1250 Cliff Rd• . ..
OFFICE USE ONLY 05/22 /90
METER # 3 51?1 9 ''2 PERMIT DATE
/ ? Cp g d PERMIT # 114(31
C H I P # dZ?--,--- C 7399
METER SIZE S RoG B.P. RECEIPT #---
? -.- 7.fo - 2 p B.P. RECEIPTDATE0_!L-8 9t'
ISSUE DATE
_X PRV _ BOOS7ER PUMP
1250 CLI:F RD '
z SEC/SUB SECTION 34
PLUMBER:
ADDRESS: 3650 ;XENNEB::C DR
IP
pEFiM1T REQUESTED
?'= SEWER X WATER x TAPS
COMM.IIND x RESIDENTIAL
NEW X EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Qomestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
CITY, STATE ????645 Z " '
PHONE: I AGREE TO COMPLY WITH CITY OF
i"LQ[tENCE OLSON EAGAN ORDINANCES
pWNER: "%
ADDRESS: 1250 CT.IFF RU
?AGACr, f?4 ZIP 551?3
CITY, STATE `' SIGN URE WHEN METER ISSUED
PHONE: 'Sw-36S7 .
PLEASE ALLOW TWO WORKING DAYS FOR PPOCESSING. CALL 4545220 POR INSPECTIQNS. FOR STORM
° SEWER PERMiTS, CONTACT ENGINEERING DE 1...'??
y ? ir.? ?::_ _.C/ ,' - '
? -
:R & WATER PERMIT
QF EAGAN
Pilot Knob Rd.
i. MN 55122-1$97
•
SPECIAL ASSESSMENT SEARCH SUMMARY
AS OF: 05/10J1990
PROPERTY ID: 10-03400-011-02
S/A# ASSESSMENT DESCRIPT. YEAR TM RATE TOTAL ANN.PRIN.
"'--- SUMMARY OF LEVIED 0.00 0.00
****** 1990 P&I CERTIFIED 0.00
-'-'-- SUMMARY OF DEFERRED 0.40 0.00
------ SUMMARY OF PENDING 0.00 0,00
-"--- SUMMARY OF CLOSED 0.00
Press ENTER; or F1, F4, F5, F7, F8
PAYOFF CD
0.00
0.00
o.oa
.
CITY OF EAGAN Remarks
Addstion S .ti nn 3!
?' Lot Rlk Parcel- 7(? CI-3I
owner? Street -1250 Cliff Rd. ??IIQ_ ?1L _f.?2_
scate_ E2.gariPmn 5123
? :'C-
Improvement Date Amount `
???X'?
Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
SAN SEW TRUNK
SEWER LATERAI
WATERMAIN
WATER LATERA
WATER AREA
STORM SEW TRK
STQRM SEW LAT
CURB & GUTTER
SIDEWALK
STREET I,IGHT
WATER CONN
v ? I CITY OF EAGAN ror office sa Only
# r?CO
PERMIT
CON
3
TRACT
830 PILOT KNOB ROAD, EAGAN, MN 55122
PRICE RECEIPT
PI'IONE 454-810p DATE:
Site Address 1250 CLIFF gp
Lot 011 _ g?? 2
-? Sec/Sub 34 BLDG nPE
WORK DESCRIPTION
Res. ?
`
_ New tf
m Name Muk. ? Add-on
Comm.- Repair
;y Address 36 KLNNEBEC DR other
? Cfty EAGAN
Phoste 454-6645
RES. PLgG. ONLY - COMPLETE THE FOLLOWING:
` Name FLORENCE OLSON NO. FIXTURES TOTAL
Water Closet - g3
oo
? Address 1250 CLIFF RD .
s
Bath Tubs -$3.00 -'?
S Cay EACAN 434-3b87
Phane S"?' -?.oo
$3.00 -'--
Kitchen Sink - $3.00
r...,...i..«,.?.? UrinaUB
idet - $3.00 --"--
.?
COMM.
lIND.
F?
EE ?
ry Tray - $3_00
A??
