3363 Heritage LanecirY oF EAGAH
3795 Pilat Keob Rood Eayen, MN 35122
• PHON[s 454-8100
BUILDING PERMIT Receipt #
To be wed for Est. Vclue 57r?T)• Date
N2 5142
19 `
Site Address '?C'z'ltaC?E T,Pn(°. Erect 'Q Occupancy
Lot Block ? Sec/Sub. Alter ? Zoning
Reppir ?
Parcel #
Fire Zone ?
Enlorga ? Type of Const.
W Name hAove p .# Stories
3 qMreys Demolish ? Front ft.
0Ci Phone Grade 0 Depth ft.
Approvalt Fees
°C Ncme
,o
?? Address Assessment
Permit _
~ Ci Phone Water 8 Sew.
i
P Surcharge
k
h
Pl
?? -.j -n --
ol
ce
?W Name
W Firc onc
ec
SAC ,.. _
U0 Address Eng. Water Conn.
<W Ci Phone Plonner WaterMeter
Counci I
I hereby acknowledge thot I have read this application and state thot Bldg. Off.
the informafion is correcf ond ogree to oomply with oll opplicoble APC Total '
Stote of Minnesota Statutes and City of Eagan Ordinances.
5lgnature of Permittee
/1 Building Permit is issued to: on the express condition Hwt
all work shall be done in accordance with oli appliocble Stute of Minnesota Statutes and City of Eogan Ordinances.
Building Official c
hrmM # Oote laoad PMNMw
b- z s- ?9 t ?A
'7- `?-
?.c. R?Il?`! '7-0-7
INSPECTIONS DATE INSP• Rouqh-In Finol
Footings Date Insp. Dote Insp.
Foundotion _ Plumbing `-,-?, 4,;, /?'1-Va
F?ameiins. ? -?
9
-a MK?ani?l ?
?-9
Finol ?
?
v:'r-ae
Remnrks:
CITY OF EAGAN
3796 Pilot Knob Rood
Eagan, Minnesoto 55122
Phone: 454-8100
HEATIW - PERMIT
Dote:
6-Z8-79
Site Address: '^•-,?
Lot jd Block ? Sub/Sec.
Name ?3Dnn Voge?""`i _
e Address 261E 40ti1 AVE.
a
City t,- ?? 5W6 _ Phone: 72?-)---679V
Nome r?? P?T• & i1t.Q.
.
? 4133 150th St. W.
Address
e
0
,
_,??i?
?_
City Phone:
This Permit is i55ued on the express condition thof all work shall be
Minnesota Stotutes anld City of Eagan Ordinances.
a14XM'.ICN AIR RDQ[7IM
No.
14$1
Receipt No.: 1485P
Single I
Residential X
Multi Res., Comm./Ind. I
New/Alter./Repoir
Cost of Installation
2G.Ci?
Permit Fee
?.r
5urcharge ?
Tota l done in occordance with all applicable State of
Building Official
CITY OF EAGAN
3795 Pilot Knob Roud
Eagan, Mlnnesoto 55122
Phone: 454-8100
'?L'N=Nr PERMIT
Dote: ? 9-79
Site Address:
3363 Heri.tage I,am
Lot 14 Block 1- Sub/Sec. -W1CP'aY
Name NDrin Vogelpohl
? Address 2616 40t1 AVe. SO.
3
O
City ?? 5W6 Phone: 71'4-679F
Nory+e }btZ PlxvbiricJ & i ic3atl.i`?
i ddress 4130 ??'i St.
; o
3_ - .. ?
City Phone: L. f
This Permit is issued on the express condition Yhot all work shall be
Minnesota 5tatutes and City of Eagan Ordinonces.
