdzvision or Tax Parce ID )
IF E}ISTING STRL'CiL7RE, DATE OF ORIGINAL B[1ILDING PERMIT ZSSL'ANCE: .
?
PRESEW ZONING/pROPOSID LSE: 1-bn Year}
? CONP4EEtCIAL/REZ'AIL/OFFICE
? ITIDCS2RI11I,
? TNSTI'IUT'IONAL/GOVEpIZ=
Z, ?
3) ?
NAME:
ADDRESS:
j CITY, STATE, ZIP:
PHONE:
4) •?• :.? ?,i?'?ssi??! ? f?
NAMEe . -6
_ AnDxFSS; /
CITY. STATE, ZZP: ?
PxONE, 24U - ? 5
a
Active
Fxpired
Not recorded
St?tial
•5' ' 1 i1 Y• 1 W: '71' :? '9? ' .71i
? CON[UCTION 1O CITY SEtidEEt 0 CONNECTION RO CITY WATII2 ? OTFIER_
6) ? • u • r ? PI,EASE HOLD ApPROVID PERf•1IT FY)ft PSCK-UP BY ONE OF ABOVE --•- --
? PLEASE MAIL APPROVID, PERMiT 'iC) 1. C2) 3, ¢ r ABOVg
-I) (Circle one) r / "
[] R-1 SING?,E FAMILY
? R-2 DCPLEX (74,a Units)
? R-3 7UWPII30T_1SE (rhree + Units) ( Dnits)
R-4 APARTNENT/COPIDOMINItfi1 ( Units)
NAP+E:
ADDRESS:
.
CITys STATE. ZIP: J ?
pxorE: 7r
MASTER LICENSE#
7)
. FOR CITY USE ONLY PERMIT # ISSUED
LE? y ? ?'?
Pd w/gldg. Permit FEES:
$ $ /d ?-n SEWER PERMIT (INCLODE SURCHARGE)
$ $ WATER PERMIT (TNCLUDE SURCHARGE)
$ $ WATER METER/COPPERHORN/OCTSIDE READER
$ $ WATER TAP (INCLCDE CORPORATION STOP)
$ $ SEWER TAP
$ $ 47 /1 Q ACCOUNT DEPOSIT - SEWER
$ $ ACCOC'NT DEPOSIT - WATER
°? $ WAC
$ - S7S. Lrz? $ SAC .
$ $ TRLNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TR['NK WATER
S C- d $ WATER TREATMENT PLANT 5URCHARGE
$ $ OTHER:
$ $ er"v TOTAL
Zp e?7 4/?3
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCA VATION IN PUBLIC RIGHT OF WAY?
Q YES IF YES, THEN A" PERMIT FOR WORK 6VITHIN PLBLIC
Q
NO ROADWAY" MUST BE
DIVISI ZSSUED BY THE ENGINEERING
ON. LIST AS A CONDITION.
SUBJECT TO THE FOL LOWING CbNDITIONS:
APPROVED BY:
TITLE:
DATE c
"o.
PERMIT # RECEIPT DATE:
51-Iq5A
2002 iiESIDEN'['IAL PI,UMBING PERMIT A3'PI,ICATION
cITY oe EAG,aiv
SSSO PILOT KNOB itD
EASAN, MN 55122
651-6$1-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITEADDRESS: 44I1 9 G1o1/e,.Y'
OWNER NAME:cJnY4rlS D I) , S?GL TELEPHONE #: V5 i 4S4 'QSD ?
(AREA CODE)
INSTALLER NAME: H. P. Pipcwad,s TELEPHONE #: t,? 1-_365 I'?J 4-0
(ARF_A CODE)
STREET ADDRESS: .3?01 D DDbD ? .
CITY: ? STATE: ZIP:
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
. MODIFICATION/ALTERATION TO EXISTING DWELI.ING UNIT, INCLUDING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
_ RPZ: new installation/repaidrebuild
I 30.00
_ lawn irrigation system I, AUG 2 9 2002
? I 11
ReplacemenUadditional: _ water softener 1 water heater $ 15.00
State Surcharge $ 50
I S ?
