1510 Deerwood BendAddress: 1510 Deerwood Bend Zip: 55123
Lot: 19 Block: 1 Subdivision: Woodstone Townhomes
THE FOLLOWING ITEMS WERE/WERE NOT WMPLETE AT FINAL INSPECTION OV
Yes No Comments
Final grade - 6" from siding ,f
Permanent steps - gazage ?
Permanent ste s- main ent
Permanent drivewa
Permanent as
Sod/Seeded lawn
TraiUcurb dama e
Porch
Lower level finish
Deck
Fireplace
Verify with your builder that roof test caps from the plumbing system have been removed.
Turn off water supply to the outside lawn faucets before freeze potenrial exists.
Call the City's Engineering Department at 651-681-4645 prior to working in right-of-way or installing
irrigation system.
IIUILDINGINSPF,CTOR ]acd/bldginsp/Fortns/2002/finalinspecdon checklist
(6 59 7 s'1
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
,P ?? ?
a_&LL1JQ_
4ay
New Constmdion Reouirements
RemodellReoair Reouirements _._._..... __..
_
Office Use O?Fd
3 registered site surveys showing sq. ft. of lot, sq. fl. o( house; and ail roofed areas 2 copies of plan CM&Stm'eY?Recd '?Y -11
(20% maximum lot coverege allowed) 1 set of Energy Caiculalions for heated addilions 7AT'1025 PI9f.itiOCtt _Y _N..
2 mpies of plan shaxing beam & window sizes; poured found design, etc. 1 site survey for adcfitions & decks Ir88Pre5Raqurced t;Y N
iselofEnergyCalculations Add'Aion - indcate'rfon-sitesepticsystem DirSileSeptic5yslem ..`.Y_N
3 copies of Tree PreservaGon Plan if lot platted aHer 7/1/93
Rim Joist Detaii Options selection sheet (bldgs with 3 or less unils
Date Constructiou Cost
SiteAddress Unit/Ste #
GA Y. ? S/.
Description of Work
?g[n
6[
ed4? ?ru,ro in
_
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Multi-Family Bldg _ Y ?N Fireplace(s) 0 _ 1 _ 2
n
PropertyOwner <•?-[ nB ?z, 4r (,? -?-
nre(' ?Ohnrm
Telephoae#(fpS'1 ) 71(0 -00577
ContraMOr BCtsittl Z QA sq
Address 9-Dv/ ?4 Ae 4z City /19.nn e: ,ovit'i
State Zip_?S Telephone#((Piz ) 3v; -4C36'1
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Su6mitted
Have you previously constructed a building in Eagan with a similar plan?
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Y_ N If so, 25% plan review
Telephone
Telephone
Telephone
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
&a.e / LE
Applicant's Printed ame
%
Applicant's 'gnature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext.Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-piex Cy 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg'6Yor_N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 36 Demolish Interior ? 44 Siding
? 32 Addition 0 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
4 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg) -Give PCA handout to applicant
Vatuation Occupancy MCES System-' .
Census Code Zoning ? City Water •-,
SAC Units ? Stories Bobster Pump
# of Units d Sq. Ft. PRV
# of Bldgs ? Length Fire Sprinklered
Type of Const -611%1 Width
REQUII2ED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) ;[ FinaVNo C.O.
Footings (addition) JY Plumbing
Foundation ? HVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final
? graNing _ Siding _ Stucco _ Stone _ Brick
Air Tes[
R.I.
Fireplace _ Final _ Windows
_
_
? Insulation _ Retaimn5 Wafl
Approved By: 'S f r a 3 0y, Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
b iv? 1 IC)
2004 RESIDENTIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
?O•SZ)
Date --6- l-:22-- I C"'"f DF?P P2w p?
Site Street Address ???n C? Unit #
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Pro ertOwner
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Telephone #
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Contractor Telephone # ( )
Address City State Zip
The Applicant is: -klowner _ Contractor _Other
Aiterations to existing dweliing $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnarou (add $121.00 if a 5/8" meter is required) LL
Other:
Water Softener _ Water Heater $ 15.00
_ replacement _ additional
_ Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ 50
Totai $
"L.?