APT. BL
DGS
.
- E
X Floor Drains - $1.50
-"--
TOWNHOUSE ?^tll??p _ RES. RATE APLLIES ?-- Water Heater -$1,5p --
MINIMUM - REg1Bl7'j,?ligEE
$12
? Whirlpool - $3.00
.
MINIMUM - COMM.IND./FEE
$?
? Gas Piping Outlets -$1.50 ?-
STATE SURCHARGE PER PERMIT
'
? (MINIMUM -1 PER PERMIn ?-
(ADD $.50 S/C PER EACH $1,000 OF PERMIT FEE) ?ftener -$5.00
-
We8 - $1 a.00
-
Private Disp. - $10.00
.
S1GT?ATURE OF PER Rough Openings - $1.50 ?-
MITTEE U. G. Sprinkler System -$12.00 -'--
PERMIT FEE: ___Tz _-W
FOR: CITY OF EAGAN WA RN'AROMSTATES S/C: SQ
GRAND TOTAL: ?12_54
? • ??''
Pl+
No L?o
Mer w 1Mr1
r f'r A n/` ry1 r.?? r.r.y
_. ?? - ..----°--- t V??y1 • w • ;qll-u nn edit
. ,u.a. 110AD1
_ ? L ?? 1 1? ? •
? ?? , ? • ? ? ? ?
? f "h_
i • , " ?• , ?--?- ?
+ Q-._-
?
? f
?-;?? 1 ' ? ? ?? ? -- 4??•--- -?
• t ? ? _?.?- ? ?? t
?
?"r ' • , ? ? -4-?
1 ? • ` x
?Mh(,? ? y • ? ? ? '? ?
? -- ?-
.
?
? ?,? ? ? ? ? ?, ? I . !
??? . , ?• ?
04---
1 ?
?1 A ' 1 i t a ? i r ?
?
' ?t f ????4 ?"""?
•:?
? TRUNK AREA WATERI?111IN 11ND TRUNK AREA SANITARY SEWER
?? LA'l'ERAL BENEF:IT FROM TRUNY. WATERMAIN
? 4 -7 6-7
194, x s
2004 RESIDEN'I'IAL BUII.DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
NewConsWclionReauiremenfs RemodeVReoairReauirements
3 regislered site surveys showirg sq. iL of b6 sq. ft. ot house; and all rooTed areas 2 copies of plan C??fSur?e Reid?Y'_ N
x;
(20% maximum lot coverage allowed) 1 set of Ener9y Calculetions for heated additlons ??"??s?, f^y t?
s _ 'h.
2 capies of plan slwvdng 6eam d window sizes; pou2d found des5 Y !ea te, n, etc. 1 sne surve for addNOre & dedcs TW?? `
lsetofEne?gyCalculations Adddion-indicateilonsHesepGCSystem
3 copies of Tree Preservafion Plan rf bt plat[ed aRer 111193
Rim Joist Defeil Opfans selection sheet (Md?s witli 3 or less units
Date ? L? Construction Cost D ano%=-
Site Address ?T/_ /J Q
UniUSte #
Description of Work /,vao,-V 0`- NrPc,? ?'i? r
Multi-Family Bldg _ Y? N i
Fireplace(s) ? 0 _ 1 _ 2
Property Owner 4? f-.(m.? Telephone #(?1 O L% o (D
Contractor -ti
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Tvlinnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , Residential VentilaHon Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted SubmiNed
• Energy Envelope Calculations Submif[ed
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone #(
Telephone #( ?
I hereby apply for a Residential Building Pemut and aclrnowledge 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 pernut, 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 appmved plan in the case of work which requires a review and
approval of plans.
•-?.-? -X 0l Qn?
Appl? icant'sPnntedName ApplicanYsSignature
OFFICE USE ONLY
Sub Types
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. AR - Multi
? 03 01 of_ plex ? 09 07-plex -< 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt- SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level O 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 In! Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 Windows/Doors
? 34 RepleCement 'Demolition (Entlre Bldg) - Give PCA handout W applicant
Valuation °"f V?-i Occupancy MCES System
Census Code ? Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings(new bldg) FinaVC.O.