No. 1184
Receipt No.:
Single
Residentiol X
Multi Res., Comm./Ind. I
New/Alter./Repair. Cost of Instollation
Permit Fee 10•00
Surcharge
Total ?."
done in occordance with all opplicable State of
Building Officiul
CITY OF EAGAN
Owner NU l01141 41 7 t'(4 i,
. 11; fLl1 Gi hLL t-,
Remarks
Lot 14 Bik ? Parcel 10 48000 140 01
5treet 3363 i-Ieritage Lane State Eagan, NIN 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
' STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK y10 1979 411.84 27.46 15 329.49 A009599 10-23-80
?e STORM SEW LAT 1973
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 75.00 14064 -3-79
WATER CONN. 270.00 14064 -3-79
BUILDING PER. #5192
SAC
PARK
CASH RECEIPT
- CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
.
DATE
eec¢Iveo /
FROM
AMOUNT ? I
& DOLLARS
?oo
? CASH ? CHECK
FOR.`. . C?
FUND CODE pMOUNT
.2 ?
Tha7ku4
7,V?
BY
White-Payers Copy
Yellow-Posting CopY
Pink-File Copy
CITY OF EAGAN WATER SERVICE PERMIT
-3295 Pilot Knob Road PERMIT NO.: _
J.'ogon, MN 55122 DATE:
Zoning: No. of Units:
Owner:
I
Address:
ite Address: ?r p
'Plumber:
Meter No.:
Connection Chorge:
Size: Account Deposit:
Reader No.; Permit Fee:
1 agree to oomply wilfi fhe City oi Eagan Surcharge:
Ordinoeces. Misc. Charges:
Totul:
By Date Poid:
Date of Insp.: Inso_r-
CI'1'Y ,JF EAGAN
379
b Pilot Kneb Road
Eogon, MN 55122
Zoning:
Owner:
Address: --
Site Address:
Plumber: ?
1 agree fo canply witU tbe Cify of Eagan
Ordinances.
R.?
Date of Insp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
!-.)0.00
Connection Charge: 425,00 T ' -
Account Deposit: - --
Permit Fee:
Surcharge: -
Misc. Chorges:
Totol:
Date Poid:
This requRst void 18 months from
q 'R 71229
Date of this Re uest
I, as O Licensed Electrical Contractor O Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. AWe l'l9yf 4?yeCit
Section Township Range County
Which is occupied by ?(??/?'I
(Name of Occupant) .
Is a roughin inspection required on this job? No ? Yes ? Ready Now ? Will Call ?
Power Supplier Address " c ' t1Electncal Contractor ?Q`? ?/ L Contractor's License N???
Mailing Address ( 6 (/Zl- 9
I rical G tr t r or ownar Making Thls Installatlan)
Authorized Signature one No. 4591d ?.ssS
(EI ca n r or o er n9 This Installation) .
?? ?RD (O, ? This i?npection request will not 6e accepted by the
. ? State Board unless proper inspectian fee is endoud.
Minnesota State Board of Electricity
1954 University Ave., St. Paul, Minn. 55704-Phone 645-7703
REQUEST FOR ELECTRICAL INSPECTION
?ECK BELOW WORK COVERED BY THIS REQUEST
/S/Sd
R 71229
Type of Building Ne Add. Rep. Check pppliences Wired For Check Equipment Wired For
Home ? ? Range iemporary Wiring ?
Duplex 00 ?? Water Neate[ Lighting FixNres - ??
Apt. Bldg.
Commeicial Bldg. ?
? ??
?? Drye[ ?
FVffE'?«?? Electric Heating
Silo Unloader ?
?
Industrial Bidg. ? ??
?'' Ayr„C¢nditier
Li?
' Bulk M0k Tank -
L
i
t ?
Farm ? ? ?
? ?,y
Q s
Othex ' ? {??
0.? f}[ere?) p
e
s? ' .
, H
re?
COMPUTE INSPECTI00'EE! HELOW
ServiceEntranceSize: # 'Fce FeedecsflSubFeeders: x Fee Cixcuita: # Fee
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres / G
301 [0 200 Am s. 31 to 100 Amperes 31 to 100 Am eies i / (/i)
Above 200 Amps. Above 100 Amps. Above lO?Am s.
