4740 Hauge Cir
Use BLUE or BLACK Ink
For Office Use
I
- - - - - - - - - - - - - - - - -
-1- I Permit ✓ -3 0
City of EaAila Permit Fee: ✓ J~ f j
3830 Pilot Knob Road I I
Eagan MN 55122 I I
Phone: (651) 675-5675 R 0 t1 I Date Received:
I I
Fax: (651) 675-5694 I Staff:
-----------------I
2011 MECHA4 AL PERMIT APPLICATION
Date: Site Address:
Tenant: Suite
RESIDENT/ OWNER Name: 0 L G Phone:
Address /City /Zip:
~ma r1z
CONTRACTOR Name: 1-~6, License
s
Address:/ dle ~G city::^T_
State: ► l)11 Zip: Phone: O 5/✓6 a~/
Contact: ;4K ; Email
g lit
TYPE OF WORK New Replacement Additio I Alter ti
etc ~ f~ ~ ~ ~ s2 1
Description of work: f-0-An 67'
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
PERMIT TYPE -/Furnace New Construction ^ Interior Improvement
✓/Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
_ Heat Pump _ Under / Above ground Tank Install / _ Remove)
" When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x1%
$55.00 Minimum (includes State Surcharge)
Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee Surcharge
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance
with th pprovedplan in the case of work which requires a review and approval of plans.
x x
App i ant' Printed Name Applicant's Signa e
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground - Rough In Air Test -Gas Service Test -In-floor Heat -Final
Exterior HVAC Screening Inspection
PERMIT
City of Eagan Permit Type: Building
Eagan. Permit Number: EA096762
Date Issued: 11/01/2010
OR Permit Category: ePermit
41~ it~ of E3
E
Site Address: 4740 Hauge Cir
Lot: 1 Block: 4 Addition: Ridaecliffe 1st
PID:10-63980-010-04
Use:
Description:
Sub Type: e-Windows iDoors Construction Type:
Work Type: Windows Doors-New ; Replacement
Description: House
Census Code: 434- Occupancy :
Zonin,:
Square Feet: 0
Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee S3K $88.50 0801.4085
Valuation: 10.593.00 Surcharge - Based on Valuation S3K $1.50 9001.2195
Total: $90.00
Contractor: - Applicant - Owner:
Pella Windows & Doors Turnkey Sales Heng Lou Wang
1 300 25th Ave N =100 4740 Flange Cir
Plymouth SIN 55447 Eagan SIN 55122
(763) 74-1400
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 Cite of Eagan Ordinances.
ApplicantiPermitee: Signature Issued Bv: Signature
CASH RECEIPT
. - : ?'CiTY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE ' 19
RiCtIVED ' FROI4 . . , ? ,
annouNr $
DOLLARS
1 oo
0 CASH 0 CHECK
POR
?
FUNG CODE AMOUNT
7
?
Thank You
T j
? 4}??501
( &U
J
)
?
?
J \
BY ' t
White-Payers COpy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
Addition RidgeclifE Fi.rst Addn Lot 1 $ik a -Parcel#10 639$0 010 04
owoer Street 4740 Hauge Cir le State. ESgari, NW 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF, .
STREET RESTOR.
?
GRADING
SAN SEW TRUMK 1982 298.08 - -
SEWER LATERAL
WATERMAIN
WATEfl LATERAL
WATER AREA 1982 298.08 12-2S-91
STORM SEW TRK
STOFiM SEW LAT
CURB & GUTTER
SIDEWALK
STREET IIGHT
Road Unit 260,00 10-24-84
WATER CONN. 470.00 it to
BUILDING PER. if if
SAC if i'
PAR K
CASH RECEIPT -'i
;:' . .
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
R6CEIVED
DATE
19
AMOUNT $ I
& DOLLARS
+oo
White-Payers CopY
Yellow-Pasting Copy
Pink-File Copy
I-1 r w c u I-I i+ u r r- v
Thank Y
BY
I Receipt
PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee 1c." Fill in numbered spaces S/C (
Type or Prrnt legibly Tot. :.' ..?'
;?
1. Date /4* 2. Installation Cost ?
3. Job Address TCil .% , LotBlk. •i Tract
r
4. Owner J'?
I 5. Contractor /(?&_A/ZeCMECrr Phone
6. Address j?C'o 4k /vl,
7. City 5tate ,?li? Zip ?-
8. Building Type: Residential El Commercial ? Institutional El
1 9. Work Description: New 19
1 10. Describe
1 11.
Add O Alter O Repair Cl
No.
--? Fixtures
Water Closet No. Fixtures
Cesspool/Orainfield
?- Bath tubs Septic Tank
D Lavatory Softner
Shower Well
/ Kitchen Sink
Urinal/Bidet OtherG>;
'/
? Laundry Tray _
Floor Drains i
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
oomply with all ordinances and codes governing this type of work.
Signed : ' for
Rough Final
Inspections: Date Insp. Date Insp.
