3811 Country Creek Way
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CITY OF EAGAN
. • 3795 Pilof Knob Rood Eagaa, MN 55122
N? 4 7 t 3
PHONE: 4548100
BUILDING PERMIT Receipt # "43?
To be usad for Est. Value Dote `19
Site Address Erect ? Occupancy
Lot Block Sec/Sub. Alter ? Zoning
Parcel # 1 1 Repair ? Fire Zone <
E
l of Const
T
arge ?
n ype
.
W Nome Move ? # Stories
; Address Demolish ? Front ft.
Ci Phone Grode ? Depth ft.
°C Approvala Fees
Name
0
?a Address
Assessment
Permit _
°C
Ci Ph
~
Water & Sew.
Surcharge
one
r
Police
Plan check
F W Name Fire SAC
?a Address
W Eng. Weter Conn.
W
M
Q
Ci Phone Planner eter -
ater
Council
I hereby acknowledge thot I have reod this application ond stote that Bldg. Off.
the informotion is correct and agree to comply with all opplicable
$tate of Minnesota Statutes ond City of Ecgon Ordinances. ApC Totcl
Signature of Permittee
A Building Permit is issued to: on the express condition that
all work shall be done in ocmrdance with oll applicoble State of Minnescta Statutes and City of Eagan Ordinonces.
Building Official
PennR # Date Iawd ?maMho
Plumbing /a G <- - o? --a - 7 JL
Mechanical G y? - 7d vy„?„L ,??
INSPECTIONS DATE INSP• Rough-In Flnd
Footings ,j -e,15- ? Date Iruo. Date Inap.
Foundation Plumbing ?-?- s
Frame/ins. - - Mechaniool
Final
Remarks: ,?-4'?c?% J? /i•to ?o,..??j .?.t-o-"`?'-_'.-'? ?.?o-a?c--? i'?-0 ????"i'"'-'
/ - i
CITY OF EAOAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PH O N E: 454-8100
BUILDING PERMIT Receipt *
To be used for Est. Value "? t • Date %' J''" .1 L i ,19 Site Address Lot A_Block Sec/Sub.
Parcel No.
iIAY
a Name
3 Address A}
° City Phone `, "=`i`'` -.,
C'i 5T0[S !'(1Q1.S
City
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 Statufes and City of Eagan Ordinances.
Signature of Permittee
A Building Permif is issued to:
on the express condition that all work shall be done in accordance with al I
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
OFFICE USE ONLY
On Site Sewage OccupanCy
MWCC System Zoning
On Site Well (Acfual) ConBt
City Water (Allowable)
PRV Required * of Stories
Booster Pump Lenn?e,
tn
D
dp
S.F. Total
FootDrint S.F.
APPROVALS FEES
114' '
Engr./Assess. Permit
Planner Surcharge
Council Plan Review ?
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
a,.,.
TOTAL
Psrmit No. Psrmit Holder Date Telsphone i?
Plumbing
H.VAC.
Electric 711 ,
Softener
Inapection Date Inap. Commenta
Footings I ?
Footings II r
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bidg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Final ? cr Q.? he., ?,, i??e ??C
Well -2
Pr_ Disp.
0
CITY OF EAGAN Remarks
Addition CEDAR GROVE #11 Lot 3 Blk
Ow er ??i .Qd?? ?•B??'J Screet ?11 Countxy Creek Way
?-? IV
Improvement Date Amount Annual Years Payment Receipt ate I
STREET SURF. 1/4
STREE7 RESTOR.
GRADING
ree - , ,
SAN SEW TRUNK 0 ? 1968
* SEWER LATERAL
*
WA7ERMAIN
WATER LATEHAL 2 7 (o
WATER AREA
* 3! 1 -
STORM SEW TFjK -71 1971
6
1.6
2
f
'
Cc ?Ji ?"
