3256 Hill Ridge Dr
Use BLUE or BLACK Ink
t-----------------,
! For Office Use I
! a
Ila
d ! Permit I
of En
3830 Pilot Knob Road I Permit Fee: a. E
Eagan MN 55122 i Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 i staff.
3P~g ~pl k , /
~ ~J Ion ! ~
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: y gat) • ZO// Site Address: Unit
RESIDENT / Name: A Phone: 76, ' yyq - (1/6._)
(
OWNER Address/ City /Zip: !o A/* l
Applicant is: owner Contractor
TYPE OF WORK Description of work: 0 P
Construction Cost`s Multi-Family Building: es /No
Company:!} Contact: -A.t_
V
CONTRACTOR Address: 5A 7 6 fib, n e_ City: . p,~,
State: N- Zip: _ijf //O Phone: Imo/ - 762
{lam 9r~
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 maybe 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. Cali 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. ntiwv.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 app vx `J Pi I~ ~P (ttr» x
Applicant's Printed Name A p nrs Signature
Page 1 of 3
PERMIT # _
• ' ' PLUMBING PERMIT
CfTY OF EAGAN RECEIPT it _
3830 PILOT KNOB ROAO, EAGAN, MN 55122 DATE:
:ONTRACT PRICE: PHONE: 454-8140
Site Address 2L ' j ?
Lot ??-- Block ?
., `. ?. . ?
y Name ?_ <<?
?o Address
c City Z,,
Name
c Address
]?a._
_
BLDG.TYPE
eclSub Res. l.
Mult.
Comm.
Other
9
WORK DESCRIPTION
New
Add-on ?
Rapair
I "
FEES
GOMM /IND FEE - 196 QF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE R 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
BEYOND $1,000.00)
FOR: CITY OF EAGAN
_?_Ki?chen Sinkv $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIn
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
J OU
FEE:
- ?
STATE S/C: ? `"GRAND TOTAL: f J ' ? `?
CITY OF EAGAN
454-5100
DEPT. OF BUILDING INSPECTIONS ?
* *
Correction Notice
Located at Y ll%,- Z?Z
I have this day inspected this structure and
these premises and have found the following
violations of city codes governing same:
S
When corrections have been made, please
call 454-8100 for inspection.
Date
Inspector City of Eagan
DO NOT REMOVE THIS TAG ••A
. . . . , . . . :. . . . ... .
CITY OF EAGAN ... ..r. _ _ . .
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 :
BUILDING PERMIT Receipt # -
???
To be used for r:' c'.;IA Est. Value 132,00'=' Date 19 `- f
Site Address --' 52 d? 3264 HI11, R1P1G.E ,e't ?
1
Lot Block Sec/Sub. ROBER'f KAR/?TZ OFFICE USE ONLY
PafCel N0. Occupancy - FEES
Zoning -
cc Name CEflU bIM (Actual)Cons1 BIdg.Permit 798•00
%d?g
A=i =
(Allowable) ' w?
0 - ,
Surcharge
City Phone # ot s?ories - ??
Plan Review
Length _
p
` L --?'EK-??r'v
?IdR12 "1
Depth -
SAC
City
'
' ,
?? TO?? AN
F S
Address `' S.F. Total -
cc
City ? ?fyY`'Phone 9?2-2 &!0
S.F.Foatprints - SAC, Mcwcc
1Nater Conn
On Site Sewage _
?
W W
Narne
On Site Well -
Water Meter
i? AddfeSS MWCC System -
t7
<W
City Phone
CiryWater _
Acct. Deppsic
S!W Permit
PRV Required _
I hereby acknowlege that I have read this application and state that the eooster Pump - S1W Surcharge
fnformation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
;,• Treatment PI
5ignature of Permitee ' • APPROVALS Road Unit
A Building Permit is issued to: Planner - Park Ded.
on the express condition that all work shall be done in accordance with all Council -
applica6le State of Minnesota Statutes and City of Eagan Ordinances. gid9, pff. _ Copies
31 t`" .j`?
Building Official Variance - TOTAL
? Permit No. Permit Holder Dats Telephone #
WATER
SEWER
PLUMBING
?.? r?9
H.V.A.C.
ELECTRIC 0-0
Inspection Date Insp. Comments
Footings I /UoT
?Ni??J'T?V? U/ ?"/?rF?.??l?/
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul. GL TU C?i th? ?.c'.iC ?t e-^
Fireplace
Fnal Htg. D
Final Plbg.
Const. Meter Plbg. Inspector- Notily Plumber
EngrJPlan
81dg. Final
OedcFtg-
Dedc Fnal
well C1?G(.?- ?? _ ; ?. /?ir?c.s•sEs ?'
Pr. Disp.
?/!G? ?iZ? I? --•f/ 1 I
oi?e.rf" }Cccra7-7- Plzc7
CITY OF E:';G!!N
3795 Pilot Knob F:cad
Eagan, N?innesota 55122
PERNIIT NO.: 52
The City of r,agan hereby grants to 14ilbert OD• -Culligeui
o£ 1001 Marie Ave. So., Se. St. Paul
Irene T. Brink
a Wate Softener Permit for: (Owner) Steve Parranto_
Hillridge Dr.
at 1942 Davennort_ Pursuant to application dated 7/4/76 ,
Fee Paid: S10.00 dated this 19 day of July
a.00 s/c
Euilding Inspector
Mechanical Permits:
Bid Total:
I f
?
f ? .
r ;
?
CZTY Cr EC:GIi!7
3795 Yi.lot Itnob Foad
Ea„an, Minnesota 55122
??erf kar? P?a?"
PEP,MUT NO.: 51
ilie Ci+y of Eagan hereby g=nnts to Milbert Co• - Culliqan
of 1001 Marie Ave. So. St. Paul
Water Softener Permit for: (Cwner) M. StYose & J. RonChetto
2835 Vilas Iane k
=r 256 Hillrid4e Dz. ? pursuant to application dated _ 6/29/76
Fee P,;i d; S10.00 dated thie 9 day of JVIY 2 19 76
1.00 s/c
°uilding Inspector
Dtechcir.ical Permits:
3id Total:
,?/??8q ?r7 y?
