Loading...
600 Lone Oak RdCITY OF EAGAN Remarks 'Addition AUDITORS SUH #38 Lot 1- e? Blk 1 Parcel 10 03800 090 02 . Owner??'?.. ?ts????? (eon Losye- /%/r Qi State 3s?9.s/i Improvement Date Amount Annual Years Payment Receipt Date STREET SUAF. STREET RESTOR. GRADING SAN SEW TRUNK Z 1970 540.00 21.60 25 Paid SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA STORMSEW TRK 1984 2249.00 149.93 15 STORM SEW LAT CURB & GUTTER SIDEWALK STREET I.IGHT WATER CONN. BURDING PER. SAC t? 00 PARK i CITY OF EAGAN Remarks Addition "AUDITORS SUB # 36 Lot Owner Street State 9•d Improvement Date Amount Annual Years Payment Receipt Date STR EET SUR F. STREET RESTOR. GRADING SAN SEW TRUNK 1970 452.25 18.09 25 ? ?.. 3?y 9 a i?-7 SEWER LATERAL ' WATERMAIN WATER LATERAL WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK 1 Parcel 10 03800 090 02 .? CITY =of EAGAN BUILDING PERMIT Oaner ••.......... DEDRICKSON.t...STEVE .. . ........................•••••-•-• Addrese (presen!) ..... 5.1.1 .... . a.r.a.t.oga ..,..... S . t ...... P . a . u . 1 ...... S ..................... •......._.......... Builder .............MARV,IN__,VIESROCK........ ............................... Addraas Box 167 Osceola, Wisc. 54020 715-294-2188 .............................................................................................. DESCRIPTION ..: j. N2 4133 3795 Pilc3 Knob Road Eagan, Minnesofa 55122 454-6100 Da3s ...11/8/76 ......................... aries To Be Used For Front Dep3h Heigh! I Est. Cost erm!! Fea • Asmarks 7 S/F Dwlg. & Gar. 1 44' 50' I 37,000 108.50 c LOCATION S Slreel, Road or other Descriptioa oi Location I Lo! Sloek Add[lfon os TraC! 600 Lone Oak Road ? I Section 12 $arcel Ain niann This permit does nof aulhorize the use of streets, roads, alleys o: sidewalks nor does it give the ownes os hia agent the :igh! !o create any situaiion which is a naisaace or which presenla a hasard !o the health, aafe3y, eoavealsacs aad general welfare to anpone in the cammuniiy. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is !o certify, lhat._ Ma r v i n V i e b r o c k has permission !o erect a.S / F_ Dw 1 g & G a r: _upon ......... .. .................•••- ihe above describemise subject io the provisions of all applica e r in aes for the C' pf Eagaa. -•••••••.....-??L••• .. ...... r..::.•• ...................._•••°-..... Pe ------- . . . __ .... . .-°---•••••••••........__....... ........................ ayor Huqdiny Inapeclos 09( 0: MECHANICAL (RESIDENTIAL) Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit d ?ozz:) Date Site Address ? K ? Unit # Property Owner 1"\ I 1! Y V L_°?? Telephone #( ) ' ?l?h__ b;r-, 4 f-1jCkj-' h ? Contractor v? k Street Address 19 c) 1 V-1-- V C, <; ` , `' , ??- ':4City 4-1 State fQ ::? OL v-? Zip Telephone # ( ) The Applicant is Owner _ Contractor Other Add-on, modification or alteration to existing dwelling unit $ 30.00 furnace replacement air exchanger ? air conditioner other State Surcharge $ .50 $ ?