516 Hackmore Ct? ITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: ?j f=' •' ?';
Eagan, Minnesota 55122-1897 Date Issued: 1 l`il /`a fl
(612) 681-4675
SITE ADDRESS:
? ? . ?;r?!'KMlflRf f..l
A41110MN 14t:fit..t :tRt,i
PERMIT SUBTYPE:
1-
L -:
19a'.' b9l:J,.f? 1
APPLICANT:
TYPE OF WORK:
.?
? "IAN REWw;:u HY 011c1-- 8Ar;,'1
I Ail as nf__'f2. s?n ercnnPy0 .i•. . i-.4 , re,7rnI r',r.r1" S f .e.xa i. 1 311 1 t:, iri,t P.f:
? a '16 3
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS iY1 /11'ri
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST y.
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
lRR4GATfON
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TFST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
? .. ?
W-ertiftca#e of Cccupanc?
Witi) of Cfagan
2e*artmcKt aF SKi[bi»g au4oection
This Certiftcate issued pursuant to the requrrements of the URiform Building Code
certifying that at the time of issuance this srructur+e was in correpliance wi[h the various
orrlinances of the City regulating building corutruction or use. For the foflowing:
use clwmr,ca;a,,: SF IW sag. eerm;t r,o. 23018
Oc-p-Y Ty'Pe -?AY12 Zoniag District Ri Type Const. VN
Ownerotsuitair#JOES BY r37A.SF. namess 25[Y) W('iY Ril 42, IMV[iJF.
euitding Adcbess S16 H'AKMM M1RT l.ocaliry TA- E1. AtTITM RTTY' 3im
/'i
nate:
? Mtalng o
POST IN A CONSPiCUIXJS PLACE
.. .
`+CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
SITE ADDRESS:
`.ti 1 UMN It ! 1+.
ON RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
1. t,
H61t`,RMUlti.
i- iklJl
I PERMIT SUBTYPE:
4 fi I ? 1 ?. ,-.. .?....?.. ..
TYPE OF W4RK:
INSPECTION .. . ..
,, .
f: F! fl N K'; ;" 1-' 111
W F' t fi Ft - V ri t i f: Y ir ( Ft 1
I r- -1
Permit No. Permit Holder Date Telephone #
SNV
PLUMBING
HVAC ?
ELECTRI
ELECTRIC
Inapection Date Insp. Comments
Footings I
I
Foundation
Framing
Rooftng
Rough Plbg.
Rough Hig.
Isul.
Firepiace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
./
Deck Ftg.
Deck Final
weu
Pr. Disp.
a4 i
9 REOUEST FOR ELECTRICAL INSPECTION
??? ?? ? 5ae meGuaBre for compleMg ihis larm an back af yellaw copy
"X" Below Work Covered by This Request
E9.00001-08
?.?,'?/5?3; ?
?.?r..
aw Add Rep TypeofBwltling ApphanceSWired EquipmentWiretl
Home Range Temporary 5ervice
Duplex Water Heater Electric Heeting
Apt Buiidmg Dryer l.oad ManagemeM
CommJlndusinal urnace Other (Specity)
Farm Air Condiiioner
Omer (sVeciM Conirector's RemaMs
Compute lnspection Fee 8elow.
s pther Fee # ServiceEntranceSrze Fee # Cucurts/Feeders Fee
Swimming Pool ? 0 to 200 Amps /SCl 0 to 100 Amps S O?
7ransformers Above 200 _ Amps Above 100 _ Amps
S19n6 Inspeatork Use Only TOTAL
Irrigation 8ooms
Speaallnspecnon -492
AlarmlCommunicahon ?
THIS INSTALLATION MAY R? ISdONN ED IF NOT
Other Fee COMPLETED WITHIN i HS
I, the Electrical Inspector, hereby
trf
th Rouqn-in oa?a 30 y
cer
y
at the above inspechon has
been made. F,,,ai oe?e ?
l
OFFICE USE ONLY
This request vmtl 18 months fro.
? _
,.o
? , ? g
,1 ?-
3 ?7 8 ? a?/?a
0
3
o
ReQUes 3te rta o.
p Fough-In Inpsectmn Pequrt
all inspecior when reatly)
(Vau m
ust
c Ins ection OtM1er Than qaughdn
? qeady Now ? Will Natiy Inspector
? -l ?
_
/
rJ,Yes ? No DateReatly
I Q.IrEnsed contractor ? owner hereby request inspection of above electncal work at
Job Adtlress (SIreBt 8ox or Route No I
S'/ 41 C f' Ciry -
?
Sedion N. Township Name or No Range No Coun
0 4A,
Occupan[(PRMT) Ppone No
oc 11s 3 3
Pow^er SuoDlier Atldress
Elxmca ConVaa`or IGOmpany Nama)
?'1i J 8 h ConVactor5 4cense No
c 4-0 C)
Maibng dEress l nvactor or Owne Makmg InstallaLOn)
m' ?
y ? ?° ,v_?