? 9 9 301 ?
a ?
Reqvest Date +
3= a?- g 9 Fre N Rough-In Inspe
q w ?
? on
? Ready Now ill Notly Inspeccor
Wh
R
d
'+
es ? No en
ea
y
I icensed contractor ? owner here6y request inspection of a6ove electrical work at:
JoD Atldress (Sireet, Bmc or Route No ) Ciry
31 r. ?G'c, ct rv
Sepbn No. Tovmship Name or No. RangB N. Couny
I ?
Occupant (PRINT) Phane N0.
5y- G y?/
Power Supplmr T Oress
Electr¢al onVactor (COmpairy Name) Conlrazior's Licenee No
- z. e 4 Y? S v?
Maibrg Address (COnVactor or Ovmer Mekng Inso)
a Vh & u n 55 4
Au?hor SgnaWre (Coniractor/Owner Malting Instellation) Phone Number
- ) o 5
MINNESOTq STATE BOAPO OF ELEC?qICITY THIS INSPEGTION REOUEST WILL NOT
Grigge-Mbwey Bitlg. - Foom &173 BE ACCEPTED BY THE STATE BOARD
1827 Unlvuefry Ave., St. Paul, MN 5510G UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION
? Sea insVUC[ians for completing ihis krm on beck of yellow copy
10 ` g930t "X" Below Work Covered by This Request
^. E&00001]
2f
e Add Rep' TypeofBwlding AppliancesWrted EquipmerrtWired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt Building Dryer Other (Specify)
Comm.llndustrial Furnace
Farm ' Air CondRioner
Oth r(9penfy) Contr do,ffi flemaBS.
S? 1 (?
`? 'r } r?
Compute inspection Fee Below: `??0. i Y WV r e daY?S e6
# Other Fee # ServiceEMranceSze Fea # Circurts/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers A6ove 200 _ Amps Abova Amps
Signs lnspeaor5 Uee only: TOTAL Q
Irri9ation Booms ?•
Special InspeCtion
Alarm/Communication
Other Fee - f
I, the Electrical Inspecbr, hereby RDi9^-'" ///?{? ?J
? D8?3',?
certify that the above inspection has
been made. .? r
i,?" ? ._X,1'4 o?,?? ?
OFFlCE 03E ONLY This requesi witl 18 maMhe from
IE 9 9 3 0 2 ?ai
r
? ?
z?lt
_
r?
a
Request Date "
3 F2 0. Rough-in In ion
Rp
7
? ReatlY Now ?I?
R
tl
??IX
es
O No n
ea
y
1 licensed contractor ? owner hereby request inspection of above electrical work at:
Jab Adtlress (Street, Bwx or Route Pb.) /
A`4 ?7'"• Ciry ?
Q.A/)
Secnon Na. Townahip Name a No Range No. Counry
.V W Q
OccupaM (PRINT)
OeAn'y PMna No.
Power Suppber AtlEress
Eleclrwal Contreclor (Company Name)
i
+
rf)
1
1 ConlracT rS License No.
? 0
Ec
r
er
Z-
r?
MailingAtldre%(COMraciororOwnerMaMngl t
-? h a[wn)
? 7
D n .
AulM1Orized Sg^ature (COntrac[apQmer Making Insfellafwn) Pho?re umber
"
1,?. 5 3 - /v 5
MINNESOTA STATE BOANO OF ELECTHICRY THIS INSPECTION REQUEST WILL NOT
GriggsMltlway Bldg. - Rcam 5173 v BE ACCEPTED eY THE STATE BOARD
1827 Univeraity Ave., St. Peul, MN 55f00 UNLESS PROPER INSPECTION FEE IS
Phonegl 602-0800 ENCLASEO.
REQUEST FOR ELECTRICAL INSPECTION
n See inslmctione tor compleling Ihis form on back oi yellow cupy
o - 7 ?
9 SM302 'JC" Below Work Cavered by This Request
E&-0WOi-O]
• '5/02 1`;2-
e Add? Rep. TypaofBuiltling App6ancesWired EquipmentWiretl
Home Range Temporary Service
Duplex Water Heacer Electric Heating
Apt. BuAding Dryer Other (Specify)
Comm./Industnal Furnace
Fartn ' qir Conditioner
O her'spealy) A Sc Con ctorS Remarks.
Compute Inspection Fee Belbw: ? f'a ? r ?? IYe. d a maq ? I YPi
# Other Fee # ServiceEMranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Abo _ Amps
Signs Inspector9 Usa Onry: 70TpL_?0,3D
Irrigation Booms ?
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical Inspector, hereby
certify ihat the above mspaction has
been made. Rough-sn
Final oate7 _ -
Data
OFFlCE USE ONW
This reque5t voitl 18 monNS kom
BUILDING PERMIT
FIRE DAMAGE
To be used for REPAIR
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eaga„ MN 55121
PHONE:454-8100 C
R 't
Est Value $32,000
eceip #
1?4 16193
Site Address 3262 & 3264 HILL RIDGE DR
Lot 12 Block 1 Sec/Sub ROBERT KARATZ OFFICE USE ONLY
P0fC81 NO. Occupancy - FEES
Zoning -
w Name CEDAR Ri.I7FF (ACtuaqConst _ BIdg.Permit 298.00
?. 018}A& ._3369 CF.OAR RT.TTFF (Allowable) - Surcharge 16.00
City EAGAN Phone a oi smries -
Plan Rewew
Lenqih _
o Name R A UNGERMAN Depih - SAC
Ciry
0
? Address _4330 UPTON AVE S S F. Total ,
-
, SAC, MCWCC
? City MINNEAPOLISphone 922-2800 SF.FooWrmts -
Water Conn
On Ste Sewage _
U?
w
Name
On Ste well '
- Water Meter
?
w
Addf05S MWCCSystem -
aw
City Phone
cmy wacer qcct.Deposit
-
SM/ Pemmt
PRV Reqmred _
I hereby acknowlege that I have read this apphcation and state that the Booster Pump - SiW Surcharge
mformation is correct and agree to comply wRh all applicable State of
Minnesota Statutes and C o a?n Or i nce?s
/ Treatment PI
;/
(
Signature ot Permitee ? " '" '^' APPROVALS Road Umt
A euilding Permn is issuetl to: R A UNGERMAN Pianner - park oed.
on the express condi[ion that all work shall be done in accordance wrth all Council
apphcable Slate of Minnesola StaWtes a
City of Eagan Ordinances.
n
d Bldg DIt _ Copies
y
?
