1025 Diffley RdEAGAN TOWNSHIP
BUILDING PERM!'r
Ownex -1C.0'_-/_----- -_-=----`---..._....-------.-..
Address (Presenl) ._-..... ..
Builder ._.....---- ------ .....__--------- _.----------- ---------------------------- __.
Address .--'....----'- ..............--------------..--'--"--'---
-----------------
DESCRIPTION
N° 883
Eagan Township
Town Hall
Date .... ..?....? ? ? ?
...........-----'-"-'-°-----...
Siories To Be Used For £ron! Depfh Heighi Esl. Cosf
l ermi! Fee
P Remazks
Zet '° a Lw *4 ?
o LOCATION
5fieet, RoaC or oiner Uescrlpi3on oS Locai3on Lo! Slock AGd3iion ox Tsaci
X' ?7 ?- ?-?-?-??
This permit does not aulhorise the use of slteels, zoads, alleps or sidewalks nor does it give the owner os his agent
the right to creaSe anp siSuaiion which is a nuisanee oz whicb presenis a hazard Yo the heallh, safeip, convenience and
general weltare !o anyone in the eommunilp.
THIS PERMIT MUST BE PT ON T$E PAEMISE WHILE THE WOAK IS IN PROGRESS. ?,zn..?
This ia to eeslify, 1hai....---- ..?-------------_._hes permis9on !o erecf a..... g...._ .....'.'_"'•? 1" "..
the above described premise s ' c! ! psovisions of !he Buildin Ordinance for Ea TownshiP a PYd Ap. •?pon
11.
1955. ?
-' ......... . ........ .. ..... ... ..c?.......-............. ......... Per ..................... .. .C.C......" .. .................
Chaizm n of Town Board °Bui ldin Inapecfor
?-?--i
.. _ . ,,
ir'LG` z.4-
CITY OF M:GAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
PERMIT N0.• 199
The City of Eagan hereby grants to
of Rosemount
OoZCOrBA A8rdM8r9 CO.
a WELL Permit for: (Owner) Rolland Kirchner
at 1025 Co. R$. 30 ? pursuant to application dated 8/12/74
Fee Paid: $10.00 dated this lZ day of August 7.,19 74 .
. s c
Buildin; Inspector
D"2chanical Permits:
Bid Totala
CASH RECEIPT ')
CITY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
/
DATE ' 19 ?
RHCEIVHD , -r--
FROM --t I - F
AMOUNT $ I
te DOLLARS
Teo
Ej CASH L]'CHECK
?..
FOR
f 1r .'J;A r.. coi-Fn f.l r l d i 10
FUND COOE AIAOUNT
?
Thank You
HY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
?
Raceipt PWMBING PERMIT • Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legib/y Tot.
1. Date 2. Instailation Cost I
3. Job Address ' Lot - Bik. Tract .
4. Owner ' • "
5. Contractor Phone.
6. Address r
7. City ' State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe '
I 11.
No, Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs $eptic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Fiough
Inspections: Date Insp.
This is yaur permit when nurrAbered d appr edf,
OF EAGAN 454,8100
INSPECTION RECORD
f CITY OF EAGAN PERMIT TYPE: I "" N `'
` 3830 Pilot Knob Road Permit Number. N si 1 t. ;
Eagan, Minnesota 55122-1897 Date Issued: 4?`? ! k 1/•?? '
(612) 681-4675 I
SITE ADDRESS:
I??, f+ i f l I l-Y N[?
k[irf.11Nrk PLAfA
PERMIT SUBTYPE:
„
APPLICANT:
i t, I .' ? ?i ?? ?l '. .' ".t
TYPE OF WORK:
frF •,i f. 11, 1 I liM
FkAMiNio
? ..,. . . . .,. .. .
1 1 NF+t
1?r:ri
at rr'RArr0N
4nr,. r; S!; 'rn tt',MT)
Permit No. Pormit Holder Date Telephone M
ELECTRIC
PLUM8ING
HVAC
InspecNon Dete Insp. Comments
FOOTINGS uneaerie alitwdy fjlae??? ?e7? i --rlo4
FOUND
FAAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDO FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL ,
?G7/?/ /T lhJVlc, J/TU /vV/ I?f.w"V inc?,
CITY OF EAGAN
Additi0n rlnwuvun r tanz,n LOt dl-
Ow/n?er -1 ' ? Street 1025 Geuttty--&ee?