_ Footings(deck) g FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof Ice & Water Final Pool Ftgs _ Air/Gas Tests Final
? Framing _ Siding _ Stucco _ Stone _ Brick
Fireplace _ R.I. _ Air Test _ Final _ Windows
_
_ Insulation _ Retaining Wall
Approved By:
---------------------
- , Building Inspector
------------------------
------ -
--
---
Base Fee
Surcharge
Plan Review
/0 O? n?
l?
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
(, -5 a 3 ?
2004 RESIDENTIAL BUII..DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New CoreWcflon Reauiremems RemodeUReaair Renuiremenffi
3 registered site surveys shwring sq. R of lot, sq. ft oi house; and II rookd areas 2 wpies of plan
(20% maximum Wt coverage allowed) 7 set of Energy Caknlations for heated additions 2 coples of plan showing bean & window sizes; poured found design, etc. 1 site survey for addilions
8 decks
t set of Energy CakulaUons Addnion • indicate ff onaile septlc sysfem
3 copies of Tree Preserva6on Plan ff bt plalted after 711193
Rim Jast Deml 0ptiAns selection sheei (bldgs with 3 w less unils
Date
Construction Cost
Site Address UniUSte #
Descripdon oF Work
1?2
v J/ ?Uo Dc+a,? ea ?,?
Multi-Family Bldg _ Y _YN Fireplace(s) K0 _ 1 _ 2
Property Owner ? g ? l$ B .,,- Telep6one #( GS7 )V SLI 01-149e
Contractor O
Address 1 oZ ' ? City F' 51k^e,
State Zip Telephone #( 6? ?fV-,1,5y v C7
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Yvlinnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilatlon Category 1 Worksheet • New Energy Code Wwksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with
fee applies. ,
Licensed Plumber
Mechanical Contractor
Sewer/water Contractor
_ Y _ N If so, 25% plan review
#(
#(
I hereby apply for a Residential Building Pemut and aclmowledge 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 pernut, 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 appro plan in the case of work which requires a review and
appmval of plans.
ApplicanYs Printed Name Applicant's Signature
'
Iq
SEWER GONNECTION CHARGES
CITY OF EAGAN
SEWER & WATER CONNECTION CHARGES - 1990
EXISTING PROPERTIES
SAC $ 700.00
Previously Pd.
Receipt #
ACCOUNT DEPOSIT 15.00
SEWER PERMIT & SURCHARGE 15.50
TOTAL: $ 730.50
WATER CONNECTION CHARGES
WATER CONNECTION $ 625.00
Previously Pd.
Receipt #
ACCOUNT DEPOSIT 15.00
WATER PERMIT & SURCHARGE 1550
WATER METER 90.00
TREATMENT PLANT FEE 252.00
PLBG. PERMIT & SURCHARGE 12.50
TOTAL : $1, O10 .470
TOTAL FOR SEWER & WATER HOOK-UP: $1,740.50
?CO,C i - Icps
1,4Q .'i C.
--•---------------------------------------------------------------------------------
F-I?•4D
t'd. ?1040.;)0
OFFICE USE ONLY
? ?A? , Sew<r
TAPS
PRV R?
ASSESMENTS .Q$
520 cuY.'iv,E o'P (?iar.q
? _1J` A 6
PROPERTY OWNER FLORENCE OLSON
TELEPHONE # 454-3687
ADDRESS 1250 CLIFF RD
L O11 B 2 SECT. SECTION 34
PID # 10 03400 O11 02
DAKOTA COUNTY
loll, ?