Total $
I hereby acknowledge that I have read this application, statethatthe information is corcect, and a e to complywith all applipble City of Eagan ordinances. It
is the applicanYs responsibility to notiy the property owner that the City of Eagan assume no ility for any da a s caused by the City during its normal
operational and maintenance activities to the §eilities construUed under this permit vith C' ,?oRerty/right-o?asjgn(pu
OF PERMITTEE
------------------
? F-,?? ?
j Perrnitp: &U/0 7 7 I
? Permit Fee: ;?7-3'? V 1
? DBte ReceiVpd: ? i
I (?p 1
I Sta%: ? V I
1
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Data: -Z -?? Site Add,ow: 5(?7 - ?/?lq r Ipu?J ?.?v
Tenant:
Sulte #:
RESIDENT 7 OWNER Name: r- Q?-Jr1Jp?r5 G/'550GF`'C iJ Phone:
Address ! Gty / Zp:
Applicant is: _ Owner _X_ Canuactor
TYPE OF WORK pescription of xrork:
ConsMiction Cost _ f!5? C7d1f . 0 O Muiti-Family 6ullding: (`!es ! Na
CONTRACTOR Name: ?yE
?`?P?5 NDA'ip -?-m?DFOJ&in r Ucense ;y_ 20 ?5 7
,
Address: 11?6 W,
City: rwfn " 0 ? f0Stete: IV-d 2ip:
Phone: (2_I-4S'3!4Z3' ContactAerson: 406 d.tiLfaSGS
COAAPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDtNG
_ Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Ener9Y Code • aeside,ssl venmanon carec«y i waxssnom . New Energy Code Wakshee!
Category subrnmed suanitted
(d submisslon type) • Energy Envelope Calculations Su6mnted
In the last 12 moMhs, hes the Clry of Eagan Iseued e permlt tor a slmllar pian besed on a mastar plen7
_Yes _No If yes, date and address of master plan:
Licensed Piumber: Phone:
dAecherdcal Contrector: Phone:
Sewer 8 Water Contractor. Phonre:
OTEc Plans amt su documerrts fheFyOUSt?t?tnlt aaeCOnslder?edYo be pti?lic !n/amaNort. Po?iiarss bt °
°- the Iirfom?Niiiii 0fay be elass!/led aa nbrywblic Hyau pmrlde-specttlc vbsons ft+et woule??4ei?r?ll tA?City ta ._
r K-
?
. 1
?y p?y?•
?{TO?V4Y>?f'
[
I Aereby acknowledge that this informatian is canplete and accurate; Mat the woAc wlil 6e in contormance wiN the ordinences and codes of the City d
Eagan; that I understand this is no[ a permit, bu[ only an a{pIira4on fw a pertnit, arM work is not to st w7th ut a pertnit; that the work wdl be in
accordance with the approved plan in the case of which requues a review end approval
x ? s,c
x ?r; be? ?" Or,/?- S
Applicant's Printed Name AppIICeM's Signature
Page 1 of 3
, ?- - - 11,6k 377 bA146E 57
...--
r.
•?AORE coNsut.TUio EuouiEEns
ENGINEEflING P«t111EtIS ond IAND 3UItYEYOIIS
COMpRNY, ING.
l 1000 EJ157 14fiM STREET, BURNSVILLE, 1?lHNESOTA 5S33T f'fl 432'3000
'et C GLz ? ? ?7
LUTS 25, 26,27 ANU 28, BLOGK 3, EDEM ADDIT1oN,
? DAK07A COU?.lTY, MINNESOTA
CY3`5't4:? DENor65 EX15T/NG ELEVA-I tUN
(135,o) UEN07E5 PROPU5EU ELEVATIUN
- IIJDICATES DIRECTION OF SURFACE DRAItJA6E
NORTH 92yB-Q = FINISHED/ 6ARA6E FLOOR ELEVATIUN
ScALE : I'' 30'
L T' AN
/??ease` ?no(,ec?e _ y E
?j S F P7C/fR' 4J3q- S?1 Z' e-`. W E
BY
Dare ?_
t_?.? 1 ?
I ARA04A6E AlJD
? 30935,oJ ? UTILiTY EASEMENT
j c? 9"D5.9 /60•0 `19?5
r 9 L.o
_92.00
1 - - -
fd
I
? LOT ? g
? o
? ? ?936.9 93,7 13?0 ?}b,?? IN
N
N
N 8I
'/ ?k?- I
W ??? x a PkoOO5?0 i -tJAJlT -._ ?„f
I
?S.no
z.cn=-;-
??? D v EAST ? r
BUfL ? ?'?
K ? a ? 4 1
oo r937.? ) ?? N
"Pij 937.7) = 1`?34•0? `141,0) 7 IVi
v I I LQT? L -D ,oc? S
2 ?1
? - J
ILr,l '?r, 7B.oo -? [9?T?' B2.oo 'in
`aI 2
30' FReN?Fl6?'???? ?