I This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAQAN
FN
Fi!l in numbensd tpscet 8/C
Typs or Prinr lepib/y Tot
1. Date 3??:, 2. Installation Cost 280O.0r 3. Job Address 4; f+G ziai<<`e r?1.1•. Lot ; Blk. ! Tract
4. Owner
5. Contractor
8. Addross
Phone `254-W-7
7. City • State Zip
8. Building Type: Residential Q Commercial O institutional ?
8. Work Description: New U Add ? Alter O Repair ?
10. Describe ???;i1.L:_ I?'S1'• lT?''? r 'EuelType +. ??-, -
11.
No• EqLiipIDBpi 8 TU - M. Ea.
Forced Air No. Eouioment CFM
Air Handlin
:
Mfg. g
Boilen
Mfg. Mech. Exhaust
Unit Heater
Mf9• Other
? Air Cond.111'^73`!
Mfy,
Gai. Pipinq Outlets
12. I hereby certify thai the:above information;Ps true and oorrect, and I agree to
wmply with all ordi?anoes an sgovqtning this type of work.
17,
5gnsd : for
/ Rouyh ? Final
In=pections: Date` Insp. Date Insp.
This is your permit when numbered and approvsd.
Approved CITY OF EAGAN 4648100
BUILDING PERMIT
Te 6e uaed fo. SF DWG/GAR
Receipt #
$85,000 pote OCTOSEZ 24 . 19 84
SiteAddrama 4740 HAUGE CIR
Lot Block 5eclSub.
Parcel No.
W Name ORRIN THOMPSON HOAIES
z Address
9 City MTKA Phone 544-1333
et
o SAME
Name
Z
oU
Address
u?
?'
City Phone
?a
? W
Name
?- Address
?
u ,
,, W City Phone
Erect U" Occupancy
Remodel ? Zoning _
Repair ? Type of Const. V
Enlarge ? No.StorieS
Move
Demolish ?
? Length d
Depth 42-
Grade ? Sq, Ft.
Approra Is Fees
Assessment
Woter 8 Sew.
Police
Ffre
Eny.
Planner
Council
Permit '' -? u u. v v
Surcharge 42.50
Plon check 194.00
SAC 525.00
Water Conn. 4 7 0. 0 0
Woter Meter 63,4 0
Rood Unit 260 _ 00
? Parks 942
Total • '
1 hereby ocknowledga thot I have read this application and stote that gldg. Off. 10/24/$
tfie intormotion is correc ogree to comply with oll oppliceble APC
Stots of Minrtesota Statut crpyo??pf Ea,qa Ordinonces.
Var. Date
Si9nolure of Permittee I
A Buildirtg Permit is issued M: ORRIN THOMPSON HOMES on the express condition ihar
oll work shall be done in accordonoEiritFi'@II opplioobl St f . Minnesota Statutes end City of Eagon Ordinances.
°°?__ _
?- -),•?_a--', ? i_ <_ : _? ; ?
Buildinq pfficiol ?-
CITY OF EAGAN 9648
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 'PHONE: 454-8100
Psrmit No. Permit Holder Date
Plum6ing f. ? ? 17 :E)
H.V.A.C. 6165 IN If, ?I (
Elactric q -k • v U
Softenor
Inapection Date Insp. Other
Footings .
Fpundation
Framing
Rough PIb9•
Rough HVAC
Inwlatian
Final Pibg.
Final HVAC .? ?
Final
con/oCC. 5
Water Deseribe Location:
VYell ?
Sewer
Pr. Diap.
CITY OF EAGAN
3830 Pilot Knob Road
P: O. Box 21199
Eagan, MN 551??
z?ing:
NOWMr:
Add/EES:
' Sit! AddrlSS: . . ., t?P1?('? (??+rh#a-`=tc ?
`? M??urriber t:? • J.+i q-
7Neter No.• O
sru: SLg , . . . _.
REOdOI MO.: 3K_ 3 F
1 agree to eonnplq wil6 Mw City of Eaqen
Oediaenaa.
By
Date of Insp.:
/ S
WATER SERVICE PERMIT
PERMIT NO.: _
DATE:
No. of Units:
COnnection Charge: ? ? ••. v? „u
Aocounr aposir: 15 Permit Fee:
?.
Surcharge:
Mltc. Chorpes:
Total:
Date Pa1d:
•P. v. 8ox 21199 PERMIT JNO.:
Eagan, MN 551?? DATE:
ZO^"'fl: No, of Unlts:
; r'r R OTL?SO[. .;O?';;:g
Owner:
Address:
w a5Qe '., rc e 1'4 Qe __. C
Sita Addrcss: • -
Plumber. _
Meter No..
Size:
Reader No.:
r. eat
Connection Charge: '' • ••. vv pu
1lccount Deposit: T."
Permit Fee: ,
1"M /o ooaqlp wNU 1w C'iryr of E"Pw Surchwrge:
Oeriwnam ?A1- n......?. . ? _. - , "eter
By -
Dcte
of Insp.:
? CIT EAGAN
3830 ot K nob Rosd SEMIER SERVICE PERAAIT
P. O. Box 21199 PERMIT NO.:
Eegan, MN 55-721 p^TE. ::, ;` .: 4
Z"gng; Rl No. of Units: - 1
Own.r: Orrin Tbompeoa Fb?e
Addrcss: - ..._?. ,
sir. Addm= 4740 Hauge Circle Ll B4 t g li ff L
Plumber. •
10-24-84 4722e pa
?oMw te MwA wllh ew Cihr N Eq"w Caxoctlon Chorpr. 425.00 0 pd .