Improvement Date Amount ? nnual Years Payment Receipt Date
STREET SURF.
STFiEET RESTOR.
GRADING
SAN SEW TRUNK (? c1 p 1982 335.00 22.33 15 . 00 COU a- -1
* SEWER LATERAL f- ? 1952 2376.10 158.41 15 L z a
• S@1'v1Q.' 1982
WATERMAIN
**WATERLATERAL i4Ci (?$ .2 Cou luy?
G(-LZ-KI
WATER AREA 1982 335,00 '3 6• 0 Cl - Z- Z '
** Servioe 1982
STORM 5EW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 260.00 #45631 8-20-84
WATER CONN. 4]0.00 " 'T
SUILDING PER. #883 " I'
SAC
525.00
PARK
. WATER SERVICE PERMtT
PERMIT NO.:
DATE:
No. of Units: ?
' No..
to eomPly wilh &s Cky of Eaqon
?on Charge:
unt Deposit: _
Permit Fee:
Surthorye:
Mlsc. CFarges: -
Total:
Date Paid:
CITY OF EAGAN WATER SERVICE PEttMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 5NIP D/1TE:
Zoning:
No. of Units: i
Owner. :!• c.:tte r e9t;I t2 s
/lddress: .
Slte Address: . ounty . u'1azA Addt?
Plumber• rxc
Meter No.: Connection Chor9e: 4 •00 pd
Si Ze: Account Deposft: 1 ? ?
Recder No.: Permit Fee: 1?.?? pd -
I pree to aonoly wi16 !IN Ciryr of bge• Su?dhorge: • S0 Pd
Ordiwe.a.. Miac. Charfles: 63.ncl ?pl :neLer
Totol:
BY Dote Patd: ?
Date of insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830
P Pilot Kno6 Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE: - --
Zoninp: ' No. of Units: a
Owner. e
Address:
Slte Add.
Plumber:
1.fre. to oomop wilr Nie Citi of B.la. Connectlon Charqs: _ 425 . 00
Ordlnenas. Accowit Deposit: 15. 00 d
Permk Fee: ' ? p
BY Surcharpe:
Dote of (nsp.: Mlsc. pwrges;
? ?' ? Total:
DoM Poid:
2004 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan 7:t
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construc6on Reouirementa RemodellReoair Reauirements
3 registeied site surveys showing sq (L ot lot sq. ft of house, and all roofed areas 2 copies of plan
(20%maximumlotcoverageallowed '*-
) 1 set of Energy Calculations for heated additions
2 copies of plan showmg beam & window s¢es, poured found design, etc. 1 site survey for addNOns & decks
lsetofEnergyCakulations Add"Aion-indicateifon-sdesepticsysfem "` -
3 copies of Tree PreservaGon Plan'rf lot platted a(ler 711/93
Rim Joist Defail Options selectlon sheet (bldgs wifh 3 or less unRs .
Date 0? p
Site Address
UniUSte #
Description af Work ?,n _ 9,4)% 140n, o
Multi-Family Bidg _ y _ N
Construcfion Cost I. 3-f I -
Fireplace(s) _ 0 2
PropertyOwner SCt,YnL'.Q l ?O?nSQ? Telephone#(0l )y% 'VSSO
RMA HOME SERVICES, INC.
Contractor Home Deopt Installed Sales
Aadress 3200 Cobb Galleria Pkwy.Ste. #200
state Atlanta, GA 30339
763-542-8826 BG20268257
CiTy
_ Telephone # (
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category - Minnesota Rules 7670 Categorv 1 _ Minnesota Rules 7672
(?l submission lype) .• Residential Ventilation Category 1 Worksheet , • New Energy Code Worksheet
Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? Y N
fee applies. - -
Licensed Plumber r; y 1'3 ??' Telephone #(
Mechanical Contract n\vtliG 0 2614
Sewer/Water
Telephone #(
Telephone #(
If so, 25% plan review
I hereby apply, for a Residential Building Permit and aclmowledge that the information is complete and accurate;
that the work will be in conformance with the ordiuances 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 pernrit, and work is not to start without a
pernut; that the work will be in accordance with the approved plan in the case of work wluch requires a review and
approv of plans.