BmldingOffiaal , 1-? m I (e ???izA I y
f'1' J' Vanance - TOTAL 314.00
. ?
" EAGAN TOWNSHIP
BUILDING PERMIT
Owner ---. iav . . - ---?
I? __ --
.... .-{--? -------sa-? - ..--'-°--'
. .. .. ............ . . . . . ? J.?r?
Address (present) :?.?`f `? ?"""'-
-------'-" ..................... ...................................................
Builder
Address
DESCRIPTION
N°
.
Eagaa Township
Town Hall
Cl/
2916
Da1e _.?d'_ .."C7-71.-
....-.-•-.•••-------°--°
5tories To Se Used For FronS Dapth Fieight Permit Fee
Eat. Cos! Remarks
? a
a?m ? 9
I CP, G?7' `¢. .C4y ?
(>-o -
/ s ee. 00
/?-g i 9-7 L
Tb? LOCATION yxi /• "'
8ireel, Road oz olher Desezipiion of Location I Lo! Sloek Addition or Trae!
ka-?-u. ?
/e .Yi3ea
This permit does a'ot aulho:ise the use of alseets, zoada, alleps or eidewalks aor does it give the owaes or his egent
the righ! !o creala enp situetioa whieh is a nuisanee os whiah presents a hazard !a the health, safelp, coaveaieaca and
geaeral welfase !o anpone in the commuaiSp.
THIS PEAMIT MUST BE EP?T O_LN PR£MISE WHILE THE WORK IS IN PROGAESS. _
This ia !o cerlity, thai ..... .............:...------------ ...... hespermksfon !o eree! a.1?:?....K..?t::...*?..?...^..T':`."... .`up
the above described premise aubjeei !o the proviaiom of the Buildiag Ordinance for Eagaa Township adop2ed April 11,
1955. ?-y?--
._......_.............. ..........:.......?..?..... ...... v Pas .................. . 'c.......l.R.................. .'................ .................... ..
v C? K3. Suildinq Impecios -t
Pt&LA &,PCe 6
MASTER CARD 4l?-
STRUCTURE AND
Permit
No.
Issued Issued To
Coniractor Owner
BUILDING
PLUMBING .3 20Y
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OiHER I
Items Approved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION
L
L
l CESSPOOL
FRAMING
FINAL
ELECTRICAL y
-
_ TILE FIEID FT.
HEATING
-
GAS INSTALLATION
r? DEPTH
OF WELL
SEPTIC TANK
CESSPOOL
DRAINFIELD 71 i
Aj
PLUMBING 0. - -
WELL
SANITARY SEWER i ? Q"
/'
2-?Y 7cl
Violations Noted
on Back
GOMMENTS:
?5
COMPLIANCE INSPECTION REPOR.TS
70 BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTIQN
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
DESCRIBED AS
F-I REINSPECTION REQUIRED
DATE OF REINSPECTION
REVEALED
CERTI FICATION - I certify that I have carefully inspected the abwe in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to ba at variance wi[h ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
DATE
1989 BOILDING PE1MIT APPLICATION = CIT4 OF EAGAN
SINGLE FAMILY DWELLIHGS I T ? q-3
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OE ENERGY CALCULATIONS
NOTEs ADDRESSE3 FOR CORNER LOTS - CONTRACTOR/SOMEOWIVER MUST D9SIGNATE WAICA ADDRFSS
IS DESIRED. NO CHANGES NILL SE ALLOWSD ONCE HUILDING PEAMIT I3 I330ED.
MULTIPLE DFIELLINGS RENTAL UNITS V_ FOR SALE UNITS i OF UNIT3
INCLUDE 2 SETS OF PLANS, CEHTIFIC9TE OF SURVEY - CHECR WITH BLDG. DEPT.v 1 SET OF ENERGY
CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTUAAL
1 SET OF SPECIFICATIONS AND 1
REvwR FieeDAnnA&E
To Be Used For:
Site Address
Lot 12- Block I
Parcel/Sub
Owner C'E.f:9.2 ?31--UGF
& STROCTURAL PLANS,
SET OF ENERGY CALCULATIONS
Valuation o 9JI 0-;C? o Datee -311YA ?
Address 3 3 o ?;;?l u
City/Zip Code 41rr/U /7/'/ S S?2Z
Phone
Contractor
Oecupancy
2oning
Actual Const
Allowable
ll of stories
Length
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well _
MWCC System _
City water
Address y3so Zll-;r? A`S '_I PRV required
Booster Pump _
City/Zip Code
9PPROVALS
Phone ?,21 0?- Planner _
Arch./Engr. _
Address
City/Zip Code
Phone S
Council
Bldg. Off.
Varianee
FE63
Bldg. Permit z9axo
Sureharge fo,00
Plan Review -
SAC, City
SAC, MWCC
Water Conn
Water Meter
Aect. Deposit
5/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Copies
TOT9L 31A/. AO
NOTE: Sewer & Water Permit fees and aecount deposit fees srill be ineluded in the building
permit fee. Proeessing time for serrer and Water permits is txo days once a licenaed
plumber has applied for a permit at City Hall.
