4715 Lenore LaneCITY OF EAGAN Remarks
addicion- Ridgecliff First Addn. Loe 5 Qik 9 Parcel #10 63980 050 09
oWner Street 4715 Lenore Lane scate Eagan, NW 55122
Improvement Date Amount Annual Years Payment Receipt Data
STREETSURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL
WATERMAIN
WATER LATERAL 1982 1260.79
WATER AREA
STORMSEW TRK 1982 638.24 2
STORMSEWLAT 1982 955.45 5 955.45 C007616 12-2 -81
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT 4260.00 - -
WATEF CONN. .
BUILDING PER. #9106
SAC
PARK
I
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
^ - ^^--
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(612) 681-4675
,
SITE ADDRESS:
? ? . .- I AMI
t? 1
I PERMIT SUBTYPE:
I
r, Is i , i. APPLICANT:
? . , urnNi
TYPE OF WORK: W
?,a
.,I,I 1 0 1 H(
?D>RS+NA
te/csa/'at
Permh No. Permit Holder Data Telaphone #
ELECTRIC
PLUMBING
HVAC
Inspectlon Dete Inep. Commenffi
FOOTINGS ?
FOUND
FflAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
O' v
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
, CITY OF EAGAN
? 3830 Pilot Knob Rosd, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100
BUILDING PERMIT ReceiPr #
To M usad for Est. Value Dcte , 19_
Site Addreu Erect ?
Lot Block Sec/Sub Remodel ?
. Repair ?
Parcel No. Addition ?
Move ?
W Name - Demolish ?
; Address
fnt Impr.
?
? City Phone Install ?
,? Name Approvals
=u
°uI
?
? W I Name
x? Address
u
?W City Phone
I hereby ackrowtedpe thot I hove reod this applicotion ond stote that
the intormotion is tOrrect ond o9ree to wmply with oli opplicoble
State of Minnewta Statutes and City of Eagon Ordincnces.
No.
Depth
Sq. Ft.
Assessment
Water 8 $ew.
Police
Fire
Erg.
Plonner
Council
Bldg. Off. APC
Var. Date
Sipnoturc of Permiftae
A Building Pertnit Is issued to: c
oli work sholl be dona in accordance with oll cpplicable Stote of Minnesota Statutes ond City
Buildirp Officiol
Permit
Surcherge
Plan Review
SAC
Water Conn.
Water Meter
Road Unit
Tr. PI.
Parks
Copiea
Total
tha exprcss conditlon thai
1 Eapon Ordinonces.
Pnmit No. Pwmk Nolda Dou Telephone i!
Pk umbinq
H.VA.C.
ENetric
Soft?r
Inspection Data Insp. Othsr
Footings I
Footings II
Foundetlon ,?..
Framinp o Q lS /r? rG.UGt:SF- - I)v
RooHnp U Sr-i'G Go,r-
Rouph Plbq. ip
Rough Htg. 4?j,01F7
Insul.
Flrepleq
Flnal Ntp.
Finel Plby.
C G
Flnal
Cwt/Occ. L
Water Describs Loeation: ?
Wsll
Sewer
Pr. Disp.
CASH RECEIPT -?
CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19 RECEI?VED
AMOUNT
& ooLuws
?oo
? CASH ? CHECK .
. -T- ;
1?? /.? , ? • -?"/?.?_ .. .
PUNO CODE AMOUNT
?
?
s
a `
? ,
? . ?
?3
Than u .
?
BY
L ?
White-Payers Copy
Vellow-Posting CopY
Pink-File Copy
CITY OF EAGAN N? n
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 0 911t4
PHONE: 454-8100 /
BUILDING PERMIT Receipt ?t Ll ?57v-
Te 6e_uqd Fer Si? DWG/GAP.st Value $lO1t000pme MAY 24' 198?0
SiteAddress 4715 LENdRE LN
Lot 5 Block 9_Sec/Sub. RIDGECLIFFE 1
Parcel rvo. 10-63980-050-09
a Name lnvi•irovi? veu,a,c,i ulv
Z Address 1712 IiOPKINS CROSSROAD
? City M`rxA Phone ' 544-7333
Name SAf;r
ip
Address
? City Phone
rc
W
Narne
F
_? Address
u
?W
City
Phone
1 hereby acknowledge that I hove read this application ond stote thaf
the in4ormotion is correct and agree to comply with cll applicoble
Stote of Minnesota Statutea and City of Eogan Ordinances.
Sipnoture of Permittee -
A Building Permit is issued to:
oll work sFall be done in occo
Buildiry Officiol
THOMPSON V
Fff?nH? opplicqpls
?C ? U ?? f[
Erect 11'
Alter ? Zoning -•-
Repair ? Fire Zone
Enlarpe ? Type of Const.
Mova Q # Stories
Demolish ? Length
Grode ? Depth ? Sq, Ft.-
Aoororals Fees
Assesement
Woter & Sew.
Police
fire
Enp.
Planner
Countil
Bldg. Off.
APG
Permit • 0
Surcharye 50.50
Plan check217.75
snc 525.00
Water Conn. 470.00
WaterMeter 63.00
Road Unit 260.00
TMoI • uzT-.-7
on the express conditlon thno
Stotutes and City of Eoyon Ordinonces.
Permit No. Parmit Holdsr Misa Permit No. Holder
Plumbinq ?
H.V.A.C.
Well
WMer
Disp.
Sawer
El.ctr,c p?o4o i z t I ?I ? r YO . d o
Inspection DaM Insp. Other
Footinys
Foundation
I
*
HVA W4,a
ion
Inwlat
Final Plbp. .? •?
Final HVAC
Flnal
Watar Deacribe Location:
Well
Sawer
Pr. Disp.
Receipti c
MECHANICAL PERMIT Permit No.