Au?hon e namre IGonnac?orOwner Making Installabon) hone Number
'?? 'v-qlV? - - -
MINNESOTA STATE BOAflO OF ELECTRICITY THIS INSPECTION REQUEST WILL NOi
GnggHMlpway BIEg. - A.D. 5.173 BE ACCEPTEO BVTHE $TATE BOARD
11121 Unlverslty Ave., St Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 601-0800 ENCLOSED
Efiddress sifi HaCfq-nuF rrxmr Zip 5512,3_
Lof "' 4' Blk t Sub avmmN PJMM 31M
THESE ITEMS WERE ! WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: aJ y' Yes No Inspector:
Final grade (6" from siding) LZ
Permanent steps (garage) v
Permanent steps (main entry)
Permanent driveway
Permanent gas v'
Sod/Seeded grass ?
TraiUcurb damage
Porch 1/
Basement finish
Deck L/
Please vei with the builder the removal of roof test caps from the plumbing system and the shuaoff of water supply ro
the outside awn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in righFof-way or installing underground sprinkler system.
White • City Copy Yellow - Resident Copy Pink - Contrector Copy @
? _ - _ _ _ _ _
- - - - - - - - - -
I pO[O1iiCe?USe ?
I
? Permil#: 6?6 i
I ?
i PermitFee:
I ?
? Date Received: i
I ?
? StaB: ?
L______________
2009 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:
Tenant:
Site Address: 5- 1
ffv-cLmor-e- ?
Suite #:
RESIDENT/OWNER Name: / ( `"i5k2 &S?+ CO - Phone:
Address/CityJZip:
CONTRACTOR Name: hc?Sc?1 Tjw"\ 6;License#:
Address: 3Qq,?- LNJ NL,)
State: P?A) Zip: 5-T-3 cl /
J
4
?
--- -
City: l
6 l,
0
Phone: 76 3-?2 7-76g d Contact Person:
TYPE OF WORK _ New _ Replacement _ Repair _ Re6uild &Modify Space _ Work in R.O.W.
Descri tion of work:
PERMITTYPE RES/DENT/AL
Water Heater Water Softener
Lawn Irrigation ?Add Plumbing FiMures
Lower Level)
? RPZ /_ PVB) ? Main X
Septic System _ Water Turnaround
New
Abandonment
RES/DENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge) I
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround" (includes $.50 State Surcharge)
'Water Turnaround (add $165.00 if a 5!8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
...
I hereby acKnowietlge mat tnis mrormanon is compie[e ano aceurafe; mai me worn wm uc nI wII..t.,, .- ....,..,.?..? ..,•.. .----- -•- -, -Eagan; that I understand this is not a permit,
but only an application for a percnit, and work i not o start wilhout a ermit; Ihat the work will be in
accordance with the approved plan in the case of work which requires a review and approval o ns
X X ? .
Applicant's Printed Name Appl nYs Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: UnderGround Rough-In =AirTest° ' GasTest° _Final
zc?Cx?I?X? :?C?:Aczcuxtr.cscsc?c?:czcx{r,nz3:?zcuz?r%?cr.c?ezcu?c?cx,crcr.c%c?C
CITY I:F EAGAN
CASHIER: S TEkMINRL ND: 782
P4TE: 06/22/58 TIME: 13e45:E3
in_
NaKE: ronn sruRcEoH
3210 4091 53E. HACk:T4DRE DR 74.75
2i55 9001 516 HRCl;riOfiE DR 1.50
3430 3001 516 NRCF;M4RE UFt 0.50
Tofal Receip+, R:nount: 76a75
CR033736
USER rIl: MFNCY
FERMIT
CITY OF EAGAN PERMIT TYPE:
N G
3830 PilOt Knob Road permit Number: 032283
Eagan, Niir'mesota 55122-1897
(612) 681-4675 oate Issued: m 6/19/9 s
SITE ADDRESS:
516 HACKMORE CT
LOT: 4 BLOCK: 1
AUTUMN RIDGE 3RD
P.T.N.: 10-12302-040-01
DESCRIPTION:
&`ilding.Permit Type
,Building 4ork Type
?"Census Code."N.
p?
F?
/ n q
'F
+ ..}
GARflGE/ACCESSORY
NEW
437 ALT. NONRES.
) L t
REMARKS:
PLAN REVEWED BY MIKE BARCK
CALL 445-2840 REGARDING ELECTRICAI. PERMIT AND INSPEC7IONS
FEE SUMMARY:
VALUATION $3,000
Base Fee $74.75 COPIES ' $.50
Surcharge $1.50 Total Fee $76.75
Subtotal $76.25
CONTRACTOR:
?