G.?CC? ?YZSO? ?
ApplicanYs Printed Name ApplicanYs Signature
. _ . , . . ? .?t. . . .. . ...
Installed
Siding and Windows
LIMITED POWER OF ATTORNEY
CUUNTY OF COBB
STATE OF GEORGIA
KNOW ALL PEOPLE BY THESE PRESENTS:
THAT I, David N. Katz, a resident of Montgomery County, Pennsylvania
("Principal"), and a licensed contractor of RMA Home Services, Inc., DBA Home
Depot Installed Sa?es located at 660 Mendelssohn Avenue North, Go!den Valley, T,N
55427, having a license number of BC- 20268257, do hereby appoint, name and
constitute Elder-7ones Building Permit Service, Ina ("Agent") as my true and lawful
attorney-in-fact and do authorize and grant said attorney-in-fact for me and in my
name, place and stead the power to execute, acknowledge, sign and deliver (in such
form as may be required by the municipality) a permit application, or any other
instrument(s) which may be necessary and appropriate, in order to obtain the proper
permit(s) from the City of Eagan, Minnesota for the installation, maintenance and
repair of windows and siding (the "Work").
The powers conveyed to the Agent by this Lirnited Powe: of Attomey are
limited solely to the express powers delineated herein ancl apply solely tu the Work.
This Limi*ed Power of flftorney sha11 expire and automaticaUy be revoked on the 21 st
day of?vfa-y, 2004, which date is one year from the execution hereof. Further, the
powers conveyed by this Limited Power of Attorney may be revoked by Principal at
any time by express revocation and shall also be revoked by the Principal's death,
disability, incapacity or incompetence.
IN WI'I'NF_SS WE-IEREQF this Limited Pokver o_fAttem.ey is executed this
21st day of May, 2003
D a v i d N. Katz
S WORN TO AND SUBSCRIBED BEFORE ME by David N. Katz on this
21st day of May, 2003.
<
Notary Phlic in for the State o eorgia
My Commission Expires: January 21, 2006
396816.0
Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor.
3200 Cobb Galleria Parkway, Suite 200 • Atlanta, GA 30339 • Phone (770) 779-1300 • Fax (770) 984-0709 • Toll free (800) 79•DEPOT
,I
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
auxLozNG?
028815
09/11/96
PERMIT TYPE:
Permit Number:
Date Issued:
SITE ADDRESS:
P.I.N.: 10-42100-020-01
1025 DZFFLEY RD
LOT: 2 BLOCK: 1
KIRCHNER PLAZA
DESCRlPTION:
(HCCESS TO BSMT)
Permit Type SF (MSSC.)
?.ork Type AL7ERATION
[E???w 434 AL7. RESIDENTIAL
,ei!sf4l ?h ?, tuie. jG,II 's i@IC? jQmIffi, - y
aa '? ?ei ??e o?
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
VALUATION
$51.25
$.80
$52.@5
$1,600
CONTRACTOR:
? .
I h?P?i
infarmj?
..: StBtu'C=i
OWNER: - Rpplzcan
JONNSQN DON
xezs DIFFLEY RD
EAGAN MN
(612)454-5756
55123
Aj1
ISSUED BY: IGN U??-?
f
? - ' ? .
CI,?"Y (ii:: :i:('yi.ifiiN
r ..., ... ?I?:'{t4..N.A.. N_ls .. „...
i E., 09 , !?n. I.n?,. ,,,...
... ' 1.:'A?,,,..,
._..?
'ifi;
p.'N"ic.C 1.1(.1N Jfll..iNSON
.??.:.;.;;..?? 900i 1025 .. ?. i.:..,._. ?._I...1ii? r.y?? 51.25
r i,_?
,:,r_ ' ... ! ,1.... . ;:'_:;!::;:':'; 9001 . 0.,1; ?,-y?.:?:ri I:?].I", ......4 , ?;,- v.J.? ,
. . 0,.M
_.
