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1861 Deer Hills Tr Use BLUE or BLACK Ink _e 0 7q -7 1 City of Eapn j Permit#: I {jj I 3830 Pilot Knob Road Permit Fee: 1 Eagan MN 55122 RECF'IV'=U Date Received: I Phone: (651) 675-5675 I Fax: (651) 675-5694 DEC 17 2019 Staff. , 2010 MECHANICAL PERMIT APPLICATION Date: sz _~L\ - l+ Site Address: A_tC r Tenant: c' Suite RESIDENT / OWNER Name: Ck i Q~ A~/L _ 4'1 Phone: ` -h (1~ V_ Address / City / Zip: l ! I CONTRACTOR Name: BURNSVILLE HEATING & AIC, INC. License y r ~Sr,'~C (2 Tl l Address: Suite 120 City: Bumsville, MN 55337 State: Zip: Phone: _~2 ~~c(~~° 0( Contact: Y 1 Email: TYPE OF WORK New 2L Replacement Additional Alteration Demolition Description of work: L. NOTE: Roof mounted and ground mounfe4 mechanical equiiiimia tt ls:t'etiulred *'I: a scrooned >ay City Code. Please contact the Mechanical 14p#ctor fcr Irif~omlakion orl. t nP d s r69ri'n6' rye, '-p s PERMIT TYPE RESIDENTIAL COMMERCIAL 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( O(C,k Vl ~rYl :C( Marshal and Plumbing Inspector RESIDENTIAL FEES: $50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) $90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEE COMMERCIAL FEES: $70.50 Underground tank installation/removal OR Contract Value $ x1% $50.50 Minimum (includes State Surcharge) Permit Fee - If Permit Fee is less than $1,000, surcharge is $.50. - If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge $1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 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,aoDherstateonecall.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. X-L q) 61 x 0 f -a (~(j Applicants Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: petit, Required Inspections: Under Ground ~ Rough In Air Test as Service Test ~Irr-flogr Heat. ~]~trla( Exterior HVAC Screerting lnspe'ction CITY OF EAGAN 3830 Pilot Knob Rosd, P.O. Box 21-199, Eagan, MN 55121 ' PHONE: 454-8100 BUILDING PERMIT Reu;pt # 5 _--- Te be wrd ia E st. Value Dat e 19 Site Address ?. • ' i..T.•L S `l ; Erect ? Oecupancy ? .? UN Lot Block SeclSub ±:? t P1 Remodel ? Zoning 'd i . Parcel Na. Repair ? Type of Conat. Addition ? No. Stories ` . t;?.' , ;?,c.•_:r:l;Y ;?'lfn'„ Move ? Length 41 W Z Name Demolish ? Depth Q ? Address I t I ? ? n , mpr. Sq. Ft. City Phone • ? ''? -- ' :i ; Install ? Z? Mame uu Addresa ? City ?W t? Name W ?? Address tW City Phone $iQnoture ot Pert»ittea ? A BuHdinq Perm+t Is issued ro: oH work sholl be done in accordonte Buildinp Official Assessment _ Woter & Sew. Police EnG• Planner C.ountil Bldg. Off. 7/ i`ir! -? 5 APC Var. Date Stotutes and Plan ReView SAC " Water Conn. Water Meter ' --? Road Unit Tr. PL Parks Copies GU' U c 50 uo' 00 nc 1hot I inspection Date I Insp. I ather I Framing Final Dftaibs Recsipt MECHANICAL PERMIT Psnnit No. I CITY OF EAGAN ' N ;' F C . Fill in numbsred tpecsa 3/C Type or Prini legibly ToL 1. Date 2. Installation Cost f 3. Job Address Lot Blk. Tract Y : 4. VAi l? _ ? ' ? T? S 5. Contractor Phone B. Addreas 7. City ? i ' E ' ." . ' ;,. State ?' 2ip ? ? •` 8. Building Type: Residential 9. Work Description: New ?C9 Commercial ? Institutional ? Add ? Alter O Repair ? 1 10. Oescribe L t k i_ N 1_ •; 1. Fuel Type I 11. No• ' Equinment 8TU - M. Ea. Forced Air No. Equiament CFM Air Hsndling: Mfg. 1114 ?- Boilers Mfg. Mech. Exhaust Unit Heater Mfg. Othet Air Cond. Mfg. Gas, P'iping Outlets I hereby certify that the above information is true and correct, and I agree to comply with all ordinances and codes governing this tYpe of work. Signed : for Rough Final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY UF EAGAN 454-8100 ? Rooaipt PLl1MBIN0 PERMIT Permit No. CITY OF EAGAN ? F~ ?Fill in nLmbered tpacst 8/C Type or Pr/nt /e,pfbsly Tot 1. Date 2. Installation Cost j f' ' % ! ot , , ? 3. Job Address - L Blk. • Trect ----?-- 4. Owner x-A: _i 6. Contractor c - Phone tiL 6. Address 7, City $tate Zip 8. Buildiny Type: Hesidential b Commercial ? Institutional ? 9. Work Desaiption: New Add O Alter 0 Repair ? 