OWNER: - Applicant -
STURGEON 70DD
516 HACKMORE CT
EAGAN MN 55123
(612)727-6855
that the
T hereby acknowledge that I have read this applie$tinn,and st7S
intormation is correct and agree to'comply uith al1 applicab,ltate of-Mn.
Statutes and CS,ty of Eagan Ordinances. °
?? -
APPLICANT/P MITEE SIGNATURE
I
52,2838 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN -7(;
. ? 3830 PII.OT KNOB RD - 55122
681-4675
New Construction Requirements RemodeVRepair Requirements
? 3 registered sRe surveys ? 2 copies of plan
? 2 copies ot plans (inGude beam 8 window sizes; poured fid. design; elc.) ? 2 site surveys (exlerior additions 8 decks)
? 1 energy calculations ? 1 energy calculetions for heated additions
• 3 copies of tree preservation plan iF lot platted after 717/93
required: _ Yes _ No
DATE: WoS/q t CONSTRUCTION COST;#?d a
DESCRIPTION OF WORK:
STREET ADDRESS: S/ b ttIt(_ICwta fLc ?
LOT: q BLOCK: I_ SUBD./P.I.D. #:
PROPERTY
OWNER
CONTRACTOR
ARCHITECT/
ENGINEER
Wl \ -7y?^bKS?
--7 G
Name: 1 12G0-*`j -r-060 Phone #: !7 ??' /0 II
Last First
Street Address: ?/ G &,+C1?0--,t- C 7
City ?WC? State: ftit nJ Zip: 5_!?_1'Z 3
Company: Phone #:
Street Address:
City
State:
Zip:
Company: Phone #:
Name:
Street
City .
Sewer 8 water licensed plumber (new consWCtion ony):
and lot change is requested once permit is issued.
License #
Penalty applies when address chang
I hereby acknowledge that I have read this application and state that the infortnation is correct and agree to compiy with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances. r--. ?? 4
Signature of Applicant: « -
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Plan Received _ Yes - No _ Not Required
Registration #: _
State: Zip:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 S-piex
? 04 SF Porch ? 09 12-piex
O 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New ? 33 Alterations
K 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MC/WS SAC
City 5AC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 11 Apt./Lodging ?
? 12 Multi RepaidRem. ?
M 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
Basement sq. ft. MC/WS System
Main level sq. ft. City Water
sq. ft. Fire Sprinklered
sq. ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code. ?r3 7
Footprint sq. ft. SAC Code ? i
Census Bldg ?
Census Unit v
Building A/1,13 Engineering Variance
Valuation: $ 3, ov?. --
?, ~:e .q-O A i r,o ,v f
11 .Z? -21) DN
?., % SAC'
C? Nt?AGuUnOvs?R
.
' a..
IUV l? _ /LL> tbD I(? _ 2S V. -
? CI•TY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Datelssued:
eurLoiNG
023018
03/01/94
SITE ADDRESS:
P.I.N.: 10-12302-040-01
DESCRIPTION:
516 WACKMORE CT
LOT: 4 BLOCK: 1
AUTUMN RTDGE 3RD
Building'-.Permit Type
Building Wo,rk Type
'UBC Occupancy ,,
? Construction Ty
j ? 2oning ?--?
I Building Length %
r Build3ng width
?. Building stories
?-
?
SF OWG
NEW
R-3 M-1
V-N
R-1
70
36
2
REMARKS:
PRV S& W PLBR - VALLEY PLBG
FEE SUMMARY:
VALUATSQN
Base Fee
Plan Review
Surcharge
SAC
SAC %
3AC Units
Subtotal
$818.00
$531.70
$75.50
$880.@0
100
$2,225.20
$151,000
MISCELLANEOUS $1,828.50
Total Fee $4,053.70
CONTRACTOR: - Applicant - sT. Ltc
HOMES BY CHASE 18955337 0001619
2500 W COUNTY ROAD 42 260
BURNSVILLE MN 55337
(612) 895-5337
OWNER:
HOMES BY CHASE
2500 W COUNTY ROAD 42
BURNSVILLE MN 55364
(612)895-5337
I hereby acknawledge that I have read this
information ie corract and agree to comply
Statutes,and City of Eagan prdinances.
j _ ? -
? -
APPLI A /PE S URE
applicatian and state that the
with all eppliceble State of Mn.
?
?SUED ? BY: ?GNAT E
15011
CITY OF EAGAN 1994 BUILDING PERMIT APPLICATION 681r4675
:70
---
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 capy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date ;2-- Val uati on of work 1.3? 3O0
Site Address: It
STREET SUITE M
Tenant Name: (commercial only)
IAT BIACK ? SUBD. ?'flfjy/? /SC P.I.D. #
Descri tion of work:
The applicant is: Owner Contractor ? Other cnescribe>
Name .? Phone !'r-S ?S93,Z
Property LaST F,RST
OWn@C Addresso?rNwD GU• cz?s
STREET ? STE #
City State -2?'lrt-_ Zip ST3G?