??ott) EWA`bh??aNOA?orv
DIFEGTGP
(672) 450-2611
PUBLIC HEALTH DEPARTMENT Fax (612) 450-2948
HUMAN SERVICES DIVISION 33 EAST WENTWORTH, WEST ST. PAUL, MINNESOTA 55118
flEP! Y Tp
PUEIIC Health NuTng $ervmB
Environmenlel Hnllh Servieea
? Emergmcy MeCinl Sen¢ea
April 30, 1990
Mrs. Elorence Olson
1250 Cliff Road
Eagan, Minnesota 55123
Dear Mrs. Olson:
RE: Surface Discharge of Wastewater
? PuEbc Health NorLny SernCe
BurnsvJle OPoCe (8121 475-8055
1101 WestCty RE 42
Bwnsnlie. MN 55331
C E R T I F I S D M A I-L
RETURN RSCSIPT REQIISSTSD
We investigated a complaint of illegal wastewater discharge from
your property on April 18, 1990. Verifying the complaint, we
obsetved that sewage is being discharged to the surface in the
ravine behind your house, 1250 Cliff Road, Eagan.
You are in violation of County Ordinance No. 113. (On-Site Sewage
Treatment Systems) and Minnesota Pollution Control Agency (MPCA)
Rule 7080 (Individual Sewage Treatment System Standards) by:
1. Discharging wastewater to the surface; and
2. Not properly operating and repai=ing or reconstructing
your on-site sewage system to prevent malfunctions or
failures which may pose risks to public health and
safety.
You are hereby ordered to comply with Ordinance No. 113 and MPCA
Rule 7080 by completing the following in a timely manner:
1. Immediately cease your iaproper discfiarge of sewage to
the surface by frequent pumping and/or reducing water
usage.
2. Contract with a County-licensed ISTS (Individual Sewage
Treatment System) pumper-cleaner within ten (10) working
days to properly pump and clean your sewage system as
required in order to schedule a licensed ISTS installer
to evaluate your sewage system and determine the cause
of the malfunction or failure.
AN EQUAL OPPORTUNTY EMPLOYER
3. Contract with a County-licensed ISTS installer and
- coordinate with the ISTS inspector to undertake the
following within 60 working days:
a. Evaluate your sewage system's malfunction or
failure;
b. Determine if your sewage system is conforming and
repairable or if your system is non-conforming and
must be reconstructed to meet applicable
regulations; and
4. Perform all such repairs or reconstruction of tne sewage
system as required by the ISTS inspector, or connect to
a public sewer system if one is available in your area.
I have enclosed a current directory of County-licensed ISTS
installers and pumper-cleaners. Please contact Doug Reid,
Buildinq Official, Eagan (612-454-8100), and our office when the
sewage system is pumped and cleaned and is open for inspection to
evaluate its operation and determine specific requirements to
correct above conditions. Should you have any questions or
require assistance, please contact me at telephone 450-2940 or
Ron Spong at 450-2607.
Sincerely,
Berhane Worku
Environmental Health Services
Water Quality Management
BW/sh,
WQM:SDWW
pc: Ron Spong, Environmental Health Supervisor, Wate= Quality
Management
Doug Reid, Building Inspector; Eagan
Jay Stassen, Assistant Dakota County Attoxney
Encl.
aA Rcf- c F; l.e
WAIVER OF HEARING NO. 00334
SPECIAL ASSESSMENT AUTHORIZATION
I/We hereby request and authorize the City of Eagan, MN (Dakota Co.) to
assess the following described property owned by me/us:
Plat and Parcel #10-03400-011-02
for the benefit received from the following improvements:
ITEM OIIANTITY RATE AMOUNT PROJECT NO.
Lateral Benefit from
Trunk Water Main 349.39 Lin.Ft. $ 14.18 $4,954.35 224A
Water Trunk Area 2.02 Acres 1,450.00/Ac 2,929.00 224A
Sanitary Sewer Trunk
Area 2.02 Acres 1,435.00/Ac 2,898.00 88 Pt.II
TOTAL $ 10.782.05
to be spread over 5 years at an annual interest rate of 88 against any
remaining unpaid balances.