10. Describe - -- ? - - 11. No. Fixtures Water (:loset No. Fixtures Cess l/Drainfield Bath tuba poo Se tic T k Lavatory P p an $ h ShOVVer ner o WeI I Kitchen 5ink Urinal/Bidet Oth Laundry Tray er Floor Drains Orinkinp Ftn. Slop Sink Gas Piping Outlets 12. 1 hereby certify that the above information is true and correct, and I ayree to comply with all ordinances and codes governiny this type of work. Signed : ? _ . for Rou9h Finsl Inspections: 6ate Insp. Date Insp. This is your permit when numbemd and approved. Approvad CITY OF EA(iAN 4644100 Receipt PLUMBING PERMIT CITY OF EAGAN I fill in numbered spaces ? Type or Print /egib/y 1. Qate ?/'V'/?y^ i r 2. Installation Cost 3. Job Address Lot Biktl 4. Psrmit No. .- Fes ? S/C + Tot ? i Tract ? 5. Contractor #'I f?ii PhonA 6. Address ?? ? ?r ? n ° :'' ?% ? - ?• ? ?.. ( 70• 7. City ??,??•1 State Zip 8. Building Type: Residential'-C Commercial ? Institutional O 9. Work Description: Ne4k 10. Describe 11. Add ? Alter ? Repair O No, Fixtures Water Closet No. Fixtures Cesspool/Drainfield ? Bath tubs tic Tank 5e tt Lavatory p Softner _iO Shower Well Kitchen Sink Urinal/Bidet Other'???? Laundry Tray Y 0 Floor Drains Orinking Ftn. ! Slop Sink Gas Piping Outlets 12. I hereby certify that the above information is true and correct, and 1 agree to comply with II ordinances 3nd codes governing this type of work. Signed :.-?' for r Rough final Inspections: Date Insp. Date Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 454-8100 CITY OF EAGAN Remarks Addition SUN CLIFF FOURTH L t 5 B 1 P l 10 72? 050 01. K Owner 5treet 1861 ?er 1 S a1 State ?ga1' Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, 303.92 . 3, (o 4f -- /('j / /U ' - S STREET RESTOR. A ?? -f8' 17-S15- GRADING -/a9'a /0-/7- S SAN SEW TRUNK $, 3a C -/ - 9-?5- SEWER LATERAL 1985 6-1 /o -17 -2-t WATERMAIN -+ 15? (? -O/ G- 91- -'T WATER LATERAL WATER AREA n , 95 • , 3 STORM SEW TRK . 6 -3 r .? C. STORM SEW LAT 78.08 . a , s orm w Lat 039 1986 739.56 147.91 5 4,32,S6 C-/d9?d /a -J7 CURB & GUTTER SIDEWALK STREET LIGHT Services /0.3 198 529.15 105.83 5 29• / C--/0954 0- !7-X " Road Unit 280.00 54087 7 29/85 WATER CONN. 500.00 " rT BUILOINGPER. 10665 sAC 525.00 PARK N waM sErnricE PERM Road P. O. Box 71199 ' PERMIT NO.: Eagan, MN 55121 DATE: Zanirg: _ No. of Unih: Owner: :7'1=' • /lddnsx Sitr Mdroa: Plumber. ••. , AMhr No.,c sim: Readw No.: o ? .. ? ..M to CO.* Wbh th. gY a?tC ? Date of Irap.: /'3 CbNrA0tdr1;C66r": Mix. crorgm Totoi: Date Paid: 3830 Pilot Knob Road ?M URVIM PRMIT P. O. Box 21199 PERMIT NO.: Eagan, MN 55121 p^TE: Zoning: No. of llnits: ' Owvfer: . . . . Address: Si» Addross: ? ? Plumber. ._ . - = ..., - I ?? ro Gen* W" !is alp o/ yps Corxuctlon ?Oro°' OAIMaey, hwunt Deposih _ Psrrrnit Fee: Surd By '°'go' Date of Irtsp,; Misc. Chorqss: ??'? Totol: DoM Pioid: _ CASH RECEIPT CITY QF EAGAN P. O. BOX 21-199 EAGAN, MINNESOTA 55121 19__(jr RtCi1V SD Is I & POLLARS 1 oo E)CASH [3CHECK FON A_JPA-? V FUND CODE qMOUNT ? Thank You B N_ 54419 White-Payers CoPY Yellow-Posting Copy Pink-File Copy CITY OF EAGAN ! ? P. O. BOX 24-199 j EAGAN, MINNESOTA 55121 ' DATE 19 ' RtC[IVlD RRpt AMOUNT $ I ? I CASH RECEIPT 8 DOLLARS +oe ? CASH ? CHECK ;?. ? `... ?- ; 7 FuNO CODH p/AOUNT ; ...? _? , . , ? .? u ,• ?t??. • •t, Thank You By , R - I,. I - . ' l '1 ? . T_ 2 • White-Payers Copy Yellow-Postinp Copy Pink-File Copy .• CITY OF EAGAN N° 10 6 6 5 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55127 v ?? PHONE: 4548100 BUILDIN6 PERMIT rteceipr # To 6e wed fa SF DWG/GAR Est. Velue $56,000 pate JULY 29 19 85 Siteqddreb 1861 DEER HILLS TR Lot 5 elock 1 sec/Sub. SUN CLIFF 4TH Parcel No. W nlame HERITAGE ENERGY AOMES INC ? Address 4655 NICOLS RD Citv EAGAN Phone 452-5950 Neme SAME s? Addreas • Clty Phone ?uW Neme Address ?W City Phone I hereby ockrwwledge that I hova recd this aDClication and state that the inlormntion Is correct ond agree to complY with all applicable State of Minnewta Stotutes d City of EoOr i on Sipnoturc of Pemuttee A Buildinq Permit Is issued ro HERITAG ENERCIY F. all work ahall be dona in acaordenca witMa pplimbla Stuta of , Buildfnp OHkiol ?C?l ereof 91 oca,peocy R3 Remodel ? 