937 Jefferson Lane? CASH RECEIPT ?
CITY-O.-F-E?GAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
. ? .y. ,
DATE 4 , '•.• 19 '
rfc?rveo f- ,
F(74M
aMOUNT
8 DOLLARS
• iao
? CASH dCHECK
sv -'?--? ?
C ? 3 7 61 WAite--PaYers CoPY
Yelbw--Poeting Copy
Pmk-File C,opy
Thank You
DATE:
RE:437 JF,FFERSOH LANE, L8, B2. LEXINGTON POlIiTE 3rd
x Your Sewer 8 Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
ICALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
_ Yc?" r? Sewer & Water Permit for the above property cannot be completed for the iollowing
reasbns:
/ t*Your Sewer & Water Permit for the above property has been completed, but the meter cannot
j be Issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) befvre issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
DATE: 4/11/$9
RE: 937 JEFFERSOH LANB. L8. D2. L6XINGTON POINTE 3rd
xa
Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
TLL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
YoSewer & Water Permit for the ahove property cannot be completed for the following
reaso s:
iFour Sewer & Water Permit for the above property has been completed, but the meter cannot ?
be issued or occupancy allowed urrtil further notice. ?
COIiAMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POUCY. I
Secretary, Building Inspections Dept.
vn ui.un - ?/ 7v
- 683-9604 CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHO N E: 454-8100
IT
Totrusedfor SF DWG/CAR
Site Address 977 J8l
Lot 8 Block 2
Parcel No.
W Name J05EPN !i MILI.ER
3 Address
0 Cit FARMING'I'ati
y ' Phone 431-2001
Z? Name SwW$Q Address
? City Phone
r
W W Nam
? e
? ; Address
a W City Phone
I hereby acknowlege that I have read this application and state that ihe
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan fJrdinanc,es.
. .i ,
Signature af Permitee ' - - -
A Building Permit is issued to: JOSSPH M MILLER
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Slatutes and City of Eagan Ordinances.
Building Official
A 'b
M 17033
., -"7/,,
Receipt # i..f ", f €Lr?
Oate SEP 7 , I g 4'9
OFFICE USE ONLY
Occupancy R-g M_L FEFS
2oning PD R'=1
(Actual) Consi Ynk Bldg. Permit 626•00
(Allowable) Y--A Surcharge 48•50
# ot Stories
L
th
68'
Plan Review
313•00
eng
Depih SAC, City 100•00
S.F. Total - 575'00
S. F. Footprints _ SAC, MCWCC 580.00
On Site Sewage _ Water Conn
On Site Well Waler Meter 90.00
MWCC System ? 30.00
City Water xx Acct. Deposit
PRV Required _ S/W Permit 20,00
BoosterPump - S/rySurcharge 1'00
228•00
Treatment PI
APPROVALS 340'00
Road Unit
Planner
-
Park Ded.
Council
BIdg.Off. _ Copies
Variance - TOTAL 2,951.50
Permit No. Permit Holder Date Telephone #
WATE'R L
SEWER
PLUMBING
H.V.A.C.
ELECTFiIC
InspeCtion Date Insp. Comments
Foot«ugs t
Foundation
Framing 6
Foofing
Rough Plbg.
Rough
Isul.
Frepiace
Final Htg.
Final Plbg.
Const. Meter Plbg. Inspedor - Notify Plumber
Engr.IPlan
Bldg. Final
Deck Fig.
Ueck Final
Well
Pr. Disp.
?
y Name
Addre:
i c City
,
? Name
c Addre;
p City"'
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN ?
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
PRICE: PHONE: 454-8100 For Office Use Onl
? Forced Air
Boiler
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
S c/Sub BLDG,TYpE WORKDESCRIPTION
N
r
t
' ew
Res.
1 ?
-C. •' i
c
Mult Add-on
• ? ? Comm. Repair
tT l r Phone aher
,.
?
, ; ? FEES
`
,
r..l HVAC 0-1 00 M BTU - $24.00
RES
.
ADDITIONAL 50 M BTU - 6.00
(RES. HVAC INCLUDES A/C ON NEW
Phone
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1
50 EA.
. M BTU COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES .
M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
M BTU
}?'''? ?- •
M B REMODELS -
MINIMUM COMMERCIAL FEE - 12.00
20.00
TU STATE SURCHARGE PER PERMIT - .50
CFM (ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
FEE
SiGNATURE OF PERMIr
S/C: - '
TOTAL• '`}?? FOR: CITY OF EAGAN
? '. .
corRw?cT
PRICE
Site Ac?'! ress
Lot
?
? Name _
? Addr"s
c CRy
PLUMBING PERMIT For
CITY OF EAGAN PERMIT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPT
PHONE 4548100 DATE: _
Phone
FEES
COMM./IND. FEE - 196 OF CONTRACT FEE
APT. BLDGS. - COMM, RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APLLIES
MINIMUM - RESIDENTIAL FEE $12.00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 S/G PER EACH $1,000 OF PERMIT FEE)
OF
Res. New ',
Mult. Add-an
Comm. Repair
Other
RES. PLBG. ONLY • COMPLETE THE FOLLOWING:
Ng. FIXTURES ?O
Waber Closet - $3.00 $
?- Bath Tubs - $3.00 , Pu.
z- Lavatory - $3.00
-? Shower - $3A0 ?
?- Kitchen Sink - $3.00
UrinaVBidet - $3.00
?- Laundry Tray - $3.00
-? Floor Drains - $1.50 -'
-t Water Heater - $1.50 ?