.......?. .......,.-:1Y=??. . i:; t_]SX`i
f:RO61 :l.W...,
U::i,..i'1 .1!;';:: j'..i;",NIr..,Y
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
165 lff 1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
? 3 registered aHe surveya
? 2 copies ot plans (include beam 8 wfndow sizes; poured fid. deaign; etc.)
? 1 energy ealculations
? 3 copies of tree preservation plan H lol platled after 7l7193
requfred: Yes _ No
l
RemadeVReoair Reqy?itements J/?
? 2 copies of plan ? 2 site surveys (exterior additions 8 decks)
? t energy wlculatione tor healed additions
?
S?,
DATE: ?? I CONSTRUCTION COST:
DESCRIPTION OF WORK: I.f -_UL ( Ttil_
STREET ADDRESS: lb2 S
LOT t BLOCK
f\/ A ?) .
SUBD.JP.I.D. #:
4S 4 _S? E
PROPERTY Name: Phone #:
OWNER
LWi
Z S b
`
fIM4i
,?.ee
uv
? ?0 •
/
Street Address• td ? C
City: ? IA-C, H'i , State: MM . Zip:
CON7RACTOR Company: ti ' Lt Phone #:
Street Address: License #:
City: State: Zip:
ARCHITECTI Company: Phone #:
ENGINEER
Name: Registration #:
Street Address-
City: State: Zip:
Sewer & water licensed plumber: Penalty applies when address change and lot
change are requested once permit is issued.
I hereby acknowledge that I have read this applicaHon and state that the information is correct and agree to compiy with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Appiicant:
OFFICE USE ONLY
Certificates of Survey Received _ Yes No
Tree Preservation Plan Received _ Yes _ No
OFFICE USE ONLY +... -
h'
A r?
.•N• -A?
_J
?? •fN ? .
BUILDING PERMIT TYPE
n 01 Foundation o 06 Duplex ? 11 Apt./Lodging o 16 Basement Finish
? 02 SF Dweliing o 07 4-plex ? 12 Muiti Repair/Rem. ? 17 Swim Pool
? 03 SF Addition o 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility
0 04 SF Porch o 09 12-plex o 14 Fireplace ? 21 Miscellaneous
U<05 5F Misc. ? 10 = plex ? 15 Deck
WORK TYPE
? 31 New 33
X-, Aiterations ? 36 Move
? 32 Addition ,
? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main leve l sq. ft. City Water
UBC Occupancy sq. ft. Fire Sprinklered
2oning sq. ft. PRV
# of Stories sq. ft. Booster Pump
length sq. ft. Census Code.
Depth Footprint sq. ft. SAC Code
! 3
Census Bldg
Census Unit
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $ 1, 00
Surcharge
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total
% SAC
SAC Units
07i13 '93 14:10 ID:DAICOTA CO-WSC
FASt:6128917031
MUHTCIPAL NOTTCE OF WELL P IT APPLICATION
/ J"/' `
PaGE i U
V ! °„-
DAROTA COUNTY ENVIRO2iMENTAL KRMEMHT DEPAR'17SSPIT
WATER AND LAND MAIiAGFddENT BBCTION
14955 Galaxie Avenue WeOt, Apple Valley, ![N 55124
Tel (612) 891-7011 FdX (612) 891-7031
DATE: July 13, 1993
To: Tom Colbert/wayne Scriwanz Fax #: (612) 681-4612
FROM: SOater and Land Hanagement
RE: Well Permit /: 43-9166
Municipality : Bagan
Well Typeti?8@811nq
Rev:lewer t Luehre
NOTICE:
The Wstex and Land Manaqement Section of the Dskota County Environmental
Management Department has received the followinq permit appllCation for
the well described. Tf you require futher reviem of the appllcation or
if you have any questions or concerns about it, aotttact the Erivironmental
Bpeaialist listed above or our offfce at (612) 891-7011. If triare 1s tlo
reeponse from yaur offioe withirn 24 HOURS (exoluding wsekends and
holidays), sre mill asewae that you have no objeations to the issuance of
the perm3t. Please note that permit iesuance ig alvays conditfoned an
the permit applicant's observanae of ahd cpmpliance with all applicebla
laws and codes. A aopy of the wall permit will be forwerded to your
offiCe when wmpleted.