Ordinmaea. AccouM 15.?' ?
a?t: rT
^?•
P.mnie F..: 10.00
.50
BY SuncFwrpe:
Misc. Cl?orpes:
Date of Irop.: Totol:
Dah Poid:
CREDIT MEMO
CITY OF EAGAN N° 2989
3795 PIIAT KNOB ROAD
EAGAN, MINNESOTA 55122
Phone 4548100 Octo6er 25, 1984
? -1
, WENZEL PLUkBjNG & HEATING INC
3600 KENNEBEC DRIVE
EAGAN MN 55122
L
DETRCN AND MqIL WITX YOUi CXECK.
1'OUR CANCFIIED CNKR IS YOU4 RECEIPT.
I
N° .2989
10/24/84 Recei:pt No. 47247 - OVERPAYMENT
OF ACCOUNT DEPOSIT FOR 3666 WOOD-
THRUSH COURT - DEPOSIT PAID WHEN
OWNER OBTAINED BUILDING PERMIT $30.00 CR
rnio er cN[cK No.
o•*
388 • 00 +
42•50+
194•00+
525•00+
470•00+
63•00+
260•00+
1?942•50*
? . .
?ALL CONTi?MUS LICENSED WITH THE CITY OF EAGAN - INCLUDE 0 SETS OF PLANS,
0 CERTIFICATES OF SURVEY
P1an Number: Z-?'Z SF17? d- Ga2 Q SET OF ENERGY CALCULATIONS
To Se Used For• ',?S•?_owU'/?'P'R. Valuation: ` ? Date:
Site Address: L?1`\O 85.Da7. %' • •
Lot: \ Block: L? Sect/Sub Ridgecliffe i Erect: ?
Parcel #:
owner: ORRIN THOMPSON HOMES
Address: a ivisiono .. ome orporatiwr
1712 HOPKINS CROSSROADClty/Zip Code: rAINNETONKA, MINN, 55343
Phone #:
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./Eng;
Address:
City/Zip Code:
Phone#:
Remodel:
Repair:
Enlarge:
Move:
Demolish:
Grade:
Occupancy: R-3
Zoning: 2-I
Type Of Const:
# Stories:
Length: ?Z
Depth: 4 Z
Sq. Ft.:
9APPROYALS. I
Assessments:
Water/Sewer:
Police:
Fire:
Engr.:
Planner:
Council:
Bldg. Off.:
APC:
Variance:
Permit: ?6j?j,w
Surcharqe: 42.5`
Plan Rev. :
SAC: S25 "=
Water Conn: 4-70.?'
Water Meter ?3,
Road Unit:
o z Parks: 260.°°
J?
/ q'
i
2&x 4L ° WIca x54=?35n4
?--t) r. 2z- 7 28( -.? Y. s 4= I 5 4+ 4
Z2 `X 22 =4 b 4 XPt = 532¢
gq-27Z
A_
•f
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
. PHO?lE:454-8100
BUILDING PERMIT
Receipt #
N° 9648
?7.ta.v
Te M u"d (er SF DWG/GAR Est.Volue $85,000 Date OCTOBER 24 19 84
SiteAddress 4740 HAUGE CIR Erect EIX Occupancy R3
Lot 1 Block 4 eec/sub. RIDGECLIF FE qemodel ? Zoning Rl
Parcel No. Repair ? Type of Const. V
Enlarge ? No.Storie?
? Name ORRIN THOMPSON HOMES Move ? Length
-
Z
Address 1712 HOPKINS CROSSROAD
Demolish
?
Depth ?
?
MTKA
544-7333
Grade ?
Sq. Ft.
City phone
Name SAME
s? Address
?- City Phone
C?
?w Name
So Addrest
V
Mw City Phone
1 hereby ackrrowledge that 1 have read this opplication and state thot
the inlormotion is crorrect and pgree to comply with all opplicabla
State o4 Minnewro Stotute's' ?and Ciry of Eagon Ordinances.
Signoture of PermiMee ???fm CA&n
A eullding Permit Is issued to: ORRIN THOMPSON HC
all work shall be done in accordu wit II aooJicabl Sta}g ftAii
ApOrovals Fees
Asussment
Woter 8 Sew.
Police
Fire
Eng.
Planner
Council
eiay. ott. 10 / 2 4
APC
Var. Date
Permit ? "" • ""
Surchcrge 42 _ 50
Plon check 1 94 _ 00
SAC S25_00
Water Conn. 470 _ OQ
Woter Meter 4; -A - ? 0
Road Unit 26n n0
Parks
Total _TIT T47-.5-0
on the express condition that
Statutes ond Ciry of Eogan Ordirwnces.
Buildirq OFfldol
CITY OF EAGAN . Na 14 8 4 2
3830 Pilot Knob Road, P.O. Box 21-199; Eagan, MN 55127
PHOM -E'-454•8100 v a g--??