Whirlpool - $3.00 ? Gas Piping Oudets - $1.50 7'5•?
(MINIMUM -1 PER PERMIT)
Softener - $5.00
wen - $ 10.00
Private Disp. - $10.00
-T Rough Openings - $1.50 ?
PERMIT FEE: STATES S/C: '
GRAND TOTAL: ? .
CITY OF EAGAN
3830 Pilot KnQb Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE aDDRESS.
?-? N t A h (:
i!?,1 Id l: I 41 ti F' +? t N I i.. .3 (t G?
PERMIT SUBTYPE:
ON RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
. , I 1 Iq
TYPE OF WORK:
INSPECTION D. . ..
I oARK.`.. iSf'PARIRTE WFR14T TS ARE 1?t Wl)IPtED V00 E tlsl.: f Ri C AI lJtlitl
Permit No. Permit Hoider Date 7elephone S
ELECTRIC .y??aoo o °-
PLUMBING -
HVAC T 1
Inspection Dab Insp. Comments
FOOTINGS - )G- <
/?
FOUND
FRAMING 3?
?l7 ? ?'!t tb 7;1 44tb
d.? Qt1?,K? Ixi T/.v GL+?nt?t F!' J?
RQOFING ? ??+?0? L zx ?d Jo?srr
ROUGH
P! UMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL 1L;?J
?
z?
GYPBOARO
FIREPLACE
FIREPLACE
AIR TEST
FfNAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FIfVAt g.? 0413
BSMT R.I.
BSMT FINAL
Decx FrG
DECK FINAL
.? _
Terttftrate uf (Orrupanry
titp of (Eagan
Erpwchnm a# Butldiitg jwprtinn
This Certificate issued pursuant to the requirements of Section 306 of the Unifonre Building
Code eertifying that at the time of issuance this slrucrure was in compliance with the varrous
ordinances oJ the Ciry regulaung building construction or use. For the following:
usca.mfic.m SF IW/GAR siag. Fernfif Nw. 17033
o-p.ar Troe R3/Hl zoning Do„ix PD/Rl ,yx comt VN
o..f H,,&i;g .AOSPH M. MIIUER AM,,,,, 18133 aMAR AVE. S., FArEMI[;mtrt
BtuU,g Ad&= 937 JEFFfR.9ClV LANE L.1u,,L8, B2. IP.XIII= POM 3ED
?, ? - e: NCaVV@??t 7,1989
x? W
auam?
POST IN A CONSPICUOUS PLACE
f
ER & WATER PERAA?T
OF EAGAN '
Pilot Knob Rd.
n, MN 55122-1897
DATE ' I f ? ` ' I -- ?? ?I
METER #
CHIP #
METER S12E
ISSUE DATE
PERMIT DATE otttteg
PERMIT# J-QAR?_
B.P. RECEIPT # r 17 6n
B.P. RECEIPT DATE ? -?" i t?
- PRV - BOOSTER PUMP
LOT
CITY,
PERMIT REOUESTED ;
0 , '
--??SEWER -,kWATER _ TAPS
COMM/IND --ZRESIDENTIAL
ZlP NEW - EXISTING
4 "
?• '% Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
ZIP
- ? ?
1 AGREE TO COMPLY WITH CITY OF
EAGAN ORDINANCES
STATE ZIP
SEYYER 3 WATER PERMfT
CITY OF EAGAN - `
3830 Pilot Knob Rd.
Eagan, MN 55122-1897 ?
DATE
SIGNATURE WHEN METER ISSUED
• OFFICE USE ONLY
METER # 'VI 0y A PERMIT DATE
cHIP # (20 73? a r y Pk'-)ERMfT #
METER SIZE `h B.P. RECEIPT # - 3.7?n
ISSUE DATE B.P. RECEIPT DATE 918/89
_ PRV - BOOSTER PUMP
SITE ADORESS L
LOT -,?j-LBLOCK
APPLICANT:
ADDRESS: _'
CITY, STATE
PHONE: _
PLUMBER:
ADDRESS:
CITY, STAI
PHONE: _
PERMIT REQUESTED
3R-, i
--X,,SEWER _-XNATER _ TAPS
- COMMI/IND _,/RESIDENTIAL
ZIP ? 7 -,XNEW _ EXISTING
21P 'AQ513'1,.7
Lawn Sprinkler Meters are to be Instal{ed
Ahead of Domestic Meters on Water Line.
Credit?Vy(ILL NOT be given for Deduct Meters.
?
I r?aanF r- I v
OWMER: EAGIC N D
ADDRESS: ?
CITY, STATE ZIP C;
PHONE:
PLEASE ACL?4W6'*0RK WG DAY$` F0FE pROCE3SiNG: 6LL ?220 FOR
SEYVER PERMRS, CONTACT ENGINEEFiNrp DEpT,
-------- ---__.- -?---- __ _ ?--- -
INSPECTIONS. FOR STORM
SIGNATURE WHEN METER ISSUED
_ CITY OF EAGAN N2 17033
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 •
J?"?j?/'
BUILDIO PERMIT PHONE:454-8100 Receipt # 0, ?«?? ?