Transformers RemoteConUOlCirc.
f
Partialurothe}fee d
S' ns Special lns ection Minimum fee $
Remazks
TO'[AL FE !'??
. y S
I, the Electrical [nspector, herebyM tha eAov6 inspection has been ma?
(Rough-in) ? ? Date _ 7 Y
7
(Final) Date 1,7 _ '7
y
This request void 18 months from ?`?'-?
CITY OF EAGAN
3795 Pilor Kne6 Roed Eagan, MN 55722 N2 5192
PHONEs 454-8100 Alriz
/ /
BUILDING PERMIT APPLICATION Receipt #
To bs uaed fo. SF Dwlg & Garage Esr. van,e 57.000. Dare 5-3 19_Z2_
Site Address 3363 H2Yitdge L3ne Erect ?p Occuponcy R3
Lot 14 Block 1 Set/Sub. MCRae- Alter ? Zoning Rl
parcel # 10 48000 140 Ol Repair ? Pire Zorre 3
5
9
rc
0
ou
u?
r
Enlarge ? Type of Const. V
Name NOYICI VOClElAOhl Move ? # Stories
Address 2616 40th Ate_ Sn_ Demolish ? Front SZ ft.
Name
Grade ? Depth . 3L ft.
Approva4 Fees
Assessment _
Woter 8 Sew.
Permit 171. V V _
Surcharge 28•50
Plancheck 75 •50
y,C 525.00
worer Conn.270.00
WaterMeter 60•00
toad Unit 75.00
- - - Police -
Name k'epla Plan S?r'cri Fire
Addresa 1199 C1 i ff Rnzd Eng.
<W ? Cgy B' Ville phone 890-4636 Planner _
Councu _
I hercby ack+wwledge that I hove read this application and state that gldg. Off.
the informotion is corre d agree ro comply with oll appifcable
SMte of Minnesota tu d Ciry of Eagbn Ordirpnces,, APC -
Stgnoture ot
A Building Permit I5 issued to:
all work shall 6e done in acco
Total 1.185.00
L on the express eondition that
Stute of Minnesota $tatutes and City of Eagan Ordinances.
Buildtng Offirial
****?****??******??********************
CITY OF EAGAN
CASHIER: JS TERMINAL NO: 672
DATE; 09/01/00 TIME: 06:58:26
ID:
NAME: ZE VANG
3210 9001 3363 FIERITAGE L 43.00
2155 9001 3363 HERITAGE L 0.50
Total Receipt Amount: 43.50
CR136797
IISER ID: JAN
2000 BUILDING PERMIT ApPLICATION (RESIDENTIAL) ?3 SO
cin oF EAcwu
3830 PILOT KNOB RD - 55122 1
651-881-4875
New Conshucflon ReaWremenh Remodel/Reoalt ReauiremeMs C co??,1wM
> 9 reglstered slfe wrveys showinp aq. fl. Of bt, aq. R. 01 fwuse 2 eopies of plan
and g@ rooletl areas (20%6 mmUmum lot covemae ailowed] i sef af energy colculailons for heoted adtli8au
> 2 copiea of plans (show beam & wfndow sizes: poured fid. deslgn: etc.) t sife wrvey for exfeAOr addilions d decka
> 1 set of energy ccICUIaNOna
> J Copies o1 tree preservadon plan il IoT platted arter 7/1/93 V U DATE: A?G ? 1? O O CONSTRUCTION COST:
DESCRIPTION OF WORK: ?C eLQ?
STREET ADDRESS: 35? J R-9,6 ??.c.- La r, e. ? 6-,4(7,4l,) mN1 SYl 2-f
LOT: --H- BLOCK: ? SUBD./P.I.D. S:
Name: V LAGf V G Phone l:
PROPERTY Laaf Ftrst
OWNER ???