Company Phone
Contractor Address License # Exp.
City State Zip
Company _ 42 Phone
Architect/
Engineer Name Reaistration #
Address '
City State Zip
Sewer & water licensed plumber 6 orl- . Processing time for
sewer & water permits is two days once a ea has been a proved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all plicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
?
BUILDING PERMIT TYPE "? ? • ?°'"''
O 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
)p 02 SF Dwg. ? 07 4-Plex 11 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory 0 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc.
? 05 SF Misc. 13 10 Multi. Add'1. 13 15 Deck O 20 Public Facility
? 21 Miscellaneous
WORK TYPE
,0 31 New ? 33 Alterations O 35 Tenant Finish ? 37 Demolish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (Actual ) V41 Basement sq. ft . 1,5)L y MWCC System
(Allowable) 1/& lst F1. sq. ft. City Water ?
UBC Occupancy 3 2nd F1. sq. ft. 16&?? PRV Required ?-
Zoning ? Sq. Ft. total , Booster Pump
?` of Stories footprint Sq. ft. Fire Sprinkler
Length ?D On-site well Census Code _hp 7-
Depth ? Dn-site sewage 5AC Code
APPROVALS Census Bldg ?
Census Unit
Planning Building Assessments
Engineering Variance
REGIUIRED INSPECTIONS
? .Site P Fo oting ? Framing JR Insulation
? Wallboard El Fi nal O Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
7rails Ded.
Copies
Other
Total:
SAC %
SAC Units
vatuecfm: S O?
Rg _4--
3?.r 2 S,r /s; /S_
(S?-
3 Qy zja _ 4O6y
r?.rlo ?_
J22%xsy=
z
Qar.
?zx3z?-??_ ??zb y
S??/S(
??
UUIF1.14! ,? -
,?Gm?°c ??y -•,?te^.
-
-- ...,., .. . ' • . . . •
" slil nuuii 7-
ESS:
CUN111hCT0 1l: bAiEs _f'1I011Et QGj$•5?3?
bETEitNIIIE• «OI11;RIli SUUhRE FOO TACE OF' EACI Ia
I.. IOtAL EXPOSEU VII1Ll AItEh. ,.?.... sq f t x "U"
2. TOTAL RUOK/CEIIINC ARCA......
' ?4?2 4i7 •
sq
ft
x
"U"
r????5?
3. TOTl1L EXPOSK0,14ALL AfIEA CAICUlATI011Sf
• • , , ,. , ,
Total exposed wall
'
ar•ea above floor' ' '7
• .. p?d(?
Sf)
f t
'
. .
'
.
..
..
'1 .
,
/ _ . ..
• .
.. 4
. • • ''.,'.
e) Total 4ia11 wlndow areat • .
' •
-?? .Plazed.,... _1?.3 sq ft x "U"
glazed,,,,,, sq ft x "U"
b) 4F` 4D ''
Tota) door oren sq ft x "U" '
,,,,,
c) ',
•1"ota) sllJlnn pless'door 'mreat',,
. , .
•
, . . . , . . ,
. • . . .
--? 9lozed.:.... `l"?a sq Ft x uUn L
qlrzed.'..... sq, ft x nUn . e ,
J) Total flreplace wall erca •• rd sil ft x "U" d
e) Tota) wa11 fYAining aYea .
(nvorac
pe tWO ...... , . ..._' "-2697
sq
rc
x
l'U"
p 9a- °
.??
' f) Total net aal) nrea above •
floor (Insuluted)..,...._
7
st,
f t
x
„U„
. 0 IK3
q) Total rim Jolst.area...,._ f? sq Ft x "U'!
Total foundat_lon
4
.tirca (Expose•i).......... Ov
sq
.ft
.
h) Total foundatlon
wlnJort area ............. sq ft x nU'i .-. e .
I) Total net fovndation"
arca above.qr'aJc?......._' $(? sq ft x "U" "1?
s TOTAI a) thru I)
if'Item pJ Is tlic san,e as,- or la9s tlian Item pl, yov liove met tl,c Intent of
S.h.C. Sectlon 6006 (c) 2.
F.x?usi:u nuuiAciL ific I:AICULAfII)tlSs ' , .
'Total expnsed . • • ` .' . " °`,
, rnof/cclllnq area?....?.,_ IA&2 sq ft ? .
J). lotal ? ,• , , ?
skyl loht. arca........ O sq ft x"U"
'.rl
k) Total roof/ccl llnq framl'ig ..?? ,•,. ? , .. ;
• . aren (Averape
......_ Sq (t x nUll ??•7i? n ??/?•'.
. ' + ..._T. ,
I) Total net Insalated
- YOOf/CCillflq bI'08. .....r,?? S'q r t X "U" t0?? .tl. .?? i/. .• !?? •
. • , TOTAI J) thru 1)
total,or N1, Is thc same as, or less than 02, yuu hovc met the Intent oF
f.C. Sectlon 6606 (c) I. , . .