To qe used for SF DWG/GAR Est. Value $97,000 pate SEP 7 1989
Site Address 937 .IEFFERSON LN
Lot $ Block Z Sec/Sub. LEXINGTON POINTE
Parcel No. _ 3RD
w Name JOSEPH M MILLER
I Address 18133 CEDAR AVE S
City FARMINGTON Phone 431-2001
o Name SAME
g? Address
City Phone
ww Name
x -' Address
a W City Phone
I hereby acknowlege that I have read this application and state that the
information is correct an agree lo comp ly with all applicable State ol
Minnesota Statutes an y of Eapan rBinaiSqes
Si9nature of Permitee
A Building Permil is issued t JOSEPH M MILLER
on the ezpress condition that all work shall be tlone in accordance with all
appliwble State of Minnesota Statutes and Ciry of Eagan OMmances.
Bwidmg Oiticial
OFFICE USE ONLV
Oaupancy R-3 Z-1 FEES
Zoning PD R=1
(ACtuaq Const V-N Bldg Permit
0
626.0
(Allowable) V-N- Surcharge 48.50
# ofStories
68'
Plan Review
313.00
Length
DBDth 38' SAG Ciry 100. 0?
S.F Total - SAC, MCWCC 575.00
S.F. FaolOrints _
580.00
On Sita Sewage _ Water Conn
OnSUeWell - WaterMeter 90.00
MWCC System Ni-
XX
Acd. DeposR
30.00
Ciry Water
PRV Required _ S/YJ Permit 20.00
Boosler Pump - Sryy Surcharge 1.00
Treafinent PI 228.00
APPHOVALS Roatl Unit 340.00
Planner - park Ded.
CoumA
BIGg.O1L _ Copies
Vanance - TO7AL 2,951.5
?}
? O. ?
41 6???9
REQUEST FOR ELECTRICAL INSPECTION
Minnesota State Board ot Elechicity
1821 University Ave, Rm. 5-128, St. Paul, MN 55104
Phone (612) 642-0800
Home Duplex Apt. Bld . ther.?l New Addn
Commercial Indushial farm ? nL `o S E'- ?- - L 'Remod Re air
Air Cond. Ht Equi . Water Hlr. Load Mgmt Ofher.
Dryer Range Elx. Heot 7emp. Sarvice
"X° above Me work covered by this requesG Enfer remarks in this space and on the back oi Fhe whife copy only.
Calculate Inspection Fee - This Inspecfion Requesl will not be accepled wilhouf fhe correcf fee.
Other Fee q Service ENrance Size Fee il Circuifs/Feeders Fee
Mobile Home Park Stall 0 to 200 Amps 0 l0 100 Amps
Skeef Llg./Tro(fic Sig. Above 200_Am s Above 100_Amps
Tronsformer/Genemtor INSPECTOR'S USE ONLY TQ ,.
Sign/Outline Lfg. Xfmr. ?)
Alarm/Remote Conhol
Swimming Pool
I hax cem ihal I??s ted Ihe ekcmcol irubllmion descri6ad herein on the datex smied
?ffl90h0fl BOOIII RwgMn Dak
Spetial Inspecfion
Investigative Fee F??I
THIS INSTALLATI6N MAY BE ORDERED DISCONNECTED IF NOT COMPI.ETED WITHIN 18 MONTHS.
// d/J' OFFlCE USE ONLY This request void 18 monlhs fiam validoM1On dok prinled m th?s X.
7 7 /
IIlf?lliil8 Illlalllllllllllllllllllllllllllll?????? ?? 3?' ????
* 0 4 1 6 2 U 0 4 s ,?Q?
PLEASE PRIN7 OR TYPE
Reqvest Da Roughln inspecM1On ?eqwred8 ? No Inspe Jim O?her Than RougMn ? Reody N ill Call
? ?? ?Vo? must wll ?he inspeclo? m ready? Dok Ready:
/
I, ? licensed conhactor, wner hereby requestinspection offhe above elechical work at:
Jo6 Anddress ?S?he/eq Box, or
o. l
?
?
? pry
Zip Code
.nsCJ.-t V7,
7
/ ? e
Secnon No Townshtp Name or No. Range N. Fire N. Couny
Otta? Phone No
Power upplw Address
Eienr¢al Con acror ?Cony Noma)
omp Conrcocbr f:wnse No Maater 6c, No. (Plom Elen OnFy)
Cti
?q 'C 0 W
MaA', Addre
ss
{?
Ionk
actw a Owner Pentortnmg Imblbiton)
/
-
y
,
/ /VD (.l?
Avihorized ret6onhaciorn n e Insmlivnon? Pho No. ???0 „!
Y
owuwin-i+a/vo
?j Q ?p? REQUEST FOR ELECTRICAL INSPECTION
9/P J/[U / ? See instrucM1Ons br complemg Uis fo(m on back ot yellow copY
r-
? 5 4 9 4 6 "X" Below Work Covered by This Request
#1'-% EB-00001-07
?lv?s
ew Add qep 41L TypeofBuilding AppliancesWired EqulpmentWired
r+ome Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Other (Specify)
Comm,/industrial Furnace
Farm Air Conditioner
anar (eceary) Contraclor5 qemarks:
Compute fnspection Fee Below:
# Other Fee # Service EniranceSize Fee # CircuiGS/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
SignS Inspedork Use Only. TOTAL
Irrigation Booms
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby R°"yn-m
l ?
i
certify that the above inspection has
been made. F,nsi oe?
OFFlCE USE ONLV f?
r is request wid 18 months from
?Kq , 9?as5
? 54946
/8
,
Request Da[e
9- 2 6- 8 9 Fre o gh-in InspeciiM
retl?