Shee1 Address: '
Cly ??Vl State: Zip:
. Company: Phone
(area code)
COMRACTOR
Sheet Address: License # Exp.
CNy State: Zip:
ARCHIIECT/
ENGINEER Company: Name:
Telephone #: ( )
Sfreef Address: Regishalfon
Ciry State: ZIp:
Sewer/water licensed plumber (H installina sewer/waterl: Phone #:
I hereby acknowledqe Mwt 1 have read this applicaNon. stafe fhat 1he fnfortnaHon is cortect, and agree to comply wNh a6 applicable State
of Minnesota Sialutes and CNy of Eagan Ordinances. /y' l
Signature ol AppUcan1:
OFFICE l1SE ONLY
Certificates of Survey Received _, Yes _ No Tree Preservetion Plan Received _ Yes _ No _ Not Required
OFFICE USE ONLY
BUILDING PERMIT 3UBNPES
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 21 Porch (3-sea.)
? 02 SF Dweiling ? 08 06-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 03 01 of _ plex ? 09 07-plex ? 18 Deck ? 23 Porch (screened)
? 04 02-plex ? 10 OS-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 17 10-plex PI6g _Yor_N ? 25 MisCellaneous
? 06 04-plex ? 12 12-ptex ? 20 Pool ? 30 Accessory Bidg.
WORK TYPE
? 31 New ? 36 Move Bldg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)' ? 44 Siding
0 33 Alteration ? 38 Demolish (Interior) ? 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
" Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
SAC Code
No. of Units
No. of Buildings
Const. (Actual)
(Ailowable)
UBC Occupancy
Zoning
# of Stories
Length
W idth
Basement sq. ft.
Main level sq. ft.
sq.ft.
sq. ft.
MISCEILANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS
Planning Building
Engineering
Variance
? 31 Ext. Alt - Muiti
? 33 Ext. Aft - SF
? 36 MuRi
Permit Fee ValuaUon:
Surcharge
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. DeQosit
S!W Permit
S/W Surcharge
Treatment Pi.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
% SAC
sq.ft.
sq. ft.
Footprint sq. ft.
Census Code
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
$
L ? BL I
SUBD. ?C" L ON{'.
CITY USE ONLY ? ? ?? ? ?
RECEIPT #:
RECEIPT DATE: oV
PERMIT# St ? ?I 1
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF.EAGAN
3830 PIIAT IINOB RD
EAGAN, NAI 55122
651-681-4675
Please complete for. ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES
EACN !t
TATAI
Atterations to existing dweiling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Ga5 pi ing outlet ' minimum -1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laund tray 3.00 x = $
Lavato 3.00 x = $
Septic System newirerurmsnea • requlres MPC ile. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installation/repaiNrebuild 30.00 x = $
Rou h o ening 1.50 x = $
Shower 3.00 x = $
Underground sprinkler H dwelling ts under wnstruction 3.00 x = $
Under round s rinkler ifexisting dweiling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
WBter Soften@r If dwelling under consWctlon 5.00 X = $
Water softener if existing dwelling 30.00 X = $
Water turnaround 30.00 x - _ $
State Suroharge .50 -> -> -> $ .50
7ota1 _> _> -> ?
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
--------------------------------------------- ---- ------ ----- --------- ------------ ------- --------------._---- ..- -------
I hereby adcnowledge that I have 2ad this appliption, sfate that the information is cortect, and agree to compy with all appliwble Cily of Eagan ordinances.
tt is the applicanPs responsi6ility to notify the property owner that the City of Eagan assumes na liabiliry for any damages wused by the City during ks
nortnal operetional and maintenance activkies to the facilkies constructed under this permk within City property/rigM-of-way/easement.
SITE ADDRESS:
OWNER NAME: : k/1.{e lC G TELEPHONE #: 66S1) `"o -- D,(Bg
(AREA CODE)
INSTALLER NAME: 1fe-1 ?!?/??2• /eo-' L` TELEPHONE -G.,-V?