. . ;.
.? . ?.
' , , , • '. ' ''!::''. .. ?? .. ~ :•t'??..;..; . .
• . , . . • • • , .r•"j . .? . .
. • • ... .
. . . , . ., .
ALTEItIIA?E UUI111111G EIIVELOPE bCSIRiI , • , ? utlllzc thc total envelope system methocl, the volues,estobllshed by the sum .f Items p) and Fh shall not be greatcr than. the sum of
(tems pl and !!2.
I' + ?. ,. .
3• + /?, , ?? e• ' ,.
. • • \ .
, . ? ..
r_IntiL,ir_.nrin
1 here6y certlfy'that I have calcullited the "11" factors anJ "R"
alucs i?ercin nnd that tlIc buildinh Iierc dcscrihed mcets or excecds the State
f Hlnnesota Er?cr?y f.onscrvatlon Aet.
. . , .
. ? ?
' . . . . i ? rynnt?ire ?`?.?•,?,?
???F ?
LOT BtfRVEY C8EC1CLi8T FOx 8E6ZDENTIAL
? H4ZLDING ERlSIT 7?PPLICI?TION ?
PROPERTY LE(il?L=
rt? Date ei 8urvtps ? a
DOCIIMENT BTl1ND},RDe
0 • Reqistered Lnnd Surveyor signature and company
0 0 • Building Permit Applicnnt '
G1?0 0 • Legal description
0 Td? 0 • 7?ddress
V13 D • North arrow and-bar- scale
I?G 0 • House type (zambler, valkout,. aplit w/o, split entry,
/ lookout, etc.)
@',D 0 • Directioaal drainnqe arrows with alope/gradient t.
• Proposed/existing newer and vatez services
B'/D 0 • Street name
8' D 0 • Driveway
ELEVATSONS
Existina
1_'?C1 0 • Sewer aervice
B? 0 0 • Lot eorners
6}?0 0 • Top of curb at the driveway
• Elevations of any existing adjaeent homes
Bropoaed
0 • carage floor H?0 D • First floor
19o?0 0 • Lowest exposed elevation (walkout/window)
V0 0 • Property corners
8?0 D • Front and rear of home at the foundation
PONDIN6 I?REAS [if tsbiicablel
fl C?? • Easement line
NWL
D V 0 ? HwL
0 0_/?? • Pond f desigaation
D O O • E7aergency Overfiow Elevation
LI'?6 0 • Lot liaes
?1 0 • Aight-of-way and street width (to beck of curb)
L? 0 0 • Proposed home dimensions iacluding any propoaed decks,
overhangs grenter than 21, porches, atc. (i.e. a11
structures requiring permanent footings) '
gr't) 0 • Show all easements of record and any City utilities within
? those easements
II 0 0 • Setbacks of proposed structure and setback of adjacent
? existing homes ,
D 0' 0 • Retain?.3? repirements, if any
Reviewed
z/ZY/ Fe-
OCtobez 1992
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Vert-
?•
. 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
, .
- cirv oF EAcaN
--, 3830 PILOT KNOB RD - 55122
851-681-4875
??1,?A v, ) ?
> s wol.ama we wner +?wft w. n. a wt, .a n. a nw,se 7 a y? - d O s coaie, a?ao
antl ?I roofed arew l40% mmdmum bt coveraae dlowetlf t fet ot anergy adculaMwm for healed atldiMons
D 2 Copies ol plans (Yww beum 8 wintlow sizea; poured hW. desiyn: ete.) 1 tite wrveY for e?dor adchHOns d dacb
a 1 sef o(anerpy CdqilcHOrq
a J eopies d Iree preservaMan plan H lot plaMed adler 7/1/93
DATE: 7/7/Z-DdE> _ CON5fRUCTIONCOST: t666D
DESCRIPTION OF WORK: CiAC-K PDiCC 14 ( O
?
SiREET ADDRESS: '?/ ? C?as o 2C C Vb%ji <1 ! fZ ' A-"-?? ?
-
LOT: ? BLOCK: SUBD./P.I.D.O: ?-?-??A-V" ?
?)
Name: STUAZ-vebnJ 7D6 f) ?f
Phone#:
PROPERTY taar fliat i..) ?CI -'l 3?- S770
OWNER
SheetAddress: Sl(n HITELA
'+oYZG 67-
G y L-A"lsRr-) srate: MnJ vp: Sc-fz 3
. Company: Phone #:
(area code)
COMRACTOR
Sfreet Address: 1lcense p ExP.
City State: Zip:
ARCHITECT/
ENGINEER Company: Name:
Telephone g: ( )
\
Sheef Address: Regishoilon C
Cryy Stafe: ' ZiP:
Sewerlwater licensed plumher (If Installina sawarfwaterl: Ptane #: (I
I hereby xknowledpe Ihaf I have read th's appifoaHon, atWe Mwl ihe IMomalbn ffi earect, and agree b eomPly wHh a0 apWcabk Sfe#
W Minnesota StahAea and Cify of Eaqan Ordinances. ?