EAGLaN TOWNSHIP .
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SESdER SERVICB CONNECTiON
DAT8:12/29/72 (4/29/73)
NUMggg 1338
OWNEA• Rivergate Villa -Bldg' 1$ Address 3256-58-60-62-64-66 Hillridge Drive
PLUMBER Berghorst Plumbing Co. TYPE OF PIPE heaw cast ison
DESCRIPTION OF BUIID ING
Industriai Commercial Resideatial Multiple Dwelling No. of units
xcc 6 - townhouses
Location of Connectiona:
Conaection Charge 1170.00 bi led 4,95/73
s?/> ?
Permit Pee 10.0 pd 12/26/72
.50 pd 12/26/72
Street Repairs
Total
Inspected by:
Date
Remarks•
By
Chief Inspector
In consideration of the issue and delivery to me of the above pezmit, T.
hereby agree Co do the proposed work in accordance with the rules and
regulationa of Eagan Totmship, Dakota CounCy, Mianesota
By
Berghorst Plumbing Co.
Pleaee aotify mheu ready for iaspection and comectioa and before any portion
of the work is covered.
?
EAGFN TOWNSHIP
3795 Pilot Knob Road
SC. Paul, Minneaota 55111
Telephone 454-5242
PERtRIT FOR WATER SERVICE CONNSCTION
Date: 4/25/73 (12/29/72) Number: 1188
Billing Name• Rivereate 4illa-Bldg' 1$ Site Addreas3256-58-60-62-64-66 Hillridge ?rive
Owner: Billing Address
Plumber: Berghorst Plumbing Co.
Location of ConnecCion Meter Size /v'2 Connectioa Chg. 540-00 billed 4/25/73
Meter Noa' / O PermiY Fee 10.00 d 12 26/72
. 0 pd 12 26/72 s/c
Meter Readinp?_ Meter Dep.
Meter Sealed: Yea- Add' 1 Chg. a2e7 ?
NU 1bta1 Chg.
Inspected by
Building is a:
Residence
t4ultiple x Ko, UnitsRg
Commercial
Industrial
Other
Date ?OR
xemazka: pF.C1\ON F ?E?ERS•
t10 RE"\NS S.? ED
n ?eaZ`1 1N
Sy:
Chief Inapector
In conaideration of the isaue and delivery to me of the above permit, I
hereby agree to do ttm propoaed work in accordance with the rules and
regulatians of Sagan Tosmship, Dakota County, Mlanesota.
By: ,?.z? ?
Berghorst Plwnbing Co.
Please notify the above office when ready for iswpecCion and connection.
?
?412Z
2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings & townhomcs/condos when permits are required for each unit
-# 3r.s19
Date/S// Q'7
Site Address 3 A La c 0Jl Unit #
Property Owner Telep6one # r) y 9 9
LOFGREN
Contractor HEqTI
N
5465 2727H STREET W, STE
4
Street Address .
•FARMINGTON An i c CitY
S Zi Tele
hone # (6J ) ) -)&LJ o 3J 3
tate p p
Bond #• Expires:
The Applicant is _ Owner ? Contractor _ Other'
Add-on or alteration to exisGng dwelling unit p?
'<<Itj J 4004 ?1fl+
$ 30.00
?
furnace
-Additional k_Replacement I ll
jc:;y L'
air exchanger ---?---
airconditioner _New _Replacement
other
State Surcharge $ .50
$ 36 ,
S6
Total ,
I hereby apply for a Residenrial Mechanical Permit and aclaiowledge 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
persnit, but only an application for a permit, and work is not to start without permit; that the ork will be in accordance with the
approved plan in the case oF work wluch requires a review and approval of plans
K a
Applicant's Pr nted Name plicant's 'gnature
2004 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commercial/indushial buiidings
multi-family buildings when sepazate permits are not required for each dwelling unit
Date
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires:
The Applicant is _ Owner _ Connactor Other
Work Type
_ New Construction _ Underground Tank _ Install _ Remove "see be/ow
_ Interior Improvement _ Install Piping _ Processed _Gas
Nature ofWork:
'When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing Inspector
Pel'1171f Fees: $70.50 Underground tank installation/removal
550.50 Mirtlmum (includes Sta[e Surcharge)
o[
ContractValue $ x 1% _ $ PernutFee
• If ne rmit fee is $1,000 or less, add $.50 => $ S[ate Surcharge
If nermit fee is over $1,000, add $.50 for
every $1,000 ermit fee $ Total Fee
i ncrcoy appry ior a commerciat mecnanical Yemnt and aclmowledge that the informa[ion is complete and accurate; that ihe work
will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; Wat I understand this is
not a pemvt, but only an application for a pernvt, and work is not to start without a pemiit; that the work will be in accordance with
the approved plan in the case of work which requues a review and approval of plans.
Applicant's Printed Name
ApplicanYs Signahue
Approved By: , Inspector
2007COMMERCIAL BUILDING rERvuT aPpLICATIOrr
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
S
. ... . .
• Structural Plans
(2) sets -
• ArchitecWral Plans
sets
(2)
• Nchitectural Plans
CodeAnalysis
SQ
(1)
• Civil Plans (2) • Structural Plans (2)
(2) •
• ProjectSpecs (1)
• CertifcateofSUrvey (1)
" • CivdPlans (2) • KeyPlan (1)
. CodeMalysis (1) • LandscapingPlans
i (1) " • Master Exit Plan (1)
. ProjeCt Specs (1) s
• Code Analys (1) • Energy Calculations (1) not always"
• Spec. Insp. 8 Testing Schedule ?* ? • Certifcate of Survey
& Testing Schedule
ec
Insp
• S (1) " • Elec. Power & Lightlng Form (1) not always"
• Soils Report (
) .