G Reatly Now Will NoNy Inspxtor
,
a
a
ves ? No ?
aa
y
I licensed contractor ? owner hereby request inspection ot above elearical work at:
JoG Atltlress (Slreet, Box or Route W J City
937 Jefferson Lane Eagan
SecUOn No.
TownsMp Name or No.
Range No
County
I Dakota
Ocwpam (PRINT) Phone No.
Joe Miller Construction Co. 431-2001
Power Supplier Adtlress
Dakota Electric Farmington, MN 55024
Eleclrical ConVaclor (Cwnpany Name) Cornrapork Lcanse No
Midland Electric Inc. 041610
Mailing Adtlress iCOnUector w Owner Meking Inslallation)
14055 Grand Ave So, Suit& E, Burnsville MN 55337
FNhonzeA Signalure (COMractoNOwner Making I stalla?wn)
• Plane NumOer
?? 892-6688
MINNESOTA STAiE BOAqD OF ELECiPICRV
Grigga-Midway BWB. - Poom S173
1821 Unlveniry Ava., SI. Paul, MN 55104
Phwre (812) 8124[I800
THIS INSPECTION REQUEST W ILL NOT
BE ACCEPTED BYTHE STATE BOARD
UNLESS PROPER INSPECTION FEE IS
ENCLOSED.
RESIDENTIAL
BUILDING PERMIT APPLICATION
'- ` CITY OF EACAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Constructian Reouiremenh
• 3 registered site survays shovring sq. ft. of l04 sq. tt, ol house; aM all roofed areas
(20% mazimum lol coverage allowed)
• 2 copies of plan showing beam 8 vnndow s¢es; paured found design, etc ?
• 1 set of Energy Calculations
• 3 wpies of Tree Preservation Plan d bt platted after 717193
• Rim Joist Detail Ophans selacUOn sheet (bldgs wAh 3 or less unAs)
DATE 02
SITEADDRESS / 3 ? `/-C AI_sQ^ (6 'L"?`" MULTI-FAMILYBLDG X Y _N
TYPE OP WORK Cc-f-cM,L Addn - FIREPLACE(S) _ 0_ 1_ 2
,
APPLICANT 0
STREET ADDRESS 520u- CITY STATE_ZIP
TELEPHONE # CELL PHONE # FAX #
PROPERTYOWNER TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNES01:A RULGS 7670 CATEGORY 1 MINNESO'I'A RULES 7672
(d submission type) • Residendal Ventilafion Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Confractor: __
Plumbing system includes:
Mechanical Contractor:
Mcchanical systcm includcs:
Sewer/Water Contractor:
_ Air Conditioning
_ Hcat Recovcn• System
Phone #
Phone #
P'ce: $70.00
I hereby acknowledge that I have read this application, state that the information is rrect, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan ' ces. ??
Slgnature of Applicant
__.__-______.__-----------°---°------____ ..-°---------------•-------------....
. OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
_ Waler Sottencr _
_ Water Hcater _
No. of Baths
_ PllOttC #
Lawn Sprinkler
No. of R.I. Baths
RamodeUReoair ReauiremeMs
. 2 copies of plan
. 7 set of Eneyy CalcuWtions for heated addihons
. 1 site survey for ezlerior addiGOns & decks
• Indkate A home served 6y sepUc system for addihons
VALUATION
'-? a.d-6
Fee: $90.00
PEIZMIT
? CITY OF EAGAN
3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G
Eagan, MinneSOta 55122-1897 Permit Number: 029514
(612) 681-4675 Date Issued: 0 2/ 21 / 9 7
SITE ADDRESS:
937 JEFFERSON LANE
LOT: 8 BLOCK: 2
LEXINGTON POINTE 3RD
P.I.N.: 10-45072-080-02
DESCRIPTION:
4uildig-;1?ermit Type
'Building WhA?rk Type
CerisLts 'Code
l. . C
J ?
t,
Od b?.
3F ADOITION
ADDI7ION
434 ALT. RESIDENTIAL
....°H'
REMARKS:
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL WORK
FEE SUMMARY:
VALUATION
Base Fee
Surcherge
Total Fee
$10,000
$162.25
$5.00
$167.25
CONTRACTOR: OWNER: - Applicant -
FADDEN TIM
937 JEFFERSON LANE
EAGAN MN 55123
? (612)473-1657
?
I hereby acknaw3ed,ge that I have read,th.is.a.pp,3icatian-anct State that thre
infiormation is correctand ag.ree tQ;c¢mRly_ with al,], appli•caple State afi Mn.
5tatutes end.Ci?? t of Eagan Ord3nances:
A L'ICANT/PERMITEE SIGNATURE
?!}Pf4 f\1.,fl I ?I?
? D B : SI NAT RE t
-
?
1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
, ciTr oF E?caN / I ?
3830 PILOT KNOB RD - 55122 Cdr?k'1.?G? z'
681-4675
New Construdion Reauirements RemodeVRaoeir Reauiremenb
? 9 registered site surveys ? 2 copies M plen
? T copies of plane (Indude beam & window slzes; pourad fid. design; etc.) ? 2 site surveys (exterior edtlitions 8 Eedcs)
0 1 energy celalatlons ? 1 energy calculations Tor heated a0ditions
? 3 copies oTtree Pmservedan plan B lot platted efter 7l1f93
. ``
requlred: _Yes _ No
DATE: -7 -9 7 CONSTRUCTION COST: 16 067
DESCRIPTION OF WORK E? c ?0
STREET ADDRESS:
Q
LOT ?l BLOCK ? SUBD./P.I.D.