2oning Ri Repair ? Type of Const. V Addttion ? No. Stories Move ? Langth 43 Demolish ? oePm 46 Int. ImOr. ? Sq. Ft. Install ? Apprwalf Fut Assessmmt Permit - 3Ur00 Wafer 6 Sew. SurCharge 28.00 Paliu Plen Review 150.50 Firo snC 525.00 Enp. WaterConn. 500.00 Plunner Waterroteter 63.00 Council Roed Unit 2$ 0. 0 0 BIdg.Off, 7/25/$5 TcPI. 132.00 APC Parks Var, Date Cop!" Total $1, 979.50 JMES INC on ths expres eondition thai ieww Statutes ord Ciry o7 Eopcn Ordlnancet 1 .1 / \ 1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH TNE CITY OF EAGAN INCLUDE 2 SETS OF PLANS 3 CERTIFICATES OF SURVEY 1 SET OF ENERGY CALCULATIONS To Be Used For:Sl ily LC 4?AmlLL/? Valuation: `?j(o,COO.g2 Date: Site Address: ' /(4j(,?OFFICE USE ONLY Lot: ? Block L Sect/Sub '5?40 CLA%rect ? Occupancy 4- P1 Remodel Zoning Parcel Ik 4 70S O - ? j Repair Type of Const Enlarge ll of Stories Owner Move Length Demolish Depth Address Grade Sq Ft City/Zip Code Phone APPROVALS Contractor E*I4WC 1S)C-2Cvq ODA\C-3.T,1Assessments Permit S 12Ji 4G 55 Water/Sewer Surcharge ]. L Address Police Plan Review ?--A?? C ??« Fire SAC l ity/Zip Code Engr Water Conn Planner Water Meter Phone 0 Council Road_Unit Bldg Of?j, ar ks Arch./Engr. APC reatment P1 Variance Address TOTAL City/Zip Code R-3 IZ -1 1Z 93 lt? o? ?iOI • E97 - 10 150.50 52 5 00 , - p5 m 132.% Phone 1l 'L¢ x f?8 ? qi2x ?q- ' 4-?z4g ?. ? 1845 ZO x 22- 4lv x l? - 4g9 0 55?33 "18C?1 DeerN;ll. : ? . . ?? Fpr: ?iERITAGE ENERGY HOMES, INC. NOTE: O Denotes Wooden Stake Proposed Garage Floor E1.=905,1 (404.8) Denotes Proposed Finished Ground E1. -r-- Denotes Direction Of Surface Drainage Vertical Datum - N.G.V.D. 1929 ? ?4 Q ? (v ?yo3. 3.??Se? ?9., f'V!'^'? ? C/ ?? .Dr°'n°9? l`? ? _' Y/IO ??/? '?, ? ?' ?'`' `?=? ??oQ??3 N? ????? C. R. WINDEN d?SSOCIATES, INC. IAND SURVEYORS T?l 645-36?6 1?81 EUSTIS SL, 5T. PAUL? MINN. 5610• ??+..,?..:.:t:.»._..?._...._: - Y,,.. ,_ Scale: 1"=30' a Denotes Iron ' Monument Bearings Are Assumed ?D ? ? ?, ? -o ? ? op ? ? ?, o ? ? i? $ 4,? ?. ?Q ? \ \°/ ?:? ? ? ? ? N ,? ? ?? ???0 ?/ '•. ?? \ D ?o; , ?o?s/ ? '?'(90?.68) ?9 \ .? . .? Lot 5, Block 1, SUN CLIFF FOURTH ADDITION, Dakota County, Minnesota. wE MERE6Y CEN11fY TMAT TMIS IS A TRUE AND CORRECT REPqESENTATION OF A SURVEV OF TME ?OUNDARIES OF TME IAND AlOYE OESCRIlE? AND OF 1KE IOCATION OF All lUIIDINGS, If ANY, TMEREON, ANO ALl V?S16LE ENCiOACMMENTS. If ANY, fROM ON ON SAID IAND ' C, R WINDEN 6 ASSOC?AiES, INC Do?ad ih???dar o! i?ur7E A D IiES '``:?':.? . ;'?y0/i..??i,. br Sur.?yo?. M?nn?wio Rap?srro??on No 77iF EpSe'?en? ? 1 e°'?1 ? ?? ? r9?°?Os ?o? ??a ? ? I!` ?? r. ?? ?'v'. u?? ??? `r. , ? ? ., cl ?$ ?. ??? ay ?..,. i ? . •? ? ??; ` .. ? 'f??D°??? \ ?/ ?? ? . .?6? ?v ao ??j??? ?o \?O ?; ? .? . p"• BlCTBRIOR BNVELOPS AVERAGE •U' EOMPUTATION OWNERt = .- -, SITE ADDRESS: ? - CONTRACTORs DATE: e)I`?1-. --- I. Design Cons-deration: SBC 6006(c)2 Totsl exposed wall;,aiea: ?•.?j ?j?,.-7'' X , ? ` . /Y? o?r2-nr?-y AREAu SQ• FT• X 'U' CALC. 'U" ? Windowa .AIQ-, -- -? - ?U.$ ? Doora Siiding Glass noor I °% Wall Framing Area (avg) I?.G . oE) Net Wall Area --- ? 14-01 Rim Joist Area ,044 Total Net Fouadation Tota1 calanlatea •v• isr LO5+& L 2G<,q7 : , OIL , Since the total calculated 'U° is le ss than the•design qualification required, we have met the intent of SBC 6006(c)2. • II. Design Considerations SBC 6006(c)1 Total roof and ceiling areas iol X ARBAS $Q. FT. X "U" • ???CAI.C. 'U' ; 10% . Framing Area_ (avg) A 'q ---- ' Net Insulation Areas I(o, a TOt81 C61CU18ted • U" 18" I fj. (o? ?- Z S•?' Since the total calculated 'U• is lesa than the deaign .'• vIL qualification required, ae have met the intent of SBC 6006(c)1 ?>. ?i?1PLiNc? / - .?= . _ IIJT_AiV---- , Cab _. - --- - - --??lT A?IL ---- ? ?' a.]t. & Siding .45 c,:"r,p, ?.8. ?. ' - -- - .. ? - • - - -?`?` - 2x4 s?ua " 3?r? Ins. I'J,o _ ____---- - -q•?`'- - '°5?4 R,r?pJC Shtg. (,•O. - - -- - _- -----_---?-?? --?