967 Kettle Creek Rd
Use BLUE or BLACK Ink
For Office Use I
j Permit `1 -7a
City o Eap I
55,00
3830 Pilot Knob Road Permit Fee: II ~1
Eagan MN 55122 j Date Received: t2 10
l
Phone: (651) 675-5675 I O-VI
Fax: (651) 675-5694 Staff: 0
2010 MECHANICAL PERMIT APPLICATION
Date: 1Z_ I D Site Address: (0 -7 / f , ~i C
Tenant: Suite
RESIDENT / OWNER Name: On e/_;e? Phone:
Address / City / Zip:
CONTRACTOR Name: 0. `f'f ~e i icense#: 8
Address: Q ? l~ f r City: 81~i y
State: W 1~- Zip: Phone: l 9D-6J4
Contact: Email:
TYPE OF WORK New X Replacement Additional Alteration Demolition
Description of work:
NOTE: Roof mounted and giro u6 mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / J 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) $ 6 Wt."-) 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.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.
,TGC
Applicant's Printed Name Applicant's Signature
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
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
7o be used for S! WA/QU Est. Value $Gt oom
1447 "s
Receipt # 1 ? 7& ?
Date D`cxmm 7 19,7
Site Address ?? ?U so"
Lot s Block 1 Sec/Sub. MING= SMAU
Parcel No. 7U AM.
c Name 'roLL= CYTY Caft_
= Address b» 1 1?g iT.
? City 'A.Y. Phone 431-1211
a
.o Name - u?
?Q Address'
?m City Phone
"' ¢
u W Name
WW
?
=o Address .
g W City Phone
I here6y acknowledge that I have read this application and state that the
information is correct and agree to comply wi[h all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signatufft ot Permittee _
A Building Permit is issuetl to: COLUM CITY_ CM_
on the express condition that all work shall be done in accordancewith all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building ORicial -
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System = Zoning
On Site Well (Actual) Const
City Water x (Allowable)
PRV Required # of Stories
Booster Pump
APPROVALS
Engr./Assess. _
Planner _
Council _
BIdg.Off. _
Variance _
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Surcharge
Plan Review
sAC, City
SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P7
AM(COPr)
TOTAL
?
?
rf
YD
40
?
? 367.a
.
30.54
143.111
1oo.a_
s:s.a
sts.a
`7•(K?
ws.oL'.
180•OU
•
2 2dj.S:
. ..
BLDG.
PERMIT I30.
, .
,:_ _ f, ?? ,?- ; ?_E,? __%?. ?•???
01 3210 Bldg. Permit
01-3422 Plan Check ? --- ?--' `J
01-3445 5urch./Adm.
01-3446 SAC/Adm. ? .J
01-2155 Surcharge
17-3860 Road Unit CD
- r
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 kater Meter ? ?-
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 5ewer Permit
79-3866 5ewer Conn.
11-3855 Park Ded.
TOTAL
? CASH RECEIPT
CITY OF EAGAN
3830 PILOT:(PTOB ROAD
EAGAN, MINNESOTA 55122
i
DATE RECCIVED
FROM
AMOUNT $
?' I . ` .
8 DOLLARS
?oo
[]CASH CHECK
FOR\
BY
? 96 Z k; White-Payart Copy
Yellow-Postiny CoPY
Pink-File Copy
Thank You
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: '+ f I i' I nf;
3830 Pilot Knob Road `' ri `''•?
Permit Number:
Ea an, Minnesota 55122-1897
9 Date Issued:
(612) 681-4675
SITE ADDRESS: APPLiCANT:
PERMIT SUBTYPE: TYPE OF WORK:
Permit No. Permit Holder Date Telephone 8
ELECTRIC
PLUMBING
HVAC
Inapection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TE5T
FINAL PLBG
fINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
( t
?C?
DECK FINA1.
.: ..
tgrr#ifiratr rf Orrupttnry
Citp of Cagan
luPpttx'hIlPltf D# g1ttlbttm jitwPlttDtt
This Ceraficate issued pursuant to the requirements ojSection 306 ojthe Uniform BuiJding
Cade certifying that ar !he time of issuance this structure was in compliance with the various
ordinonces of the City regula[ing building corutruction or use. For the followrng:
uw awneauoo SF ixlG%GAR elae. rtrnfit No. -!
Oocupaacy lype 1: ; 7qoing Di+lria Type Cortu.
owoerofBiulding fTft-?"Tre?_. pddreu E.?.,?'yt' 'SSI a,.
BuildingAddrtas l.oality 13. J1,
p,te: .'ANZJARY 27, 1988
suamng arK.;.i
POST IN A CONSPICUOUS PLACE
?- --' CITY OF EAGAN
. ,
3830 Pilot Knob Road, P.O. Box 21 •199, Eegan, MN 55121
PHON E: 454-8100
BUILDING PERMIT Receipt# ?" ??:': •'`i? ?
To be used tor+ Est. Value ?1'? Date ??? ? t 987
i
Site
Lot } BIoCk i Sec/Sub. LinI??m SQUMR
ITIN •
Parcel No.
: Name COLL= C_TY CMT
W O
z Addres?
o
City ' ' Phone 431-
,o Name
?i Addre
a
OFFICE USE ONLY
u
On Site Sewage Occupancy
x
st-
MWCC System Zoning
On Site Well (Actuaq Const w
City Water x (Allowa6le) rit
PRV Required # ot Stories
Booster Pump Length ?