CITY OF EAGAN Fee 20.50
fill in numbered spaces S/C .0
Type or Print /egibly Tot. 20.50
1. Date rl-:1+-f`4 2. Installation Cost 000 00 ,
3. JobAddresq,715 nr-Lot Ij Blk. c Tract ?
4. Owner 0;;3IN THOMF'S9N FI0ME,:'.
5. Contractor R' Y'.1. L:LTE-1", H.:: PI'iG Phone 825-(ic'67
6. Address 4637 Ch1CC:ao 've. ''o.
7. City ?•r1s• State 2ip 55407
8. BuildingType: Residential 0
9. Work Description: New El
Commercial ? Institutional ?
Add ? Alter ? Repair ?
10. Describe Inst-LU heating &:'.C Fuel Type "I8t G^s
11.
No. Equioment STU - M. Ea.
Forced Air 135
000 No. Equipment CFM
Ai
H
dli
.,
Mfg. r
an
ng:
_ Boilers
Mfg. _ Mech. Exhaust
_
I_ Unit Heater
Mfg.
AirCond. j6
OOCi tn
Other
?
Mfg.
1_ Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with alI ordinances and codes gorerning this type of work.
Signed: for
` Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt PLUMBING PERMIT Permit No. 1-414
CITY OF EAGAN
? ' <f Fee?Q,rQ,Q_-
? Fill in numbered spaces S/C .50
Type or Prini /egibly T
t 20
50
o
. .
1. Date 5/30/84 2. Installation Cost
3. Job Address 4715 Lef10Pe Ldtl@.ot Blk. Tract ?
I 4. Owner Orrin Tbanps.on Hames
5. Contractor _y1enze]meth _ Phone a52-15b-ri
6. Address 3600 Kennebec Dr
7. Citv Edgan State Mn Zip 55122
8. Building Type: Residential 23 Commercial ? Institutional ?
9. Work Description: New Qi Add ? Alter ? Repair ?
? 10. Describe
1 11.
No,
. Fixtures
Water Closet No, Fixtures
Cess
ool/Drainfield
/ Bath tubs p
Se
ti
T
k
? Lavatory p
c
an
S
ft
?
Shower ner
o
Well
Kitchen Sink •
Urinal/eidet water heater
Othe
i Laundry Tray r
dl SPOSd
L FloorDreins dishw&
r
.e
Drinking Ftn.
Slop Sink
Gas Piping Outleis
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: _ %
? for
Rough Final
Inspectioris: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 4545700
BUILDING PERMIT
To be used for POOL
Site Address 471 !
kot S Block -
o.,.,.,.i ni..
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199,
PHONE: 454-8100
Fcr vnfi'e i 1 n nnn
I? I Cdyress ? ? ???
he i?452-0137 I
? Cily Ei7RSVILLE Phone 894-1480
?W Name
?= Address
gl City Phone
I hereby acknowlepe thal t have read this application and state that the
information is correct and agree to comply with all applicable State of
Minnesota Slalutes and City of Eagan Ordinances.
Signature of Permitce
A 8uilding Permit is issued to: ?"'
on the express condition that all work shall be done in accordance with all
applicaDle State of Minnesota Statutes and City of Eagan Ordinances.
Buildirg pfficial
?r-
R ,. -,_ ? •
MN 55121 • ' ° ? '` '? '?
#
e ?1l?= ?0 , 19 41
OFFICE USE ONLY ?
M-Z FEES
_ Bldg. Permil 117.00 1
(Allowable) -
N of Srories - Surcharge 5.00 ,
;
Length -&1I Plan Review .
Depth SAC, City
S.F. Total
SAC, MCWCC
S.F. Footprints
-
On Site Sewage _ Water Conn
On Site Well - Waler Meter
MWCC System _
City Water _
Acct. Deposit
PRV Required - S/W Permit
Booster Pump - S/W Surchaige
APPROVAIS
Planner
Council
Bldg. Oft.
Variance
Treatment PI ,
Raad Urut
- Park Ded
-- ? Cppies ? ? .
- TOTAL
- _ _ _ _ --- - - - J
'PermM No. PermR Holder Date TeNphone N
WATER ,
SEWER
PLUMBING
H.V.A.C.
ELECTFIC
Inapection Date Insp. Comments
Footings t 106,0
Foundation
Framing
Roofing
Ralgh Pibg. -13-?
Rouglr Htg.
Isul.
Fireplace
Final Htg.
Orstat Test
Final Plbg. Plbg. Inspector- Notity Plumber
Const. Meter
EngrJPlan
81dg. Final
Deck Ftg.
Dedc Final
Well
Pr. Disp.
1 -7 -0
i
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
1 P:RMIT NO
:
P. O. ¢ox 21
99 .
Eagan, MN 55121 DATE:
Zonin
: of Units:
No 1
g .
Owner. -20,11gsrnz ev
-
?
?? 4 R ?•'?
t? `
Address: _
?
?'
?
??
I
ite Address: ?715 T°nore an .5 r RiazeCliffe lst
,,-
umber: W44l?C?.??`?'fi&'?f'1
?Meter No.: . f`.onriettion Charge: 470.00 pd
SFze: ' q Kt2odrs't Deposit: 15. 00 P d
/eader N <<,: ,,,,??' ?
No.:
?R
• ?it Fee:
?'erm
10.00 p
d
i agrae W canplr wilU !M Ciry of Eagen Surcharge: .51) P d
Ordinanaa. Misc. Charges: 63. q0 n d mer?-r
Total:
g
? Date Paid:
y
Date of Insp
: In$•:
.
CITY OF EAGAN eCUUCO ceQVl[ C PCQOAIT
30 Pilot Knob Road 6711
0. Box 21199 PERMIT NO.:
gan, MN 55121 DATE: J-S-•
ning: No. of Units: I
rner: :o:apsor. Vall.ey Div
,..,,,I .».