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete
and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will e'n accordance with the approved plan in
the ev nt a plan is required to be reviewed and appro
Applic nt rinted Name r- i '
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OP L''C}U1Y.
Steel
#6 0 16."
? Edge F
and Back
60 i/,,2
lote:
1. Top Lateral Support is
Provided Prior To Backfilling
2. Provide Perimeier Drain Ai.
Back of 1Vall• 4° Perforated
Tile Witla Fabric Wrap
3. Grout All Cores
4. Min. 24" Lap Length All
Bars
5. F'm = 1500. psi, 12"
Blocks
S, Fs = 60 ksi
7. F'c = 4,000 psi
8. Grout: 4,000 psi
Section A-A
$CALE: NONE
.05;03/02 08:22 FA% 6128927900 MW JOHNSON CONST _UCTION
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13., r1-?" t. r I w ?DENTIai ?3 ? ?
?°r??'S 6 ? ? BUILDINC PERMIT APPLICATION ?a . s a
P P W ao cQ- CITY OF EAGAN
3830 PILOT KNOB RD - 55122 -4 53
651-881-4675
New Conatruction ReauiremeMS RemodeVRenalr ReauiremeMS C.( /
• 3 registered sile surveys showiig sq. R. of IM, sq. R. M house; and all roofed areas • 2 copies of plan ?0
(20%maxMum lot coversge allowed) 1 set of Energy Calculafions forheated additions .? Z?
• 2 copies of plan showing beam 8 window s¢es; poured found desgn, etc.) ?. 1 stte survey forexterioraddilions & decks
• 7 set of Ene`gy Calculations . IndicaGe'rf Iame served by seplic syslem for additbre /U
• 3 capies ot Tree Preservatlon Plan H bt qatled aNer 711/93
• Run Jolst DefeY Optiore selectlon sheet (Wdgs wilh 3 or less unils) (. Y-?
DATE V/ALUATION
JOB SITE ADDRESS 1,51ZO
IF MULTI-FAMILY BUILDING, HOW MANY UNITS? -
PROPERTY OWN
TYPE OF WORK 1017?9-/ /'e2)1 ?
APPLICANT ?zt"' ?JIJ x /I
ADDRESS
PAGER # CELL PHONE #
FIREPLACE(S) 0 _ 1 _ 2
_ PHONE#
' I?W ZIPCODE=??,?`
_ Fax # 2!i?-?9,?-
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMP M
Energy Code Category ? MINNESOTA RULES 7670 CAT'EGORY 1 O?? u?
(check one) - Residential Ventilation Category 1 Worksheet Sub d MpR 14 2002.
- Energy Envelope Calculations Submitted
_ MINNESOTA RULES 7672 By? S
, - New Energy Code Worksheet Submitted
Plumbing Contractor. ?/ p/I?)ZZ _Ik6l
Phone #:
Plumbing Syscem Includes: Water Softener /f/a I,awn Sprinkler Fee: $90.00
L Waler Healer / No. of R.I. Baths
.? No. of Baths
t- 04,
10
MechanicalContractor. ? ?7l '4 a,
Phone#
Mechanical System Includes: o Air Condilioning Fee: $70.00
Y AtO ?l ?-
Sewer/Water Contractor:
Phone #
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have repd this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan /Ouli7 ces.
Signature of Apptlcant \_ An ?
?//'
Cert?cates of Survey Received ? Tree Preservation Plan Receird _ Not Req red
Updated 2002
OFFICE USE ONLY
? Ot Foundation
? 02 SF Dwelling
;,k? 03 01 of 2 plex
? 04 02-plex
? 05 03-plex
O 06 04-plex
? 07 05-ptex ? 13 16-plex
? 08 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ,6? 18 Deck
? 11 10-plex ? 19 LowerLevel
? 12 12-plex Plbg_Y ar _ N
? 20 Pool
? 21 Porch (3-sea.)
? 22 Porch/Addn.(4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscelianeous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
O 36 Multi
g 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
z
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation /;Lp? Occupancy 9-3 MC/ES System
Census Code loA Zoning r' 0 City Water
SAC Units a/ Stories o9- Booster Pump
Nbr. of Units d/ Sq. Ft. P,05O PRV
Nbr. of Bldgs o/ Length 50 Fire Sprinklered
Type of Const ? W idth t?*' d
REQUIRED INSPECTIONS
? Footings(new bldg) ? FinaUC.O.