Depth
S.F. Total
Footprint S.F.
p- City rnone pppROVALS FEES
; 36r0?
? 6
yVj W Name En r./Assess.
9 Permit ?? ?0
? =
=n
Address Planner Surcharge
(aJ??
Q W City Phone Council Plan Review
100
00
Bldg. OH. SAC, City •
I hereby acknowledge that I have read this application and state that the Variance SAC, MWCC 325•00
s13 ??
information is correct and agree to comply with all applicable State of
n Ordinan
Minnesota Sta[ut
nd Cit
f E Water Conn.
---- 6T
-Oo
es a
y o
aqa
ces. Water Meter .
Signature of Permittee Road Unit O'00
COLL= CITY Cnew x YV0'00
A Building PermR is issued to:. Treatment Pt
on the express condition that all work shall be done in accordance with all ?Lar?? ??
applicable State of Minnesota Statutes and City of Eagan Ordinances. 2
Building Official TOTAL ?
?2?? •?
-"-
Permit No. Permit Holder Date Talephone it
Piumbing _ ? , , ?, ? :/,:%j'•
k.V.A.C.
:
Electric c-v (p ?
Sottener
Inspoction Date Inap. Comments
FOOtlfl(JS I "??/ ? r
Footings II
Foundation
Framing
,
?.
v,
Roofing
Rough Plbg.
Rough Ntg.
Isul.
Fireplace
Final Htg.
Final Plbg.
Bldg. Final c?s r/« cl ? y 4 f J,j !
C6ff. OCC. ?l e[ R.rt Lr ?.
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
PERMIT #
PLUMBING PERMIT
CITY OF EAGAN RECEIPT q
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE
Site Addre?s
Lot = % Block JSec/Sub
? Name ?; E,,
r Address ,:%7.
c City ' Phone
Name _
Address
Phone_
FEES
COMM/IND FEE - 19b OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE 8 CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - 50
(ADD $.50 S/C IF PERMIT PRICE GOES
OF
FOR: CITY OF EAGAN
BLDG. TYPEj WORK DESCRIPTION..
Res. ? New --??
Mult Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLaWING:
NO PIXTURES TOTAL
? Water Closet - $100 $
?
?Bath Tubs - $3.00
Z Lavatory - $3.00
-Shower - $3.00 y
Kitchen Sink - $3.00
-Urinal/Bidet - $3.00
Z Laundry Tray - $100
Z Floor Drains - $1.50
/ Water Healer - 51.50
_Whirlpool - $3.00
Gas Piping Outlets - $1.50 '
(MINIMUM - 1 PER PERMIT)
-Softener - $5.00
-Well - $10.00
- Private Disp. - $10.00
?Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL:
CONTI
Site Ac
Lot -
PERMIT #
MECFIANICAL PERMIT RECEIPT # ?
CfTY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55722 DATE
PHONE: 454-8100
m Name k-
! Address
c City
1
Name
rL_
oi
' TYPE OF WORK
Forced Air
Boiler
Unk Heater
Air Cond.
Vent
Gas Piping Outlecs #
Other
? TYP
BLDG
Sub .
E WORK DESCRIPTION
?
, , Res.
New
Mult Add-on
,? - Comm. Repair
Other
M BTU $
M BTU $
M BTU $
M BTU $
CFM R
R '
FEE:
S/C: ,
TOTAL•
FEES ?
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - &00 ;
(RES. HVAC INCLUDES A/C ON NEW
'
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIr) - 1.50 EA. ?
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLIES i
TOWNHOUSE 8 CONDOS - RES. RATE APPLIES ?
MINIMUM RESIDENTIAL FEE - ALL ADD-ON & ?
REMODELS - 12.00
MINIMUM COMMERCIAL FEE ?
- 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYOND $1,000)
i
I
SIGNATURE OF PERMITTEE
w
FOR: CITY OF EAGAN
d
CITY OF EAGAN
3830 Pibt Knob Road
P.O. Box 211.99.
Eagan,'MA 55121
f Owr
E Site
€ Plun
f
Permit No: Date:
B/PNo: "' Date:
MWCC:
"
2oning?
CityChg:
'
No. of Units:
Acct Dep:
Permit Fee: I agree to comply wNh the City oi Eagen
Surcharge: • 5`?T'•? Ordinances.
By
SEWER SERVICE PERMIT
CITY OF EAGAN Permit No:
3830 Pilot Knob Road Meter No:
P.O.Box21190 ' ReaderNo:
Eagan, NiN 55127
Site
Conet.
eek Re
Date:
Size:
Date:
ton Sa 7th
Conn. Chg: _ 525.00pd .,?
Zoning:
Acct Dep:_
Permit Fee: 15 •uoDa
10. OOnd No. of Units: 1
Surcharge:
Tr. Plant . 5dpd
180. QOpd I agree tc comply with the Clty of Eagan
_
Meter
r Ordinances.
Misc
: 7 00€4
. BY
WATER SERVICE PERMIT
CITY OF EAGAN Permit No: f Date:
3830EilofXnob Road Meter No: ffg 3? / Size:
P.O. Box 21199 Reader No: Q3 T?Ll/ Date: Z s'L ?