Sire Address: 4715 I.enore Lane LS E9 RidgeCl.iffe '_et
Plumber: enz??i _i
i, 3"'?;
1 ayroe M eompy wteh eM Gy ai Eagan Connection Charpe: 425.00 gd
Ordinonea. Account Deposih 15.00 pd
Permit Fee: 10.00 Td
Surchargo: >G pcl
By Misc. Chnrges:
Dote of Insp.: Totol:
Insp.: Date Pald:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zo^in9: No. of Units: ,
Owner t : ;!y D: v
Address:
Site Address: 4715 Lenore Lane I, z °13 ?.'?te lst
Plumber: iJa,! a., e L?' °c5
Metar No.:
Connection Charge: /? 7?:. ?J?1 pd
Size:
Actaunt Deposit: ,
l_;
Reader No.: Permit Fee:
i'. 70 p
1 a e w oom wNU Nha Crt' of Ea
ore vb r gen
Surcharge: •5 pc
Ordiwneas. Mlsc. Charges: 00 Pd ?c:ter
Totol:
BY Date Paid:
CITY OF EAGAN Ng 19575
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 65121
PHONE: 454-8100
BUILDIIdG PERMIT Fieceipt # C- I S0 Z Z
To ba used for POOL Est. Value $10, 000 Date AUG 20 , 19-21--
Site Address 4715 LENORE LN
5 Block 9 Sec/Sub. RIDGECLIFFE 1ST
Lot OFFICE USE ONLY
PdrC21 N0. Occupancy M-2 FEES
Zoning _
W Name DALE & DIANE MILLER (qduaq Const Bldg
Permit 117.00
o Address 4715 LENORE LN (kuowable) _
- . 5
00
Surcharge .
City EAGAN Phone 452-0137 a ot stor+es _
1 Flan Review
Len ih
9 ?+?
?
o VALLEY POOLS-INC
Name oePin 1$' sAC
cic
??
Address 651 CLIFR RD
S.F.TOtaI ,
y
Um
City BURNSVILLE Phone 894-1480
S.F. Footprints
_
SAC, MCWCC
C
W
On Site Sewage ater
onn
I w W Name On Site Well
Im - Water Meter
z
5 Addfess MWCCSystem -
a W City/ PhOf10 City Water _ Acct. Deposit
PRV Required _ S!W Permit
I hereby acknowlege that I av read this application and state Ihat ihe eooster Pump - SMI Surcharge
inlormation is correct and ree to comply with all applica6le State of
Minnesola Statules and City t E an OrdinanI es. Treatment PI
Signalure ot Permitee APPROVALS Aoad Unit
A 8uilding Permit is issued to: VALLEY POOLS INC Planner - park oed.
on the expwss condition that all work shall be done in accordance with all Council _
50
applicable State of M?nesota Statutes an ?ty of Eagan Ordinances.
/1 p I
/ Bldg. Otl. _ Copies .
,
1
Building Ofticial r,11Xin ?r,?. 1?
??- Variance - TOTAL 122.50
rnis eaues wia y? u?? .
18 mpnths irom
A 064016 L-5 8.9 1&d1ea4kt- I
(ofi qW
(.(o.oU
Reques ?t,. (A ?j Weguired2 ?- „ fire No. Rough-en Inspec[uon
0I?adb Nom?6mi11 No7ity Inspec'
' "6 ?? Yes ?No W TOM° PAMdV
aa.Licensed ElectriCal CanlraGtor 1 hereby raquBSt impection o1 a6orc
? Owner electrical murk insialted at:
Street Address, Boa w Rou[e No. Cevy _
i
1 41 ?m V (Lc U? 1* 1J,-A r
eciwn o. Township Name or Na . Ragme Wo. CmnMy
?A-K6TA
Occupant IRtINT) p
q-? SD ? V N ? Plwrte P@0.
Power SuPPli(m?
Ri" Address p ?
L NL-rv?rylJ1 U?
Electrical Contractor (Conpanry Name)
?u ??-`-R+.c Cootracm."s Locerc:e Wo_
A31525 -Z
Mailing Address (Contractor /a?r?Owner Making ImtailationF
1q„ c.
Authorized - ?roNre ctor/Owner Yaking Insullation) Pbaffic PIYmder
? 0•
MINNESOTNS,pTE BpARp OF ELEC761CfiY TM? INSPIEGTION pEQUESf i1LL NOT
Griggs-Yidwav Bldg- - Rooei M-791 BE ACGEP7ED'BY THE STA7E HO11RD
1827 Univarsity Ava., St_ Paul, YN 55104 UNLFSS P90PEH IWSiECTON fEE 6
?o.._.... Im?I ento?I I EC/CIOSED_
? ° ` v9:QUEST FOR BECiinCAL INspECTION EB-00001-04
A 1 6- w-Pls,:re •G-. tarm an haek ae mleos wu„_
1-6 ""X"" 8e/ow Wk ? Wercd hy This Repuest
Add Rep- TVPe of 8uildim} Appiiaxes W'ned Equipyxet B/ired -
Home Range Yeeepcwarv Servuce
Ouplex Mtater Heater Lighe Fixtuses
Apt. Building D(yQf EICGEfpC WP.aEA
Camiercial Bldg. Fumaoe Su@o fYnlaader
Industrial Bldg. Air Canditioner Beu7k Milk Yank
Farm Uer ceo onbea NS?efi B ,
A Fee ServiceEntranceSize p Fee Feedcrs/Su6tacd Fes Gircuils
t -- 0 to200 Oto?A 0 m3Q Anws
Above 200 A 37 m 1Q0 A?s
4 3Y ro 1QQ? Anim
Swimmi Pool A6ove 100_ A6ove 100-AaWs
Trans#wme?s Ir?igation Bnars ,757-) Paertial:"091ter Fee
oIyo apectai irIS(ecinn
Remarks S qC),50 70T
/ ?•
Rouph-in a
ElectrGCal .