PROPERTY
OWNER
Name:
? ?
m Phone #:
C,? U73-(6S-7?ays
CONTRACTOR
Street Address ?
City: 45c, S C, ^ State:
PId-1
Company: ? 61.` 62P .- 5;
?
Street Address:
City: State:
Zip: -3?
Phone #:
License #:
Zip:
ARCHITECT! Company:
ENGINEER
Phone #:
Name: Registration #:
Street Address:
City:
5ewer & water licensed plumber (new construction only):
and iot change are requested once permit is issued.
Penalty applies when address change
i hereby acknowledge that I have read fhis application and state that the infortna6on i a gree to compty with all applicable
State of Minnesota Statutes and City of Eagan Orclinances. ^
Signature of Applicant: ?
OFFICE USE ONLY CEIVED
certifirztes of Survey Rece;ved _ Yes _ No F E B 18 1997
Tree Preservation Plan Received Yea No _ Not Required
- - $?:__..------?---
State: Zip:
BUtLDING PERMIT TYPE
OFFICE USE ONLY
0 01 Foundation o 06 Duplex o 11 Apt./Lodging ?
n 02 SF Dweliing o 07 4-plex ? 12 Multi RepaiNRem. o
003 SF Addition o 08 8-plex ? 13 Garage/Accessory ?
n 04 SF Porch ? 09 12-plex ? 14 Fireplace ?
? 05 SF Misc. ? 10 _-plex a 15 Deck
WORK TYPE Ne,d y- sros- ? 0. ,-4o
0 31
'?32 New
Addi
i a 33 Alterations n 36 Move
O t
on ? 34 Repair ? 37 Demotition
GENERAL INFORMATION
P
?
?,. _ .
/ .?.
16 Basement Finish
17 Swim Pool
20 Public Faciliry
21 Miscellaneous
Const. (Actual) Basement sq. ft. MCIWS System -?
(Allowable) Main levei sq. ft. City Water ?
UBC Occupancy sq. ft. Fire Sprinklered
Zoning ' sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. y 3<I
Depth Footprint sq. ft. SAC Code o L
Census Bldg i
APPROVALS Census Unit o
Planning Building KA8 Engineering Variance
,
Permit Fee Valuation: $ 10, 4)00
Surcharge
Plan Review
License i z u«! ? ?? r? ? sy = q, c> ? z
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit S/W Permit
S/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Traiis Ded.
Other
Copies
Total:
% SAC
SAC Units
:- -:
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
MULTIPLE DWELLINGS
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - fi STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLZES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH AD?RESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
?t-c 14- Valuation: -? Date:
To Be Used For:
Site Address 9, 32 JeTtZj's on Ln
Lot g Block a
Parcel/Sub LCXIN!>'TaJ 1"o)NT?: 3R'o FiDDpI.
owner Tim + E!)cn Fadden
Address 931? 3eF?e?sc??-i Lv-,
City/Zip Code C`cL'-\c,lr-' SS/23
Phone (Q. I ?,.
Contractor
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
OFFICE USE ONLY
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length 2 Z'_
Depth ) 2
S.F. Total
IFootprint S.F.
COMMERCIAL
FEES
Bldg. Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Copies
SUBTOTAL
Penalty
TOTAL
A=
On site sewage_
On site well
MWCC System V"
City water
PRV _
Booster Pump _
APPROVALS
Planner
Council
Bldg. Off. !?&03
Variance
e
SINGLE FAMILY DiIELLIBGS
?'31'3 OF PLANS
':s?GISTERED SITE SUA9EY3
i SET OF ENEAGS CALCS.
1989 HIIILDIBG PEAMIT APPLICAiION
CTlY OF EAG9N
!lDLTIPLE DUIELLIliGS
2 3ET3 OF PLAH3
9fiGISTfiRED STfE 3IIAVEl3 -
(CHECB KTl'H BLDG DIV. )
1 SET OF F1iBRGZ CiLC3.
COlB'MRCI9L
2 SETS OF 18C813ECTURAL
8 3TRUClQRAL PLAN3
1 SET OF SPECIFIClTIONS
1 SET OF SNERGI CALCS.
!lOLTIPLE DWELLINGS EENTAL 0liTlS P'M SlLE DItITS f OF OHITS
p6TEt IDDRE53ES FOA CORNEA LZTS - COAiRACfOR/BOMEOAltEA MOST DF'SIf38ATE iiBICH LDDHESS
IS DESIAED. NO CHANGE4 iiII.L BE ALI.OWED ONCE BUILDINfi PSAHIT I3 I8SOED•-
3EitER i NATER PEAMTf FEES lND ICCODAT DEPOSIT F6fiS NII.L 88 INCLODED VITH SHE HOILDINfi
FENHIT FEE. PAOCFS3ING TIlE FOR SEWER AAD YT9TER PEIIMIIT3 IS TiiO DAYS ONCE E YERMIT SILS
HEEN (OMPLETED INDICATIAG A LIC£A3ED PLUlIDEA.
PENALTY APPLIES WHENs PERMIT IS NOT PAID FOR IN SAMF's MONTH TT IS REQiJESTED.
LOT CHANGE IS REQUESTED ONCE PEAMIT IS ISSIIED.
?, ,,,?I c-?
To Be Used For: //? t.Q. Valuation elJ ?- Dabe:
31te Address -73;?_z???. •••?
LoL 0 Block
Parcel/Sub??J?(i?.?/a??
Owmer
Address
City/Zip Code
Phone
Contractor ? G???-GYE'?C-
6ddress x!!??:12) &Izlt", aC, AD
cl 7, 000" FICE DS6
occupancy R-3 M-?