? Footings (deck) _ FinallNo C.O.
Footings (addition) _ Plumbing
Foundation _ HVAC
?
Drain Tile Other
Roof Ice & Water Final Pool Ftgs _ Air/Gas Tests _ Final
? Framing _ Siding ,?V Stucco Stone
Fireplace _ R.I. _ Air Test _ Final _ Windows (newlreplacement)
.? Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
? l
UltlI=,N,r,,ia ?3S,•?f C' /0
l? fL
90/ PC`' 6y ?-
Building Inspector
---- 9 8 ?6 ?-
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4i8n
?f $ G54 '
ToWI
MNcheck COMPLIANCE REPORT i
Minnesota Enerqy Code I Permit #
MNcheck Software Version 3.0 I
I
? Checked by/Date
I
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 3-6-2002
DATE OF PLANS: 03-06-02
INFORMATI
ot 19
ne
Eagan
OMPANY INFORMATION:
MW Johnson Construction, Inc.
17645 Juniper Path Suite 100
Lakeville, MN 55094
COMPLIANCE: PASSES
Reauired UA = 435
Your Home = 358
17.7% Better Than Code
Area or CavitY Cont. Glazinq/Door
Perimeter R-Valu e R-Value
----
- U-Value
---------- UA
----
-----------------------------------------
CEILINGS 1800 -------
44.0 -
--
0.0 49
WALLS: Wood Frame, 16" O.C. 1116 19.0 2.0 62
WALLS: Wood Frame, 16" O.C. 1008 19.0 2.0 56
BSMT: Conc. 8.0' ht/8.0' bq/8.0' insul 992 10.0 0.0 57
GLA2ING: Windows or poors, Above Grade 246 0.480 118
GLAZING: Windows, Foundation, <= 5.6 ft2 6 0.480 3
DOORS 38 0.350 13
HVAC EQUIPMENT: Furnace, 90.0 AFUE
-------
--------
----------
------------
-----
-------------------------------------
COMPLIANCE STATEMENT: The proposed buildina desiqn described here is
consistent with the buildinq lans, cific ations, and other calculations
submitted with the permit pl' The proU?sed buildinq has been
designed to meet the re ' e n f the Min nesota E nergy Code.
Builder/Designer __ ? - ? Date0> -a -d2-
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GARAGE WALL
TYPICAL SECTION
SCALE: HONE
lote:
1. Top Lateral Support is
Provided Prior To Hackfi]ling
2, Provide Perimeter Drain Ai.
Back rai Wal1• 4" Perfarated
Tile With Fabric Wrap
3. Grout Al] Cores
4. Min. 24" Lap Length All
Bars
5. F'm = 1500. psi, 12"
Blocks
6. Fs = 60 ksi
7. r'c = 4,006 psi
8. Grout: 4,000 psi
Section A-A
SCALE: NONE
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LP PLUMBING (RESIDENTIAL)
Permit Application
City OfEagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
Date if) /-?-/0-3
Site Address I ? IC) Q A D 1Yzy yT-L (A Unit #
PropertyOwner l' h-P-.ti QQ- -?bLQ 1x-u Telephone#LO7)1
?
t
Cuntractor
\
Y,
Address City
State Zip 5? b 1 LO Telephone #(1
The Applicant is _ Owner ? Contractor _ Other
Septic System New Refur6ished Submit 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional consultant fees may apply.
Alterations To Existing Dwelling Unit, Including $ 50.00
_ Adding fixtures to lower levels or room additions, excluding water sokener and water heater
_ Abandonment of septic system
_ Water turnaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
Water softener _ Water heater D OC? 'A? ?L 2?03 $ 15.00
_ replacement jj additional
By
State Surcharge $ .50
Total
I hereby apply for a Residential Plumbing Permit and aclmowledge that the iuformation is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; 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 plaas.