? ii? Pgcfar. hereb7
Final i17/ tl6li L1e 04Mf9
i im Iws 6aeo
IIIW I991WinYOIO
REQUEST FOR ELECTRICAL lNSPECTION
?
( 0 ? ?See instmclions ior completing ihis form on Dack o7 yel!ow copy.
`X" Below Work Covered by This Request
ee-oooo,-oa i
? y.
a
?Nt ?ysa.l?[ew Add Rep.I TypeofBuilding AppliancesWired EquipmentWired
-, D?'?
I
_ !
-?
_
?
L_ HOme
Duplex
Apt. Building
Comm.llndustnal
Farm ____ _
-
Other (specity)
__- Ran g TemporaryService
Water Heater Electric Heating
_-- Oth-er (Specify)___
Fumace
1Air Conditioner
-L----------
Coniracbr's Renri,He? I
. lO
YA
1 ?
?Co mput e Insp ection Fee Below:
-
#
? - Other I
--
Swimming Pool __?
--- ----
Transformers Fee
t----
__ Circuits/Feeders Fee
Service EntranceSize ?Fee # j
-?-----?---- -
0 to 200 Amps ? o to 100 Amps
--
Above 200 AmpsAbove 700 __ Amps
- ? Signs
Ir ir g iat on Booms
--?
? Special Inspection I
--- Inspector's Use Only: JOTA Xo
?
V I
iarm/Communic
?r
A THIS INSTALLATION MA ORDERE DISCONNECTED IF NOT
-
-
-
Othei r Fee I
-1-------
I, the Electrical Inspector, hereby COMPLETED WITHIN NTH . t
- 7
Rou9n-;n le
certity that the above inspection has
been made. Dat
OFFICE USE 3NLV
This request void 18 months irom
1
b' ?5'/ q/ .
?Ip 33?5?:5?q . ?S (l/? ? a?
/ ?o
Request Date Fre o. Rou9h-i
)( ? 9 O I q q . _
-
ction
u Reatly Now ? ill Notity Inspecmr
When Read
?
es -
y
No
I=-, licensed contractor F(owner hereby request inspection of above electricai work at
Job Atltl?e s IStreet Box or Route )
?? City
-
ti
N
?7
h
S
N
N
R
N t
C
ec
on
o.
owns
ip
ame or
a T
ange
o
PRINT
t . oun
y
Ph
N
an
(
)
II £r' --- one
o.
---
--
P
owe, SuppLer
IAdtlress
---
-- - - - - - - - - - - - - - - - -
?Electrical Contractor (COmpany Name)
?
--_
Conlractor'S License No
.
Q
_mf owa t' -------
--
---- -----
?----
Maiimg Antlreu (Conaatlor or Owner Making Instaliation)
? r
Autno z S?g ture on2ract ?wner Makm s allationi Phone Number '
5 ;?--o l 3 7 _----
MINNESOTA STATE 00ARD OF£L&TRICITY' THIS WSPECTION fiEQUEST WILL NOT
Griggs-MiOway Bltlg. - Room 5-173 ° BE ACCEP7E0 BY THE S7ATE 60ARD
1821 University Ave., S4 Paul. MN 55106 .. UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
Fur.L F.ASEMGNT oPTIVN `1 1 1 VC 4'1\]'11Y
,P• ?
j ?j 11 R. lUlJl? G Jl= l?7 VL rlld ? I
1 site plan w/e7evations &
Plan ,
'?2F/DWBUILDINC: PERT•LIT APPLTCATION 1 set of energy calculations,
` ? O I ,OOp i
Ib I3e Used For Valuation -" Date
5ite Pddress: OFFl(E USE ONLY
Got ? slock ? sec./sub. Erect OccuPancS' ?- 3
Parcel ? : I ? - (0 3c( $ c) - C? S d - a ? A1ter zoning (z-
?
Repair Fire Zone fJ
P-
Q,rner:
Address:
City/Zip Gode:
Phone $ : - -- .-
Contractor: THOMPSOlV VALl.EY DIVISION
a Division of.U:S. Hame Corporation ,
A[3dZess: ' 1712 HoPKINS CROSSR0A0 '
City/Zip Code- ?MINNETON,KA' MINN. 55343
P}ione 'v _ sc"k 4
Arch. /E7ig. _
Address:
City/Zip Code:
Phone #:
Enlarge Type of Gonst. $?
Nbve # Stories
Demolish Front Z ft.
Grade Depth • °jt?. _ft.
APPF3OUAIS F'E:E''S -
Assessmnts
water/Sewer
Police
Fire
.
gxJ Planner
Council
Bldg. Off. s
APC
Permit 49j5, ?E
Surcharge 50,C?to-
Plar, C7-,eck Zl, "
SAC 525 ?'
Water Conn, 470.
Water Meter (03.
Road Unit . 2(oD,
TOTAL
30?, zO =750,?54 = 4c-),500
.,, 2O ?c ? 2 = Z?o r? 54 = I 2q c9U
ZZ x22
.
= 484 ? I I =
53°z4
=7 &0?
? 2 x 20 = 24U x 4 I = ?'Sqo
looc?4
I d l,o?
?
r
CITY OFJEAGR,N
lr o 9104
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?T
? PHONE: 454-8700
BUILDING PERMIT ReceiPt #
Q
To ba used For SF DWG/GAREst. Volue $101, 000 rlrp' MAY 24, 198
Site Address 4 715 LENORE LN
Lot 5 Block 91" sec/Sub. RIDGECLIFFE 1
Parcel rvo. 10-63980-050-09 '
? Name THOMPSON VALLEY DIV
; Address 1712 HOPKINS CROSSROAD
b City MTKA Phone 544-7333
SAME
o Name
? Address
?