BUILDING PERMIT ZSp? Receipt# O
To be used for BASEMENT FINISHESt. Value V Date APRIL 15 ,i9 88
Site Address 4740 HAUGE CIR
Lot 1 elock 4 Sec/Sub. RIDGECLIFFE 1ST
Parcel No.
m Name HENG LOU & MEI-YEN WANG
3 Address 4740 HAUGE CIR
a City EAGAN phone 454-9255
, o Name
?a Address
P City Phone
t-,
ww Name
zg Address
a w . City Phone
I hereby acknowledge ihat I have read ihis application and state that the
informalion is correct antl agree to comply with ali applicable State of
Minnesota Statutes and City of Eagan Or inances?` j?
Signature ot Permittee /.^r'y-tL
.-?' ?? ?"'
A Building Permit is issued to: G LOU & MEI-Y N WA
on the express condition that al I work shal I be done in accordance with al I
applica6le State ot Minnesota Statutes antl City of Eagan Ordinances.
Building Official?. !PA I
l
OFFICE USE ONLY
OnSkeSewage _ Occupancy
MWCC System _ Zoning
On Site Well _ (Actuap Cons[
Ciry Water _ (Allowable)
PRV Required _ # of Storias
8ooster Pump _ Length
Depih
S.F. Total
Footprint S.F.
APPROVALS
Engr./AssesS.
Planner
Council
Bldg. Off.
Variance
FEES
Permit 34.00
Surcharge 1.00
Plan Review
SAC, City
SAC, M WCC
Water Conn.
Water Meter
Road llnil
Treatment Pt
purksCopies .50
TOTAL 35.50
t I-1'1i S/ REQUEST FOR ELECTRICAL INSPECTION . es-ooooi.a
See instructions for completing this form on back of yellow copy.
A nq7 Q,7.B "X" Below Work Coveced 6y Thrs Request I I T f
Nff4 AddI ReO. Typa oi BuilEing APPIiunCee WIIBd EquipTBnl WirBd
Home Range Temporary Service
Duplex Water Heater Lightiny Fiztures
Apt. Buiiding Dryer Electric HeaUn
Commercial Bldg. 01, Fumace Silo UnloaAer
Industrial Bldg. t?, Air Conditioner 8ulk Milk Tenk
Farm i ei oeci v [ er (SUUr.ify)
t 9r SVecify Othcr Othor
ompute lnspection Fee Below
M Fee ServiceEnvance5ixe k Fee Feedars/Subfeedars % Fea Circuits
l'}, 0 ta 200 qm s 0 to 30 qm s 0.LU 0 to 30 Am
Above 200 qmps 31 to 100 Amps 31 to 100 A
Swimming Pool Above 100-Am s 1
Above 100-Am ' 1.
Transiormers Irri ation Booms ${ _ t? 1
Partial /Othor fee
Si.gns Specialinspection
$ /-
?
()
TOT
pY
FEE
pg? kg iD.
j a
-
/ ; i- Mi?l
V'
Rouph-in Date
?' ?,the Elecirieel
Inspectoq heraby ..
? certiiy thet the above
final ` D81e ,/ nepec[ion hea been
• . J ?7-meda.
Tla repueat vale 18 monllm Irom
This re0uest void
18 monNs lram
A 097078
y,
0-6U
Nequest D te Fire No.
ti
NouB.-i? Insuec
Faired7
Reetly Nuw ?Will Notitv. InsPec-
?
? ?
Yos No lar When ReaCy
? Licensetl ElecVical Con[ractor I hereby roquect impection ot ebove
? Owner alectricel work Inatelled at:
Stteet Address, 8oa or Route No. City
y'tti o &AUU'9; Qr-ut. 06Arv'
ecuon o. Township Name or No. anee No. County
???
. v/?Ipf-?+J -A
OccuOant IPRINTI Phone No.
0 P-c-, ri t?MP??J 4-h%+
Power Supplier Addre
s
s
^
^,?l ?y-^? I
,?
,?IF/"?IIR11?
Elecvical Conuactor (Company Namel Contrar.tor's License No.
B?? ??r?c 93qs ?s - Z
Mailing Address (Con[rxctor or Ownar Meking Inswilation)
C tfi` RAn
Authorized Signa (C trector/Owner Makinelnstallation)
PhoneN
umber
mber
l r
MINNESO A STATE BOARD OF ELECTPICITY - THIS INSPECTION PEUUEST WILL NOT
Gripgs-Midwey BId9. - poom N•191 BE ACCEPTED BV THE STATE BOARD
1821 UniversilY Ave., St. Peul, MN 56104 UNLE55 PflOPEN INSPECTION iEE IS
Phone 16127 297-2111 ENCLOSEO.
REQUEST FOR ELECTRICAL INSPECTION ee-oocooi-os
?j
, Siee instructions for completinB this form on beck af Vellow copy. Ci'2x ? ??
???6 2 01 _ "X" Be/ow Work Covered by This Request ?? V
MIew4Adtlj Xi TyOe of BuildinB I AGOliamea Wired I Equipmenl Wiretl I
Silo UnlO
8ulk Milk
ee
k Fea ServiceEntrence5ixe tt Fee Fextlers/Subfeeders k Pee Circui[s
U to 200 qm s 0 to 30 qm s 0 tn 30 An )s
Above 200 Amps 31 to 100 Amps 31 to 100 A s
Swimming Pool Above 100 _Amps Above 100_/amVs
Transformers Irrigation Boortts Partial.I Other Fee
$igns Speciallnspection
S X.