Applicant's Printed Name licanYs Signature
⸿മ匊牵敶潹❲敃瑲晩捩瑡匊剕䕖⁙但⁒›睍䨠䡯华乏䕄䍓䥒䕂⁄十㨠潌獴ㄠⰹ愠摮㈠ⰰ䈠潬正ㄠ佗䑏呓乏⁅佔乗佈䕍ⱓ䌠瑩⁹景䔠条湯慄潫潴䌠畯瑮ⱹ楍湮獥瑯湯敲敳癲湩慥敳敭瑮景爠捥牯䥴奁ㄠ‰䕒❃ൄ爊✫慩湦✷眠㈠⾰湍楥眬Ⱬ㽳㤠敲㽡䝉匠⬱䘠䭇假൩䘊‧數瘬慸潥漮㥎뀰〰〧∰⁗〱〰൏伊佌⁔兓但呏䝁⁅ി㴊㌠㐬㈴午⁅兓但呄䝁⁅൯㴊ㄠ㜷‴뀭൯䰊呏䌠噏剅䝁⁅⺰‽ㄵഥ㼊⁉⁉慯正镲⁷慡⸿‿敵䭣䤠ⴠⴠ∠汭✠锢›‿㔮㔷ㄮഴ渊‿牐灯慯摥㌠⸹㌸⁉㘱吠楷潈敭倠潲潰慳佌⁔兓›但呏䝁䤊ㄠ挲搠䤯吠楷潈慭圠琠䕒⁔䅗䱌 ⰴ㔰സ䤊漠〠〠ㄠ挲搠䤯爠⁶⁷汌൬嬊弭ㅟ椠潳㝥牎ㄱ㌳㙦楦‷猱漬漠䠠䕓匠⹑䘠住䅔䕇愲ⴠㄠ㤴ല뀊䰠呏䌠噏剅䝁挊牡‿‿൨䐊潲㥰挲丠瀠䜠牡条⁰㜳ി弊彊 楥愮甿㼿㤸⸹′潎䕲愺㽮湗ൕ䤊䄠汇⁓⑃笠Ⅺ坻歱റ倊佒佐䕓⁄䱅噅呁佉华䐧ാ吊灯漠潆湵慤楴湯ⴉ朠攤Ⱞ䜊牡条汆潯뀿婔ॏ愽慳⽳慌䥲㵡慡穥慂敳敭瑮䘠潬牯㴉㜸൳䄊牰硯敓敷敓癲捩॥‽敓潮癯഼倊潲慰敳汅癥मി䔊楸瑳湩汅癥मഭ䐊慲湩条楄敲瑣潩獮㴉敄潮整晏獦瑐䌠湴䅵ഉㄊ〰伮⁖㨳‱慍桸浖匠潬≰‿敗慴䵬杮圠污敂删煥極敲Ⰺ爿属⸿⬭椠性㼠⬭‿മ㼊ി䨊㽟䨠䤠牁❡ി✊㭲Ⱝㄠ锺ⴭ爮⬿Ⱜ ⸮⸠⸮›㨮㨠㩺ി䈊久䡃䅍䭒ബ䰊潩൱䌊倮മ䔊⁉略›㜸⸵〸䍓䱁㩅ㄠ椠据〳映敥൴䠊䑅啌䑎䱐义⽎䝎䈠䝎义㙂汒䝎匠剕䉖䩙䝎〲㔰倠湬传歯䐠楲敶慅潧Ɱ䴠⁎㔵㈱ല倊潨敮›㘨ㄵ 〴ⴵ㘶〰潆㩸⠠㔶⤱㐠㔰㘭〶ശ䴊义䕓䉔䍁⁋䕒啑剉䵅久協牆湯⁴潈獵楓敤ⴠ敒牡ⴠ䜠牡条楓敤ഭ䤊䠠剅䉅⁙䕃呒䙉⁙䡔呁吠䥈⁓卉䄠吠啒⁅乁⁄佃剒䍅⁔䕒剐卅久䅔䥔乏䙏吠䕈䈠問䑎剁䕉⁓䙏吠䕈䄠佂䕖传卅剃䉉䑅倠佒䕐呒⁙十匠剕䕖䕙൏䈊⁙䕍传⁒乕䕄⁒奍䐠剉䍅⁔啓䕐噒卉佉⁎乁⁄佄卅丠吰倠剕佐呒吠൏匊佈⁗䵉剐噏䵅久協传⁒久剃䅏䡃䕍呎ⱓ䔠䍘偅⁔十匠佈䅄䕔㼠ℯ佸⁚⹏䥌䕃华⁅啎䉍剅ㄠ㌴㘷ぎഺ《刲ㄭ㤰佂䭏ഺ圊潯獤潴敮
i
Aaron Perkins 651-493-0706 p.3
Use BLUE or BLACK Ink
For O-W-meUse--------- I
I
so g(01
Permit it City of Fatah I Permit Fee: ✓
3830 Pilot Knob Road I I
Eagan MN 55122 I Date Received: 1
Phone: (661) 675.5675 1 Staff.