?.?
Sipnalure ot AppUoant
OFFICE USE ONLY
CeRiflCates of Survey Received _ Yes _ No JUL - 7
Tree Preservation Plan Received _ Yes _ No _ Not Required -r2n?
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundation O 07 OS-plex
? 02 SF Dweiling ? 08 06-plex
? 03 01 of _ plex ? 09 07-piex
? 04 02-piex O 10 OB-plex
? 05 03-piex ? 11 10-piex
? 06 04-plex ? 12 12-plex
WORK TYPE dPE-1Q
0 31 New 0 36
0 32 AddiUon ? 37
0 33 Alteration 0 38
? 34 Repair 13 42
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
Ad P--
O 13 16-plex ? 21 Poroh (3-sea.)
? 17 Garage 0 22 Porch/Addn.(4-sea.)
O 18 Deck O' 23 Porch (screened)
O 19 Lower Level p 24 Storm Damage
Plbp _Yor _N ? 25 Miscellaneous
? 20 Pool O 30 Accessory Bldg.
Foee?A l w R6eF-
?
Move Bidg. O 43 Reroof
Demolish (Bldg)' ? 44 Siding
Demolish (Interior) ? 45 Fire Repair
Demolish (Foundation) ? 46 Windows/Doors
• Give PCA handout to applicant for demolition permit
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq.ft.
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building
i
Permit Fee q S. a.
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
SMI Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
TotaL• 11'Ll. G(o
SAC Units
% SAC
sq.ft.
sq. ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
G0 Engineering Variance
Valuation: $ D Op ?
3f5o k -qo - /0 1 350 6L"
. ,
O 31 ExC Alt - Muib
O 33 Ext. Alt - SF
O 36 Muw
.
: - `
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIItED FOR EACH UNIT.
X NEW CONSTRUCTION
P,DB-ON A/C
ADD-ON FURNACE
FIREPLACE INSERT
DATE
FEES
HVAC: 0-100 M BTCT $ 24.00
ADDTfIONAL 50 M BTU 6.00
GAS OUTLETS (MINIMUM 1 @ $3.00 EACI-) 6.-7•co
ADD-ON/REMODEL (EXISTIING CoNSTRUCi'toN) $ 20.00
STATE SURCHARGE .SO
TOTAL ?D•5 7
STTE ADDRESS:
OWNER
INSTALLER: \' tN-?t . t`o \ 1 ,Q C\
#• ,-,{ o o- /--)"
ADDRESS: ?. C) . ` /')- 1 ?C? 1 c?- nl ?v, S J-
CIT'Y: VC'K-f'n k nc? ?c°rr--? STATE: (Y) 1 c1 Yl _ ZIP CODE:
TELEPHONE #: `"'t IrJL? ?G'C7 ? °lL.
1994 MECHANICAL PERNIIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
.-.
PLEASE COMPLETE FOR ALL COMMERCIAI,IINDUSTRLAI. BUILDINGS. ALSO COMPLETE
FOR APARTMENT BUILDINGS OR OTI-IER MULTI-FAMILY BUILDINGS WFIEN SEPARATE
PERMTTS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
DrSTE: CONTRACT PRIf;E: $
NEW BUII,DING
INT'ERIOR IMPROVEMENT
WORK DESCRIPTION:
1% OF gg,?_?M FEE
PROCESSED PIPING:
MINIMUM FEE:
STATESURCHARGE
TOTAL
FEES
$
$25.00
$25.00
$.50 FOR EACH $1,000 OF FEE
n>. ._,?. .
$
SITE ADDI2ESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (aMPxovEMErrts oNr..Y)
INSTALI,ER:
ADDRESS:
CITY
STATE: ZIP CODE:
TELEPHONE #:
SIGNATURE OF PERMTITEE CITY INSPECTOR
1994 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 681-4675
PLEA3E COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOVJNI'IOMES .AND
CONDOS WHEN PERMTTS ARE REQUIRED FOR EACN UNIT.
NO. FIXTURES
t SHOV'IER
-3_ WATER CLOSET
BATH TUB
? LAVATORY
? KITCHEN SINK
LAUNDRY TRAY
HOT TUB/SPA
? WATER HEATER
? FLOOR DRAIN
_L GAS PIPING OUTLET • minimum -
ROUGH OPENINGS
WATER 50FTENER
PRIVATE DISP. • Dak.Cry. lic.
U.G. SPRINKL.ER -home unaer const.
ALTERATIONS • to «i:ung
WATER TURN AROUND
STATE SURCHARGE
TOTAL:
SITE
EACH TOTAL
3.00 3- -
3.00 9-
3.00 (,-
3.00 01-
3.00 3-
3.00 3 ?