- Total ? I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; that I understand this is not a permit, but only an application for a permit, and work is not to start without a pernut; that the work Il be in accordance with the aPProved Plan in the case of work which re4uires a review and aPProval of Plans. v ,vs K ? C(/Y1/YICv ?I Applicant's Printed Name Appli ant's Signature .P city oF eagen PATRICIA E. AWADA Mayor May 12, 1999 Mr. and Mrs. Ken West 600 Lone Oak Road Eagan, MN 55121 Dear Mr. And Mrs. West: I am returning the enclosed photographs that belong to you. This would include the photos sent to Tom Hedges, and those supplied to me during an inspection of your property. As an update, I would like to make you aware that the last site inspection of 560 Lone Oak Road indicated no zoning or storage violations. In addition, I am enclosing the engineer's report regarding the status of the drainage issue. Should you have any comments or questions, do not hesitate to contact me at 651-681- 4690. Sincerely, M. Granley Code Enforcement PAULBAKKEN BEA BLOMQUIST PEGGY A. CARLSON SANDRA A. MASIN Coundl Members THOMAS HEDGES City Administrator E. J. VAN OVERBEKE City Clerk Cc: Tom Hedges, City Administrator ; Mike Ridley, Senior City Planner MUNICIPAL CENTER 3830 PILOT KNOB ROAD EAGAN. MINNESOTA 55122-1897 PHONE: (651) 681-4600 FAX:(651) 681-4612 iDD: (651) 454-8535 THE LONE OAK TREE THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY Equal Opporfunity Employer MAINTENANCE FACILIN 3501 COACHMAN POWT `eA6AN. MINNESOTA 55122 PHONE: (651) 681-4300 FAX, (651) 681-4360 iDD: (651) 454-8535 : , . MEMO ? city of eagan TO: Russ Matthys FROM: Crsig E. Knudsen DATE: Apri127,1999 SUBJEGT: Outdoor Specialties - 560 Loae Oak Road. Identified wittun is a brief mmnery of everns associated with the drainage problem at 560 and 600 Lone Oak Road. The pmblem originated with the construction of the home at 560 Lone Oak Road a couple of years ago and then escalated this summer with the corninuation of landscape and grading as we11 as an expansion of outside storage. On 7uly 16, 1998 the City received a complaint about the drainage &om 560 Lone Oak Road. A1so about the same time the Community Development Department received a complaint regarding outside storage and a landscape business. In addition to several letters, MarS' Granle5' and I mex with Chris Rossman of 560 Lone Oak Road on site to zvaluate the problem and establish nacessary coeredions• Many of the complaints by the neighbor were legitimate and primarily due to the original neglect from 560 Lone Oak Road to conuol erosion and to follow outside storage requirements. As a resutt of efforts to eliminate the problems the property owner proposed to conshuct a pole bam for storage and stabilize the site to eliminate the erosion In addition, Mr. Rossman constructed a small detention pond to reduce the runoff to the adjacent property. With the control of erosion and reduction of storniwater discharge this property owner has made considerate efforts to eliminate the problem. It should also be understood that Mr. Rossman did not significanfly change drainage pattecns within this drainage district. The stormwater runoff has always followed the same general direaion. It was only with the lack of erosion control cariying silt and an increase to the impervious surfaces adding sliShtlY to the volume that created the problem. With additional time for the e.stablishment of additional