1- City Phone
?
W
? Name
_? Address
`W City Phone
Erect ff Occuponcy R3
Alter ? Zoning
Repoir
?
Fire Zone N/A
Enlarge ? Type of Const. V
Move ? # Storie
Demolish
p 52
Length
-
Grode ? Depth ? Sq. Ft.-
Approvais Fees
1 hereby acknowledge that I have reod this applicatian and state that
the informotion is corred and agree to comply wiTh all opplicable
Stote of Minnesota Statutes and City of Eagan Ordinonces.
Signature of Permittee
A Building Permit Is issued to: THOMPSON V2
nll work sholl be done in accordanc4iG'if?3?l oppli le
?._
Building Official
Assessment Permit -$-- 4-3$?0
Water & Sew. Surchorge 50 . 50
Police Plan check 217.75
Fire SAC 525.00
Eng. Water Conn. 4 7 0. 0 0
Plcnner Warer Meter 63 . 00
Council Road Unit 260 _ ? 0
Bldg. Off.
APC Total $2 ,021. 75
on the express condition ihat
Statutes and City of Eogan Ordinances.
CITY OF EAGAN 'I O H'I 7
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 fj/ ?.
PHONE: 454•6100 `7 ?OL?")
BUILDINt3 PERMIT Receipt #
Te ba wad fer DECK Est. Value $1,300 Dote AUGUST 19 1 S35
SiteAddresa 4715 LENORE LN Erect ? Occupancy
Lot 5 Bl ock 9 Sec/Sub RIDGECLIFFE STRemodel ? Zoniny
.
Repair ?
Type of Const.
Parcel No. Addition ? No. Storias
BALE MILLER Move ? Lenyth
Z Name SAME Demolish ? Depth
? Address Int Impr. ? Sq. Ft.
City Phone 452-0137 Install ?
? AM ADProvals Faea
S
E
O
v Address
§
? City Phone
u °C
u
Name
?
,„
?? Address
?W Name
City Phone
I hereby ocknowledge thot I hove read this application ond state thal
the in(ormatian is correct and ogree to comply with oll opplicoble
5tote of Minnewta Smtutes d City of gan Or mances.
Signoture of Permittee ??,,,?-1 ''`- b/7
N Building Permit Is issued to: DALE MILLER
cll work shall be done in acmrdonce with 011,.e1)olicable Stots-6f7oli
Assessment
Water & Sew.
Police
Fira
En9•
Ptonner
Council
Bldg. Off. $ 19 $ r'J
APC
Var. Date
Permit -?L L. V V
Surcharge 1.00
Plan Review
SAC
Water Conn.
Water Meter
Road Unit
Tr. PI._
Parks _
I liVyma _T73_.UU__
Total
, on the express condifion that
nneaota Statutes and Cify of Eagon Ordinances.
Building Officiol
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.T.N.: 10-68980-050-09
DESCRIPTION:
REIVIARKS:
FEE SUMMARY:
Base Fee
SurcMarge
7ota1 Fee
CONTRACTOR:
$25.00
$.59
$25.50
.
PERMIT
? C? 54o?r/ o? 9 C?
PERMITTYPE: Bu=LozNG
Permit Number: 028984
Date Issued: 10/ 0 4/ 9 6
-4715 LENqRE LANE
LOTs 5 BLOCK: 9
RIDGECLIFFE 1ST
(GAs)
ermit Type
c?;;r k T y p e
FIREPL.RCE
NEW
434 AL7. RESIDEN7IAL
b'&.i ?i 41a
??? M, 1'-?? A+??1 p'`t
_??-i- +;?
??ra
OWNER: - Applicant -
MTLLER qIRNE
4715 LENQRE LN
E,qGpN MN 55122
(612)452-0137
-
ISSUED ? S?AT? ? E
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
11404 1996 FIREPLACE PERMIT APPLICATION
681-4675
DaTE: _ I L - LI - l b
DESCRIPTION OF WORK: X CONSTRUCT NEW FIREPLACE: _ WOOD BURNING
_ INSTALL GAS INSERT ONLY IN EXISTING FIREPLACE
_ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
O'THER:
ff GAS
ROOM TO BE INSTALLED IN: 75?vy\z tr\t-
STREET ADDRESS: Lr- ?a a v-\ rv? r?
LOT ? BLOCK SUBD./P.I.D.
__----
APPLICANT: (circle one only) ? OWNER- CONTRACTOR
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.
PROPERTY Name: f- r n-e Phone #: 3'7
OWNER -_ ? Fl?
?
?-? c?
Signature:
Street Address:
City: State:OC'?-? Zip: S s/ a a
FIItEPLACE Company: Phone #:
INSTALLER
Signature:
Street Address: License #:
City: State: Zip:
GAS LINE Company: Phone #:
INSTALLER
Name:
Signature:
Street Address:
City: State: Zip:
. ? . /
?
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
HOTE: ALL CONTRACTORS 14UST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation:/ 3 G5 C? - 0 UDate:
Site Address: Lori9DU`e- LaA?e- OFFICE USE ONLY
Lot
? Bl
?
:
ock
Sect/5ub Erect X Occupancy
,I,o,I- Remodel Zoning
Parcel # Repair Type of Const
i ,
1
Ow
C
ba
M
[
" ' _
Addition ?k of Stories
ner
-
e
44
t
I. Move _ Length
Demolish Depth
Address Int.Impr. _ Sq Ft
Cit y/ Z ip Code Install
---------°
----------------°-----
Phone ??a- ? o L3 7 APPROVALS FEES
Contractor Assessments Permit Z z,°°
Water/Sewer ? SUrenarge O°
?
Address police Plan Review -'
?
Fire SAC
City/Zip Code Engr Water Conn
Planner Water Meter
Phone Council Road Unit
-
Bldg Off
3 reatment Pl
Arch./Engr. .