.
p
. Meter size must be esta6lished
y
y
y
y
y
y
• SAC determination - call 651-602-1000 e e
• Meter size must
• PYOjectSpecs (1)
• EnergyCalculations (1) x'
. ElecVic Power & Lighting Form (1) '"
• Master Exit Plan
. Emergency Response Site Plan
• Soils Repart
• SAC determination - call 651-602-1000
. Fire Stopping Submiftals • Fire Su ressionlAtacm Form l
1
y
• SAC detertnination - call 651-602-1000
Call MN Dept of Health at 651-201?500 for details regazdirtg food & beverage or lodging facilities.
** Contact Buildmg Inspecrions for sample and i£required
•'* Peimit for new building or addition will not be processed without Emergency Response Site Plan.
?
?
?7 '?
,
1 ?? ? ConsYructian Cast
Date ?
_
?
3a5 "& Uni
USte #
Site Address
Tenant Name ? a O a a- Former Tenant Name
a6 a ??
r'1 "4 T'
? R?Pl/4Ge
f w U Q c az"'
-
or
Description o
14 t L ` '`. `.? tJ .z
Telephone it ( )
Property Owner
G 1-72y /?f A 3 k?
Applicant is: _ Owner ? Contractor Contact #: `
J?wz?
/m 3
,
Contractor Ae-Y
Address 3 73J M +u N o e- ?Q Ai le) U a- City f"
? I
) 1' J 333
-)
) Zip SS y? Telephone #(610
M 7.
State
A- stablished • Meter size must be established?f applicable
b
Arch/Engr
Address
State
L icensed lumber installing new sewerlwater
Zip
_ RegistraUon #
CiTy _
Telephone # ( )
Phone #: L
p
I hexeby apply for a Commercial Building Pernut 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 the State of MN Statutes; I understand flus is not a permit, but only an
application for a pemut, 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.
G/??`l ?
Applicant's Printed Name Applican Wiaturec
02/07/2013 11:03 5073566021
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (661) 675-5694
AMWW BB
2012 RESIDENTIAL BUILDING PERMIT AP
PAGE 02/06
Use O_LUE, or BLACK Ink
For Office Use
Permit*: 10/1Z( -
Permit
Fee: &N•
,
l' Date Received: c) I
Staff:
L
2 JICATION
7,/
Date: '7 1 3 Site Address: JZ6 L4f SII gi by"' Unit #:
Name: sca a-eilttrein f&i rj A
• Address / City / Zip:'1;2_51 , �;Q R i p o. pr,
Applicant is: X Owner Contractor
RESIDENT /
OWNER
DAto (14,,/\
Phone: 65I-=451-1^it(AD
ITYPE OF WORK Description of work
Construction Cost: .11-kg14‘bb Multi Family B tiding: (Yes / No )
n
Contact; T W,eo-kiLS
a 1y
CONTRACTOR Address: C1' iin� \1 .. S
Company:
State: V1 Zip:55AlaP•N Phone: &)D 'l 5--) , 4)
1 License #IjC--395 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for ad
bi)II'+ifl3
COMPLETE THIS AREA ONLY IF CONSTRUCTING A N
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a no
Yes No If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
7
Sewer & Water Contractor Phone:
itponal information)
2oninc 3
BUILDING
ster plan?
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be p
5 the information may be classified as non-public if you provide specific reasons
conclude that the are trade secrets.__
CALL BEFORE YOU DIG. Call Gopher State One Call at (631) 464.0002 for protection against underg
before you intend to dig to receive locates of underground utilities. ww I.clooherstateonecali.orq
l hereby acknowledge that this information is complete and accurate; that the work win be in conformance wit
Eagan; that 1 understand this isnot a permit, but only an application for a permit. and work is not to start
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
days of permit issuance,
x S
Applicant's Printed Name
x
Applicant's Signature
is information. Portions of
at would permit the City to
nd utility damage. Call 48 hours
the ordinances and codes of the City of
out a permit; that the work will be in
de must be completed within 180
Page 1 of 3
SUB TYPES
Foundation Fireplace
7 Single Family Garage
Multi Deck
Lower Level
01 ofPlex
Accessory Building
WORK TYPES
_ New
Addition
7(
Alteration
Replace
Retaining Wall
DESCRIPTION
Valuation
Plan Review
(25%_ 100%
Census Code
# of Units
# of Buildings
Type of Construction
3Z‹- P (
DO NOT WRITE BELOW THIS LI
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
Move Building
Fire Repair
Repair
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Occupancy
Code Edition
Zoning
Stories
Square Feet
Length
Width
,Nk Drain Tile 1 ✓ t--
( Roof: Ice & Water _Final
Framing
Fireplace: Rough In Air Test _
Insulation
Sheathing
Sheetrock
Reviewed By:
Siding
Reroof
Windows
Egress Window
_ Storm Damage
_ Exterior Alteration (Single Family)
_ Exterior Alteration (Multi)
Miscellaneous
Demolish Building*
_ Demolish Interior
_ Demolish Foundation
_ Water Damage
*Demolition of entire building - give PCA handout to applicant
MCES System
J-c907SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC _ Gas Service Test Gas Line Air Test
Other:
Pool: Footings Air/Gas Tests Final
Siding: _Stucco Lath _Stone Lath _Brick
_Final Windows
Retaining Wall: ^ Footings ` Backfill _ Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
Use B�.UE or`BLACK'Ink
�----_–_
-------�_�,
� �ar Offlce Use l
• � � (.C��E'� ;
C�t� af�� �� � ���#:
� 1 / �� 1
� PeJntitFee: `-° 6
3830 PilO#Knob Road 1 �
Eagan MN 55122 I Qafe Receiued; E
Phone:{651}675-5675 � {
� �tat#:
Fax: (651}675-�694 _�.T__.�_�_��___.:_.�,...�
2��5 RE�Ii�EN�'fAL PLUMBING PE��[��►PR�I+�ATio�
� . . •
r3ate•�.�r.s"�; site ad�r�ss: �o�S"t� ,�r ll �'l`C��'�... ��"'
Tenanf: Suita#:
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, ; Address: tT�.l rr 1�`� �.�!L2 l G�l�/� ���. City; �,���7��J�J��. ;
F Gontractar � —F � �
� vtate:,���Zip: ;���� � Phone: ��f^� _ '��'�'�~����L�` i
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�w.o-....,n....�..,..+a�w+..-++.��r...y...,•.....P,w.,.ti..�.�.+.w„•......v.-. .....-....�+w..,. .