WSI.L CONTRACTOR INFOkMATION:
Associatad WQiI Dlrilling
AppliCation Receivet9: 07/13/1993
Anticipated Dri111nq/5ealing,Date if knoan: 07/14/1993 Time: 50:00
IACATION OF WELLS
PLS Coordinates se %, aw %, sw jj sw o, Sec 23, Town 27 , Range 23
Well Loeation 1025 DiPfley Roas
Prappzty Ownar Bab Gerrite
Well Owner Bob Gerrits
Ptd Number - - -
WELL INFORMA'
Diameter
Casing depth
Total depth
SWL
Aquifer
PION:
4
198
194
170
Unconsolidated gefli,mente
CODIIdENTS :
R=95% 6128917031 07-13-93 02:11PM P001 Sk02
?
z/a4
? CITY OF EAGAN
APPLICATION FOR PERitiIIT
SE';IER AND/OR WATER CONNECTIODT
(PLEASE PRINi)
PROPERTY ADDRFSS: !J [? J D;'FF?E R
T.Frar• DESQ2I?'TIv^:7:
(Lot/Block/Subclivision or Tax Parcei I.D. Nlnnber) C .
ir =S7=`;G ST°S;CP^:ZE , DaTE GF ORIGi :AL ctiILLl`iG P=-,?ST ISs":?NC°_:
P2.j:.-`..- ?.•??II•.:(:/b:±C_°C?.-.."'? ',75E_ -&r At9_
R-1 S'u11GL,r ,. r^. _ .l,r,Y "--- _-' -- ' .
? R-2 GUP= ('?`NO Wi ITS )
? R-3 'ICiiv'NHOIJSE (TI1RF^ + LJNIT5) ( UD7IT5)
? R-4 PpAR'Il'^T/CJNIX'dLTVi'IU,%1 ( LNITS)
? COMMII2CIAL/RESAI7,/OFFICE
? I1i.'DUSTRIAL
Q 1NSTIT[,TIONAL/GGVERL?AIE:'v'I`
2) APPLICPV'T (PLEASE PRINi)
NAhfE:
ADDRESS:
CITY, STATE, ZIP: _
PHOi?E:
3) p=qgER
rAti?_ ?PLEAS^ PRINT)
G
'; E li I
c
7
'
•
?' FOR CITY l1SE OHLY
u;c
c
f?
?
,,
eff?„-
ADDRESS: PLUHBERS LICE,ySE:
?
Active
CITY, STATE, ZIP: Expired
- PHO'VE: uSTw ?
pLt1MBER LICEMSE # 00
? ot f Reco d
atr nitia
41 CX,'C.UI'A'V'P/CJ'?IEE2
NFV'"IE:
ADDRESS:
CITY, STATE, ZIP:
Pizo*rc: A, k?
CAI.v>•v t,??+P>?^??.??-cd?T ?
5) INDICATE WI;ZCH PEP.hiIT IS BEMTG REQCiESTID:
,,_,/CCNA1ECtION Tp CITY SE?i?1ER
LV1 CO",=ICN TO CITY LVATER
? OT:2 (PLE715E DESCFtIBE)
ol i.vulllilti v::c:
? PLP.ASE F?OID APPRWID PERNLiT FOR PICi:-UP BY ONE OF P,BCJVE
? PLEASE ?iAiL APPROV"Dr. PER%IIT 'Lt7 1, 2, 3, 4 AEUVE
(Circle one)
7) SI=TL',PE: _ 4?4 -, ????7?.???c.?°??:? DA'I'E: s, -al - FY
? ?! Ol:al:iq}l?J1? ? i All?:?-?J? ? 1l /t . .. . . . .. . • ? J :.
.. . . . . . . .. . . . ??f????A i q i Yf:si:i il? S !l ltEl:f??+l? lr f? ? ?S t:ia?iL• {e
F 0 R
PER^tIT °- ISSUED
C I T Y U S E 0 N L Y
FEES: $
? SEr.,,, E? n?o?.tr^• (I'C
; Li ?..RCH?RG... ?