The undersigned, for themselves, their heirs, executors, administrators,
successors and assigns, hereby consent to the levy of these assessments, and
further, hereby waive notice of any and all hearings necessary, and waive
objections to any technical defects in any proceedings related to these
assessments, and further waive the right to object to or appeal from these
assessments made pursuant to this agreement. ?
Dated: -) 9 '- F[? ?,,?'?.2? ?
Florence H. Olson
STATE 0
? )SS
COUNTY 0
On this /C % Jy day of 19,'?6) before me a Notary P,ublic within and
for said County, personally' appeared rG oh? C:--i?Gc `-/V. IS;GS Dlt) to me
personally known to be the person_ described in and who executed the foregoing
instrument and acknowledged that ,S executed the saIme as yd E,? free
act and deed. ---,/
4"4 A- 14;,Jj 1
Eagan Public orks Department
14:51 OCT 22, 1996 ID: DRKOTFl COUNTY TEL MD: 4388517
16, ojqov - ol/- o ;2-
?
•5798 PAGE: Sii
Municipal Notice of WeU Permit Application
Dakota Cwnty Ernironmentel Maaagemem Depafttnetrt
Wata wd Land Managemcw Sediou
14955 GeEaxtie Avenue West
Apple Valley, NIId 55124
Tel (612) 891-7011 Fax (612) 891-7031
DATE: October 22, 1996
TO: Taen ColbertlWayne Schwanz
FROM: Wata and Land Management
RE: WellPpmit #: 96-h110172
Muoicipafiry: Eagpn
Fax #: (612) 6814612
WeI( Type: Seakd
Envirwimcutal Spaciaust: Olson
The Water and Laad Management Sectaon af ihe Dakota Coumy FnviranmwNal 1NanagemsR Depazhneat
has receivad the followmg permit application for the weU described. If you requae Eudxr ieview of 1Le
application or if you have any quesEions or concerns about it> mntatt the Environmtental Specialist listed a6ave
or our office a2 (612) 891-7011. [f there is no response 6nm your office arithin 24 HOURS (exclu3ing
weekends and hoiidays), we will assume that you have ao ob,{ections to the issuance of We permit. Please oote
that pe:mit issuaacc is always coaditionod an thc pmmit applicaat's observana of and oompSance wiiL all
aPPlieable state, countY, and mumcipal laws and codes.
WeU Caotrac[or: Hardnann Well C.oanpazry
Date applicadon received: October 22, 1996
Anbcipated Drilling Date: _! /_ Time:
Anticipated Groutmg Dau: % Time: -'- _
Property Owncx: Duane Olson
Well Owner: Duane Olson
WELL LOCATTON:
PLS Coordioates: 1/4, ae 1/4, nw 1I4, ne 1/4, Sac 34, Town 27, Range 23
Strcet address: 1250 Cliff Rd
PINIViunber. 10-03400-011-02
WELL INFOM
Diameoer:
Casiog depth:
Total depth:
Static Waur L,evel:
Aquifer:
CONAAENTS:
4
I55
160
136
unoonsolidate3 ssdimeats
R-97% DAKOTA GDUNTY I0-22-96 02:67PES P001 it47
CITY USE ONLY
L BL RECEIPT #:
susD. 16 - 0.W0 - o/l - O?- DATE: ?? -8?(O/
1996 PLUMBING 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
FIXTURES EACH
Shower 3.00 x
Water Closet 3.00 x
Bath Tub 3.00 :c
Lavatory 3.00 x
Kftchen Sink 3.00 :c
Laundry Tray 3.00 :c
Hot Tub/Spa 3.00 :c
Water Heater 3.00 :<
Floor Drain 3.00 x
Gas Piping Outlet ' minimum -1 3.00 x
Rough Openings 1.50 :<
Water Softener 5.00 x
Private Disposal ' Dakota Cty. Iicense 65.00
(new and refurbished systems)
U.G. Sprinkler ' home under const. 3.00
Alterations " to existing 20.00
Water Turn Around 20.00
STATE SURCHARGE
TOTAL
bQ TOTAL
?lo•?