SETBACI( LlNE
L_.•
41.e?
g?
o ?
I hereby certify that thie ie a true and correct rnpneantition of a traetoi
land as sho+m'4nd deacribed hereon.. Ae prepared by mn on this 71V - day of
17tA" 1 19 fG .
ltinn. lte6. Ho.
u •
? CITYOF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
000785
06/15/92
SITE ADDRESS:
44196 CLOVER IANE
LOT: 25 BLOCK: 3
EDEN
DESCRIPTION:
/"Building Permit Type DECK
' Building"Work Type NEW
l Building Length 10
Building Width, e
,
,
?
< . ?
c1
REMARKS:
RECEIPT N C. (~ I ?/ /I"C\ `j
FEE SUMMARY:
8ase Fee ;26.00 COPIES $2.50
Surcharge 4.50 Total Fee $28.00
Subtotal $25.50
CONTRACTOR: OWNER: - Applicant -
SCHUL72 SCOTT
4919B CLOVER LAnE
EAGAN MN
(612)681-0067
I hereby acknowledge that Z have read this applicat3on and sCate that the
information is correct and agree to comply with all applicable State of Mn.
? Statutes and City of Eagan Ordinances. J
ITEE SIGNA UR - - ISSU BY. S 1TURE - - -
- APPLICANT77
INSPECTION RECORD ? Control No. o r? 3 r,
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number.
Eagan. Minnesota 55123 Date Issued:
(612) 681-4675
SITEADDRESS: Lor: 25 BLOCK: 3 APPLICANT:
94196 CLOVER LANE SCNULTZ SCOTT
EDEN (612) 681-0087
PERMIT SUBTYPE:
DECK
REMARK3: RECEIPT N
r-
TYPE OF WORK:
Control No. 0635
NEW
BUILOIN6
000785
06j15/92
L
-
.,. . .. _ ,
37 AA4E-57
r'OB ` CONSUlT1110 EN61t1E4flS
ENGINEE(iING P????+t+Ens ond LAND iunvtvons
COMPANY, INt,
< 1000 EAS7 146M STREET, BURNSYILLE, YINHESOiA 83337 PIt 432'3000
CeTz Zj'LZCCLJ? C-QJ SL[7"7!''By
Zaval Ih4cr4,o2ion:
l VSLD )
( 9bs, o )
-?--
WORTH 9?•?
SCALE ! I" ° 30'
BY
LU75 E5. 26, 27 qNU 28, BLOCK 3, EDEN ADpITION,
DAK07A CDUMTY, MINNESoTA
DEAIOTES EX15TIN6 EIEVA'fIUN
DENUTES PROPOSEU ELEVATION
IuDICATES DIREC7"/UN OF SURFACE DRAINA6E
= FINISHED , 6ARA6E FLOOR ELEVA7IUN
N
3.
L_?.?
?
4
O
J
?
?.
? ,'? ?,- ? ? ?
L_?_i 1 ?- ?Ci'i
i
1 PRAINA6fi AIJp
? 935.oJ EAST UTILITY EASEMENT
935-j /60•o? `iD4:S
BZ.oo _ _u1
id
I LOT
? LOT25?I
L
I?
?
N
h I Q
?936.? ?'7 I15.o
g'
1
?q;6xJ
7? ? N
IN
h O
I PROPOSED
? 4_U,(JIT
aY? ,
?tj -+78.00 -`9?
2 o ? , - - ? -= 82.ao :, rr
'
I
I \`
H BVrL
gg IN6 FnsT
/Q
?90.?
oo `37
g
1
? I t
Cas.-? 937,7) i .
,
?J N
9'?.0? `19i,o) I lin
io' LOT I °
?? LoT 28 ???I I
° ? 5
78,00
i93G.?? i9?3.2 )
\?U. 0? 30' FRoNT
u?
6 AS ?9???Z?
LOtN
B
SETB C
A K 6iNE
I ?"? ' i r, I ??? I ' J e.1
? 1
L_.. L_??
19µi.e)
_0?