• -- - -?,.a - --- -- __-- Sidin? `$idinp • --- - = - - .71 -- - --- - - -- ---' - --- - - - , ? -? - Ext. Air Ext. Air ' - Total nR„ ' T,tai "R" • ? l/g 1/R . "Ii° . - - -...?. : , .. TSRU CEILING Int. Air ?. ? THRU CEILaNG ? MDEBEa S.R. nasvLnT?cK ' C1P,. Member 4 ? Ine. 44, to Still Air ' .?I . Tntal "R" . 1/R . "U" .pl°I(o ' - 1 .., 1iiM CCNC. BIIC. Int. Air C.S. {i2^) . .. Q"a?IDBR--(LIns. (Opt.) Ezt. Air S,R. (Opt.) - Sidinlz (Opt.) - ?-• .'? Totel "R" . ' ?d 53 ?. . i ..?'.. ? ... 1IR . ,tUiv e -o9S ? s • . • . .s:'. I . ? ? j Int. Ait . . . Lob S.R. , S(O Ina. ' SD a Still Air Total "8" ' 61. vS 1/R . "Li" _ , p!9 THI31 RIM J?ST • Int. Air 3J -- - '.? , ins, ----- - ?'?.? --- A" fl-)od - ' --- 3?4P-1'1-6X'T'Eg' (,o.o Sidin{" Ext. Air ?-? 2-ital "x" - l/R . "U" ,? , a? 1. ' 2/84 1 CIT Y OP EAGr,N 7 APPLICATION FOR PER:tiIIT SEIdER AND/OR WATER CONNECTZODi (PLEASE PRINT) 1) PF.OPERTY ACDRESS: D w r??-Ar / f 4' / TFsaL D.SCRIP'?'ICV: C?loc.lE' / ,ScitLi??"-? Y1?? (LccBlock/Si:: divisicn or Ta.t Parcel I.D. Nt,.:?,-?er) AW4 ' ?' _^..•;Z?':'=:G S'L'DS:CTT;'cE , DlT' 0F CP?Gulai., u;IL^•L"? ISS.;;-\G._ pors= ?.•?.?•F;?p?OPOv? C'S: XR-1 Sy:GL° FPMSLY . ? R-Z DL?i= MNO L^]ITS) ? R-3 :C:'vrvTCg ('!'I?:.°.? - L':I';S) ( IIlqI.,.G) ? r-4 ?,?:..=:?'TM?:T/CC_7JCet?`:r?•l ( [TiT_S) I Q CCi-n1EP1C=1L,/RE^."12I?Ot= ZC:: ? "T,T.liS i."'?- T.u 2) APpi..,T_G=.:?T (PLEAJc 7Rf??i) NAi'SE: / .sL?// /1.f d il ?JICC ae vs? 71 -- ADetZess: _ {19?Z i Y?- ZX ?'Q7X ? Crz^t, s-mm, zzP: .A?_ ?&A ,? /L1.' n?c Ssi a se' , PxoNE: 3) Pu:''BE' NALME• ADDRE..S: , ? (PLEasE Fetur) M1 ir3 ra n, 0- r FOF CIiY OHIY PLJHBE ILEYSE: I Active CITL, STATE, ZIP: PHOJTE; T ?' /Lf i?1 ?•?, ,_{r'slo y? 3-KI'i n S??ti -?-~rAJ I L^ ZL 3 PLIIhtBEA LFCEYSE N?OY-dd- 9?/?l a L] Expired Record 3 l?,,,! ? art'inicial 4) OCCG'?PP]T/C!;i:IIt NAhSE: ADDRESS: CITl, STATE, ZIP• a,t pHO`E: vS'2 R S pSc's 5) INDIGITE WI-IICH PERdIT IS SEING REx?UESTID: [M C.C21.IF.CPIO:I 'Ib CITY SaER 19 C01",VECPIC:I 'Iq CITY S•7ATER ? anmZ (PI.['r'15E D?,IBE) 6) P,:DIG,?.: C.:%: . ??T-= 1SE E?OLD rIPPP,OVID PEPYIT FOR PICK-UP BY CN7E OF ABCUE l(1 rT_E=+SE h:alL APPRpvED PF-m.•LIT 'P'J 1, 2, 3,G4).AB(NE , q „ (Circle one) 71 SIc;TL'RE: Ir 4-a Ar?.? DATE: !Ve Ma<??m r a A F 0 R PER`4IT °- ZSSUED I TY U S E ON:,Y rrE?S : $ ? JL' S? . $- $ $ . $ 'S _ l; o G $ $ S $ $ $ a ie ra ?:a?+syt? ? ar: s sa?sar . WATER PEi211IT (Ir:Ci.IID° SuRC:?ARGB) WATER METER/COPPERHORN/OUTSID= REi,DcR WATER TAP (INCLL'DE CCRPORATION STOP) SE:dr,R TAP ACCOliNT DF.POSIT - S'7ATrR wac SaC . ,_,,,,,..,`?,.u:z N.,?.1.. ,?- - _•?,...,w„r_-_•„?n,.. ., . -.,._.., TRliVK WAT°R ASSLSS:?ET j? - • TRC;NK SEiaER ASSESS:iENiT LATEP.AL BE?iEFZT/TRUNK SE;?EF, LATER1L BENEFIT/TRU.:K ;'7ATED WATER TR$ATMENT PLANT SURCHARGE ,s ' /??i' . OTHER:" TOTAL Ai".OL'NT PAID/RECEI2T n W?4_-- DOES UTSLZTY CONNECTION REQUIRE EXC.aVATION IN PUBLIC RIGi-IT OF WAY? ? YES ZF YES, THEN n"PERh1IT FOR W0RK WITHIN PUBLIC ROADSdAY" MOST BE ISSUED BY TY.E NO ENGINEERING DIVISION. LIST AS A CONDI- J? TION. SUEJECT TO THE FOLLOSJNG CONDITIONS: APPROVED BY; TITLE: DAT_°: ON o'a GaAM Mmsm RESIDENTIAL BUILDING L?a38 3 Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 $157 q;?S_ New ConsWCtion Reauiremen5 RemadeUReoair Reouiremenls Offce Use Onlv 3 registered site surveys showing sq ft, of lot, sq. ft. of house; and all roofed areas 2 copies W plan _ Cert of Survey Reod (20% maximum lot coverage allowed) 1 set of Energy Calculetions for healed addidons _ Tree Pres Plan Recd 2 coµes of plan showing beam 8 window sizes; poured found design, etc. 1 site survey for addi6ons & decks Tree Pres Not Reqd 1 set of Eneigy Calculatrons Addition - indkate 'rfon-sife sepfic system _ On-site Septic System 3 copies of Tree P2servatwn Phen it lot plaRed after 711193 Rim Joist Detail Options selection sheet (bldgs with 3 or less unAs Date 10 / S / Q _-) Constructlon Cost OaD - Site Address ?? ? Dwh(ji3 ( u lj UniUSte # d ,J Z Description of Work ? SP Ll SOVI r?