vegetation this issue should be resolved. However, the property owners at 600 Lone Oak Road at some point constiucted a bemi along the property line blocking the natural drainage. It appears as though the berm was constructed `"'itlun the limits of the City Code although it can resuh in a back up of stormwater runoff Thei'efore, damages as a result of this dispute is between the two private property owners and should be subject to claims based on litigation if so desired. _ r ' MASTER CARD LOCATION 600 Lone Oak Road, Section 12 Parcel 10-03800-090-02 OWNER STEVE DF..DRICKSOPT STRUCTURE AND LAND USED AS Single/Fam. Dwlg. & Gar. Permit No. Issued Issued To Con}ractor Owner BUILDING 4133 11/II/76 i kar.vin Viebrock PLUMBING ,? ?d ?,? ? ? ? CESSPOOL _ SEPTIC TANK VJELL ?- ELECTRICAL ? HEATING GAS INS7ALLING I SANITARY SEWER i OTHER I OTHER I Items Approved (Initial) Date Remarks Distance From Well FGOTING SEPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD FT. FINAL ELECTFICAL HEATING DEPTH OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBWG - -? WELL SANI7ARY SEWER , Violations Noted on Back COMMENTS: ;? ` nate: !O- <Z -?.C BUILDITdG PERMIT APPLICATION LOT BLGCK ADDITIOlU PARCEL & SLCTION PNT4T3ER IE' UNPLATTED ,ADDRESS OF PARCEL b O0 7,OiQTNG OCCUPANCY USE C'/iIZCLC pAMjL-j R?5!'Oa1JTf,AL ?' ?} 4 X ES2Ii?lATED COST J? ?o v-:::-o OF1idER 57t?L%E C?E02lC:KS 0 iU TELEPAONE N'0. 6L75-AyJDRESS 5?I cS/1AWT0614 S7'•Y'iiz)[. .J1???itJcc5pTr3 SS//? . b CONTRACTOR M,41WuU 0l625e-?'OG< TELEPEiONE 110. DRESS B01C /E3 7 65CEO Li} CjjkS (;-Ck)•S t,CJ 540 ZO Ydote- Include site plan, building plans, and energy calculations vrith this appiication • ? Signed?? . ?%?1!lcr?ut.x LLAocQ OFFICE USE VALUATIOid /?? 01- J ' SAC CZA^tER COidNEC^1I0P1 UdA'I'ER HETER BUILDING PERhTIT FEE SURCHARGE FEE PLADT CFi13CK FEr. S/ PARK DEDICATIOi1 FEE oTxErc ToTAL* . APPROVALS: ASSESSME'NT CLERK BUILDING DEPT. POLICE DEPT. TrJATER & SZdMR AEPT. FIRE DEPT. PARif DEPT. ' ?? cuWc uiviSiuri i • ' [X1EIZ1UIt LNVE:Lbf'E AVEItA,iE °u" (,OM{'UIl1TION UWr1[R ?T?j c- AED22I cKsarj 1 SITL ADDRESS L601E' OqK ?OWF'? RdflC COPJTRIICTOIZ W(W. JiC-R2GCK D(1TE 10-Z4 --7?p PHONE 7j5-244-Zt8? . DeCermine working square fooLage of cach. l. Totai exposed t•rall area ...... J//a? sq. ft. x•?7 =?SBZJ?I 2. Total roof/cei 1 i ng area .. ... sq. ft, x.O 6 Total exposed wall area above floor = I d S 3- 3 a. 7ot;al wall window ai°ea ........................... ./68. ?4 b. Tota l door area ................................. c. Tof:al sl iding cilass door -area ................... tl t/? . 79 d. ToCal fireplace wall area ....... .. ............ --?- e. ToCal wall Pi•ar.iing a.rca (average 10%)............ 9?._ f. ToCal net wall arei above floor ................. .S y. ToCal rim joisi: area ............................ BT? Total exposed foundation area = '-' ^ h. Total foundation wirdow area ..................... i. Toal net foundation area above grade ............ Uetermine "U" value of each wall segment. a.?g• ? 4 X $lull b. 0 •Xliuil • 33 = L 3.3 S c. A 4.779 X ,,U,l • ?s = z.9.1J d. -- z "u„ = C?Y oTNF.P.S e. ?•? ? Xlluii f.73 x „ull 9•-v i?x lluti Dg ? ?p•?? . h. - X llu" .