3.00
3.00 ?--
3.00
3.00 3 -
1.50
5.00
20.00
3.00
20.00
20.00
.50
4a. s0
?.
OWNER NAME:
INSTALLER: U 9I,?y Q? 6 r
ADDRESS: ?D I U C 2a c Y' L.
-
CITY: STATE: M- ' ZIP CODE:
pHONE #: ( ) q A? -a r a,
C_??
SIGNATURE OF PERIvIITTEE
1994 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
PLEASE COMPLETE FOR ALL COMMERCIAL/INDLJSTRIAI, BUILDINGS. ALSO FOR MULTI,-
FAMILY BUILDINGS WHEN SEPARf1TE PERMITS ARE NOT REQUII2ED FOR,.EACH
DWELLING UNTT.
_ NEW CONSTRUCTTON
ADD ON
REYAIYZ
WORK DESCRIPTION:
CONTRACT PRICE: $
Fi3E: 1'7c OF CONTRACI' FEE.
STATE SURCHARG& $.50 FOR EACH $1,000 OF ?!.E„Tfltif? FEE.
AtINlDiUNi FEE: $ 25.00 "''"?°°' »
CONTRACT PRICE X 1% $
STATESURCHARGE $
TOTAL S
SITE ADDRESS:
TEt.iANT NAME: sTE, *`
OWNER NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #:
STATE:
ZIP CODE:
FOR:
CITY OF EAGAN APPLICANT
1994 PLUMBILVG PERMIT (COMMERCIAL)
C1TY OF EAGAN
3830 PIT.'OT KNOB RD
EAGAN ,MTF ?55122
(612) 681=4675
?----------------i
i Fbr,cs?c?vse
? Permit #. O/7 7 / ?
' l?D
I Pertnit Fee: ?
I
? Date Received: ?0 ?
j Staff: ? (-!e I
I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION 12'/a0
Date: ? ?TJ Site Address:
Tenant:
Suite #:
?7
?I gS 'A J
? s
i
RESIDENT / OWNER U ro Phone:
i
Name:
5 IY
1
Address / City /Zip: S 1(Q I' G'IMO?C CC)Vv'1' ia5J ?7o?,3
Applicant is: _ Owner XContractor
TYPE OF WORK Description of wor
k
' ?SQ?K t?G
?
z
"' Multi-Family Building: (Yes NoX)
di
C
C
t
t
ru
os
ons
on
:
CONTRACTOR CO t"? fl ? License #: oU(l (1d'7'j ?
Name: I Y1 ISkcj Qe SC c
,
Address 1c??Q I.?vL )C ???c 1?1?- J U L YC #1
Zi
:
t
" St
p
a
e:
City:
Phone: 6 I`j3 V 970 J Contact Person: (?Yf 1 i ln 1?lU!/l ??'l
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category t Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 submi55ion type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a permi[ 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 documents thaLyou submit are considered to be public fnformation.= PorYions of
ihe information may be. c/assified as non public if you prov,ide specific.reasons ihat would permif the City-to.w
conclude that ihe are trade secrefs.
I hereby acknowledge that this infortnation 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 onty an application tor a permit, and work is not to art wRhout a permrt; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval ans.
x A6?1 rl',v7 FE x ?
Applicant's Printed Name I r? ApplicanPs Signature
?
2008 Page 1 of 3
D_ C 1 -?
}
DO NOT WRITE BELOW THIS LINE
SUB TYPES
? Foundation ? OS-plex ? 76-plex ? Accessory Building ? Pool
? Single Family ? 06-plex ? Fireplace ? Porch (3-season) ? 6ct. Alt. - Multi
? 01 of _ Plex ? 07-plex O Garage ? Porch (4season) ? Ext Alt. - SF
? 02-Plex ? 08-plex ? Deck ? Porch (screenlgazebo/pergola) ? Multi Misc.
? 03-Plex ? 10-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
? New ? Interior Improvement ? Siding ? Demolish Building"
? Addition ? Move Building ? Reroof ? Demolish Interior
? Alteration ? Fire Repair ? Windows ? Demolish FoundaGon
? Replacement ? Egress Window ? Water Damage
' Demolition (entire building) - give PCA handout to applicant
DESCRIPTION:
?
Valuation J/
c .ZZC-
Occupancy ? i mCES S
ystem
Plan Review Code Edition 111 /r ZUO 7 SAC Units
(25%_ 10D% Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Const. Width
Footings (new bidg) Sheetrock Meter Size:
Footings (deck) FinallC.O.
Footings (addition) ?6 FinallNo C.O.