( A 4'l ? tivn (1 ii(,? h bk ,) , Multi-Family Bldg _ Y^ N Fireplace(s) _ 0 _ 1 _ 2 Properry Owner (1.YUQ,J tu?? Fu 1 u_) Telephone #( ) Contractor ? Q YVl O S? uo 61 S i Address LS(() bft pl(1 o k.? ? S City twal)II(j)(Ind State MVI Zip &SI 1 -1 Telephone # ((p!? ) -1 -1 b - 2 3 (o ? COMPLETE THIS AREA ONLY IF Energy Code Category - Minnesota Rules 7670 Cateeorv 1 • Residential Ventilation Category 1 Worksheet (J submission type) Submitted • Energy Envelope Calculations Submitted Licensed Plumber Mechanical Contractor Sewer/Water Contractor I hereby apply for a Residential Building Pernut and acknowledge that t* inform11%fi::1s complete and accurate; that the work will be in conformance with the ordinances and codes of t?i'0' CiS3c-o??ag d'fihe State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval ofplans. n A NEW BUILDING Minnesota Rules 7672 • New Enargy Code Wodcsheet Submitted Telephone #( Telephone #( Nr? ?1 L(UA ' Applicant's Printed Name Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of_plex ? 09 07-plex ? 17 Garage / 22 Porch/Addn, (4-sea.) ? 04 02-plex ? 10 08-plex X 18 Deck ? 23 Porch (screenlgazebo) ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Pibg_Y or _ N ? 25 Miscellaneous Work Types ? 31 New ? 35 X32 Addition ? 36 ? 33 Akeration ? 37 ? 34 Replacement Valuation R060 Census Code d/ 3?[ SAC Units ? Nbr. of Units - Nbr. of Bldgs ^ Type of Const ? Int Improvement ? 38 Demolish (Interior) ? 44 Siding Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors •Demolition (Entire Bidg) - Give PCA handout to applicant Occupancy Zoning Stories Sq. Ft. Length W idth Footings(new bldg) ? Footings(deck) _ Footings (addifion) _ Foundaaon _ Drain Tile Roof Ice & Water Final ? Framing _ Fireplace _ R.I. _ Au Test _ Final _ Insulation 4 av -1:14 ey. I MC/ES System ?-- City Water ` Booster Pump -^ PRV ? Fire Sprinklered REQUIREA INSPECTIONS FinaUC.O. ? FinaUNo C.O. _ Plumbing HVAC Other _ Pool ? Ftgs _ Air/Gas Tests _ Final _ Siding Stucco Stone _ Windows (new/ieplacement) ? _ Retaining Wall Approved By ' .? ? 30 Accessory Bldg ? 31 Eut. Alt - Multi ? 33 6ct. Alt - SF ? 36 Multi Misc. Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility ConnecYion Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total / ,5.3 i? lYo 17 3303,?,? ? W? bit cr. /toT g" ?? ?' GL-,YJ= ?? ?,?......?, ._. w _..? . ..: ..: . . ....... .. • ' ? • • ? ? For: iiERITAGE ENERGY HOMES, INC. NOTE: ' O Denotes Wooden Stake Proposed Garage Floor E1.=905.1 (464.8) Denotes Proposed Finished Ground E1. ?- Denotes Direction Of Surface Drainage Veztical Datum - N.G.V.D. 1929 N 1.4 . lJ ? C. R. WINDEN 3, ASSOCIATES, INC. IAND SURVEYORS iol 945-3646 1781 EUSTIS ST., $i. ?AUI, MINN. 66109 ??..-..:.:?.......,-.... _ . ... - SCHle: 1"=30' s Denotes Iron Monument Bearings Are Assumed C9p3 sd? 3.2p ? ? C` ? EQSe?en? ? 1 ???1 E ,07? ?- l9o0 s ?p r'?qo i ? F- vz? F f .pr°ln?g N ?5?a ? c &0o i ID ? ? -o R 4.1 o- ? ?861 Dee?N;fl. . , \v i ? J??? ZA? . / fFs ?` fl \ s q ?, /? /-GO r2ivs 13.vcx ro rr?oY o . ? N •? ,, 06; • ? a?,? ?? io' s,:r?,,? ? ?,? ?, ? ?? ? qo ? ? {. . 3 • ?. \??''• s ? ?'(9oi.68) "?9 \ ,,.. Lot 5, Block 1, SUN CLIFF FOURTH ADDITION, Dakota County, Minnesota. WE MERE6Y CENTIfY TNAi THIS IS A TRUE AND CORREC! REiRESENtATION OF A SUNVEY Of TME IOUNDARIES OF THE IAND A60vE DFSCRilED ANO OF iME IOCATION OF All 6UIl01NGS. If ANT, TMEREON, AND All VIS16LE ENC4OACMMEN7S. If ANY, FROM OR ON SAiD IAND Dotad tAn;17tp doi ofJunE A.D. IVBS C R wiNDEN 3 ASSOCIAiES, INC br , !y..r ,?• j,?'!?1 ?1,. Svrwro,, M.nne.oto Rapt.votion No 772F ?----------------- ? Pertnit#: V j ? 4. LZ) I ? PertndFee: ? s I ? DateReceived: 'b ? ? I 1 StaffI I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Tenant: Site Address: Suite #: RESIDENT / OWNER Name: Phone: Address / City / Zip: Applirant is: _ Owner ? Contractor TYPE OF WORK Description of work: 1'tL ? Construction Cost: --z ?0G ? Multi-Family Building: (Yes _ / No ? Ng CONTRACTOR License#: Name: Address: ?4'7 City: State: Zip: ? iPh :64?