Eagan, MN 55121
Owner. C;itv Geu
SiteAddress: 967 hettle Cree': Eoa?' 311 '.(2::'.',: t= j'-?
Plumber ?r" ???1 4
Conn. Chg: 525. OOpdf,,.,, g:,?i ,,,, ,.3{rbQROb,
Acct Dep: 15. 00"
?IQf•l
Permit Fee: - -
rcharge: .5?Vnl j1??F)l8*e
. Plant i00. JJD Ordina
er 67 nn...a yly
?l
I ith the CR of Eagan
;
WATER SERVICE PERMIT I
CITY OF EAGAN N°_ 14 4 71
3830 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
PHONE:454-8100 ? ?j???9
BUILDING PERMIT Receipt# /
To be used for SF DWG/GAR Est. Value $61, 000 Date DECEMBER 7 19 87
Site Address 967 KETTLE CREEK ROAD OFFICE USE ONLY
R3
LEXINGTON SQUARE
Lot 5 Block 1 Sec/Sub on Site Sewage Occupancy
.
7TH ADD. MWCC System X Zoning
Parcel No. Vn
On Site Well _ (Actual) Const
COLLEGE CITY CONST
x Name
Cirywater
X (Allowable)
Vn
Address 6970 151TH 5T. PRV Required # of Stories
3
? City A.V. Phone 431-1211
BoosterPump
_ Length 40
Depth 44
, p Name SAME S.F. Total
?Q Address FootprintS.F.
? City Phone APPROVALS FEES
? W Name En9r./assess. Permit $ 367.0(
Planner Surcharge 30.5(
=Z Addf@SS Council Plan Review 183. 5(
Q W City phone Bidg. Off. SAC, City 100.0(
I hereby acknowledge ihat I have read this application and state that the Variance SAC, MWCC 525.0(
information is correct and agree to comply with all applica6le State of Water Conn. 525 OC
Minnesota Statutes and Cit
vof? gan Ordinan es. 67
0(
?
Signature of Permittee Water Meter
Road Unit .
305.0(
A Building Permit is issued to: COL GE CITY CONST Treatment P1 180.0C
on the express condition that all work shall be done in accordance with all
??1c(copy)
. 5C
applicable State of Minnes
ot
a S
j
?
tut
es and City Eagan Ordinances.
/
?
?
(
J
?
, TOTAL $2
.283 5?
•
Building Official__S?'6t?la
?-
J
.o4uesl void ? PO /'J 0
18 months trom
D
0 7 6 `? 27 J. .' !aI , M .
Renuest Dale
' Fire o. Hough-fri.l spection
flequiredl `
?Ready Now ?WIII Notify, Inspec-
m
Wh
R
/S r ?
?Ves No r
r.n
eadY
Licensed EIecVical Contractor 1 hereby requastinsoection o/ above
?j Owner alectrical work installed at:
$treet Address, Box oRute N 7 ?
f
`
9
11 Cit?.
cc
c
a?>
, ?
L ?/
ecLOn o. Township Name or No. Range No. Cnw /
9 o TA
OccuOant (PR T),.,
?
Cy r ' PYwne No.
Power piie
A ?
1
CX Addr?e ?
0
A a
eG
Electri I Contractor np any Nam9l?•
!/v/jJ7 L°/L GG ? C tractor's)L(ic?ense No.
?? d O
Mailing Address ( Mraclor r Owner Making Instal
Au[horize i nawre on r tor Opner Making Installation) Phon Number
N ?Y
MINNESOTp STAfTE 80AflD Of ELECTRICITV THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N•191 BE ACCEPTED eY THE STATE BOAHD
1821 Universitv Ave.. S1. Paul, MN 56104 UNLESS PROPEH INSPECTION FEE IS
Phone(612)642-0800 ENC?OSE?.
REQUEST FOR ELECTRICAL INSPECTION ? es-oooot-os
?
,
,..? See ine4ructions for completing ihis torm on 6ack Ot yellow copy.
76927 "X" Below Work Covered by This Request
New AAd Rep. Type of Building APPlinncea WifeA EquipmBnt Wir¢d
Home Range Temporary Service
Duplrx Water Heater Lightin,y Fixtures
Apt. Building Dryer Electric Heatin
Commercial Bldy. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Othror oeci v OtherlSnecify)
1 .r SVeci(y Other Othcr
Cmmnute lnsnectinn Fae Ralnw
M Fee Servic En rance Size H Fae FeadersI5ubteeders k Fee Circuits
0 Amps 0 to 30 Am s •? 0 to 30 Am s
A ove 200 qmpy 31 to 100 Amps s,cYi 31 to 100 Amps
Swimmin Pool Above 100_Amps Above 100_Am s
Transiormers Irrigation Booms .t Partial.'Other F
Signs Special Inspection ?
J?
TOTAL E
/
flertw?rks `?
?
l0
?-
Rough-in C)ate?` ?^? 1, the Elecirical
Inspector, hareby
certify thaf the a6ove
Final
} inspection has been
d
. me
e.
This request voiA 18 months from
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
? 3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConsWction Reauirements
• 3 registered site surveys showing sq, ft, of lot, sq. ft. of house; and all roofed areas
(20% maximum lot coverage allowed)
• 2 capies of plan showing beam & window sizes; poured found design, etc.)