a New .,�Re IacemeRt; ,�Re air Ftebuiid Modi S ace Work in R.(7 W. �
� TYAe of W�rk � .�.. P p � ..,_ _.— �Y P ..�.. �
s , x
; � f3escription af wotk: �� fl .�l.fl� Lll'E' i:
. _ _ �� ��st�Eni'ri,e►i.. °� - - � ,,;�'nS�-�c/! �t��'�� �-�".�'�J`C'�.f`
� ; A�u,% i�►+rJ�e r�-�`ra..�-+-c�:�-- •t�b ��ic.t'-
; ; Water N�ater ;
� f t,�wn Irtigati�n(,,,_,RP�/,�PVB) � ��ater Saft�ner � eG�
� Permit Type � ;
� ��,,,,,Septie System ; �a�¢�'lumbing Fixiures;{�Main/.,,�,,,Lovyer Level) F
r a = :
� � ��� ` Wafer Turnaround �
�' � _.___
3 Abentlonment � �
t,...y.�....,�....,s�,.�:.�.�.'.,.._.��... �,.�,..r.x.�. ...��,...s:m..:_,b,�a�-�,,....,��_.�M�.�,..,�...,..:a:.�r_.,_xa..,y�,,�e,.�..�.n=.t..>_.��a.ti.,�a„�..a.�..:�,�,..�.�.�a.�,,:�,..-.,t.�-n..r.-_„���.....,-x���
� RE5lDEt�ITIAL FE�S: �
� $60.OU Wa#er Heater,Wat�r Sufk2nee,vr Wa#er Heater and Soften�r(fncludes$5.00 StaEe Surcharge} �
; �B0.40 Lawn Irriga#ion{incfudes$S.OU minimum Stat�Surcharge) E
� $60A0 Add Plurnbing Fi�ur.es, Se�atic SY�#em Aban�ic�nmenf,Water Turnarvund*(inetudes�i5-00 State Su�charge) �:
s "Water Turnaraund(add$2t10.00 if a 5/8"meter is r�quir�d) �
§ $1,13.00 SepliG 5ystem New�$1Q.00 per;as built}(inciudes Gpur�ty fee and�5.flQ 5tate Surcharge) ;'
, �
� TO�p►L FEES$ '
�
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CALL BE�UR�YfJU:DIG. CaN Gopher State One CaiE at(651)454-(}Ot�2 for protection against underground utitity datr3age.;
Cafl 48 hours before you in#end to dig to receive lacates Of undsrgt�ound utitittes , �,��.��_���.�ia�:�...,��:{.,r�:�;
I here4y aeKnowledge thatthis ir�fo�matian is camplete and accurate;ihat 1he work wil!be in confprman�e with ihe ordinanees and codes of the City of'
�agan;ihat I untlerstand ih�s is not a permit, but only an application for a permii, and work is not ta start without a petmif; that the wark will be in
I, accordance wi#h the approved plan in the Case of work whiCh requ+res a reviewand apptoval of plans.
x �f,�-,. .r-""�^7 _ �
l�i X ��
ARp ican#'s Printed Name APP nt's 3ignature
FCIR t'��fICE USE Revieweti Byi Data;
l�equired inspectians; Under�round Rcugh-in Air'f�st Gas Test Einal
Mster Ret�ted ttems: Meter Size> Radia Read Manameter,�,,,,,�, Staff:
.. . �• '. .I . . . .
Use BLUE or BLACK Ink
�---------------
� For Oftice Use ���
• /-�-/ .
Cl�� of Ea�,aIl ��'� i Permn�:����7�` ;
9830 Pi l Ot Knob R Oad �GL�', � PermN Fee,---�� `�v I
Eagan MN 5512Z C r I �
Phono•(651)675-5675 � � Date Received:__ �
Fax: (851)675-5694 � � �
C�/ � Stafi•--- �
�����������������J
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2)sets of plans wlth all commerciai applications.
Data:��•2Q�C�---Site Address:_�,��11a._.�1_LI�L1�—+�r ----- --
Tenant:_ Suite#i:
.Y . �� � :�Kla .�������� �.������_� ���� ���� ��
� ��`:� �•:� Name:__ Phone:_
�
------------------- --- ------- --
� � _ ��:
��"`� � � `°��'��� ` m: Address/City/Zip:
,�� x r� � ------ ------------------ —
. .
f�r r�s"�`t�
,��.�2�'1 f6 Fryr"���`� "' � � � ��j���� � ^.'
.____ � i��rtr� r" � � Name:��Y�P�1��]�_��.D.Yl�'��-License#:-L�2���-L?--
�
K , ; � '�;,c,�;
,'`a y ��}����-� Address:�7���eL1C�s�_�V e- �_City: �����5�-----
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� � �
� � =n�������� State•_��ZiP:��'��--- Phone:�+.L�'�7�--�-"=� -------
r v� uii �� I�1� . - .