Zoning - I
Actual Const V- N
Allowable V-N
# of atoriea
Length 6 '
Depth
S.F. ToLal
Footprint S.F.
On aite aewage
On aite well
MWCC Syatem ?
City vater _
PRY required _
Booster Pump _
City/Zip Code
, lPPflOYALS
Phone Planner _
Council
Arch./Engr. Bldg. Off.
Veriance
Address
Citq/Zip Code
Bldg. Fermit 62.6,00
Surcharge 4g,5D
Plan RevieW 313,00
S9C, Citq IDO,GO
SAC, MWCC ? o0
Hater Conn 4AD, Oo
Water Meter 0,D0
icet. Deposit u•oo
S/W Permit 2000
S/W 3urcharge loo
Treatment P1. 228,0?
Road Unit SyA, OQ
Perk Ded.
Copies
SOBTD'PAL
Penalty
TOTAL
Phone 9
' . VALIdqTI O p,,?
360
$srnT
'2 O X 2 G: 52 0
I ?' k !V = ZZy
136p X,y= ?9oyo
6S-y. i ._. ?36c?
1X12 ? 12
13-7z k sn= Gg6 oo
, ? .
J9 o0 0 -
CITY OF BUILDINQ DEPARTI4ENT G?^
. . EXTERIOR ENVII,OPE AVERA(iE "Ull COMPUTATION
.`` (To be submitted with building permit application)
One or Two Family Dwelling Owner All other !-?7 E; L.C?) c K
Contractor d3F '?ILLZ,? GO/US'r Date
Phone
LINEAL FEET OF \% ,
EXPO5ED VIALL 'tjEF ft. above grade iGf(D
' TOTAL EXPOSED WALL AREA SQ. FT.
OPAQUE WALL CONSTRIICTION: "lJII,Value x Area
Detail JD¢3 X SQ,
refereace x SQ.
from
attached °U!v x Sq,
sheets °u'l x S@.
IOpll x S@
•
WINDOWS: "U"
Atake & Type
n u
n u
ORSt t'Ull
Fialce & Type
n o
n a
n n
Value x Area
FT. 1;7o,7I.41,74 (U) (A)
FT, ,5f? _?(U)(A)
FT. 2 = , , U)(A)
FT. _ ?U)(R)
FT.
FT. _ (U)(A)
I Nsv?, c?? ?-r ?:U?I_ ? QCo x se. Fr. 51 ?ZS= ?v9,5? (o) ( a)
uUu -
x SQ. FT. - (U) (A)
nUu x 3Q. FT. _ (U) (A)
npo x SQ. F"P. _ (U) (A)
Value x Area
nU u
? uU:i
TO:
? 1x sQ.
x BQ.
x 3e,
PALS COC33SQ.
AVERA(iE IOIIIi
FT. 'Y (U)(A)
FT.?([J) (A)
FT. _ (U) (A)
FT.? _ (U)(A)
FT. I (D(/, 'Sf> (U) (A)
" _
' (00,.?.)Zo
TOTAL (U) (A) VALUEB
DIVIDED BY TOTAL WALL AREA It0 59,CICO
AVERAQE IIU? ,115 oA lesa for 1&2 family dwellinga
ROOF/CEILIN, ?
TOTAL AREA:
Detail reference liUll_ x se. FT. ??17G = 77j(u)(A)
from
attached eheete, °Un x
flUe$ x SQ.
3Q. FT.
FT. . (p) (g)
? (U)
(A)
Describe openings IIU'I
x
SQ.
FT. .
_ (U)(A)
in roof. liiJil x SQ. FrT. _ (U)(A)
TOTAL (U)(A) VALUES DIVIDED BY '&?? -7-
TTecL?j
?? 7 3,7 5 CUYA>
TOTAL ROOF/CEILIN(} AREA
AVERA(3E 'IUII .Oj??"???or ventilated roofe.
.. ? .? ,
.i . ' ? . . _ . _ . ' .
r
`??'4 JC C 5?-i- ?s?°- Z9 -I-2q )=
?• .
, c??? 1--g- = 11 u, 0364-
?--
w ?Nr?s
?
? 3w - 24x 45
? ZuAJ -- 2v)t3(o
? I I Zw - 24x4-9?
I0,4z.k
= ?(? ?CI = 3(0.0
= 14- o?l = 14,0
'?v SCL. CJp- V?1?SL = 2g3r o
st?g. zl,o
2'?-X 2 ? C?l?• ;
.?.._..?...?._.-.-
(:!!0-Oexe=o WAIA,
i I ,, jc14i 4-,Z ?
?
I co",l?Z0
? v
?r?,7 T
`?V?IILLl1111G "u" valuee at Roof, Wall, Aim, snd Cona. Bloolc
?
AOOF/OEILINQ
1.) Interior Air P'ilm
z.) 5/e11 ayn. ea.
3.1 Ineulation
4.1
5.) Exterior Air Film
, (eTILL)
A VALUE . .
0.61 ?
.56
`I4,DO
.61
. up?l a I?R? I OZ? '1'OTAI. (R)s T.s.7g
WALL R VALU
60 _InEerior Air Film 0,68
7.) }n OYP. Bd. .45
.96) Inaulation MO O
9.1
10
) ?'1v,c.T {PirF_
F aeon?
t
8ldi l.o?.
. ,
e
ng .(>
116) Exteriar Air Film .17
apn ToTAI. (R).