• t set of Energy Calculations
. 3 copies of 7ree Preservation Plan ii lot ptatted aRer 711(93
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE
SITE ADDRESS
TYPE OF WOR
APPLICANT ! ?- fi?
IULTI-FAMILY BLDG Y vN
FIREPLACE(S) _ 0 _ 1 _ 2
STREET ADDRESS `k,? j
TELEPHONE # ?ISZ-7y?,-t?cgo CELL PHONE #
? -7 G7?
RemodellReoair Reauirements
• 2 copies of dan
• 1 set of Energy Calculations for heated addi6ons
• 1 site survey for extenor additions & decks
. Indicale if home served by septic system for additions
VALUAiION ? i ??r 0 (f)
CITY ?Z°G iK STATEH k ZIP S' 3S?y
FAx # 9C7-" Zy6
PROPERTYOWNER ..-? vGtk ?d k ` TELEPHONE# ?U-('I°33Z -'17%?
-----------------------------------------------------------------------------------------------
COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY L MINNESOTA RULES 7672
(d submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Enveiope Calculations Submitted
Plumbing Contractor. ___------------- _ Phone # _
Plumbing system includes: Water Softener _ Lawn Sprinkler Fcc: $90.00
WaCer Heater No. of R.I. Baths
No, of Baths ?
Mechanical Contractor. Phone #
Nlechanical system includes: Air Conditioning rec: $70.00
Hea[ Rccovcry System
Sewer/Water Contractor: Phone # °^ fP- ^
EI ?' =; .n l5
-------------------------------------------------------------°---------------------------------- j?"'?
I hereby acknowledge that I have read this application, state that the information is correct,agree?o comply
with all applicable State of Minnesota Statutes and City of Eagan Ordi ??
Signature of Applicant
-- - -- - -------- - ---- - ---------------- - -- - --------- - -------- - -------- - ---------- - -- - --------------- - --------- - -- - ----- - ----- - ----- - -------- - - - --
OFFICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 OS-plex ? 13 16-plex
? OS 06-plex ? 16 Fireplace
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
? 11 10-plex ? 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 20 Pool
0 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bidg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. p 42 Demolish (Foundation) C] 45 Fire Repair
? 33 Aiteration ? 37 Demolish (Bidg)` ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement *Demolition (Entire Bidg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Canst W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) Plumbing
_ Foundation HVAC
_ Drain Tile Other
Koof _ Ice & Water _ Final Pool Ftgs Air/Gas Tests Final
_ Framing Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Piumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
?-CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
PERMIT
PERMITTYPE: BUILDING
Permit Number: 0 2 8 3 2 9
Date Issued: 9 7/ 2 2/ 9 6
967 KE7TLE CREEK,RD
LOT: 5 BLOCK: 11
LEXZNG7tlN SQUARE 7TM
P.I.N.s 10-45081-950-01
DESCRIPTION:
DECK
NEW
434 AL.T. RESIDEMTIAL
e
?c *?P Yi, i
?,l ,? iix 'i aszi3
kL .A'?:,3 Q?L°I•'?" tR
? ?.
st+tt? g?; c?sr actm1k ??r?ry?? ?:?"a!x•.
? .?ro?
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Total Fee
CONTRACTOR:
$45.00
$.50
$45.5@
APPLICANT/PERMITEE SIGNATURE
OWNER: - APPlicant -
GRAY KENNETH
967 KETTLE CREEK RD
EAGRN MN
(612)456-9056
ISSUED BY: SIGNATURE
CITY OF EAGAN
`3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESiDENTIAL)
681-4675
BemodellRenair Reauirements
? 3 registered site surveys ? 2 eopies ot plan
? 2 copies of piens (indude beam d window sizes; pou2d fnd. design; etc.) ? 2 site surveys (exterior additions 8 decks)
? 1 energy calculatfons ? i energy calculations tor heated edditions
? 3 copiea of Uee presenstion plan N bt platled after 7/1193
required: _ Yes _ No
DATE: ?) u 194 1q% CONSTRUCTION COST: ???0p tr m
I -D
DESCRIPTION OF WORK:
STREET ADDRESS: lE.cf-1-1 e L. rer,;!?
LOT S BLOCK ' SUBD./P.I.D. #:
• v
PROPERTY
OWNER
CONTRACTOR
ARCHITECTI
ENGINEER
Name: 6y4 J2_ P h o n e y?T - ? e) 5?
N., .M..
Street Address- '76 ??e
City: State: A) Zip:
s Q. eyi C_
Company: ' Phone #., - -
Street Address: License #:
City: State:
Company:
?'
Name: l?? 1
Zip.
Phone #-
Registration #*
Street Address•
City: State: Zip:
Sewer & water licensed plumber: . Penalty applies when address change and lot
change are requested once permit is issued.
I hereby acknowledge that f have read this application and state that the information is coRect and agree to comply with all
appllcabie State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: ?
OFFICE USE ONLY ???ENED
Certificates of Survey Received _ Yes _ No
• .? ?? ; __u_ _?_ ????,
Tree Preservation Plan Received _ Yes _ No . -? _ _ _ _ -
:l?c?