-. _ ?Y DTN?eS ;. X 11U.11 _..,. = Y UTN E?.S 3 .....................................Tota1 = If item 1'3 is the same as, or less 1;han item #1, you have met the intent of SaC 6006(c)2. ? • , ? , y, f , ` Votal exposed roof/ceiling area , .i. Total skyiiqht area ....... .... ............. . k. ToCal roof/criling framin9 area (average 1. Total net insulated roof/ceiling area........... . Detcrmine °'U" value for each roof/ceiling segment. J. X u.U u kX liull jo4 -?? 1.?2-6 X,iUi; . d Q(o _ 4 s 7 1 4 ..................................Toi:a1 If toCal of N4 is the same as, or iess than ;12, you have met the intent of SBC 6006(c)l. Alternate Quilding Envelope Design "fo utilize the total envelope system metliod, t{ie values esCablished by the , . sum of items 1P3 and #4 shall not be gi•eater than the sum of items #1 and #2: 1. _? 8 • ??_ + 2. Z ? 3 . 'Z. 3._! .7,?• ? 7 + 4. S777. Z 5'3.06 . . ? . ,-.,?..._.,.. __.. .. „ _..._.-- _ _. -_ , •?-----?---T _ ., _, . , MiNrii sUTA :;LO?IC ItUIIJ!li;?; i:01)1: uiviMuN ?v# ? EXfLR10R LNUFLOf'E AVEIt,1V:lL "U" GOPif'Ui/1TI0iV . UcCennine working square foota(le of each. 1. Totai exposed t-rall area ...... sq. ft. x•1? 2. Total roof/ceilir,g area ..... sq. ft. x.05 Total exposed wall area above floor = 1 o 8 3. 3 a. Totil wall winrlow area ........................... . L68. 4.4 l). ToCril cloor arca ......... .. ...................... ?. d S.. S? c. ToCal sl iding glass door •area ................... t? 4. d. ToLal fireplace wall area ....... .. ............ --?? c. ToCaI Wrill frariing area (averlge lOx)......... .... ? f. Total net ti•iall area above floor 7 3g• g. Total rim jois?: area ............................ 931 .`I 1'otal exposed foundation area = -? h. Total foundation wirdow area ..................... ^ i.' Toal net founclation area above grade ............ ? Uetermiiie "U" vaJue of each wall segment. a.?g• ?F 4 X oull b. ``I ?•?S X ltupi • 33 = 7.3 S c. 44.-i9 X u?, . ?Os d. --- x "u" ---- = [boY oTNF_iz5 e. X ?lull?2- = 1D? f.7? Z7 • c5 ? X????t 0-7_ = 5 ? 9• 5 1.-L- Xlluii D g = 6. S4 n . -r- z7£3S3 017P1[R St-EOr' DEpfZ,[.C"UIJ _ SITE ADDR[SS L-01.)£ 6AK F20 Cati l4V RCb1t0 Zb CUN-fRlICTOR MA2J Jtc$fZC)G?_ nnTE W-24-'i6 !'fIONE 1%S-Z94-7I$'R ; . --- x"u" --- = E,Y DTN Ee5 X. liu,i &Y aTN Ee.s 3. .............. .................... Total . It' itcm 1?113 is the same as, or less than item #1, you have met the intent. of SaC G006(c)2. , , ?? 'fotal exposed roof/ceiling area 4 ..................................Total ° ? t. Total skyligPit area ............................. k. ToCziI roof/ceiling framing area (average 10%)..._ . ' 1, Total net insu]ated roof/ceiling area........... . Dctcrmirie "U" value for each roof/,:eiling segment. J X u U u ---- ;? „?„ ./o4 x u„ . 0 46 1.9s_3„ If total of !14 is the same as, or less than 112, you have met the intent of S[3C 6006(c)l. - lllternate Building Envelope Design To utilize i:he total envelope system metliod, the values established by tf2e ? sum of items #3 and V4 shall not be greater than the sum of items #l and #2. 1.??8•t??= + 2. Z 5-3.'Z3` 3.?q,?. 87 , + 4. ,;-?7• Z 5?3.?6 . __. . .. _.?.,.?.,. ._.. ..? W,:,, ,. ?..._.?-., ,,.-.., ?_.. .. r? .?....._ .. .... , :-?.?? _ -- _ ? . .fud-L"Mci/Y`? ? . ? tN?..? . .i '?:.. .