`_ .
nil R VALUE
12.) Interior Air Film
13. ) Ineulakion
14.) 211 Fir Rim Joiet
15. ) .P?,ICJ'- ?rTF"
16.) Maeonite 8lding
17:) Exterior Air Film
0.68
19,00
1.88
.
z 67
.17
up?? e 1/H= j.TOTAL (H)a z7'?{??•
..._?L .7
FoUi1DATI0N R V111,U
18.) InCerior Air Film 0.68
19.)
20.1 P-II STIe1P!'Fn !loo
21.) 1216 Oonorate Blook 1.28
22•)
230 Exterior Air Film
I1?JII a ???n j,07TO1'AL (A)a /3.I.7
? v ?
. .. .....r__...._.?_ ..... ..
?JKVtYIiVI.7
SERViCES
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
JOE MILLER
LEGAL DESCRIPTION: LOTa,BLOCK-?--, LEXINGTON POINT 3RD
ACCORDING 70 THE RECORDED PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
?
,
89
SCALE ; I" = 30'
io. s' cp
?
?--- -
---.----??
i OflAINAGE B UTIIITY EASEMEN73---t
?
; LOT-e ?
qtpx? .
I p1rv 0pty/ I6
I a103? `( ??prrc?a?? d
( pROGbS6p
m HoJSB
W
L?
?' z1.4 ' 20
io. s' m
20 I ?
O V ?
zML -- I----
,n . io• .
YPPb ?
'? ro I
?9
vnrz. .ri, i
N
__In
90
CD
Q1
N
m
W
O rJ.74 ? ?
Z ?
(9ss ory - --., _ .... 7984. 4)
?qS 89°50'21" E'; 8201 ?
-???-
aB
JEFFERSON LANE p? L=2 00
--R=203,48
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
39 DENOTES EXISTING SPOT
ELEVATION
tvy&i: DEYOTES PROPOSE'w SPOT
ELEVATION
DENOTES DRAINAGE DIRECTION
I hxaby certify thot tAis survsy,plan or
raport wa• prepared by ms or undsr my
direct supervlelon and that 1 am a duiy
; Reqlstered Land Surveyor under iho
; Laws of the Slate•of Minnesoto.
^( '!t-` ...
, Mn. Rsp. No.15235
INQqRT EL)LVAl10N AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION - 9?-
PROPOSED FIRST FLOOR ELEVATiON = 9?-
PROPOSED BASEMENT FLOOR = 97?-
ELEVATION
NOTE ' VERIFY ALL FLOOR HEIGHTS WITH
? FINAL HOUSE PLANS
Bradley J.
Date : l?
?
;
i
(D 4251P)061 VMPMOOiGAGEf011R15 • 1+131293BIOU • I8001621-7791 HU6 FILE-CUI'P-1--
• ? . •SIJRVEYINC? = SI7E f'LAN FUR:
SERVICES I
1260 YANKEE DOODLE ROAD U O E M I L L E R
EAGAN, MINNESOTA 55126
LEGAL. DESCRIPTION? LOT-8-,BLOCK2, LEXINGTON POINTE 3RD
ACCORDING TO THE RECORDED PLAT
THEREOF DAKOTA COUNTY,MINNESOTA
?
L
,
?
?Qw?l N 89°50'21" W 85.15(17eg)Oa
5 q
?----------- -- 1
ORAINAGE 9 UTIIITY EASEMENTS ?Ol
to ; ? I ?
N ; LoT e I N
_
2z' "?
SCALE : I" = 30' °"" rck
lo.6'm
? Prcovosso
" I
M I :?.? ' » w
ias'mO 05.94(P
° • d' I
. e
081
' Z?L -- ---- -- ?? Z '
.? io, . . ?? ,
0
89°50'21" E'; 82 OI
q0 N ?- qg?0;1?
JEFFERSON LANE q0 L=20300
_ __R=2,48
LEGEND
o DENOTES IRON MONUMEMT
a DEN07ES WOOD HUB SET
976.39 DENOTES EXISTING SPOT
ELEVATION
CEPr'OTES ?ROPCSED SPOTI
ELEVATION
DENOTES DRAINAGE DIRECTION
1 hxeby csrtity that this survsy,plan or
report was preporsd by me or undsr my
dlrecf eupervision and that I am a duly
Reqistersd Land Survoyor under ih•
Law• o} the Stote•of Minne:ota.
IN?T EELEVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION -
PROPOSED FIkST FLOOR ELEVATION = 9
PROPOSED BASEMENT FLOOR ° 478
?
ELEVATION
NOTE: VERIFY ALL FLOOR HEIGHTS WI7H
FINAL HOUSE PLANS
Brodley J, ?'sonj Mn. Re9.No.15235
Dafe: ?i?t ?%fJ i
H
(CD-425187091 VMPMOAT6AGEfORMS • 15191193-8100 • 180016214191 ,
IM -
TRI-LAND C0.
SURVEYING
SERVICES
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
SITE PLAN FOR:
JOE MILLER
LEGAL DESCRIPTION: LOTa,BLOCK2, LEXINGTON POINTE 3RD
ACCORDING TO THE RECORDED PLAT
THEREOF DQKOTA COUNTY,MINNESOTA
N
SCALE : I" = 30'
/o.5'm
ia s' m
N 89°50'21" W 85,I5(978s)44
5' q?
-- _-_-^ -1
?---- - ?
+I+--- DRAINAGE B UTILITY EASEMENTS ?