00
12
I hereby aertity that thie ie a truc and correct rapneantation of a tract of
land as shoxn'and dencribcd hereon.• As prepared by mn on thi¦ _ 7iW day of
/7iA" , 19 a .
inn. 1lea. Ho. /G46-5"
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA101696
Date Issued: 10/21/2011
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4417 Clover Lane
Lot: 27 Block: 03 Addition: Eden
PID: 10-22750-03-270
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Windows Doors-New ; Replacement
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BE - Base Fee S3K $88.50 0801.4085
Valuation: 3,000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Window World AKA Probuilt America Jill C Iaria
2211 11th Ave E, =130 4417 Clover Lane
N St. Paul NIN 55109 Eagan NIN 55122
(61)770-5570
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
_ Use BLUE or BLACK Ink
For Office Use
Permit E
i Cty V 1 Ejla~11
3830 Pilot Knob Road Permit Fee: 7,6 - j
I
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
2011 MECHANICAL PERMIT APPLICATION
Date: %Site Address:-~4:f/i~'
Tenant: Suite
_
RESIDENT / OWNER Name: ~Dh~v~`t y i~lc Phone: Co f_~L ':;L-37- 397,?
Address/ City /Zip: ✓~3~ ~i`f/~L' ~c~ . ~V" V _Q SS 3
CONTRACTOR Name: u i License
Address: ~4 City: r G1
State: H A-) Zip: Phone:
Contact:
TYPE OF WORK New Replacement Additional Alteration Demolition
Description of work: UjIC, v4-c--
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
PERMIT TYPE X Furnace _ New Construction _ Interior Improvement
Air Conditioner _ Install Piping _ Processed
Air Exchanger _ Gas _ Exterior HVAC Unit
` Heat Pump Under / Above ground Tank Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract value $ x1%
$55.00 Minimum (includes State Surcharge)
Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
TOTAL FEE
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.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
in the case of work which requires a review and approval of plans.
with the approved -plan
X -LA LA_ ~X LA_
Applicant's Printed Name Applicant's Signature
wrr~~ .sec Reviewed-13y: Date:
Use BLUE or BLACK Ink
I For Office Use 1
j Permit /40
✓ / j
City of Eap 1 Permit Fee: 2 ~ ► I
3830 Pilot Knob Road 1
Eagan MN 55122 Date Received: Z 1
Phone: (651) 675-5675
Fax: (651) 675-5694 J€ A, L.~ Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0 Site Address: C_
~ C.~ 6'J Q-/ `-n Unit
Name: y- \ G, Phone: _
RESIDENT 1
OWNER Address / City / Zip: ~LA t-1 IO -11 t-f V-)
Applicant is: Owner
• Contractor f
TYPE OF WORK Description of work: S+11 80 i,k
Construction Cosa( Multi-Family Building: (Yes No )
Company: cKS ~u 30e Contact: o t
X 111#-I~l
CONTRACTOR Address: S- eneel ye - IV City: k&Je-
State: Nt tt IV ~ Zip: S74 (v Phone: 7LQ7 ' 3Y22
License M6 3o 0"4' Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
/am-r-
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the city to
conclude that 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.gopherstateonecall.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.
Exteno ork authorized by a building permit issued in accordance with the Minnesota State 'ng Code must be completed w' hin 180
days o p it issuance.
x x
Appl ca t' rinted Nam Appli nt' S' a re
d
Page 1 of 3
q`'l L.7 , , , l r ~O NOT WRITE BELOW THIS LINE
DII , h /0~7G
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 _ Interior Improvement _ Siding _ Demolish Building`
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation r'16 OccupancyG - MCES System
Plan Review / Code Edition SAC Units
° ° t~
(25/o_ 100 /o,~ Zoning City Water '
Census Code y~~f Stories - Booster Pump
# of Units Square Feet ~a PRV -
# of Buildings / Length
Fire Sprinklers
Type of Construction Width /Q
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
- - Footings_( (Addition) - -
- - - Final /-No-C-.-
0. itequtrsd- - -
Foundation
HVAC _ Gas Service Test Gas Line Air Test
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
Insulation Retaining Wall: _ Footings a Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee 73
Surcharge
Plan Review 14 7 9
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
337 P,.E- 5?
ROBE COfiSU4.TittC1 EliOltiEERS l`T l Vtoi
NGINECRING P1.RHtiERt and LAlip SURVEYORS 7
COMPRNYI INC. z
W00 EAST 1461h STREET, ounNSVILLE, MINNESOTA 35337 Pi! 432-3000
Cep:'z ccu S2j&-C3CC= y / Z) S~ -7
Z&Q9 ._..QwScr_1oje2=an- LOT'S 25,26,27 AND 28, BLOCK 3, EpEN ADDITION,
DAKOTA COUMTY, MINNESOTA
L`L35si DENOTES EXISTIN6 rzLLV 'I-ION
( 3,s, o) DENOTF-5 PROPOSEV ELEVATION
-w---- WDICATE5 DIRECTION OF SURFACE DRAINAGE
NORTH 9W• -FINISHED GARAGE' FLOOR ELEVATION
SCALE I`= 30'
N
BY EAf ~~aN
BY.