( iZ?J "1+7 c aA ek 7 Iu`4Z C Q Urti?k`xi t tP . erson: on ac - one COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted (4 submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a pertnit 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 thet you submit are c,onsidered to be pu6lic informafion. Portions of the informationmay be Gassirled as-non-public ifyou prouide.specrfic''reasons that would permrt the City,,to conclude that the" are trade secrets. ` ` I hereby acknowledge that this information is complete and accurate; that the work will be in confortnance with the ordinances and codes of the City of is not to s without a permit, that the work will be in Eagan; that I understand this is not a permit, but only an application for a permit, ant accordance with the approved plan in the case of work which requires a review and apppla . X 1?,v1A ?-.S0?hS0?l?' X - rinted Name ApplicanPs ' re ApplicanYs P Page 1 of 3 I Far Qfi"c'e:llge - --- - ? Permit#: ? i Pertnit Fee: I ? Date Received: ? I ? ? Staff: I I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Y, i3-Od?' Site Tenant: Suite #: RESIDENT/OWNER Name: \;l?.,- ?nL1TO,4 Phone:&5i)35;7e Address I City / Zip: SRmE Applicant is: _ Owner _ Contrador TYPE OF WORK Description of work: E96011f- Construction Cost: S; ecv• Multi-Famity Building: (Yes _/ No X-) CONTRACTOR Name: Op foP License#: o?De--P /Xe- 7r'8 Address: 369? LK City: 14USt-? ?,?. State:07'v Zip: S60f?5 Phone: (763?a?3-?7d'S ContactPerson: ` JsayE COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Venfilation Category t Worksheet • New Energy Code Worksheet Category Submitted Submitted (4 submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a pertnit 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 8 Water Contractor: Phone: NOTE: Plans and supporting docuinents that you`sutirnit are conside"red to be public infonmation.; PoRions;of = the mformatron"may 6e classired as non public ?f you; provide specrfrc reasons tfiat would permrt the Crfy to, •conclude'that the are trade secrets - I hereby acknowledge that this information is complete and accurate; that the work will be in confortnance 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- t 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 fplans ? x 1111-142 ??Cif?.6 /LT x Applican£s Printed Name ApplicanY ignature Page 1 of 3 :.a ? -W &/I b7f-,_C.L 4V City of Eapn 383p pflot Knob Rosd Eapen MN 55722 `l PhOne: (851) 675-S?il?3 Fax: (651) 6755694 -----------------, i rermn Fce: i i (? i ? 08te FlscaryBtl' _../--??? [-.? ? i 1 ? i Stan' i ?----------------? 2008 RES{DENTIAL BUILDiNC?'i PERMIT APPLICATION Dl6s: 4~ Q SmAddINl:? !$ 61 ?.r , ? J) '?"l^ r/ T9110M` ?o ?n SulES i' .? 3s7'7 RE9IDENT/OWNER rN:8MWLk4_?_% fn Phoe: I reAs lChY??`_?gb ? ?rfi ?-?IU ??4 /?'?F-prs AppNcant is- - Ormer X. Car+tracta TypE pF WORK CONTRACTOR D¢scription of vtOW: 0 Y? e W 1 P Conetruction Cqst: Name: L.Ci pr , Addte68: Gty; ?t k Phone: 6111, Mulil-Family BUlltlinp: (Yes -1 No Licerse s' State: Contact Person: CpIY1pLETE TH13i AREA ONLY IF CONSTR TIN A!!W BUILDING 7fi7 ? t at t T Minnesota Ruigs ? F,brey code wo?et Er,syy Cads . rmsi mrm v?uaaw c.tea?r , worwneet •? suo nroa . F„e envaopo calcWafione samnittee (+? auMnieabn hPe) "?' In Ma hst 12 monllw, hss tno CItY of E?n Wusd e pemdt lor a simibr plsn b**ed on a mustx plan7 -ves _NO If yes, date and addreqs d master qlan: Phone: Licenwd Pknvdsr. Phorre: AAsC11PMCe1 ConLectw. Sawer & Watar Conftactcr: Phoiro: pn dllpNoftq UMf wawpCfmn fIN Coto ? nerebr aoknnwled?e n?at mb mrarmetion Is ? eaCUrale; thet ?? ???? ??°?; wprk vn ?b6 m Eegarr d?at 1 iederMaM this k not a pemitl. duY ePP?^ ror . ....... .........en .a,., x? nh.. .,?en ,wo,k wMcn raq?ea s?. ano eAwoval of d?s. L0 J3]Cd NOS213IM 9Id60 6Z09L94Z96 SS:OZ 800ZlLi/69 Zz9ST9b2S6 4b? Clty of Eapn 3830 Pilot Knob Road Eagan MN 55122 Phone:(651) 675-5675 Fax:(651'675-5694 ------------i I For Office Use ? Pertnit # I Permit Fee ? ? Date Recerved: I ? I Staff. I ------------------ 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: '1n° 9 ' 6'97 5ite Address: IeF< Tenant: Suite #: Phone: C?oS1)(p9$-3578' ?? RESIDENTIOWNER -?s Name:? Address / City ! Zip: SA-m e Applicant is: _ Owner ? Contractor TYPE OF WORK Description ofwork: fSESiOE Construction Cost: 67U?' ? Multi-Family 8uilding: (Yes No Xi CONTRACTOR r ? . V? T--O10 Licensetl: Name: - Address:,36,f 5 LSpI 671 IC1J ? State: 'Vp'/nd Zip. ol?