OFFICE USE ONLY
._,
BUILDING PERMIT TYPE
? Oi Foundation ? 06 Duplex
0 02 SF Dwelling a 07 4-plex
0 03 SF Addition o 08 8-plex
0 04 SF Porch a 09 12-plex
n 05 SF Misc. a 10 _; plex
WORK TYPE
W'3?New
n 32 Addition
o 33 Alterations
? 34 Repair
GENERAL INFORMATION
Censt (Actuan
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
0 11 Apt./Lodging a
0 12 Multi Repair/Rem. ?
0 13 Garage/Accessory o
a 14 Fireplace o
GP%15 Deck
a 36 Move
0 37 Demotition
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
v+J Basement sq. ft.
,\/1 Main level sq. ft.
72-3 sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Planning Building
Permit Fee
Surcharge
Plan Review
License
MGWS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pt.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
MCM/S System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Engineering
Variance
Valuation: $
4/ A1
n!
I
D
% SAC
SAC Units
?TRI-LAND C0.
suRvEYiNG
SERVICES
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55122
SITE PLAN FOR:
COLLEGE CITY
LEGAL DESCRIPTION: LOT 5,BLOCK I , LEXINTON SQUARE 71h.
ACCORDING TO THE RECORDED PLAT
SCALE= I"= 30' THEREOF DA KOTA COUNTY, MINNESOTA
?
\?o
93 "'7
V"c 4nt
,.4.
C)
?l° h? %
I .? - r_
I: 2 :
11
?
?Q
/49s?
/
?
us`. /3
N LN
'r + ?
9-
?
a?
•?-?
.?
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
DENOTES EXISTING SPOT
ELE VATION
DENOTES PROPOSED SPOT
ELE VATI ON
? DENOTES DRAINAGE DIRECTION
I hersby certify that this survey,plan or
report wus prepcred by me or under my
direct supervision and that i am a duly
Reqistered Land Survfror undsr the
Laws of the State of Minnesota.
/
/ LOT 5
8.
s
V>
0
? `v9 Fs.
Ro0F
\
4
"O l3'
S a A qz?
RAX a ?fF0,
c
qe
893,c7
0
Sk ,
\\9yr7
?
/
/ G4" 4e
893x
,?+?•, y?o
''4 c 414 ?1
s
e 5,
2 \?
INVERT ELEVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION = 8=9S20
PROPOSEO FIRST FLOOR ELEVATION = 9?t5 s.?o
PROPOSED BASEMENT FLOOR =
ELEVATION
NOTE'• VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
Brndlei?JSwenson, Mn. Rey. No. 15235
Date : ??i 2111Pn
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
1) PROPERTY ADDRESS :
LEGAL DESCRIPTION: L ? ? I
e
n
*ATE: PA)nIF'Nfi` OF k'EE AT TIM6 pF
APPLIcAazoN noFS Nar aoNgrzTUTE
APPROVAL OF PERrIIT.
INSPECTION OF SE.WER AND/M MTFR
IINSTA7.ra,mrpNS WML NOT gE SCEgD-
UIED UNTIL PERMIT FIAS BEFN
APPROVID.
_ tLOL/rslocK/SUbdivisidt? or Tax arcel ID )
IF EXISTING SI'RC'C'MME, DATE OF ORIGINAL BuILDING PERMIT ISSL'ANCE: ;
PRESENP 2ANING/pROPOSID LSE: ftn Year . ..
q corNERcuL/RErAs,/oFFzcE
[I INIDL?STRIAL
n INSTI2L'TIONAL/GpV?N'p
2) ?
NAN1E:
ADDRESS:
CI'PY, STATE, ZIP:
PHONE:
3) • i: ?-
NAME:
ADDRE.SS;
CIT3t, STATE, 2IP:
PHONE:
E R-1 SINGLE FAMILY
? R-2 DUPLEX (Ztao Units)
R-3 MWNHOLSE (Three + Units) ( Lnits)
R-4 APARTTENp/COI+IDOMINIDM ( Units)
? MASTER LICENSE# 33 ?j
4) .• • i?- ?
NANIE:
X-1?LL+cLS i-acense:
Active
EScpired
Not recorded
Staff 7nitial
/
_ ADDRFS.S:
CITY. STATE, ZIP: .
PHONE:
-5)
IPICONNECTION 10 CITY SEWER ?CONNECTION TO CITY WATER ? pTfIEIt '. ?
6) slief.
•?' PLEASE HOID APPROVED PERMIT FOR PTQi-LTP BY ONE OF AHOVE --- -- ---
q PLF?SE APPROVED PERMIT TO 1, 2t 3, 4, ABOVE .
'
7) (Circle one) '
t
fOR CITY USE ONLY
PERMIT # ISSUED
I ?;lj ?;_V
Pd w/Bldg. Permit FEES:
$ $ 0 . .??
$ $ 16 • j?
$ 7, QO $
$ $
$ $
SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SIIRCHARGE)
WATER METER/COPPERHORN/OL'TSIDE READER
WATER TAP (INCLt'DE CORPORATION STOP)
SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
$ $
WAC
$ G? ?-.?• U?? $
SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRL7NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$
$
WATER
T
- TREATMEPI
PLANT SURCHARGE
$ $ OTHER:
$ / .3 TOTAL
47 c4o,
RECEIPT RECEIPT
DOES LTILITY CONNEC TION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
F__j' YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
Q
NO ROADWAY" MUST BE ISSLED By THE ENGINEERING
DIVISIO
N. LIST AS A CONDITION.
SLi BJECT TO THE FOLLOWI[VG CONDITIONS:
APPROVED BY: /--??rL /)
TITLE:
DATE: 14 /a q? A 7
- I VV 1987 BIIILDING PERMIT PLI ATION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS -
INCL[1DE(DE.TS OF PLANS4a?CBRTIFICATES OE SQEtVEY, 1? ST OF ENERGY CALCQLATIOAS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTORlHOMEOWNER MIIST DESIGNATE WHICH ADDRESS
I
IS DFSIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSQED.