APC '_"
Parks
Variance Copies
Address TOTAL
City/Zip Code
Phone #
4715
. • ?
? ? . .
FOR:
U. S. HOME CORPORATION
N61 ot°w
10 0.
22 ',
?
.
?
C. R. WINDEN 3 ASSG?CIATES, tNC.
iAND SURVEYpRS T+1. 94E-3649
, 13$I EUSTiS STY Si. PAUIO MtNN. 55109
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Lot 5, Block 9, Ridgecliffe Firsi.
Addition, Dakota County, Minnesota
O
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Scale: 1" = 90'
O Denotes Iron
F?
x
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No te : ?
Proposed garage floor E1.= ?$3
(900 ) Denotes proposed finished qround E1.
--rt- Denotea direction of surface drainage
Vertical Datum - N.G.V.D. 1929
d° o
¢~
of e ?
e \
4ef l,? v4h OVOPq ?1o
'O
?
(y441.55)
WE MERE6Y CERTIf1f TNAT TNIS IS A TRUE ANO CORRECT REPRESENTATION Of A SURVEY OF TME
iOUNDARIES OF TME IAND AlOVF Qf5CRI6ED AND OF TME IQCATION OF Atl BUIIDINGS, tP ANY
TMEREON, AND All VISIlLE EMCROACMMENTS. IF ANr, FROM OR ON SAID tAND.
Oorod thi?_1?.? dor ef-? A.D. 198? C. R. WiNDEN 6 ASSOCIATES, INC.
?r
Sur.qor, Minns&sro Roqinrolia+ Ne.7726
?
41
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N7151/
SINGLE FAMILY DWELLINGS
2 SETS OF PLANS
3 REGISTERED SITE SURVEYS
1 SET OF ENERGY CALCUTATIONS
1991 BUI?SIIILICATION
CITY OF EAGAN ?s
HULTIPLE DWELLINGS COMMERCIAL ?
2 SETS OF PLANS 2 SETS OF ARCHITECTURAL ?
REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
(CHECK WITH SLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET UF ENERGY CALCS
# OF RENTAL UNITS # OF FOR SALE UNITS
PENALTY APPLIES WEiEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTN IN WHICH REQUEST IS MADE.
iAT CHANGE IS REQUESTED ONCE PERMIT I5 ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO BAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For : Valuation: Date : CS I Itc I"1. ?
47,4
Site Address 4-71S 1?X?E CALIF
Lot ?j Block Cl
Parcel/Sub
Owner \)/aA F- 06 If1?) E ?1
Address ? 1?? C,Fo()a LAof,
City/Zip Gode EA v A "kp .?? 1 2
Phone 4s z - o r-n
Contractor kd
Address 6?'- I (',1,m ck_
City/Zip Code ?? n?yiS?-Q tI \ F. j"111A)
Phone ';? n, ? - \ y w
Arch./Engr.
Address
City/Zip Code
Licmsed Contr.
(S'ignature of Contractor)
/D/ Ooo'
Qccupancy
Zoning
Actual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
OFFICE USE ONLY
M-Z
FEES
Bldg, Permit 11 7, 00
Surcharge S,(Xv
Plan Review
SAC, City
SAC, MWCC
Water Conn.
Water Meter
Acct. Deposit
S/w Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trail Ded.
Copies . S?
)50X q/
On site sewage_
On site well
MWCG System _
City water _
PRV _
Booster Pump _
APPROVALS _
Planner
council
Bldg. Off. (P•/p- ko5
Variance
SIIBTOTAL
Penalty
Lot Change
TOTAL ?aa• s b
? agrees that all woTk shall be done in accordance with
all applicable State of Minnesota 5tatutes and City of Eagan Ordinances.
L??? -1 _- -_- - ---- ? .
PQR ! . -•
V. S. SOME CORPORATION
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1341 EUSTIS ft., fT. IAUIO MINN. $5I00
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Lot 5, Block 9, Ridgecliffe First.
Addition, Dakota County. Minnesota.
Q??
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Scale: 1' s 40'
O Deaotes Izon
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\O
Qt°?° ?,?.•r' .
? qkbs'
7 1~ `
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Nota : \ .?
Proposed garage floor E1.=4"83
(900 ) Denotes propoaed finished graund E1.
--?- Denotea direction of surface drainage ? ikl. O `
Vsrtical Datum - N.G.V.D. 1929 ? ?V
(94,41C. 55) ?' .
4
WE NERHr CERTIFr TNAT TMIS 15 A TRUE ANO CORRECT fEPREiENTAl10N Of A SNRVEY Of TME
&OUNOAR{ES OF ?F1E LAND AICVE DESCRISEO ANO OF TME LOCATION Of All WItCINGS, If ANY,
TNEREON, AND Atl VISIOIE ENCROACMMENTS. (f ANY, FROM OR OP! sAiD lAND.
Ootd Mcl 16 t-adov o! M4? A.D. 1984
C. R. WINOEN t ASSOCI1?1ES. INC.
by ELW"a &-?t- .