�� ' �� �`1�
�� , M,.� ; �•� Contact: Email: �1�Y1r].�T�. lrn
i �
'° A � _ New ✓Replacement Additional AlteraGon Demolition
�' �5.;,?r i — — -- --- --
.r i ,:.�. } .•,s, �"
���� Description of work: Y'e ��j��r1Q�G___
�au s ' " '� a •:. ,. , �a � , � r������y
,. , :
�i�� {'�.Fe� �i'i��P�W�I'f i {,�X,� � ��jP
��f Yh �I,e J .�F 'Ft
�� " '���� '�`��'°���� ,_ ° `' RES/DENT/AL COMMERC/AL
� �.� �����iN`�����i ,/
Y � ° s� ��°�;� �;��s. <���� ____Fumace New Consiruction Interior Improvement
'rk� I 1 � F���.`����� �� -_
� ���, ___Air Conditioner __Install Piping __ Processed
�jt}°���� � � ��, `' ��q,�" ____Air Exchanger __Gas Exterior HVAC Unit
q �`y� ����R ,2+ " . _—_
�n h . �l�'`'�� Heat Pum
% : h F`���r �,�����,.�5��.�� p __Under/Above ground Tank (__Install!__R�nove)
,
�<u� �r`' f �'� j Other
RESIDENTIAt FEES
s60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
5100.00 Residential New(includes$5.00 State Surcharge) _$______ TOTAL FEE
COMMERCIAL FEES Contractvalue$___________x.01
555.00 Psrmit Fee Minimum
$70.00 Underground tank InstallatioNremoval =$__ _____ _Permit Fee
"If contract value is LESS than$10,010,Surcharge=$5.00 =$___ _______Surcharge"
"'K contract value is GREATER than$10,010, Surcharge=Contract Value x$0.0005
"*"If tt�e project valuadon is over$1 million, please call f�r Surcharge _$,___________TOTAL FEE
I hereby acknowledge that this information Is complete and accurate; that ihe work will be in conformance wllh the ordlnances and codes of the City of
Eagan;that I understand thls is noi a permit,but only an application for a pertnit,and work is not to start without a pertnit;that the work will be in accor+dance
with the approved plan In the case of work whlch requlres a revlew and approval of plans.
� ' _.11���.��d�.��r X_�c_���c_���=— --
Applicant's Printed Nam�' Applieant's Slgnature ,.
:.•�I� I! ��� +t�`��]I(�,9`G' �r���� �.��,[�'k 5j Ny�+�.�,,�f �{�M�.'� 9'. IFWJ+�i � /�` _ f tl��.� il:.�i�35rX�1C'�n.�G$�-�'�"��3:1°4Pogl �"�,�VI�: iz��CfH�l}�q������� �'T1� p�d'��"eY"'E:',.
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� � '" �' �+ «� Use BLUE or BLACK Ink
REtfi�����J -----------------�
� For Office Us
. ��� �� �o�� � � �q �l �
�1�� 0� ���1�I1 , Perm�t#:
� �
� Permit Fee: r �
3830 Pilot Knob Road
Eagan MN 55122 j Date Received: �
Phone:(651)675-5675 I I
Fax:(651)675-5694 I Staff: I
�---------------- !UP�
2015 RESIDENTIAL BUILDING PERMIT APPLICATION Ca
�
,,,r, , �-i�-1�
Date: 3����� Site Address: 3��G y 4 I�0 Q! Unit#: ���
�;
! �a ' Name: V�(:�19'!�3° �I°�Q{�'E%''h`,� C f -"�1�.. ��Phone: ��� ���������
�I���d��������� : �-�
��� �� �, Address/City/Zip: �� � ��� � �" �
���°` �,`� .---�
� �� � Applicant is: Owner �Contractor "�
� � � �`
�
�
�� � ���'°�a i � Description of work: �'� �►`� �
���"t����'`��i��r k'y
� �� ��, �, , Construction Cost: � ��� Multi-Family Building:(Yes �/No )
_ � ,�
� f �''
����� �' Company: 1.r.,1,N1���j7�'(�"l '�,�{�'f(C4�� Contact: �C1h (�Zr��(J�
� �._
Address: ��! � (��'�,� !"i'1)C; �t'�- City: ����,�Cyo,;"�rT
, ��'r��2��d�r�1T =v
�� ' � State: ( 1�''� Zip: ��1� Phone: (n '"���'� �Email: 1\" d�J (� � �o '`�
D
��; h � �
� � � `
,� License#: � � � Lead Certificate#: � �
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
--- —,-��- , �( �
' s� �- �� l�c�.s �� c�� `� 1 � -�'- _, �; ��� ���
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:
����77"L�:,�1� ` �'���r �r����r„ ��ur�t if5 t#,��yilha,, �rr�it��c��r`���er�+�#�i�� -t������`��� .����� ���4��
�h�r�afn r� � �: ��st�fie��r�+�����t���`t;�[f yo �id�t� ���^t;e�sc�rr���� �r+�" ���+' ,
_ � � u �� _ �' �����/�cf� ����f��� ar��[ et� �� = ,�����- � � � ��"�
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.QOpherstateonecall.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.