STORM SEW LA'f ( D 1971 22.37 1.11 20 ? 'U'"q G,b
CURB & GUTTER
SIDEWALK 187.52 , , - -
STREET L(GHT
WA7ER CONPV. 250.00 3-22-78
BUILDING PER.
sAC 500.00 9432 - -
PARK
f OF EAGAN
S Pilot Knob Raad
in, MN 55122
PERMIT NO.:
DATE:
No. of Units:
te Address: . _ '
lumber:
(eter No.: Connection Charge:
Account Deposit: .
ize: -
eader No.: Permit Fee: •
agree to comply with the Cifiy of Eagun Surcharge:
lydinanees. Misc. Charges: •
Totai: DQte Paid: . • . ,
dy
; . Date of I nsp.:
I nsp.: .: .. s
. cIrr 0;• EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
.. Eagon, MN 55122 DATE:
Zoning: No. of Units: .
Owner. .
Address: -
' Site Address:
----- ., . . .. ' . .
? Plumber: • .
-.
1 agree Fo wmply wilh the Cify of Eogon Connection Charge: ,
osit:
M D
A
Ordinances. ep
ccou ,
Permit Fee: • ,
,?
• Surcharge:
Char
es:
M
gY _ g
isc.
T
t
i:
Date of Insp.: a
o
Paid:
t
D .
Insp.: e
a
City of Eagan
3795 Pilot Knob Road
Eagan, NAJ 55122
Date: August 3, 1978
Dakota County Abstract Co. SPECIAL ASSESSMENT SEARCH
1250 Highway #55 RE: 3811 Country Creelc Way, Eagan
Hastings, NIN 55033 Lot 3, 81ock 2, Cedar Grove 11
Enclosed herein is the search which you requested made on the above described
property:
Kin o mprovement uns Beginning Orzginal Amount Balance Due
Street $ Sidewalk 10 1978 1222.97 1100.68
I further certify that accordiag to the records of said office, the following
improvements are contemplated or pending after having been approved, artd are now
in the process of planning or completian.
Kind o Improvement Approximate date o Campletion Approximate Cast
NONE
WAIVER;
Neither the City of Eagan nor its employees guarantees the accuracy of the above
information which was requested by the person or persons indicated. Nor does
the City af its employees assume any Iiability far the cQrrectness thereaf.
In consideration for the supplying of the indicated infarmation in the above
forma artd far all other consideration of any nature whatsasveT, apy clai.m
against the City of its employees rising there from is hereby e3cpressly waived.
Levied assessments to be paid to the County puditor at Hastings, Minnesota 55033,
Very truly yours,
SPECIAL ASSESSMENT DEPAR'1'MENT
/sJ Ann Goers
Assessment Clerk
.
. .
P R H'ELSHONS. Prcddent
DAKOTA COUNTY ABSTRACT CO.
HASTINGS PROFESSIONAL BUILDING
' 1250 Highway 55
Hastings, Minnesota 55033
Phone 437-5600
L. L. iHYEN, Vtce Prealdent
Please send me a Pending Assessment Search on each of the Pollowing
tracts of land:
Lot 150 Block 1. Ches Mar Fourth Addition
Dunberry Lane, Eagan, Minnesota
Lot 9, Block 2, Ches Mar First Additio n
Ches Mar Drive, Eagan, Minnesota
AND
Lot 3, Block 2, Cedar Grove No.11
3811 Country Creek Way, Eagan, Minnesota
Enclosed please find check Yor $15.00 to cover costs.
. . . Thank ypu,
r;n
:.'„ .,'..._.
Rosie
1g78 ?-
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConatructWn NggphemeMe
• 3 registered sile surveys showhg sq. fl. of bt, sq. N. of house; end gg roofed areas
(20°/amaximumbtcoveragealbwed) -
• 2 copies ot plan showmg beam & window sizes; poured found design, etc.)
• laetofEnerpyCelculetlans
• 3 Copies oi Tree Preservation Plan B lot plattetl afler 1/1193
. Rtn,bisl Detail OpGOns selectbn sheet (61tlgs witli 3 or less unfts)
DATE / j 36 ? ? Z_
4 - 3() - 6 a-
pemodeUReneir NeaulremeMS ?
. 2 copies of plan r
• t set ol Energy Cakulations for heated additions I?. J
. 7sAesurveyforexterbraddAbnsBtlecks ?
. Indkate tl home served hy seplic syslem lor addillans
G 00
VALUATION ! ) i , ? t
SITE ADDRESS Z?)<s j I ( C?vSY MULTI-FAMILY BLDG _ Y ?