TOTAL F
Hertwrks
? . _ t-
-< I the EI??
Li. - 7??.' ?aQ InsPectoq ?ereb
ey
? ^ertify that tha bova
inal ?e? inspection has Ceen
r n.da.
This request vaid C ?
18 npmhs from ?<.J/?
D 66201 k/, dAt, a4624II
Nequest Date ° ?
/
? Fire Nu. P ph- n Ins r.tion
Rnqwred?
?ReatlyNOw?WiItNoGfy.lnspeo
?O
4" (,s ?c p ? y es ? No tor When Ready
? licensed ElecVical Contractor I hereby request inspection o1 ebova
ROwner electricel work installed at:
Sheet Address, Bax or Route No.
u.-N. o l-1 ?s? City
•
eclwn o. Towntihi Name or No. Ran9e No. Cowi y
t" a?v
Ocwpam IPRINTI
HU-n! Lod 6- Phone No.
Power Suoulier Address
Elechical Conhactor ICOmpany Namel Cunvxcwr's License No.
Mailinq AdJress (Convactor or Owner Making Instailalion)
Auth ized SiPnatura (COMractor/Owner Making Installation)
l Ph??ne Number
/
MINNE50T/?TpTE BO RD OF ELECTRICITY THIS IYVSPECTION HEQUEST WILL NOT
Griggs-Mid?+a?y Bldg. - Hoom N•791 BE ACCEPTEO BV THE STqTE BOApD
1821 Univers?tv Ava.. St. Pnul. MN 56104 UNLESS PflOPEfl WSPECTION FEE IS
Phone(612)642-OB00 ENGLOSED.
Iv CO / y/ [114 X/ x
38363 ? Iil' '$?a °°
Requasl Dyre/&5/
? F No ?in InspBClion
7
? Reatly Now ?II Nody Inspector
WM1en Read
?
s G No y
I p licensed contractor Xowner hereby request inspection ot above electrical work at:
Ro
J0 0 Adtlre% ?S t, Box or I
ai Cily
.
a y r.
Section No, iownship Name w Np- Raige No. County
Occupam (PRINT) Phone No.
e
P erSupplil AdEress
Elecincal Comractw ?Comparry Neme)
l
l Conhattor5 Lkense No.
rneowi
) q
Mailing Atla
s (GOmraIXOr or Owner Makiig Installafion)
3
V
Autlqeix SgnaWre ICamrecMr/y*ner Making Inslailation) PAone Numbe1
MINNE30?T1 OpflO OF ELEGTRICITY THIS INSPECTION REQUEST WILL NOT -
Grlpge-MW g. - Room 5177 , BE ACCEPTED BV TME STATE BOARD
1821 Uniwn ., SL Pwl, NN 55106 " UNLES$ PROPER INSPECTION FEE I$
VMna1812)60t-0C00 ENClO5E0.
(?/?/C?? ;EQUESToFORoEP ECTIRI?CA?LtiNSPECTcON
a 3 8 3 6 3- "x" 8elow Work Covered by This Request
EB-00001-08
t4??
ew Atld Flep. - TypeofBuiltling AppliancesWired EquipmentWired
Home Range Temporary Sarvice
Duplex Water Heater Electric Heetinq
Apt. Building Dryer Other (Specify)
Comm./Industrial ' Furnace
Farm Air Condilioner
Olhai(s0ecity) ConVac[or5 Remerks?: I L
Compute Inspection Fee Below: '- $m `• nl? ,v
# Other Fee # ServiceEntranceSize Fee # Circuks/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 700 Amps
Transformers Above200_Amps /+bovet00-Amps
SignS Inspactor8 use Only: T079?
,Sd
Irrigation Booms D
?yy
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDER ISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MO S.
I, the Electrical Inspector, hereby Rough-in ?
certify that the above inspection has
been made. F;,,ai r oate
OFFICE USE ONLY
This request wiG 18 monltis iro.
bctCe (.0 co
2005 RESIDENTIAL BiJII.DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
?`? o s!
New Construdion Reouiremenb RemadeUReoair Reaulremenls O(fice Use OnN
3 registered sile surveys shovnrig sq. R. of lot, sq. ft. of house; aM all rooFed areas 2 copies of plan Ced of Survey Recd _ Y_ N
(20°k mazimum lot coverage allowed) 1 set of Eneigy Calalations for heated additiom Tree Pres Plan Recd _Y _ N.
2 copies otplan showing beam & window saes; poured lound design, etc. 1 sRe surveyforadditions & decks Tree Pres Required Y_ N
7setafEnergyCatalatians Addifron - IndicatedonsHesepUcsystem On-slteSepticSyslem _ Y _N
3 copies of Tree Preservation Plan if bl platled afler 111/93
Rim Joisl Detail Options selection sheet (butldings with 3 or less unAS)
Date / ?- / Q S?