MQLTIPLE DWELLINGS - RESIDEAITIAL RENTAL DNITS FOR SALE ORITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRVEY - CHECg WITH BLDG. DEPT.,
1 SET OF SNERGY CALCULATIONS
CO.MRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL:PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
Sir,ylb Fauily, it
To Be Used For: du-fnCAttQ., N2w-HoAv- Valuation: ?'?^ Date:
Site Address q?7 KR.'?'(Q. CY&k A.& - W/
Lot .? Block ? On Site Sewag
t,,-' ??.?, MWCC System
Parcel/Sub 'c.l? On Site Well
City tilater
Owner
Address ?z-? ?.lA?.X ? •
City/Zip Code EQ a.lti Jr `J 12-3
Phone ?5 1, - 9 54o APPROVALS
Contractor C a I i.2 L 044 e o nG+ruC-h i5?^
Address ta9`y6 151 Sf ,??'•
City/ZiP Code Aaa4 L", rneu 55124
Phone 431Jo?ll
Areh. /Engr. SCt'YkQ, G. S O(A kQh
Address
City/Zip Code
RW'D A?? 1987
e Oceupancy P- 3
ve Zoning R -I
Type of Const
(Actual) v-N
(A1lowable) Y-H
# of Stories
Length qo,
Depth
S.F. Total
Footprint S.F.
FEFS
Assessments Permit 36 7,00
Water/Sewer Surcharge 30,50
Police Plan Review 183.50
Fire SAC, City LDp,pp
Engr SAC 9 MWCC '15s,5, ov
Planner Water Conn 5zS.00
Council Water Meter 67,00
Bldg Off ' l2 13 Road Unit a, 00
APC Treatment Pl I_$p,Da
Varianee Parks
Copies ,SD
-
TOT9L E-62YA
.5
Phone 4k
GARAGE
Zo X2? _ ?lt?t7 X/2 = ?g01? , ?-
?OL(Se
7- `! X t-l O =
5Ay
t xio =
56a x Sg = S SGBo
,
.
lx?o = loxyy s 4 yc?
d v y Z?
i ,.
?,;,r • uu;.
tiu+
1 f,i 5,.; U r
UU ?
r?.?.> • UU-;-
r;'j•?lii,
1 r;t) • Uil :
,
.
T RI - LAN D C 0.
SURVEYING
SERVICES
1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 55122
89s%,
LEGAL DESCRIPTION: LOT 5,BLOCK I , LEXINTON SQUARE 7th.
ACCORDING TO THE RECORDED PLAT
SCALE= I"= 30' THEREOF DAKOTA COUNTY,MINNESOTA
N
i?/?
\4?s
0
qs *'1
v^ c 4.,.
,. ?.
°
/\0
.00
1 0•: tso
60
/
/
. /
?
?Q ;
F?
?
Nk? L. / \
Fn
V'
0 ? v°+ .
°s
O
'p"0
?
a?
.n.
SITE PLAN FOR:
COLLEGE CITY
^
? ? sg
?o
s
/ LOT 5 ? s,sos? o,?
. ?
A
? 6 q
Q'o'Jt 0O Fo.
a? o l?. c
5
/?•? ?
k
893x7
\
\ ` 89yx7
?
?
?` ?ara
? F.
\26b0a, O
V GY`??
6
vq ?
. 4nr
893X s
! y
2 \?
LEGEND
o DENOTES IRON MONUMENT
* DENOTES WOOD HUB SET
DENOTES EXISTING SPOT
ELE VATI ON
DENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hereby certify ihat this survey, plan or
report was preporod by me or under my
direct supervision and that I om a duly
Re9istered Lcnd Surveyor under the
Laws of the State of Minnesoto.
Bradle,?/Swenson, Mn. Req. No. 15235
Date : !/?
I f- -r
L,, , r
INVERT ELEVaTION aT SERViCE ExTENSiON=
PROPOSED GARAGE FLOOR ELEVATION = B
PROPOSED FIRST FLOOR ELEVATION = 45,,.7b
PROPOSED BASEMENT FLOOR =
ELEVATION
NOTE : VERIFY ALL FLOOR HEIGHTS WITH
FINAL HOUSE PLANS
,
oWNEa
I
LzTrniaa. ENVELopE ntEancE "w" coiirutnrIori
cownIDZA
stTE nouaESS % ?aq a.,4- j {!lI I, . 551 ZZ_
, COfI1MCTUlI COLLEGE CITY C0lISTRUCTION bA1E b 7 DIIUf1E 612-431-1211
. •' •
. , .
. Oetermine working square footage of each.
1. total exposed wall area'...... 17ZP-) sq. ft. x_. / /90,vr-
.2. Total roof/ceiling area ...... `jbO sq. ft. x=?0???
-Total exposed wall area abave flovr =_?`7 2 E•
a. Total wall wihdow area ........................... i
b. Total door area ................................. .