?//
STREET ADDRESS: 2 9?? //e..z-re- (AREA CODE)
CITY: N'LyivZBU.T?" STATE: ZIP: 69?,
SIGNATURE OF RMITTEE
_ _. /?(X?P ?%•v"'
DATE
BL'IT.DI\G PERMIT AP°LICaTIO`:
Include 2 sets of plans, 1 site plan w/elevations and 1 se[ oE energ}?caicuations.
'5F,? la? °
To be u s e d f o r Valuation
Site Address: "::G
Lo[ BLock Sec.!Sub.
N
Owne r? G' 2171 A iL/ vc j.t!
u ?
Adtiressl?)?i??
Contractor
/?? J?/ ?
Adaress
Arch/Eng.
Addrzss o 4 ?C
? ?? ?-
Parcel Nuc.ber /Q llYDOD /vo I"
Telephone
Telephone ?? ? 4 ;? ??
Telephene D I o / G jr-
OFFICE CSE 0*ILY
Erect Occupancy
Alter Zaning
Repair Fire Zene }
Enlarge Type of Cons[. ??
Kove ll of Stories
Demolish Front
Grade Dep[h
Date of An roval and Initial
Assessment
Water/Sewer
Police _
?.. Fire
Engineer _
Planner
Council ?
Fees
Yermit
? ?
Surcharge
Plan Check 7?S
SAC
?
Wa[er Connection
Water Heter i
I ? /'
g
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Q-?p SC.ALE IN FEET
5EARIN6S SHOWN A.RE
Q7? o?` ?o ?• ASSUMED DATUM
o 1* '?? o•INDICATES AN IRON Mf
.?? CAPPED WITFI MINNESOTj
3 ,? . Q. ' ?.i? •.. ' ? NUMBER 533?
p• ?i?o ••.;'f: :•'?' i-INpICATES LOW LAND
Iw.aoo.• ; ' ? -?Q?' ';• • ; . '- _
-- fNDICATES APPRO
.
587'47'49"E ? '•? ? OF LOW LANOS
_ _______J •? .
DRAINAGE AND UTILITY 1
BEINC? FIVE FEET IN WIC
ADSOINING ALL LOT LI
$EING TEN FEET IN WIC
ADJOINING ALL R1CzHT -t
?>•gL Iyr•E :,' ?h O,J?h '• LINES UR{AFiS OTHEWIS
AS SHOWN ON THE PL.
C-2
,
7 1 =11,000•' 00,'' ? - ' ,?•; NORM VOGELPOHL
. 43p az y?ti? ''•.: : .
3 ?,' _ _ •:1? PHONE: 729-1176 or
R,$3ti 2 . • i
7z9-6796
I
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1
EX';cR;Dk :N`dEl:OPE kVERAGE °U" COMPUTA710N
OwNER
SITE ADORESS
CONTRACTOR qi;;g,•, ,. m4z. i"c;;l. DAiE ?HDFtE 7?04_ (._79?0
• Dece:•mine working square fcotage of each.
1. Total exposed wail area ..,,,. 2( A 00; sq. f2, x ,17 -
2. Tota) 1"00f/CBI, i , dYed ..... S/, $q. ft. X?'05.
` ???. G
,Oi:81 ex.ji?i5E:c1 '•'z:ll ul^c-ti ni)ovC ??100r a ??
? '?
a. Tota': ???rll :ri^co?,-r area ...........................
b. "cta? Jaor area .................................