Site Address y? ?D ?Construction Cost d il
- ,L.! C' Unit/Ste #
Description of Wark
7t "C1I'
C//71 -!/"P -0-vLf
7/2" 5l Cey 'e ?o
Multi-Family Bldg _ Y N Fireplace(s) ? 0 _ 1 _ 2
Property Owner ?i??j? -r', Telephone # ( )
Contractor J!?//ZeYl 7
?
AGI-e Z
'
Address ??
State LD? -
/
?
/Lv?ec-? (?T
Zip s-7 City
/5 //??7?v ?
Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Enefgy Code Category . Residential Ventilation Category 1 Worksheet • Naw Energy Code Worksheet
(Jsubmissiontype) Submitted 5ubmitted
. Energy Envelope Calculations Submitted
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 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.
/??'?, ?r, f o .?
ApplicanYs Prin ed Name ApplicanYs Sign e
OFFICE USE ONLY
Sub Types
? Ot 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 PorchlAddn. (4-sea.) ? 33 6ct. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gaze6o) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building O 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation 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
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice&Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
Approved By:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
REQUIRED INSPECTIONS
Final/C.O.
Final/No C.O.
Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
Windows
Retaining Wall
Building Inspector
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
_ City Of Eagan ?
/ 3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Cansiruction Reauirements RemodeVReoair Reauiremenis f7 -s e?)?lu
3 registered site sumeys sfwwing sq. fl. ol lot, sq. fl. of house; and a I roofed areas 2 copies of plan Certnf BuruCyRe? 4 Y? A]
(20% mazimum bt coverage allowed) 1 set of Energy Calculalions for heated additions T[¢2 Pres Plgn EYCCd ;Y N.
2 copies oFplan showing beam &window sizes; poured found design, etc. 1 site survey for additions & decks T[e? Pf45 FTer?uired -,,,,Y ,,,,_N
1setofEnergyCalculaAons Addition-ind'?catei(onsitesepficsystem ?s?feSEpNG?'Sism P....,Id?3 copies of Tree Preservation Plen if loi pladed afler 711193
Rim Joist Detail Options selection sheet (6uildings with 3 or less units)
Date 0 a / 7- C? /10nT Construction Cost
Site Address Q.(lAP. L' ?c-C (e , f'?LS7 Ct v) Unit/Ste #
Descriptian af Wark ? u.? j ? V ya?-l!Q
Multi-Family Bldg _ Y X N Fireplace(s) ? 0_ 1 _ 2
Property Owner e 1 ,f s?
(k Telephone # (6 S( ) Gg Z " 3 3 ? ?
Contractor
Address City
State Zip Telephone # ( )
COMPLETE TFItS AREA 0I11tY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy CodO Category , Residentlal Ventllation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted SubmiUed
• Energy Envelope Calculations Submitted
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 £or 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 rz>;m» A^n4
approval ofplans. (!;
Rf' i` -?-P V,1 W GL l? kX--01A
Applicant's Printed Name Applicant's Si
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 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 x 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex p 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_v or_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
X 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement `Demolition (Entire 81dg) - Give PCA handout to applicarH
Valuation ;4:?ty! 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 -
REQUIItED INSPECTIONS
Footings (new bldg) FinaUC.O.
? Footings(deck) # FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundadon HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tes[s Final
y?L Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ AirTest _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By:
Building Inspector
Base Fee v
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
5&W Permit & Suroharge
Treatment Plant
License Search
Copies
Other
Total
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C. R. WINDEN 3 ASSOCIATES, INC.
IAND SUiVEYOQS ToL 646•3646
1381 EUSTIS SL, ST, iAULD MINN. 65108
N
COVING?'QN LANE
170
io ?
n
M.
- 32
? N 3.L
Scale: 1" = 30'
O Denotes Iron
o Dena-Fes Wood Si?ke
? 7op .f cw,'
FL 95?.J
- 56•FJ
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PropoSed
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!70'
?s? DRAlNAGE AND UTILITY EASEMENT
%
?
4°790
Lot 1, Block 4, Ridgecliffe First Addition,
Dakota County, Minnesota.
Note:
Proposed qarage f2oor E1.=9Ca.33
(90 O)Denotes proposed finiehed ground E1.
--w- Denotes direction of surface drainage
Vertical Datum - N.G.V.D. 1929
9S8 ?J
WE HERE6Y CERTIfV THAT THIS IS A TRUE AND GORRECT REPRESENTATION OF A SURVEY OF THE
IOUNDARIES OF THE LAND A60VE DFSCRf6ED AND OF TME LOCATION OF Alt 6iJIlDINGS, If ANY,
TMEREON, AND All Yt516LE ENCROACMMENTS, iF ANY, fROM OR ON SAID LAND.
Datad IAil-JA?1? daY oF Gr4nher A.D. 1V84 C. R. N'LNDEM i ASSOCIAIES, 1NC.
-?-
Surwyer, Minmsela Rapiurofisn Ne 774C
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N]3519
Enclosed herein is the search which you requested made on the above described propertq
Kind oi Innrovemenc yPq._. Beeinnias Orisinal Ar+ovnt Bal2nce Due
DIONE
I further ceriify that according to the records of said office, the following 3mnrove-
ments are contemplated or pending after having been approved and are now in the procee
of planning or completion.