Smf•M•. MiRMWg 16*NegfiM wM.7726
am »
2/84
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTIODT
(PLEASE PRINT)
1) PROPEfrPY ADDRESS: LF.Y\G f'e- L? ,,_
IZ'.GAL DESCRiPTION:
kL0t/tsl0cx/5utxt1v3-sion or Tax Parcel I.D. Numik
IF ?Ci:'r?':'. ?,°.4.,'?i,.F „, r -, ?ar••.,-Z-r,?T ._ ?'^'^ti
?. , n .._T,s_?._.?,.,1'-n.G _.=uIT
? O
PRESENT Z^iJNr/PROPOSED LTSE: B R-1 SINGLE FPMILY
13 R-2 DUPLEX (TiJO UNITS)
0 R-3 'PC7WMOUSE (TFIILFE + LNITS) ( UNITS)
p R-4 APAR'IlMEN'r/CODIDONIIlVIUM ( LINITS) ? COMMMCIAL/PETATI?OFFICE
? II?.D' TJSTRTAL }
? INSTITUTIONAL/GOV?NI'
2) AppLICAN'r (PLEASE PflINT)
I,AME; ORRIN THOMPSON HOMES
ADDRESS: 1712 Nnnkine Crnccrnari
CITY, STATE, ZIP: MinnPtnnka- Mn 55343
PHOi.'?:
3) PUJMBER NAME:
ADDRESS:
:
CITY, STATE, ZIP:
PHONE:
(PLEASE PRINT)
IJwRVVE
_?0 KENNEBEC DRIVE, EAGAN MINN. 55122
452•1565
PLUMBER LICENSE # 001445M2
FOR CITY USE ONLY
P?UMBERS LICEHSE:
?C Active
Q Expired
Not of Record
StaFf 7
4) pCCUpANT/aqNEEl (PLEASE PRINf)
NAME= ORRIN THOMPSON HOMES
aoDM-ss: SAME AS #2
CITY, STATE, ZIP:
PI-]ONE:
5) IIVDICATE WHICH PERMIT IS BEINC; RDQUESTID: ;
El CONNECTION TO CITY SDJER ?
- ? CONNBC'PION TO CITY WATER ?
. ? dPfIER (PLEASE DESCFLIBE)
?
6) IIVDICATE ONE:
? PLEASE HOLD APPROVED pEgNLIT FOR PICK-UP BY ONE OF ABQVE
PLFr'LSE MAIL APPROVED PERMIT `It7 1, 2, ? 4 ABQ?IE
j (Circle one)
7) SIG?A7.[JRE: r '/0 ;
, 1? DATE: ?j?? G
? .,..,,..,
•E ?eR.aESi??. s? re.?.r:.?:ir 3rtl.iti5s?r.isa?a.rt+ ?f ?•F?* fi? "'?ny+Sar'-?'Fa"i"!
. . .. .. .. .. . .. . .. .. . . .. .. .. . .. . .. .. .. . .. . , . . . ' #oii ? M+F ? . . . !1?!?! , . !!? .. . .. .. .. , .? , . „ ., „ , f'!i . . .. .se?rstw s
F O R C I T Y U S E O N L Y
PERMIT = ISSUED
FEES: $ /U•S 0 SEWER nERMIT (I:QCLGD:. SUP.CHARGE)
$ (?•S(? WATER PERN4IT (INCLUDE SURCHARGE)
$ Cp3-U`J WATER METER/COPPERHORN/OUTSIDE READER
$ WATER TAP (INCLiJDE CORPORATION STOP)
$ SEWER TAF
$
ACCOUNT :DEPOSIT - SEWER
$ (S?0_0 ACCOUNT DEPOSZT - WATER
$ c{7O . sJ wAc
$ S2-?c)O SAC
$ TRUNK WATER ASSESSMENT
$ TRUNK SEWER ASSESSMENT
$ LATERAL BENEFIT/TRUNK SEWER
$ LATERAL BENEFIT/TRUNK WATER
$ • OTHER
$ TOTAL • .-.-•
. ? , .
$
:
AMOUNT PAID/RECE2PTw;# <?3 /? ?? •
DOES UTILZTY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
C] YES IF YES, THEN A"PERMIT FOR WORK WITHIN
? PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING.DIV2SIOh. LIST F>S A COP:DI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE: V ?2?
DATE :
•a ? wzlw
.a??e.? ?? wt sw ? ?trrsE ? ? ?;ar ? s4 ?a•? ? r? wt? ? ? !? ?c? ? si. ! ..
TO: LOR'V11 OL50N, iTPILITY 13ILLING CLCRY. S-? )?C `
DALE PEI'EF2SON, CIIIEF BUILDIM, OFFICIAL
BILL BRANCfi, SUPERIN`I7;NDIINT OF PUBLIC ti40RKS
r°
FROM: THOh1AS A. COLBERT, DIRECPOR OF PUBLIC WORKS
DATE : NOVFS9BER 17, 19 81
RE: RID(MCLIFFE 15T ADDITION - SES+IER AND UTATER CONDIECTIONS
On September 10, 1981, a ffem was distributed listing several lots in
the Ridgecli£fe lst Addition which would not be issued sewer and water
Permits until sanitasy sewer service had been made available. Because
it is not anticipated that gravity sanitary sewer will be available to
provide service to the affected lots until July/August of 1982, Orrin
Thon-pson Hoims has agreed to install a temporarv lift station from Man-
hole No. 37 to the 4" service line for Lot 8, Block 9, Ridgecliffe lst
Addition. Attachecl to this memo is a copy of the letter we received
from Orrin Thompson Homes whereby they indicate that they will perform
the installation, maintenance and liability of this temporasy lift sta-
tion/force main sanitary sewer until such tim gravity sanitary sewer
can be extended across the future I-35E durinq the spring of 1982. There-
fore, with this tenporaYy system being installed and maintained bv Orrin
Thorrpson Hor*es, the terporarv hold on sewer and water pernnits and occu-
pancy for the follawing lots has naa been lifted:
I,ots 1-9, Block 7 '
Lots 1-6, Block 8
Lots 1-7, Block 9
Lots 18-23, Block 9
Lots 10-16, Block 10
Lots 1-10, Block 5
Iots 1-4, Block 6
Lots 1-6, Block 12
I.nts 1-17, Block 13
This temporary sanitarv force main tioill still not nrovide service to
the follcwing lots:
Lot l, Block 8
Lots 1& 2, Block 9
Lots 18-23, Block 9
Lots 11-17, Block 10
Therefore, the restrictions as referenced in my previous rmJro will still
apply to these lots.