?: -. . c. lotal sllding glass door area ................... ::?
• d. Total fireplace wall area ........................
• e. Total Wall framing area (average 10%)...........
P. Total net wall area above floor ................. ?:'fl.•?;?:?'?
g. 7vta1 rim foist area ............................ B 6
tl
Tvtal-eicposed foundation area ? 85.7o76I .,. .
h. 1ota1 foundation window'area.:.........:......... .. ?
1. Toal net foundation are"a abovq;grade ........:... 8,4.3 ?(o
` ..
I
petermine "U'value of each wall segment.
. ,
_ a.
I4-I,b?,9' .
X „ull .
A-9,017 ,
, . b; 16G7 x „u,e , Ize = 42._.-3
. C• O ,x itU„
• • J
•
{J Q
,111
V 11I!
A
w
a ?
' . e. I 7z . So z Jou,e . 09 z ? ( 5,697
. f. (291. 4-88 X loun o4-3 = 55 S?Z
g. 13 5.37(o X "ult. ?Od-) ? 3•`?
.
, ' h
. •
V v Mu11
? ` . ?
? I. S s.37 b x„U„ .079
3 ............... " Total
...................... °
?
I?5.3?.
If item 13 1s the same as, or less than.item 11? you have met the tntent
of SE3C 6006(c)2.
. . . / 5
, ,. ? , . .•. • , .
. ? .
. ... .
Total..exposed roof/ceiling area ? 9 G4
' ?. Total skylight area...........?...:.............
. k. Tntal rooflceiling iraminq area (average lOX).,. 9(e; p
1.. Tota1 net,insulated roof/ceiling area..::.......?? p
. •
p0termine,`U" value for each roof/ceiling segment. ,
? ? ? p • x uUu - e . -.
, ..
. k. 96 x '#lu„' ,174- ? I6.?104-
. •, ,
8bd-.,00 X l,Ull'. vZZ . ' ? Iq.oo3
C a 0 0 10 0 4• 6 6 9 a 6 0 0 0 a a 6 a 0 6 a 0 a 0 6 0 a 61 Otal ? -.'? J.??L •
, ' .
lf total of 14 is the sarpe as, or less than (2, you have met the intent oF
, SIlC,60U6(c)1. ' Alternate Building Envelope besign
To uttllze tlie total envelope system method, the values establislied by tlle '
sum of items 03 and 14 sha1.1 nnt be greater than the sum oF ltems .'1 and 01,
?._ 19 CiP.2g+ zrS, Pq 3._ 4.
. .
, . . . . . .
•.?• ? ?.?.?.?....?. ?a??? ? . . ? ' . . .
,
r? ? . •
u...???.??.r?.?.??. . . ? .
. • •. ..... ?.??..?......? ... ' ' ? ? . , ,
J ?
' ....?..??..?'._?.? .. . ?
? , . . .
?' ??._...??..? _?'?' ? • . . ,
• '
?
• . , . . i . , , . . . ? .
? . ?. • ? • ? • .. .? ? ' ? ' ?
? , .
,.1
V N • u
AN D? V AL E. AN.41.. Y S l:s 01:?? ? S ccT? ? a/5
R ? M Jo I S -r 1? rt F. A :
"R" - vA L uE
•(Ol _I nltF-F- l02 ,,1P- /P1L M
4-0 1 NSU LAT)ON CP•!q )
Z. a(c 2-S Z SHEATiu4 ?v ?.T-_,(Z?iG
.,?o 7 LaP siar?a 4 - ?Z,i _
l, 98 ),h" SoFi'wvo?
. 17_f ,crfR. 10 R A r+?
2?Tor n c-' R.-?• VAr-u.c
TbTA? F?ri.c,?
1 OUKI D AT ION WALL- AREA CADovc qRAoX.D
,. R., V A L u. E.
GI 1NrLRlOP? AlR hL-1-1
. ? C? oA4 GR t' rr (;[.oc.K.
? O Z K 4-
- e-i I COQ,.-O. r:,"-4-4?..
-7 EXTf-K,10R, AIQ FII.M
12,b3 1"OTAc. qwq VqLu.f-
`'wf& va-4. it 1/ l Z? 3 =c77i 7
roTnL k»rAc,f,
12Kn c.i 10r)"ft
DAtc : 9ftuv[D _
- - - ---- _ . - 'L_ ? 5
• , .r.?. ?? _ . _ . . _ . .
Wl NDoW AREA : TyP? o? w?N.???? :
45/g" INSvt- GFASS
TNe ?,vrNOOYv uuirs iyA.v t BRCn/ TiSr<O FoA? "rR:.VA??•?.t, tMIY Aec Aa LWcp
ABoJS 4NO /N4y/ a[ NssiyMEo -,A Ors14N ["scl VA"ws- oF "P-•
INGL.NpIV G Ailt fl LM 5.?.' I
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?w -
FouNaAr IO" wmao W APtIA : TyPE oiw W,N00w :
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MaY er AafiyNLu o? VAwt oF •g?M - ING1-MDIN?
AIQ 0I9-MD , .