- ? City: _(/ PhoneCio/1 Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Cateqory 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted (4 submission type) • Energy Envelope Calculations Submitted In the last 72 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 8 Water Contractor: Phone: NOTE: PJans and supporting documenfs that you submit are considered to be public information. Portions of the information may be classifred as non-public if you provide specific reasons that would permit the City to . conc/ude thaf the are trade secrets. I hereby acknowledge that this information is complete and accurate; that the work will be inconformance with the ordinances and codes of lhe Ciry of Eagan; that I understand this is not a permit, but only an appliration tor a permit, and work is not to start without a pertnit; that Ihe work will be in accordance with the approved plan in the case of work which requires a review and approval of plans x X ApplicanPs Printed Name ApplicanYs Signature Page 1 of 3 3203584631 Feb 20 09 -10:22a Up Top Construction, Inc. Mrv Liceose I.D. 920218698 14.4K 3203584631 p.1 T N?11 MiV Tnr i Tl ildt_169lA/.9 S.J' JL .ll L7JL CO1 iSTY.A???Ilk-'3011 ;9 INC• Fax Cover Sheet Date: ? o?D v ?j , Number of pages: ? ? T'O: lFr'.4lcG. Allai/44 9 ui! ?. Re: ???m ? r Comments: /_2-?o= ?!<' 777'? f'i: ???2 ?Di? a.P ??'?'/7 ! j_ -?' EiqG' ?S ??` ?'. r/Z9 r? zQfn An?VTIY /n% 6j' 1_2,.5 t= T _ / H?%K o?,? ? Fax Number: 320-358-4631 Office Number: 763-422-8785 Feb 20 09 1022a Up Top Construction, Inc. 3203584631 p.2 MN Licenae I.D. #20218698 MN 7ax LD. #41-1926969 U'P TOP CON5TR1[?CTION, INC, Date: Februarp 20th, 2009 To: City of Eagan (Craig Novaczyk) From: Up Top Coastruction, Inc. Re: James and Kathy Funston 1861 Deerhills Trail Eagan, MN. 55112 Permit #EA085928 Dear Craig, This letter is to infonn you that the J- channel was blind caulked at be address listed above for the reason that the window trim and the J- channel wrere flush with eacli other making it difficult to caulk effectivfey as well as athstetically. Please call with any questions or concems. Sincerely, Davtd J. Archambault President (6I2)919-7940 3685 Rush Lake Road - Rush Cicy, MN 55069 OfFice (163) 422-8785 - Fex (320) 358-4631 Feb 20 09 10:22a Up Top Construction, Inc. 3203584631 p.3 CITY OF EAGAN DEPARTIUIENT OF BUILDING INSPECI°IONS Correction Notice wnen corrections n `5 for inspection. DO NOT REMOVE THIS TAG ICP Z-3oa2g I have inspected this structure and these prernises and have found the folfowing violations of city codes: Date,_ ?- I ? 1 G' Telephone # 651-675-5 (,t, 8-3 Inspector ,rA)e #/51 67.? ,? 9-/ Use BLUE or BLACK Ink y _F _ _ - - _ - - - - I or Office Use I I City of Ea Ed n ~ Permit ~[d ~yL1 I Permit Fee: I . I 3830 Pilot Knob Road Eagan MN 55122 i Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: I I ' ' I ( Site Address: r 11 J ✓ A) 155/77- Unit I Name: k Phone: RESIDENT / I OWNER Address / City / Zip: f ObI J'D tU,P MI5 2 ~~+•n M Al 5S_72 Applicant is: S Owner Contractor TYPE OF WORK Description of work: ex;5~,o l~enc~ tiOJ t5VA RVVM ~V I Construction Cost:, Multi-Family Building: (Yes -/No Company: Saar.,; us, L LC- Contact: 7j~ I , 12 L,,AA a CONTRACTOR Address: ZO Z 4S t -'C City: 1~JIL~~na w. State: A ~J Zip: 5 yU ~o Phone: q-65-7w6 '0-7 Ddb License 6 Z 1 Lead Certificate 503 5! -10 If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of 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 48 hours before you intend to dig to receive locates of underground utilities. wwvv.gopherstateonecali.