Kind of Imnrovement Aooroximate Dace of Completion Avnroximate Cost
NOM
WAIVER: .' .
heither the ,^.ity of Eagan nor its empioyees guarantees the accuracy of the above infox
ma[ion vhich was requested by the nerson or persons indicated. Nor does the City or i
employees assume any lia6ility for the correctness thereof. In consideration for the
supplying of the indicated information in the above form and for aIl other considerati
of any nature whatsoever, any claim against the City or its employees risinR therefroc
is hereby expressly waived. Levied assessments to be paid to the CITY OF EAGd,Y,
3830 Pilot Knob Road, P. 0. Box 21199, Eagan, MN 55121. '
.Very.iruly yours, • ,
ov -e?
SPECIAI. ASS£SS:-fENT DIVZSION • ?
iHE LONE OAK TREE...iHE SYMBOL OF STRENGTH AND GROWfN IN OUR CO!v1MUNIiY •
1988 BUILHING PERMIT APPLICATION - CITY CF EAGAN
# 1041
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSES FOR CORNER LOTS - CONTRACTOR/$OMEDWNER MUST DESIGNATE WfiICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
MULTIPLE DWELLINGS RENTAL ONITS FOR SALE UNITS U OF UNITS
INCLUDE 2 SETS OF PLANS, CEATIFICATE OF SURVEY - CHECK WITH HLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
C0M@ttERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATZONS AND 1 SET OF ENEftGY CALCULATIONS
To Be Used For: F ga?x?aluatlon:
Ck7uo ?
Site Address
?Lot I_ Block Q- ? On site sewage
Parcel/Sub j j
-?,
Ocmer
Address 474 0 C??.Q.R
l
City/Zip Code Mltf S-_r
Phone 4-5- G
Contractor
Address
City/Zip Code.
Phone
Arch./Engr. _
Address
City/Zip Code
Phone li
Jbo '" Date: 4( ( SV8 S'
MWCC system
On site well _
City water _
PRV required _
Booster Pump _
APPROVALS
Engr/Assess
Planner
Council
Bldg. Off.
Variance
Oecupaney
Zoning
Actual Const
Allowable
Il of stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge • °°
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies ,Sv
TOTAL 35, Sc7
4740
. ? • . /,? ? C?-n
l ? s
FUR: `?? LG?
U. S. HOME CORPORATZON
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C. R. WINDEN 6 ASSOCIATES, INC.
LAND SURVEYORS !*L 646•3648
1381 EUSTIS ST., $t, PAUL, MtNN_ 6SID6
N
Scale: 1" = 30'
O Denotes Iron
8 Atnaies wood Sdake
h?7 COV I NG7-O N L A N E "E' P 9Cb
+
? 170
O 956.6?
_ _ ? O q0
10 20
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DRAINAGE AND UTILITY EASEMENT 82?
J
Lot 1, Block 4, Ridgecliffe First Addition,
Dakota County, Minnesota.
Note:
Proposed qaraqe floor E1.=9CO,33
(90 O) Denotes proposed finished ground E1.
-^?-- Denotes direction of surface drainage
VertiCal Datum - N.G.V.D. 1924
WE MERE6Y CERiIfY TNAi iM15 IS A TRUE AND CORRECT IEPRESENTATION OF A SURVfY OF THE
SOUNDARIES OF TME LAND A60VE DFSC416ED AND OF TME IOCATION OF All 6UIlDINGS, If ANY,
THERfON, AND AtL V15161E ENCROACHA4ENT5, IF ANY, FROM OR ON SAID tAND.
Detad tbil )G16 doy •F Ge+nher A.D. 1984 C. R. W?INDEN 3 ASSOCIATES, lNC.
., ??
Sur.eyor, Minnewla Raqisrrofion Ne 77ZG
. z/sa
CITY OF EAGAN
? APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
(PLEASE PNINT)
1) PROPEk7PY ADDRESS c
rFrnT• DESCT2IPTION_
(Lot/Block/Subdivi ion or Tax Parcel.I.D. Ntmiber)
37 ':' ST'??,'l.:C`ra?,'?L
F'?'TS _ _'"".. , •,- = 0:? Qo`?-n•p? ?:.•r=..'?_'`.'C' ?c
, -- - , a iIT i :a':;?:?.:
(i•?; L"1/ _E2.`-i --
PRESENP Z^i7IPX:/P?ZOPOSED USE: t5 R-1 SINGLE FPMILY
? R-2 DUP,= (Mri UhTITS)
? R-3 TOWNfiOiJSE (TFREE + t1NITS) ( UNITS)
? R-4 APAR7MED7T/COAIDOMIN2LM ( tTNITS)
Q CaMERCIAL/REPAII/OFFICE
? II'vDUS`i'RTAT.
II 1NSTITUTIONAL/GOVE211MENP
2) APPLICANT (PLEASE PRINT)
NAME: C?t'k/nl % /fo/rJPSo,?J ?inEs
ADDRE55_
-?
CITY, STATE, ZIP: /J??/c?i . %7,? 3?3?".
PHONE:
3) PUZOM
NPd`'tE: -
PLEASE PRINT)
CVY? FOR CITY USE OHLY
. .