Uqts I/Iju • II =? Foorwq?t. ? FOOfAqG ¦
SLIDINq (4-LA55 Q70g AI2&A: 'rYpc. aP DaoR:
$/g /NSuC-?G G..•
SL lOlal%Q 4L459 L?OORS 140,VL O!R'/ 7i,ST4R FoR"R=VAL•Kry TNCYAItiQ'?.1 L-'M*SO
A80?R AeJO M?1y ?1O H.3.St tiN?.p A VIS I G?PIGiA?'[) ?/AL.KL o1L 'R."• •ZBJ .?r.
Alo FILr'l$
Ny? . ?J'?1a = 1/ _1=331= Fveri 4 cr '
DooR. Artca :
7YPe p` DooR ;
7'N e¢-uAf• =T"rz,u
pO0[Z UNI'TS HAY(- 6f-fN TLSr[O .?.10 fouyA To HqVt A0l
VAULtIL ois T. B I _! ?Nq Ala ao1,.Mi,
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,5PEc/qLs ;
.
TYPE '
,
waM c-? ,?nu,+.q? ' pqr?•. s?NEc? -
3 ? 5
cJ'1-u:D / FRAM iN4
vA L ue
_?Lrvre*oR aIR Fi."
.4_5 t z G Vr.su M wAc"001+10
?, 9-15-5 sor r rvooc
Z.06 ?b I?AP siciuc, 2
` VAFWL 6ARArt•¢.
rreRIa? ?IX. f,"M
t?. 83 o rA L' R...#; /Axac.
`'?, =1/a..? . 1 / "0.9?.5 • .O
To rAL PoorAG c
i
?NSU.C.ATE-o ARlA B&TWiLaM 57I640S
,.R.._ vALwL
• . bl iure.aiorr ^IR rluM
i 11
' . 45 Z- 4Y psum y?/A??.peqQ.o
19,0 IusuLwr Ia•r [R,19 )
Z.o?o 4?/ SNtA TM IHfi $VILTR.1"Cs
, b7 IA. s1 0 104 G LRP
•ir1.1[.19M /1iR Iryt,M
Z 2. D T A L PUw j. YA LuAL-
??.,a.,?,,, , ?, Z Z.q b.
TOTA L lbOfA 4L
h ?? IWG".1t,
Unrc; 5'4uLo_.
G ? 5 ..
•R•. vA Lu &
,bl .INTE91oR ^IR FILM
,375 3?z. soRrwaoo
5/B GYPSU.M WALc.boA4D
-_ " vA,PaR
17 I NTLrR loa. AlR P14M
S, -135?T07 A L " Rwi VnLu-E
-
ro7AL FmrA49
zIJSt1LA7t? AREA i5rj-tW"N tHE X01ST-5
"R" • 1/ALtA.C
.?IWrERiOR AlR RII.M
00 ??I N3?1.LATION
•?,6 4YPSUM wAu.adaao
VAaaR DA01L4M¢.
?? 1 N rE R 102 AiR f?4 M
453roTA4 "R.?,?' vaLu.L
14,, : Ixz = i/ ?-S,3lo = o?z
l4DTA6 worAc-e.
0" A, 1 •/n/1b Rtr
pArrr siyANd____-_---
-- --
._. 566
PERMIT
City of Eagan Permit Type: Building
Permit Number: EA104832
Date Issued: 06/12/2012
of 1(]D Permit Category: ePermit
~It~ E
Site Address: 967 Kettle Creek Rd
Lot: 5 Block: 1 Addition: Lexington Square 7th
PID: 10-45081-01-050
Use:
Description:
Sub Type: e-Windows/Doors Construction Type:
Work Type: Windows/Doors-New/Replacement
Description: House
Census Code: 434- Occupancy:
Zoning:
Square Feet: 0
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
Comments:
inspection. Call for final inspection after installation.
Carbon monoxide detectors are required by law in ALL single family homes.
Fee Summary: BL - Base Fee $4K $103.25 0801.4085
Valuation: 4,000.00 Surcharge - Based on Valuation $4K $2.00 9001.2195
Total: $105.25
Contractor: Owner:
- Applicant -
Home Depot At Home Services Tin Nguyen
656 Mendelssohn Ave. N 3389 Rolling Hills Dr
Golden Valley MN 55427 Eagan MN 55121
(763) 542-8826
1 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.
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
_ _ - - _ _ _ - - _ _ - -
_ i
'Ilk f1f] I For Office Use I
Cit 01 EaRtIR I Permit
y I Permit Fee. V
I
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 I Staff:
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: U 2-. l3 Site Address: P-4 -Unit
7 2 2-m
Name: ( Ivey-((r/~= Phone: 9
f 2~
Resident!
Owner Address / City / Zip: 3 r('y~~~ r`N ext,,1~ /
Applicant is: Owner _IK_ Contractor
Type of Work Description of work: {pro " S'1 l~
U C)
Construction Cost: [3~w Multi-Family Building: (Yes f / No
Company: y Pcults (-ut ~i n - d k,-7 672k Contact: °lfk-A~ P yr
Contractor Address: City:
p: s ri q + 4(2- 6
State: Zi / Phone:
License ro Lead Certificate
3
If the project is exempt from lead certification, pleas explain why: (see Page 3 for additional information)
s
s
i COMPLETE THIS AREA ONLI 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:
L Sewer & Water Contractor: Phone:
I 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 th t 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. o herstateonecall.ora
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 `HT x
Applicant's Printed Name Applican Signature
Page 1 of 3