I N
? L0?8 ? -
? \ Opp I'
I
°1 I6
O 1
?_a??(982 41 _ _ ?e'• `./4 m
PrcoaosE?
? w HoUSE r'-' ro I T
?? = Zo I ?• ? ? ?
I 21.47? N I W
24.
-?---- ` ?
gl ?° O
L__? z
G" 10'
4q S 89°50'21" E 82'401
JEFFERSON
;. y
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
9?6-.a9 DENOTES EXISTING SPOT
ELEVATION
(q?& JL) OENOTES PROPOSED SPOT
ELEVATION
`- DENOTES DRAINAGE DIRECTION
1 hersby csrtify tAat this swvey,plan or
report was prepared by me or under my
direct supervision and that I am a duly
Reqistered Land Surveyor undw ihe
Lows ot the State of Minnesota
,/ _
Bradley J. 9,06fYSOn. Mn. Req. No. 15235
Date
?`-
INVERT EIFVATION AT SEFtVICE EXTENSION
PROPOSED GARAGE FLOOR ELEVATION = 9-
PROPOSED FIRST FLOOR ELEVATION = 9? I
PROPOSED BASEMENT FLOOR ° 97-_
ELEVATION
NOTE ? VERIFY ALL FLOOR HEIGHTS WITH
FINAL NOUSE PLANS
to 6. #"%1160 *,.# %0 0
SURVEYING
SERVICES
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55126
SITE PLAN FOR:
JOE MILLER
LEGAL DESCRiPTION; LOTA,BLOCK2, LEXINGTON POINTE 3RD
ACCORDING TO THE RECORDED PLAT
THEREOF DAKOTA COUNTY* MINNESOTA
N
,
,
I . - -,
?--- --- -.- . ?
I DRAINAGE B UTILITY EASEMENT9 ?
I N
0) ; LOT-8 ? -
'
_ry
- z7
- e (g
SCALE : I" = 30 p?
` °`0V ?tez 4? _? a.ra' m
n
? 1-ROPb56P
HoUsE. ro I m
? w MI ? F r C7/1r1. ? .
20
21.4 P i
9? . N w
M O
/QS?m
0
O'
T J ? Z ?
081
? Z"L--
I? z34' ?wv. ?? I I ,'q984.4)
4q S 89°SO'21" E': 82?01 ar
JEFFERSON ? LANE q0 L=2 00
-R=203,48
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
9-7&•31 DENOTES EXISTING SPOT
ELEVATION
147& z) OENOTES PROPOSED SPOT
ELEVATlON
DENOTES DRAINAGE DIRECTION
I
INVERT EjVAIION AT SERVICE EXTENSION
PROPOSED GARAGE FLOOR ELEVATION = 9?-
PROPOSED FIFtST FLOOR ELEVATION ? 9
PROPOSED BASEMENT FLOOR
ELEVATION
NE1 VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
I hxaby ce?tify that this survey.plan or
rsport was prspcred by ms or undsr my
dirsct supetvfaion and that i am a duly
Reqistered l.and Surveyor under the
Lawa oftha State•of Minnesota
Bradley J.
Date -
Mn. Rsq. No.15235
_ _ :._--- -- -- • .,., - - ?
? '
VMP MOflTGAGE F011MS • (3131293-8100 • IBWI621-1Z91
(0-425 4e7061 ?M
- - - - - - - - - - - - - - - - - -
For Office Uses
Permit T7 s
City of Ea of ? CO
Permit Fee: -
3830 Pilot Knob Road
Eagan MN 55122 Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
2009 RESIDENTIAL BUILDING PERMIT APPLICATION C tE
-/-a -oc( Site Address: X3-1 ~ , c t Lr, Fa-b 7
Date: /
Tenant: I rr e-°l t(_C(f-~
Suite
RESIDENT /OWNER Name: T I VY1J l L 4- £ l I & r- -Fife d. .rm Phone:
Address / City/ Zip: Cl 3 ~ Je-fersc`.--m L*i LA;bcr. e h- I~ 1 2 -
Applicant is: Owner Contractor
TYPE OF WORK Description of work: t n I Sh b u V"Yr r~
Construction Cost: __C) Multi-Family Building: (Yes No xJ
CONTRACTOR Name: License
Address:
City: State: Zip:
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
submission type) • Energy Envelope Calculations Submitted
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:
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.
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 DileV, U_)
Uek1 x ~ vt, -
Applicant's Printed Name ~ E W E Applicant's Signature
® V D Page 1 of 3
JUL242009
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #: 11700)
10-L//3
Permit Fee:
Date Received:
Staff:
45.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Unit #:
Resident/
Owner
Name: -1-71M M 1'"D -NJ Phone: 9SZ- 3 -707(p
11 1
Address / City / Zip: 937 J �i �S 0,9 L �1 M N 3
��j
Applicant is: x Owner Contractor
Type of Work
- P-2s'r=-
Description of work: -�
Construction Cost: et Coo. cc Multi -Family Building: (Yes / No k )
Contractor
Company: RT M I'LLG_Q_ Go►:c-�\9_,_
1 t 'Id i, Contact: Ni6-2JL Eii i A
Address: MIL( .Qp p I R-( EZ` y) City: LEST- ICI E_
State: 1-/M•S Zip: 5535\p Phone: p(2- 532 _967 \
License #: a_S\-(07 2 -Lo Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
ZL — e_cp C.) F- GN L\ f
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.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 the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
Applicant's Printed Name
Applicant's Signature
Page 1 of 3