NPE OF WORKS 1 U ooti ?? FIREPLACE(S) _ 0_ 1_ 2
C /
APPLICANT ?? t2 S ,p?
STREET ADDRESS/ Z?.3L9 57 CIN OW?L?'coO":?sSTATF/`"rZIP ??o
TELEPHONE #7f?? 7S ? CELL PHONE FAX # 7e'v 3 PROPERTY OWNER ?01? ?ll `(? / ?/ a? ? TELEPHONE # e/ :5j ??Z 4?99??
COMPLETE THIS SECTION FOR -NEW,, RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY I
(J submission type) • Residendal Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Conhactor:
Plumbing system includes:
Mechanical Conhactor: _
Mechanical system includes:
Sewer/Water Contractor.
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
I hereby acknowledge ihaT I have read ihis application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordin .
Signafure of Applican?
OFFICE USE ONLY
_ Water Softener
_ Water Heater
_ No. of Baths
Phone #
Lawn Sprinkler
No. of R.I. Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updeted 4/02
PERMIT# qlUq RECEIPTDATE:
MIDEP17lkL PLUM$IRfi PERMiT APPWCATIOR
crrY og EAeattQ
3830 PELOT KROB IiD
$t4HAF, MP $5122
651-6$1-4675
Please complete for: ? single family dwellings .
? townhomes and condos when pertnits are required for each unit
? backflow preventer for irrigation system
? - - -
PLANT, TOMNICKI
SITE ADDRESS: 3811 COUNTRY CREEK WAY
EAGAN, MN 55122
OWNERNAME:: (651)452-1085 TELEPHONE#:
(AREA CODE)
INSTALLER NAME: TELEPHONE #:
, (AREA CODE)
STREET ADDRESS: /R17\ A97-AA!Yi
cin.: 2905 GARFIELD AVE. SO. STATE: ZIP
MINNEAPOU3. MN 55408
Plaee a rher.k mark nnYt fe the nArmit work tvoe
New residential dwelling unit under wnstruction and not owner/occupied $ 90.00
Add-on, modification or alteretion to existin dwelling unit, including: i,$ , 50.00
• abandonment of septic system
• newinstallation/repaidrebuildofRPZ 1 EP i 2 LU?I I,
• lawn irrigation system '
• water turnaround - ?
Nature of work: r?Jpt?'? wµ? hea?vf
-r
Septic System, new/refurbished - $ 225.00
• inciudes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ .50
Total $_
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I here6y acknowledge fhal I have read this appllcadon, state that the infortnatlon is cortect, and agree to complywlth all appllcable City of Eagan ordinances. It
is the applicanPs responsibility to noU(y Ihe property owner that the City of Eagan assumes no liability for any damages caused by the C(ry duAng its nortnal
operadonal and maintenance act(vities to the facilities consWcted under this pertnit within City property/rightof-way/easement.
SIGNA RE OF PERMITTEE
Updated 1/01
.
1
? 1988 HUILDING PERMIT APPLICATION - CITY OF EAGAN
*
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BQILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL IINITS FOR S9LE UNIT3 U OF UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SUAVEY - CHECB WITH HLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMA1EHCIAL
INCLUDE 2
1 SET OF
SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
SPECIFICATIONS AND 1 SET OF ENERGY CALCULATIONS
..1-?Cy?2..6ti9_u.?l ?tJ tL?LAGtW V
To Be Used For• Valuation:
Site Address 3811 Ccwntrk, L'r:ik
i ?
Lot 3 Block Z
Pareel/Sub CEn•vf- ??r'c.•c !/ 7N
Owner g??r?l?i?a1'C
Address 12"l,t Lu uy"
City/Zip Code C'..j
Phone ATI- ?Z:; 8's-
Contractor
Address
City/Zip Code 4.py'iaY
Phone
Arch./Engr. ??v6
Address }JZL'?..
City/Zip Code
Phone # ?Cyy.
Date: 4-4'1:)Tn
/ / p0p -
On site sewage_
MWCC system _
On site well _
City water _
PRV required +
Booster Pump _
APPROVALS
Oceupancy
Zoning
Actual Const
Allowable
# oP stories
Length
Depth
S.F. Total
Footprint=S.F.