'?EtdZft-l4 --HANI
PLUHBERS UCENSE:
ADDRESS: _3100 KENNEBECURIVE, EAGAN.MlNN.55122 ? pttive
' CITY, STATE, ZIP: 452•1565 Q Ezpired
MASIER Not o Record
PHONE: PLUMBER LICENSE # Q01445MZ
a ni Fr-aT---
4) 0CCUpANI.+/a,$JER (PLEASE PRINT)
?
NAME: li?2/? ?o?n?saJ yan?E_s
ADDRESS:
CITY, STATE, ZIP:
PFiONE:
5) ID7DICATE WHICH PERMIT IS BEING REQUESTID:
? CONNECPION TO CITY SEWER
Q CONNECPION TO CITY WATER
? OTHER (PLF?ISE DESCFtIBE)
6) IIVDIC?TE ONE:
7) SIQNATG'RE:
? PLEASE HOLD APPROVID PERMIT FOR PICK-UP BY ONE OF ABOVE
El PL,E'P.SE MAIL APPROVED PERNIIT TO 1, 2. L; 4 AHC7VE
(Circle one)
DATE:
?i
F O R C I T Y U S E O N L Y
PERMIT Y ISSUED
?
FEES: SEWER P-RMIT (I2ICLliD: SUP,CHARGE)
• $ ? o. ,..?<?, WATER PERPIIT (INCLUDE SURCHARGE)
" $ ?,•?=>'- °? WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP (INCLUDE CORPORATION STOP)
$ SEWER TAP
$ ACCOUNT ?BEPOSIT - SEWER
$ ACCOUNT DEPOSIT - WATER
$ -4z , ;7 WAC
SAC
, $ TRUNK WATER ASSESSMENT
$ TRUNK SEWER ASSESSMENT
$ LATERAL BENEFIT/TRUNK SEWER
$ LATERAL BENEFIT/TRUNK WATER
, $ ' OTHER
$ TOTAL
ry
? a ? ,- ": ?°aai'a -1?' e ?
' .'r`' . ` •.,. ;r . !
AMOUNT PRID/RECESPT,,:#
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
?
NO FUBiIG ROADWAY" MUST BE I:ISUED BY THE
ENGINEES?ING.DIVISIOP;. LIS: F,S A COP:DI-
TION.
SUBSECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: az°?_?>
TITLE:
DATE :
4faRM
.. . ... ,...
71??? ?
2005 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.
Date ! ; / ? ? ? ?OOS
Site Street Address 4:7 c{-p - c $31 ? a Unit #
?
Property Owner
Telephone #(6$1) 6?
-s Q_
Contractor Telephone # ( )
Address City State Zip
The Applicant is: ? Owner _ Contrector _Other
Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee
$ 100.00
Per as-buitt $ 10.00
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures. This fee includes putting in a water softener andlor water
heater aY the same time. !f yau aie insta!linp only a water sofrener and/or water
heater, do not complete this section. Move to the next section and check the
appliance(s) you are installing.
_Septic System Abandonment
_ Water Tumaround (add $125.00 if a 5/8" meter is required)
Other:
_ Water Softener ? Water Heater $ 15.00
T
_ new ? replacement
_ Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00
State Surcharge $ 50
?a
Total
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 be in
accordance with the approved plan in the event a plan is required to be reviewed and approved.
ApplicanYs Printed Name Applicant's Si nature
------------------
? For ORice Use ?
j Pertnil #:
? Pertnit Fee:
? Date Received:
I Siaff:
I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
7Y O
Date: 5iteAddress: ?/
Tenant:
Suite #_
RESIDENT/OWNER Name: Ae'r S Phone:
?
r
Address I City / Zip: ???a h7?vSP G??
Applicant is: - Owner _ Contractor
TYPE OF WORK Description of work: :5I?J
I,r 5
?
Construction Cost: ?,P o°O Multi-Family Building: (Yes _/ No L_T_
CONTRACTOR Name: ?fKOA(ZO/'? 4??2,? License #: 2,rl 2,F<:;64 7
Address: I3 2u? D??1??? C?'
City: S7'? State: Zip: ?s".S 3 3 7
Phone:GZ 2"P6 9rr'1F ContactPerson: !l-r'iG-
[
?-
COMPLETE THIS AREA ONLY IF CONSTRUCTIIVG A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
?
Energy Code
. Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Su6mitted Submitted
(I Submission type) • Energy Envelope Calculations Submitted
In the lasi 72 months, has the City of Eagan issued a permii far a similar plan based on a master plan?
_Yes -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contrecior: Phone:
Sewer & Water Contractor: Phone:
NOTE: P/ans and supporfing. documents that you submit are consldered to be public information. Portions of
the informatTo» may be classified as non-pu6/ic fl you provide speci/ic reasons that would permit the City to
conclude that the are trade secrets.
I hereby acknowledge that this information is complete and accurete; that the work will be in conformance with [he ordinances and codes oF Ihe City of
Eagan; that I understand Ihis is not a pertnit, but onty an application for a permit, and work is not to siart withou permit that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of pla_ s.
x 4/"?K ??Ise4<ex
ApplicanYs Printed Name Appl' nYs ature
Page 1 of 3