Fax: (651) 675-5694 1
2012 RESIDENTIAL BUILDING PERMIT!! APPLICATION
Date: 6 ~ 1 SiteAddress• 15096F10 DeeluooU lg#-nA Unit:
i
t f Name: Phone:
I RESIDENT I
1Q~ _
OWNER Address I City I Zip:
Appf'rcant is: Owner A Contractor
J • o
i-
` Description of work: Q0.'r - o Te a K d Rc - Ro ~n
TYPE OF WORK
Construction Cost Is . 66 Multi-Family Building: (Yes I No
F
I Home 19 V►i dtr Contact: Aaron- Per kipi
Company: woIndeC~ s -1=1-
Address: L i n 0A m Lars e city: ci r' a A r1 eS
CONTRACTOR
State: Zip: af Phone: :Zy--2yS - 33S501 73
License #l 83 Lead Certificate NA-F-11 93A3 -1
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? v
f' Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
I k
}
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 classed as non-public if you provide specific reasons that would permit the City to
conclude that the are trade secrets. M
CALL BEFORE YOU DIG. Call Gopher State One Call at (661) 454-0002 for protection against underground utility damage. Call 48 hours
www.
be I r
fore you intend to dg • to receive locates of underground utilities. aooherstateoneca I.oa
.
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 win be in
accordance with the approved plan in the case of work which requites a review and approval of plans.
Extedor work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x Act Ir`o pey, k i vt 5 ( P-a
x
Appti nrs Printed Name Appl' nYs Signature
Page 1 of 3
City of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r �
For Office Use
Permit #:
h5300
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
Name: / c/O (3 d6-;:/(7/LC Phone:,2c-/-72_5---g75-3---
Address / City / Zip: /SOS - /< / 0 /�-e , WOQCC Ij,G- -C------12--Z-
�_Applicant
Applicantis: Owner Contractor
Type of Work
Description of work: eii-le POh t
Construction Cost: 1 C O O Multi -Family Building: (Yes / No )
Contractor
i
Company: I i C ..,,,,i- /g r Ea ' ontact: 410i1 /Wk
Address:2S-0 0 v/C i.aCif , �f City: �(� 'OCy
/ /
State: Zip: Sri- 7 Phone: 763- 5,�0.-- ocl i-{ cjct ---7 )—
License #: 6 773 Lead Certificate #: 0 1T.5--
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 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. www.qopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of per issuance.
�c
Applj ant's Printed Name
Page 1 of 3
City of Ea�all
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
,^i n
3
Permit #: 1 . 0g
Permit Fee:
Date Received: L/ %iiih(1
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
/ lsc,�r
Name: I', / (od.� �e Phone: T 7757--0;
6'S
Address / City / Zip: 46-0---/.�l'C-) )oou',.-,C. _S-12:2—
1ZZApplicant
Applicant is: Owner 'L- Contractor
Type of Work
Description of work: fviQfi(' Re/1(7_60-S j,:;
Construction Cos /: 000 Multi -Family Buildii •: (Yes / No )
Contractor
Company: CL
. A S 6k4L -ntact: a 0 ,i,
Address:V lC-k3'(3t3�c1 `ii- ►i.J.`�''e_,�fQp 1 pf1&1L.1
State: V. i,) Zip: 4,5 1{ 7 Phone: 73 SS -0- 0
License #: J0 i679%? 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 must be completed within 180
days of permit issuance.
x
a ure
Page 1 of 3