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 nn , ota State ' ing Code must be completed within 180 days of permit issuance. x ~ILt , 1 1' n Ley' x Applicant's Prin d Name Ap is Signa tuw~ Page 1 of 3 l j\ DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation Fireplace _ Porch (3-Season) _ Storm Damage Single Family _ Garage Porch (4-Season) _ Exterior Alteration (Single Family) Multi _ Deck ` Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of Plex _ Lower Level Pool _ Miscellaneous Accessory Building WORK TYPES r 3 t New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior _ Alteration _ Fire Repair _ Windows _ Demolish Foundation ~C Repla _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation 0 Occupancy MCES System Plan Review Code Edition) SAC Units (25%~ 100%.Xj Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No G.O. Required 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 r Backfill Final Sheathing Radon Control Sheetrock Erosion Control Reviewed By: , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC iiiYYYIII «1 6 6 t - i V City SAC ~ _ Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies F TOTAL Page 2 of 3 • • C. R, •WINDEN & ASSOCIATES, INC. LAND SURVIVORS Tek 646-3046 1391 EUSTIS St. $7. PAUL, MINN. 561011 For: -HERITAGE ENERGY HOMES, INC. ~Q NOTE ` o Denotes Wooden Stake Scale: 11=301 Proposed Garage Floor El.=1705.1 0 Denotes Iron 064.6) Denotes Proposed Monument Finished Ground El. Bearings Are Assumed Denotes Direction Of Surface Drainage f 1 Vertical Datum - N . G. V. D. 1929Qsern~~' t1 fn4!7 04 j IV No S97-5) 10 ~ b 1 ~ ~ j=Go 7`drHs j{ACk To s~Y o~ $ 61 Our (90).68) Lot 5, Block 1, SUN CLIFF FOURTH ADDITION, Dakota County, Minnesota. WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF All BUILDINGS, IF ANY, THEREON, AND ALL VISIBLE ENCROACHMENTS. IF ANY, FROM OR ON SAID LAND Dotal this ~~7tp~riay of~dddr7E A.D- 1985 C. R WINDEN ASSOCIATES, INC by Surveyor, M.nn.soto Registration No .779C n> I----------------- For Office Use I Permit 7 I City of Ea / Permit Fee: !1~ ® 1 3830 Pilot Knob Road RECEIVED I 1 Eagan MN 55122 I Date Received: 1 Phone: (651) 675-5675 JAN 2 7 2012 1 Staff: 1 Fax: (651) 675-5694 1 I 2012 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: ` /I -A Z Site Address: 1R(o ~)ec r ~~S ~~L FrY'a(~f 1 ( Tenant: Suite # RESIDENT/OWNER Name: ~~IA316If1~ Phone: L-01~t'~ rv._ Address / City / Zip: 1 lDL Name:--AppiiancelnStallars of MN, Inc. License Address: 14105 Rutgers St. NE CONTRACTOR rl®r Lake, City: MN 55372 11 State: Zip: Phone: (15"2 - H Dq" ~?)01 t _ Contact: Email: O I a TYPE OF WORK - New Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: r Q RESIDENTIAL Water Heater Water Softener I Lawn Irrigation RPZ / _ PVB) PERMIT TYPE Septic System Add Plumbing Fixtures Main / - Lower Level) Water Turnaround New % t - Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 State Surcharge) I $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $189.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) i TOTAL FEES $ Lon 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.goaherstateonecall.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 approva of lans. x x Applicant's rinted Name Applicant's Sig a ure FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final C!tyofEa�all 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 r Use BLUE or BLACK Ink For Office Use Permit #: 119-753 Permit Fee: 105 Q5. Date Received: 041 1 71 L3 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: / Z 10/13 Site Address: // G / ,e'erf �;11 s I � sc Unit #: Residen Ovlfn@t' ,... Name: 'I -a ¢ S F V !4 S 46 r` Phone: S-6T Address / City / Zip: 2 D 6 / \ ) IA i 1 I S I rkl Applicant is: Owner Contractor 1"ype of Works Description of work: P6C12 fm-,- ZConstruction ConstructionCost: 7w Multi -Family Building: (Yes./ No ) COntractOr 7,2 Contact: .d.> -7,2-//41:- Company: U, �� Address: Address: .7e,S1:2US 1- L4 46- / City: S 2 c,./7z,/),/ State: ./e/A/ Zip:. 0 G f Phone: ' 5— V2z �r7 g-5 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 nor► public rf you provide specific reasons that would permr#the to conclude that they`erre tr de.secretsa CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in 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 pleted within 180 days of permit issuance. x Applicant's Printed ame x App icans ignature Page 1 of 3