- . . .,. . . .... 1,j? " . O Ey. _ . .. , . c Y/i 41 ?Jr _ .- , f(?,+,?.11'P ' . . . . ? . - __ L%i . ._ .., ? ..... ? _ . . . .-.. ` -. . . . _ . .._ -_' . _ [ . - _ . ._ ? .. : ; ? .__.' : . ? _._ . . . ' . - - _ - .. . . . . ?- ..: _ . ? - . ? r n .? .. . ..... ... .. . .,.. .=..?am__,. ?- '. .,. _:.__ a. - e ° ' .- . . . . . . ... _ ._ _. ,._::. . . ...... .:.... ._.._.,.,? . . ?_ P ,.. ., / F Z ? ? i ? i ? r P s i Ki CS, `D C, ? t?Lr,;, i? 1 ?I I I ? ? I I I I I I 1 , ? i Ji i i ? ? I A I? I El I ! i I ? ! I I i ? I ? i I ? ? i ? Aj ? I I I I I I I I I I I .? I ' I i I ? I ? 1N?[ I I i 1 ; I i ? 'i I i I ? I ! I I? I I ? I I ! ? 1 I ' ? I ' . I ? . _ __?._ ?? _ ._ .? rv--_?? ? __?_. ? ? ? i- I = _? 1 I _ . _ t ? ' I I.. _.. . _r . .. r _ .? _ _? . . _ y ?-? _ • _ t_ ° i' _-'?--- - . i . . 1 1 II I i ? . I ? . ' ? I 1 I I i i ?I . ? i 1 I ? , I I I ' I I ' I I ' ? I I ? ? , ' 1 ? • ? ? j ' ' I I I I ? I I ' I I I I ? . ' I ' I ? I ?i I r I I ? . ? ? I II I 'I I ? . i i . 1 I I , I 44 40 \ Form ApqoY W VETERANS ADMINISTRATIONfU.3. DEPARTMENT OF MOUSINO AND URBAN DSVELOPMEMT HEALTH AUTHORITY APPROVAI INDIVIDUAL W HUOlFHA OR VA CASE NO. AT9 Isl ATER-SUPPLY AND SEWAGE-DISPOSAL SYSTEM H4O/FHA OR VA OFFICE IMPORTANT-This Carm should be completed and filed as requimd by ezisling Iaw 38 U.S.C. 1806 and 1810. 3?- Ao u`w PART 1-TO 8E COMPLETED BV HUD/FHA OH VA MORTGAGEE NAME AND ADDRE55 (lnNude Z1PCode) • MOFTGAGOR OR SPONSOF L• Ga?r e? L/?: ?ed/?J?g. Qo?p• 6g?9 !/ //Py Q?. 2d, l!/0o?o?6wiy, ?l?Y SS7'2 S PROPERTY AODRESS Gpo - Lo.,e DaK Rd. E?C44v. /0/? s?vt/ ?, ? o -,2-- SUeDIVISIONlLOT NO. ?y TOTAL NUMBEfl IS THERE A BASE- MENT7 IS TMIS A NEW INSTALLlaT10N7 CAN THE ATTIC OR OTHER AREA BE MAD ? O ADOITIONALBEDROOMSt(!J"Yes "h ? LIVINGIJNITS BEDROOMS BATHS , owmany ) [] VES ?NO ?YES ?NO ?VES ?NO ER-SUPPLV BY: ? SVSTEM DESIGNED FOR PUBLICSVSTEM ?COMMUNITV SVSTEM INDIVIDVAL NO.OF BEDROOMS ;GARBAGE DISPOSAL SEWAGEDISPOSAL BV: ?PUBLICSVSTEM ?COMMUNITYSYSTEM ?INDIVIDUAL ?VES r-INO PART II-TO BE COMPLETED BV HEALTH DEPARTMENT OR COMPiIANCE INSPECTOR INSPECTOR'S SKETCH (TO RBPORT AS-BUILT DEVfATfONS FROM APPROVED PLANJ - - - - - - - - - - - - - H I I H he opinion of the Q State Q County 0 I.ocal D¢partment o( Health that this individual watervsupply system Q is Q is not satisfactory as a domesUc water-supply e subject property. L e opinion of lhe 0 Stace ? Coun[y Loca1 Departmen[ of Health tNat this individual sewageiiisposal system with proper main[enance ? Can be expected to function satissfactorily, xnd is not likely to create unsanitar r conditions OCannot be expected to function mtisfactorIly. ?A SIGN 7, ' ;- _ / TITLE ? NOTE: The health authority should complete the appropriate opinion statement above and aftix date, signature and tiNe in the spaces provided. NOTE: Use of the reverse of this form is at the option of the health authority. PART III-FOR USE OF FIELD UFFICE I have reviewed the foregoing and the pertinent Compliance Inspection Report and recommend that the individual watersupply system be considered ?acceptable Q not acceptable and that the sewage-disposal be considered 11 acceptable ? not acceptable DATE vncnAnnx??uc ne?.?o.. SIGNATURE , TITLE aHUD ARCHITECTURAlSECTION CHIEF OR DEPUTV CHIEF ? VA CHIEF APPFAISAL SECTIpN OR DESIGNEE . MUO FORM 92573 SUPERSEDES VA FUNM 26?6395, OCT 1976, WHICN WIIL NOT 8E USED. . i?