Foundation _)6 HVAC
Drain Tile Other:
Roof: _Ice & Water _Final Pool: _Foo6ngs Air/Gas Tests Final
? Framing Siding: _Stucco Lath _Stone Lath _Brick
Fireplace:?R.l. _?OAirTest Final Windows
Insulation _ Retaining Wall
Reviewed By: ? Building Inspector
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
40? Clty of EapIl
3830 Pilot Knob Road
Eagan MN 55122
(651) 675-5675
RESIDENTIAL BUILDING PERMIT APPLICATION REQUIREMENTS:
New Construction Reauirements
? 3 registered site surveys showing sq. ft. of lot, sq. ft, of house; and all roofed areas
? 1 Soils Report if proposed building is to be placed on disturbed soil
? 2 copies of plan showing beam & window sizes; poured found design, etc.
? 1 set of Energy Calculations
? 3 copies of Tree Preservation Plan if lot platted after 711193
? 20% maximum lot coverage allowed
? Rim Joist Detail Options selection sheet (buildings with 3 or less units)
? Minnegasco mechanical ventilation form
Remodel 1 Repair Reauirements
? 2 copies of plan showing footings, beams, joists
? 1 set of Energy Calculations for heated additions
? 1 site survey for additions & decks
? Addition - indreate if on-site septic system
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 515 Hackmore Ct
Lot: 3 Block: 1 Addition: Autumn Ridge 3rd
PID:10- 12302 - 030 -01
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments: P
Fee Summary:
Valuation: 3,000.00
Contractor:
Seta Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823 -8046
ctures are not acceptable in lieu of inspections.
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Construction Type:
Occupancy:
$90.00
Owner:
Susan M Griesgraber
515 Hackmore Ct
Eagan MN 55123 -3068
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Building
EA078580
06/27/2007
ePermit
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA150264
Date Issued:06/27/2018
Permit Category:ePermit
Site Address: 516 Hackmore Ct
Lot:4 Block: 1 Addition: Autumn Ridge 3rd
PID:10-12302-01-040
Use:
Description:
Sub Type:Reroof & Siding & Windows/Doors
Work Type:Replace
Description:
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 12,000.00
Fee Summary:BL - Base Fee $12K $221.25 0801.4085
Surcharge - Based on Valuation $12K $6.00 9001.2195
$227.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Todd L Sturgeon
516 Hackmore Ct
Eagan MN 55123
(651) 219-2794
Krech Exteriors Inc
5866 Blackshire Path
Inver Grove Heights MN 55076
(651) 688-6368
Applicant/Permitee: Signature Issued By: Signature
r For Office Use
‘‘%::1 E AG RECEIVED Permit#: �S .33 y
Permit Fee: P.?'69
JUN 172019
Date Received: 6-24/
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff: jV1.1,-'
buildinginspectionsacityofeagan.com
111
2019 RESIDENTIAL BUILDING PERMIT APPLICATION k,"?))51):19
Date: 01` I Site Address: Ci `1"`-1 U C Unit#:
Name: ib DO /ti,(Z_ iN Phone: rio5 Z1 "•=Z 9'1
Resident/ s�(r 1 c-K-AcA+ 7 Cr
Owner Address/City/Zip:
Applicant is: Owner Contractor
Type of Work Description of work: 13A1 `P'Vdv‘ (1"4-40�Z
Construction Cost:ILL, 00O Multi-Family Building: (Yes /No Y.)
Company: Contact:
Contractor Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:
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.
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.citvofeaoan.com/subscribe.
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.000herstateonecall.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.
x D� 5114AQ-(s,,Z✓•-/ x '` "u'
Applicant's Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE 5) to /qeitte.. ine(e Cfr — /Y6,7-3/
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi — Deck _ Porch(Screen/Gazebo/Pergola) Miscellaneous
01 of_Plex _ Lower Level _ Pool _ Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Iteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair Egress Window _ Water Damage
—
Retaining Wall *Demolition of entire building-give PCA handout to applicant
—
DESCRIPTION
Valuation _9/_ Occupancy MCES System
Plan Review Code Edition 42#4 SAC Units
(25% 100% ) Zoning IV City Water
Census Code 1` Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length _ Fire Suppression Required
Type of Construction ' 6 Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final I C.O. Required
Footings (Addition) X Final I No C.O. Required
Foundation Foundation Before Backfill HVAC_Service Test Gas Line Air Test_Hood
Roof:_Ice &Water _Final Pool:_Footings _Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_Rough In _Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
/`_ Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan ,- Other:
Reviewed By: C 7.- , Building Inspector
RESIDENTIAL FEES
Base Fee !/
Surcharge in
Plan Reviewow
MCES SAC
City SAC
Utility Connection Charge (P
S&W Permit& Surcharge
OA\TI n
Treatment Plant Vf
Radio Meter Read
Copies
Oil/
TOTAL
Page 2 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA160225
Date Issued:02/24/2020
Permit Category:ePermit
Site Address: 516 Hackmore Ct
Lot:4 Block: 1 Addition: Autumn Ridge 3rd
PID:10-12302-01-040
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Todd L Sturgeon
516 Hackmore Ct
Eagan MN 55123
Applicant/Permitee: Signature Issued By: Signature