.50
?'O ? SZJ
SITE
OWNI
INST/
STREET ADDRESS- ??^?? ;???? ? ?= ?-?t •
CITY: STATE: GLJ ZIP:
PHONE #:
14 :51 OCT 22, 1996 ID: DAKOTR COI.INTY
TEL N0: 43BB517 ? J?j'?C.
? ?cd 7
#5798 PRGE: Sil
Municipal Notice of Well Permit Application
Dakota Coumy Environmental Managemem Departmern
Watcr and Laod Managemcnt Section
14955 Galmcie Ave,nue West
Apple Valley, MN 55124
Tel (612) 891-7011 Fax(612) 891-7031
DATE: Odober 22, 1996
T0: Tan ColbertJWaync Schwanz
FROM: Water and Land Management
RE: Wdl Permit #: 96-h110772
MimiciPalitY: E3San
Fax #: (612) 6814612
WellType: Sealed
EnvironmaIIal 5pacialist: Olsoa
Tbe Water and Land Management Sectim of the Dakata County Fnvironmental M2n3gement Deparhnent
has received the followmg pen?rit applira6oa for fhe well desaibed. If you raqufre finther nwiew of the
appGcation or if you Lave any questions or cmceros about it, contact the Enviromneotal Specialist listed above
or our office at (612) 891-701 l. [f there is ao response from you: office wit6in 24 HOURS (excluding
weekeads and ho&days), we wiIl assume ihat you liave no objec0ions W the issuance of tLe pcmvt. Please mote
tliat pcimit issuana is always rnnditioocd am du pennit appGcart's observance of and compGance with all
aPPlicable state, courty, and mumcipal laws and codes.
Well Contractor: Harhrum Well Compaoy
Date application received: Octo6er 22, 1996
AnlicipatedDrillutgDate: _l l Time: ---
Anticipated Groutmg Date: f/ Time:
Property Ownea: Duane OLson
Well Qwner: Duane Olson
WELL LOCATION:
P1S Coordinates: 1/4, ffi I/4, nw 114, ne 1/4, Sec 34, Town 27, Range 23
Strat address: 1250 Cliff Rd
PIN Number. 10-03400-011-02
WELL INFORMATION:
Diameter: 4
Casing depth: 155
Total depa- 160
Static Water Level: 136
Aquifer: unconsolidated sediments
CONgdENTS:
8-97% DAKOTA COUNTY 10-22-96 02:47PM POOI #47
For Office Use
+ Permit#: 5'S SO
EAGANPermit Fee: 1 Ci
Date Received: IZAZ / I e
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: $(6-e)
buildinginspections at citvofeagan.com L
/ 2018 RESIDENTIAL BUILDING PERMIT APPLICATION
/07
Date: lei Site Address: /s c L/ /,Z Unit#:
Name: ��iiq,'v G-fG�/V Phone:
Resldentl `l i
C wnefi- _"1_1. Address/City/Zip: /,,7 CG7r7- � r`-fo f ' //1
iNrya Applicant is: Owner Contractor
Description of work: /Vett
Typei.of Work
Construction Cost: Multi-Family Building: (Yes /No_ —T
Company: Pm',D E v5 T C' ' 'r4i ontact:
r a L1-C
��;�il i Address: /a?7,1101/9t749/4 ('9•: S', City: -X,40ied,e'
State:��// Zip: J✓J7� Phone: ���'—V ) j7/'mai 4 c41��c"4 f ccez- dry f '
.' License#: G/ off �lo Lead Certificate#:
If the project is exempt from lead certification, please explain why:
ND 'SAS i'Y,t/2,�3/•,✓6 */'A/7"'
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:
Fire Suppression Contractor: Phone:
MOTE:Plans ands®®"° ®' "are considered to he=ublic/nformat1r Portio re tr
classified a - .=hc if a< •vrde r .. s that w u d = e. .•� .®�x h .drat a are de" cret
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.comisubscribe.
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.
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
acco iance1th the approved plan in the case of work which requires a review and approv plan
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Applicants Printed Name Applicants Signature