1 _ ;D? ,.,,?-1
$ 14. z;-a WATER PERPIIT (INCLUDE SURCHARGE)
$
WATER METER/COPPERHORN/OUTSIDE READER
$ LQATiR TAP (INCLUDE CORPCRATION STCP)
$ SEWED TLP
$ ACCOUNT DEPOSIT - SEWER
$ ACCOUNT DEPOSIT - WATER
$ ?Z.7d WAC
$ SAC
$ TRUNK ?4ATE.°. ASSFSSMEDIT
$ TRli:1K SEL4ER ASSESSMENT
$ LATERAL BENEFIT/TRUNK SEWER
S LATERAL BENEFIT/TRUNK WATER
$ OTHER
$ TOTAL
$ AMOL'NT PAID/RECEIPT #
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK LVITHIN
? PUBLIC ROADWAY" MUST SE ISSUED BY THE
NO ENGINEERING DZVISZON. LIST AS A CONDI-
TION_
SUBJECT TO THE FOLLOP7ING CONDITIONS:
APPROVED IIY:
TZTLE:
DaTE : G- ??l s - s- V7?
? s? ? w? ir ?s ?c?: ? t? w?? tae ww w.a wt? w?? s? w.? r? ? se ar wca r?t+ rt ?s-? w?
,1--1 VI AzA-
?
and
.F cG
Secti n
WELL RECORD
VILLAGE OF E.2GAN
1_9163Z /'9?'1 ft'%/7 / 741- ---
State Liee;ica No, Permit No. Dat
Compai_y
?
Siza of tiTell_ ? Inches ? Water Level
We:?l Dapth f 7? Feet '; DravrBom:: ?'ec+t-?t 14
Caaing Depth Feet Capacity Gallons p
Started I Ended I of
w- 13%a c k d'i• ?- 9%e t /('
F
76
?huve/
cSc?n d %?.s /SS? 0;7CJ ?
?ysr 4?7 sie t st? , ?7 i,,5 sCkc-P,,T
Exterior Space Around Casing Sealed With: (]Cement Grout O(Puddled Clzy
110ther
Disinfer,tant Used aa/Fs
Hours Left in Well ?W U
Ci ? p
Dril er's
RF`P[TRN iHIS R:.CORD AFTER COMPLETION
I n+?? J RESIDENTIAL BUII.DING ffi ?? o 0
?k
?x Permit Application
City OfEagan
3830 Pilot Knob Road, Eagan MN 55222
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWction Reaui2menk RemodeVReoair Reaui2menk Office llse Onh
3 registe2d site surveys showirg sq. R of lot sq. N. of house; and all roofed areas 2 copies of plan Cert of Suney Recd _ Y_ N
(ZO%maYimumlatcoveregeallowed) isetofEnergyCakulafionsforheatedaddifions ireePmsPlanRecd _Y _N
2 copies of plan showmg beam & window sizes; poured found design, etc. 1 site survey for addibons 8 dedcs Tree Pms Reqd _ Y_ N
1 sel o( Energy CalculaUons Adddion - irro'icate if on-siTe septk system Onsite Septic System _ Y_ N
3 copies of Tree Preservatlon Plan'rf ht platted after 711193
Rim Joist Detail Optlons selec6on sheet (61dgs wiN 3 or less unils
Date q / ?? / 0J Coustruction Cost
rr
Si[e Address UniUSte #
Description of Work v-Z
Multi-Family Bldg _ Y XN Fireplace(s) _ 0_ 1 _ 2
PropertyOwner va?u? ???t?56h Telephone#(6
Contractor
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code Category
• Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calcutations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 257o plan review
fee applies.
Licensed Plumber
Telephone #[
Mechanical Contractor
Sewer/Water Confractor
Telephone #[
Telephone # (
I hereby apply for a Residential Building Permit and acknowledge that the information is compiete 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 tkus 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.
( ?rn ?-?, e I W . ? A ? -? s o m ?Z -r?.o
ApplicanYs Printed Name Applicant's Signature ?\