*) citu oF 3795 PILOT KNOB ROAD. P.O. BOX 21199 EAGAhI. MINNESOTA 55121 PHONE: (612) 454-8100 DATE: November 1p 1983 DAKOTA C1aNZ'Y ABSTRACT C0. 1250 Highway #55 P.O. Box 456 Hastings, MN 55033 SPECIAL ASSESSNfENT SEARCH BEA BLOMEViSt Mava THOMnSEGaN JAMES A. SM{TH JERRY THOPnAS THEODORE WaCHTER counN Men,oa: THpMAS HEOGES Crty nomu.snofa EUGEHE vAN OvERBEKE Citv clert RE: Auditors sab #38 Parcel # C10_03800-090-021 600 Ione pak Road, Eagan, P7N 55121 Enclosed herein is tha search which you requested made on the above described property. Kind of Improvement Runs Seginning Original Amount .".Balance Due Storm Sewver Trunk 15 yrs 1984 . $2249.00 $2099.07 I further certify that according to the records of said office, the following improve- ments are contemplated or pending after having been approved, and are notia in the process of planning or completion. ' Kind of Improvement Approzimate date of Compietion Approcimate cost NONE T WAIVER: Neitlier the City of Eagan nor its employees guarantees tlic accuracy of the above in- formation which was requested by the persai or pcrsons inJicaLed: Nor does the City or its employees assume any liability for the correctness thereof. In consideration for the supplying of the indicatecl information in tlie above form, and for all otlier consideration of any nature whatsoever, any claim against the City or its employee; rising thcre from is hereby expressly waived. Levied assessments to be paid to the County Treasurer at Hastings, 6N. 55033 Very truly yo s, cy?? ? THE LONE OAK 7REE...THE SYM90L ANO GROWTH IN Ot1R COMMUNITY PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA092850 Date Issued: 02/17/2010 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 600 Lone Oak Rd Lot: 009 Block: 002 Addition: Auditors Subdivision 38 PID:10-03800-090-02 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 openin,s, 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: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: Renewal Andersen Kenneth W West Jr 1920 County Road C West 600 Lone Oak Rd Roseville NIN 55113 Eagan NIN 55121 (61)264-4777 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 Use BLUE or BLACK Ink r For For Office Use I CiPermit ty Ol n ~ E QR1A1I Permit Fee: ~ W I 3830 Pilot Knob Road Eagan MN 55122 Date Re ived: 7 - / Phone: (651) 675-5675 / Y V '1 staff: 11 Fax: (651) 675-5694 1 1 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: p Unit Name: 4 (y il`I ~-C Phone: RESIDENT / } - OWNER Address / City/ Zip: Ob t"pN a~ lL~ C~,csl~ 12 Applicant is: Owner Contractor TYPE OF WORK Description of work: Construction Cost: Multi-Family Building: (Yes / No Company: LE Contact: CONTRACTOR Address: City: State: Zip: Phone: 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 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 the 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.org 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 q F VO 'tel . W iE S `F x Applicant's Printed Name Applicant's Signature Page 1 of 3