FEES
Engr/Assess Permit
Planner Surcharge
Council Plan Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
Ily,oo
5150
5?, Oo
/7G,So
CITY OF EAGAN N2 14 7 9 8
3830 Pilot Knob Road, P.O. Box 21-199; Eagan, MN 55127
PHONE:454-8100
BUILDING PERMIT Receipt#
To be used for POOL Est. Value $11, 000 Date APRIL 7 ,19$$-
Site Address 3811 COUNTRY CREEK WAY
Lot?_Block ? Sec/Sub.
Parcel No
a Name TOM PLANT
? Address 3811 COUNTRY CREEK WAY
o City EAGAN Phone 452-1085
OFFICE USE ONLY
On Site Sawage _ Occupancy
MWCCSystem _ Zoning
On Site Well _ (Actual) Const
Ciry Water - (Allowable)
PRV Requiied _ # of Stories
8ooster Pump _ Length .
Depth
S.F. Total
Footprint S.F.
¢ Name CUSTOM POOLS, INC
0
oQ Address 601 E EXCELSIOR AVE
City HOPKINS Phone 933-2255
?
Uw
W,
fi
ua
a
W z
a
Name_
Address
Ciry _
I hereby acknowledge t t ?have read this?Gp? ica o and state that the.
information is correct nc?gree to compy? ?py`lh ap ' able State ot
Minnesota Statutes a d i pf Eagan Orpin2Alc
APPROVALS
Engr./Assess.
Planner
Council
Bldg. Off.
Variance -
FEES
Permit
Surcharge
Plan Review
SAQ City
SAC, MWCC
Water Cann.
Water Meter
Road Unit
Treatment P1
Parks
TO7AL
114.00
5.50
57.00
SignatureotPermitte&.J?.?-
A euilding Permit is issued ro: CUSTOM POOLS_,_INC
on the express cond ition that all work shal I he done i n accordance with al I
applicable State of Minnesota StIatutes anpd City of Eagan Ordinances._
BuiltlingOfficial ??Gro EdAfA. I y
?
176.50
.
r?• y .. , .. • , i ;'
?
?
s 9
?
?i
,
i (C?-n „
p,
?•??v??
? t
;
4
I
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i r
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{
?MCITY OF EAGAN
3795 PIlat KwA Road
Eo9on. AAiwwowh 55122
Phone: 464-8100
Date:
Site Address:
Lot Block Sub/Sec. _-
No.
Receipt Na.:
Single I
Residenrial
Multi Res., Comm./Ind. I
Name ` E'•ll Constructinn New/Alter
/Repair
.
.
;
Address LYri
Cosr of Installorion
O
_
City . )rnlnqtOn P??: ? ?
Permit Fee
Name ??.?7 1•3. G'•'''_ ]?f', : :.:1. ri=: -
- Surcharye
?
? Address - 37 ChiCar . vp. SC.
e
0
U -
City ^ ? Phone:
Total
This Permit is issued on the express condition thot cll work shall be done in ccoordance witfi all opplicable Stote of
Minnesota 5totutes and City of Eognn Ordinances.
?
Building Officiol
Eagaw, Miwnasofa 55122
Phene: 454-8100
PERMIT No.
Date: Receipt No.: '
Single I
Site Address: Residential -
Lot BI«k Sub/Sec. _
PERMIT
reek Way
- Phone:
Nome PZt1IAb 11Ct Co.
New/Alter./Repair. Cost of Instollation
?
Permit Fee
Surcharge
v ? Ctry Phone: I Total
This Permit is issued on the express condition thot oll work shall be done in occordance with all opplicoble State of
Minnesota Statutes and City of Eognn Ordinances.
I
new
20.00
? Buildln9 Official
This reQUes? void
18
0 2 5 F; 3-1
Request UaYe Fire No. Rouqh-in IreVection
Requlred?
(:]RCadYNOwE]WiIlNotify.lnspec-
Wr Wh
n R
d
U ?Yes ?No e
ea
v
?Licensed Electrical Convactor I heraby requastinspec<lon olaEOVe
Owner elachical work installedat:
Sveet Add/ress, Baz or Rou?re jNo??? City
ecLOn o. Township Name or o. Hanqe No. ? C nt??