BYy
DATA 3'''I!II_iP~ls s II FCTIONS DIVISION
I
_ IDRAINA66 AMP
fN~ 301 935,0 LGAST UTILITY EASEMENT 941.e
ao 9354 /60.0- ?3t..S
I I +lr~p~
~36yt) ~_~r1 BZ.oo 'ut
~I Ln 78-00
id In
LET OT 2 5
_ 2 h (941. r e
ret :9_36. - 93 9 g3$. o r43 j~ N
1 PROPOSED 4-WIT
p , ~ r I & i ~C tp5
4z) 0
BU1L INCA IrnsT 1 Z
(q~1o. J Itn
a 98, oa r
9P.V } ~
.0i h ~ L~-? 931.7) = i `t'.~.o~ Z41.o) /i 1~
LOT ~N LOT 28 r~', I
,0 2 7 Z
I~^,,1 'ham 78.00 - 14 7,-_9 82.00 'In 15
1~~ 1931..~~. .S ►60.00 ""~-J' g3$.o~ i9~3.2I`1rf.,o~ 30' FRONT SUIL01"Co
56-7-BACK LINE
I hereby certify that this is a true and correct representation of a tract of
land as shown'and described hereon.. As prepared by me on this 7,W. day of
~ 4 Minn. Reg. No.%~s"
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:38 #582 P.041/079
Use BLUE or BLACK Ink
I For Office Use I
j Permit
City of Bap I Permit Fee: ' ~ . -1 -5
3830 Pilot Knob Road o n J 12
Eagan MN 55122 1 Date Received tJ
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9151201-3 Site Address: L44n ,L4qh t5, L4q&4gj96 Clover L CIM, Unit :
Name:_ l~ C'~ C~oliseh C0h'1Dq~ Phone:
Resident/ p l' Owner Address / CRY / Zip: ~py3 b UtV 41A PQYk ay , Ulm prWric,~T 3~ L4q C
I
Applicant is: Owner X Contractor
Type of Work Description of work: 201Y off d 1 P-Irp
I
Construction Cost. 4 0 t O -lDO Multi-Family Building (Yes No
l~
Company: 1ft COMUGtlM MaVI~01C YIf 1. Contact: C l~le,~tll~stC~(~ ,r
Address: SIyS 1h &ATia1 S'1'ref,4 153 City: Woe, Plain
Contractor
State: Jam- Zip: C_55 Z l Phone: Cnl- q, 4,L- ly
e
License # S cw1rals Lead Certificate N- 2(~ilP+0
1~7
r1fthe 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:
G
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non.-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 46 hours
before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.org
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 plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 160
days of permit issuance. ~.pn ~ `y
X_ u 1. ~clt IAIA x
Applicant's Printed Name Ap i ant's Sign ture
Pagel of 3
® 4 e f
®®®lie
E AG A N
�P
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspections(c)cityofeagan.com
--------------
For Office Use
I Building Permit #:
I I
I I
S&W Permit #:
I I
I
I Permit Fee: I
I I
I
Date Received:
I I
I I
I Date Issued:
t----------------------
RESIDENTIAL BUILDING PERMIT APPLICATION
Date:,yhql
Site Address: Unit #:
Applicant is: ❑ Owner KContractor
Name: E?z sA �A b V1�2 O k ---I U-42-N17 S taS"S C�;l C I CX,4 k 6 l/-\�
Homeowner Address: l 1 City: �c Ct 0—
V�
State:% V�Lip: 50Z Phone: 16Vai
Description of work:t-
Type of
Work Construction Cost a t , -V
Type of building: ❑ Single Family ❑ Townhome, of units JRTwin Home
Compan 3QM l/J!SE&jt'c,lr✓ n\lam Contact:
Building Address � � (_. i1'�1 VJ T {�—City:G(�f;�Y\
Contractor 1/�
State:Lip: 553��Phone�o�z�7Email. a/ylQ.�[ �e � R5q(
�/ OZCa( �O
License #:EC T (� Expiration Date: .3C 2 ��
Sewer &
Water
Contractor
Required for
new construction
Company:
Address:
State: Zip:
i License #:
Phone:
Contact:
City:
Email:
Date:
I understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
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. Contact Gopher State One Call at (651) 454-0002 or www.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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. Al
x
Applicant's Printed Name A licant's Signature