These lots are referenced on the attached map for your infonnation. If
any problems arise pertaining to sanitasy sewer availability, back-ups,
etc., please refer those calls directly to Orrin Thcr*pson Homes for the
proper resolution, If you have any c]uestions to this release of the re-
striction on the building and seaer/water penni.ts, please contact M.
Please insure that all personnel in your departn-ent are aware of these
restrictions.
TAC/jach
cc - Bob Carlson, Orrin Thcx*,pson Hor.es
'Ib: IlJRNA OISON, UPILITY BILLiNG CI,EI2K
DALE PEI'ERSnN, CEiIEF BUILaJING OFFICIAL
SILL BRANCH, SUpLRIN'IENDIINT OF PLTBLIC TqORKS
FROM: THOi"IAS A. COLBERT, DIRECTOR OF PUBLIC WORKS 41K/
DATE: NOVEMBER 18, 1981
RE: RIDGECLIFFE 1ST ADDITION - SEP+lER AND WA'I'ER CaqNECTION RESTRICTIONS
?
On Novesnber 17, 1981, a mp2m was fors,aarded listing several lots within the
Ridgecliffe lst Addition that had restrictions placed on the issuance of
any sr-ver, water or occtmancy pennits due to the umavailability of sanitary
sewer. 'I'here appeared to have been a duplication of lots that were refer-
enced for future restrictions as compared to those whose restrictions had
been listed. Please be aware that the following lots only will have re-
strictions placzed on the issuance of sewer, water or occupancy permi.ts:
Iot l, Block 8
Lots 1& 2, Blork 9
IAts 18-23, Block 9
Lots 11-17, Block 10
Please insure that these referenced lots are not granted any permits that
would allav their occupancy or use of the sanitary sewer system.
Please insure that all personnel are made aware of this correction as stated
in this memo.
TAC/jach
cc - Bob Carlson, Orrin Thanpson Harries
L s 2 ? ? 1 titc- (
70: IA1NA OLSQV. [TPII.ITY IIILLING QERK
BUIIDING INSPEL'IrICN DEPARMEM
BII,L BRANQ-I, SUPERIDIPE•2IDIIgP CF PUBLIC MRKS
FRCM: THQWS A. CtiLBER'T, DIRECIC)R OF PGBLIC WbRKS
.. DATE: SII'TIIMIIt 10, 1981 ` .
RE: RIDMCI= 1S"P ADDITICN , .
Because the followinq list of lats in Ridgecliffe lst Additian does
not have gravity sesaer outlet at this tire, the following prooe-
dures will be initiated Lmtil further notice:
UTILI'I'Y BILLING
No water turn-cns will be allvwed prior ta 8-1-62 or until sesaer
is available in these areas. "
BUIIDING LNSPECTZCN
Bui-ldinq permits can be issued £or these lots, but the builder
should be informed at tine of perniit issuanae (perhaps stamping
the building peanit wi.th "NO OOMTPANCY PRIOR Zl7 8-1-62 OP. [7N'I'IL
SES+IER IS AVAIIABLE") the restrictions cn sewPS availability.
NkLVTMiANCE DEPFIRL"•=
See both utility billing and building inspection above.
The lots with these restrictions are as follaas:
IfJIS 1-9, BIGgt 7
7A'I5 1-6, BTAQC 8
Id77PS 1-7 BLCXrfC 9
L(7I"' 1$-23 BLOCK 9
LdIS 10-16 SL(7CK 10
ICTrS 1-10 BLOCK 5
I[7PS 1-4 BLOCK 6
IJJIS 1-6 BIfJClt 12_
I17i5 1-17 BLOCK 13
ani3 are also indicated cn the attached maps. :
jac
i?
,
?.
?
?
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4715 Lenore Lane
Lot: 6 Block: 9 Addition: Ridgecliffe 1st
PID:10- 63980 - 050 -09
Use:
Description:
Sub Type: e- Siding
Work Type: Siding
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Lindus Construction
879 Hwy 63
Baldwin WI 54002
(715) 684 -4647
PERMIT
City of Eaan
Construction Type:
Occupancy:
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.
Carbon monoxide detectors are required by law in ALL single family homes.
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
$90.00
Owner:
Dale I Miller
4715 Lenore Lane
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Issued By: Signature
Building
EA088458
03/13/2009
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
Use BLUE or BLACK Ink
� ForOfficeUse---------�
` j Permit#: � v `'r " " � I
Cl�y of ���a� � �- �
� Permit Fee: �
3830 Pilot Knob Road
I I
Eagan MN 55122 � Date Received: �
Phone:'(651)675-5675 I Staff: I
Fax;'(651)675-5694 � I
. ����__�����������J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
�i Y�N� !�!, L l�`�. �s"j- - �l ��
Name: L Phone: ��"/��'�° �1.1'7�(ca
Resident/ ' y
Owner Address/City/Zip: � 6 � 'J� ��]�'C��� �{��'��
Applicant is: Owner Contractor
;:�Type of Work' Description of work: �yv��� �,uL�t��J �1�Z,IJ d Ni� �'lvS�(�� /N �I`��L '�'
' Construction Cost: � ��� r� Multi-Family Building:(Yes /No )
Company: lS ��—��1� �� Contact: ��v��7 1�2���
Contractor Address: 1 v a:�cd � f d � ��� w �City: �b �.��fV 1�J�7
State:�Zip: ���C1� �hone v� ���v�flEmail: C��i P`YL��� � �f`�'����'�
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
NOTE:Plans and supportir►g tlocuments that ya,u submit are consic/ered to be public information Port�ons of k`':
the information may be classified as,,non-public`if you provid�specific reasons that would perm�t the�`C�ty�o�
>
` conclutle that the are#raale 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.qoqherstateonecall.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.
� X � U� �.��''� X
��
App icanYs Printed Name pplicant's S' ature
Page 1 of 3