Or.cuGani(PplNT) PGh'o/ne No. /
`ej 9's-
P w¢r $upplie! ' Addre55
Eloctr^- I(? o_mra-/tor? ?Compan?y N}?me`l Co?nh/acto,r's? LiCense No.
l??.f".=-?s'K.'G%
Malling AdJress (Contracmr or Owner Makinp Instailat
S 7
?L
?
?
ir? ,,
0C
Auffiorized Signa[ (Con to?/Owner Maki Installationl
? Phone NumDer
MINNESOTq STATE BOAflO OF ELEGTRICITV IX
G,iggs-Midway eldg. - Boom N-791
1821 Universitv Ave.. 51. Paul. MN 55104
Phone (612) 642-0800
iHIS INSPECTION qEQUEST WIIL NOT
BE ACCEPTED BV THE STATE 90ApD
UNLE55 PROPEP INSPECTION FEE IS
ENCLOSED.
'/ REQUEST FOR ELECTRICAL INSPECTION ee-ooooi-os
? See instruc4ons 1or compieting ihis fwm on back ot yellow copy.
???"? ?
""X" Below Work Covered by 7his Request
? 2563
AAd Heo. Tvoe oi 6u'la'n Apohir,cm Wiratl E?uiu??e?? wiren ?
I 1 ?I Horn.? Ranae Ternporarv Service
niiNr.v I I Water Heater Liyhtiny Fixtures
Commercial Bldg. Fumac e Silo Unlonder
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Otner 0 eafv -iher Ispecifyl
tmr Succily Other 01hr,,
__.
N ..r...., ....,
Fee r.,_........,., __._..
ServiceEnhanceSize
fl
Fee
Feeders/SubleeJers
a
Fee
Circults
0 to 200 Amps to 30 Am s 0 tn 30 Am s
Above 200 qmps? 1 to 100 Ainps
t 31 to 100 Am s
? Swimming Pool 100-Amps
Above Above 100_Am s
Transiormers rrigation &oonis PartiaLOther Fee
pigns oNecm? uisVe S? 5 ?
? TOTA
Aemarks
I Rou9h.'in ?Ir?? ?. the EI ? I
I
Ilnspectoq heroby
? certity thnt the above
Final inspection has been
m
/! ade.
/cG?G
This request void 18 months from
?? 7? P 64446
Datt o this Request S
-
I, as L Licensed Electrical C ntractor ? Owner, do hereby request inspection of the above electri
cal wiring installed at: ?( - G( ?
Street Address or Route No. Cit ?
Section Township ^ Range County
Which is occupied by
Is a ronghin inspection required on this joh? No ? Yes ? Ready Now ? Will Call ?
???w Address A?L? ?
Power Supplier r ?I
?,S?p• C? Contractor's License No3`?A
Electrical Contractor (?ompany ame?
, Mailing Address ?. sO S ?->n" ?
1j?
. ,-.? (Elect al Copt ?t?OwAkln9 This Initallatlon) ^ J???. '
?
\ C-4?_ ?yVh1 .
Authorized Signature I Phone No. o t
. (ElecVical Co ector or Ownef Ma n9 Tnis Installatlon)
ttt??? This inspection request will not be accepted 6y the
Stata Board unless proper inspectian fee is endosed.
rJ !n1
Minnesota State Board of Electricity
1954 University Ave., St. Paul, Minn. 55104-Phooe 645-7703 7e.
REQUEST FOR ELECTRICAL INSPECTION P? s Q???
.,r,. nv mv1c ncnrrPc?r If
l;tlt,l;K1fGLVw n'Vnn?VVa;
Type oi Building New Add. Rep.
Home ? ?
Duplcx ? ?
ApL Bldg. ? ??
Commercial Bldg. ? El El
Indus[rial Bldg. ?El El
? ? ? -,.a
Check Appliances Wired Fo?
Rxnge ?
Watcr Heater ?
Dsye ?
Fum
Au ;dlti
Lrst
-
Check Equipment Wired For
7cmporary Wiring ?
Lighting Fixtures El
Electric Heaiing ?
Sil o Unloader
Bulk Milk Tank ?
List )
}
Fazm
Othei ? ? ? thers
O?