?7,s,
c. 'otal sl-.ding yless uoor area ................... `"" - -
C. Yotal t'irep?ace tvall area,,...................... e. 'ota'! r+ail rr`s;,.',ng are2 (r,verage 10%),,.,,,,..:., ?i
.5...-? '3 7
f. TOt2l i?r)t M73ii dl^ed d'"u0V8fl00t' ..,,...,,.......I iC [h2..:.t,L...
g. 7otal r`,ri jo1sC zrea ,,,,,,,,,,,,,,,,,,, f.00
ToCal e;:,r,c,sed four.datiai z.r;.a = ??:??L-
h. Toial foiandaCi.,. ..;doa: area ..................... i?LQ__..._
i. 70a1 net founa:.t,an al^ea ;:bOVa ;rKe .,.,..,,,,,, Q:__6 ?? --
Detr:rr,;:ne "U" +.,alue oF eac:i :+;:11 seymenC,
b ,;3 , Zn .1c?
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a. 'JUJI 2?.ZG'
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,....,.:..;?..... .? ................. T,-i.c1
1f itsn 63 i, tt;e sams as, or ?ess than item 91, you have not th2 ie;,snC
of S3C 6006(;,)2,
r r - r •
\-r _ r '. y.ry x . .. .
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expcsed rocficeiliny area
-'
;
? j. Tota'• skyliqht area .............................
iota? roor%cei'inr .`1'dmlil5 area ;average ?0%),.
iarea..
Tota. net 41rsu+a'.ed roof/ce L?d
De'_ermine "U" value •`or each roof!ceiling segmene.
X Du,l
k . ---- x ,• U„
` a .......... ........?lfv,6`''........ 7ota?
_ L445,r---z?? i
tf tota? or #4 is tne same as, or less than 12, you have rret Lhe inient, of
SBC 6006(c)1.
r.;iernace cuildin9 Envelope Design
To utilize the toia? ervelope syste!rl methOo, tne vaiues established by ttre
sum of i`cCr?7s +3 and ?4 shzl i.^.o° be greater Chan the sum of ite-ins 41 artJ 12•
z z n ----- - - 4 C9 L-
l
3.. 4' 5 = _
?F-5 •71J - 3 i. 62
1304 hAxlcc:y LFne
8urns,ille, 8linno;Ota.
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WL;pJA CO. PIAN SERV[CF
Eo ANUGRSON
qpCMITGCTURA: OESIGNING AND PLAN`:11tG
QtfICE:
7123 Cli(f Road
Bunrnllln, Mlnnesota
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47' Clty of Eapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6755694
?-----------------
? Fo%Office U
. se
? ._........._......_.___ I
? Permit#: ??l -3 ? j
i Permit Fee: ?
? Date Received:
? staH: ? I
I
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7_12-04 SiteAddress: 31 -2) lD3 !'T?i?t 1?I?S£ ??•
7enant: suE f -aE ?ANC? 5uite#:
RESIDENT / OWNER Name: Jt/ E .,t ZE VAN`, Phone: l SJ- -I(S2 - Z// I
AddresslCity/Zip: 3 310 3 /T6-R! FA(E LA•
Applicant is: _ Owner x Contractor
TYPE OF WORK Description of work: SlAi.O(' ' SD? y, roof$L j fl
/ No X)
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CONTRACTOR Name:_(1) l6_.S7?FFN R"DiOCL15?RS License#: Zd &34 33?
Address: -2!52,0 'AV €
city: State: MN Zip: 5,5, u 3
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COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
CBtegory Submitted Submitted
(4 su6mission type) • Energy Envelope Calculations SubmiHed
In the last 72 months, has the City of Eagan issued a pertnit 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 8 Water Contractor: Phone:
NOTE: Plans end supporting documenfs ihai you submif are considered to' be pubiic,information. Porfions of "
the informafion may be classified as non-pablic if, you provide specific reasons f at would permit the City to
conclude that the a"re trade secrets.
I hereby acknowledge that this information is complete and accurate; that the work will be in c
Eagan; that I understand this is not a permit, but only an application for a permit, and work
accordance with the approved plan in the case of work which requires a review and approval of
XS?EPFf'EW A. LyvnvS
ApplicanYs Printed Name
ApplicanYs
codes af the City of
the work will be in
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