Here Others
Here 7
cvv oci ntu
(,'VMYU 1 C 11vJrc.?
Service En4ance Size: t ivi
# v
Fee Feedecs$Subfeedecs: # Fee Cirwits: # Fce
0 to 100 Am s. 0[0 30 Am eres 0[0 30 Am e[es
101 ta 200 Amps. 31 to 100 Amperes 31 [a 100 Am eres
Amps.
A6ove 200 Above 100 Amps. Above 100 Amps.
_
T[ansformexs ItemoteControlCire. Paztialorotherfee
Signs Specul lnspection Minimum fee $5.00
Remaxks TOTAL FEE ?y S
I,the Electricallnspector,hereby
(Final)
This request void 18
has been made.
pate
-1)? te n -?_??r ?x
j 1-7r 3
nnxE 3-/ a- tI ;z S'
BUILDITdG PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
7b be used Por
Site Address; & vtr?P(
!/
Valuation -f 6 h1
7
Lot ? Block Z, Sec. 5ub, et; r Parcel Number iQ / G 711 D 3 o D]"
/ I
Owmer Telephone
Address AQ ?sp
Contractor
Address
Telephone
Arch./Eng.
Address
Telephone
OFFICE USE
Erect v
Alter
P,epair .
Lhlarge
Nbve
Grade
O L
ccupancy
2oning
Fire Zone .3
Type of Const.
fl of Stories
Front f'9
Depth ? 2 y
OFFICE USE
Date of Aoproval & Initial
/
Assessment D 3 Q 1J7g'
4)ater/Sewer
Police
Fire
Eng.
Planner
Lbuncil
Rldg. Off.
A.P.C.
FEES
° fJ
Permit Z04 f 0
Surcharqe?/z
Plan Check --?-/-?
SAC - e9 U!! ..o
Water Conn. ,??
S°Iater Meter
TOmAI,
?? ? J
cirr oF eacnN
3795 Pi1M Kno6 Rmd Eagen, MN 55122 N? 4713
PHONE: 4548700
BUILDING PERMIT APPLICATION $40 ReceiPt # 9432
,000. , 19
To be used for Sf Dw1gS Garg. Es[. Value Date Mar, 22, 78
. Site Address 1811 r....,.fr., r.ee? t?Erect g) Occupancy-1 ---
Lot 3 Block Z Sec/Sub. CG 11 Alter ? Zoning R- }
Porml # 10 167p 030 02 Repair ? Fire Zone 3
Enlerge ? Type of Const. v
w Name M8'r >> SiyL Move ? # Sfories
z p?res, 10800 Lytldale Ave So Demolish (] Front 59 ft.
Ci Bloomington phone 884-7225 Grade ? Depth 26 ft.
AvProrab Fees
o Name
Z? Assessment Permit.1] 5 50
o" Address
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I hereby acknowledge that I have read this application and state that Bldg. Off. _
the information is correct and agree to comply with all opplicable
State of Minnesota Stotuies and Ciry of Eagan Ordinances. APC
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Signature of Permittee I
A Building Pertnit is issued to: ' 1 on the express condition that
all work shall be done In acwrdance v'th oll pplicobl Stote of Minnesoto Statutes and City of Eogan Ordinances.
Building Official
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Date:
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: 1' LkL73
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:
Unit #:
Resident/
Owner
Name: 1 O W\'k 0 t C. -V._ \ € S)A 'li Phone: 00- f&e - 705S'
Address / City / Zip: 3 it aid ,1 1. /uek c1,- /.1(r l')-747 i31z2
Applicant is: Owner Contractor
Type of Work
FaXILAI
Description of work: ' -C t COLK c' l�a \V- \ ` *1'01.v4 e
f, 961A -N,
Construction Cost: 11 ('1-.-p, .c19 Multi -Family Building: (Yes / No ? )
Contractor
Company: Cgli Y1 fW &1Contact: ii 4 Ar
!�
Address: 229-_s- /?iii sir 4r
t ' City: ,&/./1'67-c..4
State: ‘71Zip: 53 ---VV I Phone: 76 3 f 2 2'8 '''1‘S%
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code e completed within 180
days of permit issuance.
x � \I1([C
Applicant's Printed Ntarne
x
Applic
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