� i
x X
ApplicanYs Printed ame A Signature
Page 1 of 3
�j� ��l' ���G)..e.� ��
" ' ' ' DO NOT WRITE BELO#N THIS LINE �p1-� �� �
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
_ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
� 01 of�Plex _ Lower Level _ Pool _ Accessory Building
WORKTYPES �,,.��ra�r SV1,e�t+ rOGK C� �KS Q,"1'F-`' �fOZGv` �t(�'r�-
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building Reroof Demolish Interior
� Alteration _ Fire Repair _ Windows _ Demolish Foundation
_ Replace _ Repair _ Egress Window � Water Damage
_ Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation �'�� Occupancy � MCES System
Plan Review Code Edition 3 t�aG SAC Units
(25%_ 100%�) Zoning � City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction �'� Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) X Final/No C.O. Required
Foundation � HVAC Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
� Framing Drain Tile
Fireplace:_Rough In _Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick
� Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
� Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee f�G
Surcharge v �C��'��� �� �U �� '�
Plan Review � �f ���
MCES SAC
City SAC
Utility Connection Charge
S�W Permit 8�Surcharge
Treatment Plant
Copies
TOTAL
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Aug 18 1511:05a Sunrise Remodelers 651-762-9395 p.19
, Use Bt�UE or BLACK Ink
. �-----------------
'' I For Office Use �
� � Pemn�#:/..�c�'"���� I
���� �i lJ��� i PermitFeE: ��- �� I
I
363fl Pilot Knob Road j I
Eagan MN 55722 � Oa�Recei+fed: i
Phone:(65'�)675-5675 , 1
Fax:(651)675-5694 � 5ta€f; �
,�.^ e � - i • 1 l ������.����J
''�Y v 'GLE � • �• �/t'•` ��'� C..��f G` �4«�C.Y1 �C G v-✓� .��_—___
20151��SIDEi11`i'Ii�1L �lllLl�iNG PERII�IT A1���.I�ATt�I�
C� di:r'° L31����- T���:.n L►.;�i s-ts
Qae�:�-!-Sl-I � Site Address:� 'J�Ga�I'• �i �:e���� i7. r<'v'�. 5���I un�t�:
,:>..�:t.y,-�,>�=rr,r=.��.,e..........-�.`,�.,,,�� --- -
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.,'�� � ;�� : ''���5���"3� c�co,�3 a-c�='�, 3�co�3l 3� �
; : Name: p e�
` R@Sidentl
i Owne� : Address r City!Tp:
___..__.....,.._,.�_..,.._,..,..,; APPlicarn is,-�-_-.�-_�Owner �Contractor,..�.._�._r......___...�....u.v.,��.—�,.,..._,..�,..�.,�..�.-,�....�,�..��.._�
; ,T��e���IQrlC : Description of work: �j� c�-� n�1
� �� � av /
= Consiructio�Cost: d�; Q�� • Multi-Farnily Bualding:(Yes � !No_)
._.,._....,..._�..._w-._....� = Company:��•L.Y> �� ,-�. ��vv'� rx�l-z�S Confact:M�t;L� �.�'.� ,:,;�
: ���t�actae ; Aa��ess:� �� (� �-1i:��-� L.�t �►-� ary: S't-� �c.� �
. � State:,�I�r�`Zip: � t l l v Phone: Email: i Y1�'t'�i �. S..¢Y�r: ��r 2�•�+�c�-�.�:s,
.� .� ;:t�:,.
/�i -�����3��
- .�.... .._..,�....�_.�.�.,�.�.._r_Licertse#:���f^G l�� � � ��� � � Lead Certficate# ,.�.w� ---._...._.....__.. �.-....a�.-
° if the project is exem�rt fram lead ce�tification, piease expiain why:
�M � �� COII�IPLETE THIS �PtEA OPlL`t iF CONSTRUCTINC A NEVU BUiLD(NG
< tn t�rie 9ast 12 mo�ths, has the City of Eaga�issued a permit for a similar plan based on a master pian?
Yes 1�o If yes,daie and address of master Plan: �
� LicenSed Pivmaer. �hone:
: �flechanical Contr�ctor. Pho�e:
� Sewer&liUater Cootractor. Phorte:
� Fire Suppressio�Contracto�: Phone: ��
,��...�.�:
NC�TE:Plae�s and supporfrng�acurlen�s tha�yoet s�6mit are coe�sid�ed to be publiciraform�tion. Portfons of
�la�6n�'orrnatimn Pnay 6e cFassi�ed as non p�blic if yau�rovid2 spee�flc Peasar�s fhat wauld permi�the City to �
: �onclude�ita�they are i�rade secrets. - - - - , .__._;..
CJ�►LL BE�ORE YOU DIG. CffiI Gopfier StaL2 One Calf at(651)�.54-0002 for protecfion against underground�ildy damage- Call 48 hours
betore you intend to dig to receive locates of u�derground utiitties. www.aoAherstateonecall_orn
I hereby acEcnowledge that ihis informatic,n is oor�lete and accurafe;that the work wiil be in cor:formance wilh the ordinanCes and vodes of the City of
Eagan; that I understan�Uus is not a permit, buE oNy an applicalion for a pemtit, ar�d u�rork is not to sta�i withouc a permir, ti�at ihe work will be in
accordznce with the approved plan in the case of;n�o�ic which requires a review and approvai of p{ans.
Exierior work authorized by a buiidir�g pertnit iss�ed in accordance v»th ti�e Minnesota State Building Code musE foe campte0ed wlthin 480
days of permlt issuance. �.--- .---�..
� ,��� �.�L.:.—�-�•s�s G'�'� � �
Appllcant's Prirrted l�ame � a 's igoature
Page 1 of 3
Use BLUE or BLACK Ink
r-----------------�
I For Office Use �
Clty� � Permit#: �L I
of ����� I Permit Fee: ti�� �•� �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
I i
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:-1-Y? E S ���h' ����k(1 ���� -'�-''��1`� Un t#: �
Name: Phone:
R�Si�et�! , �� �/"
:�W��� . Address/City/Zip: (G� �:�c..i�;pC�c?� . �,q�G„5,•>, �'b1 N. 551�3
Applicant is: Owner �Contractor
' Description of work:_�c,Pt�A-cfr, (� .!-l�nlLS
����.�Qt�C � � �
: Construction Cost: 3(s��� Multi-Family Building: (Yes ✓ /No�
' Company:_�µNN�� �il�la.�C7A�Rr9�Enr �Ca�2.s. L L G Contact: �1�E e�Ohl'NSG eJ
Address: �5`7�0 9��/�LE"�D• Cit C./9-n/h/u,�J ��2Ls
�t�l�tr�tzttxr ' -� y�
State:�/� Zip: 5500� Phone: 6S/--?5��d3//Email: S.bHn►SD��4/rwOn.�lld1+��� •��""
' License#: N�R� Lead Certificate#: *f0'►+
If the project is exempt from lead certification, please explain why: N� (,�g� P�.�sg,�,�
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 8�Water Contractor: Phone:
Fire Suppression Contractor: Phone:
' ��T�':Plar�s a�d�r�p�ortf�.�a�o�r�t�e�rts��a�,�or�;��btr��t�re co,rns��'�red:�a"�e;p�1ic��'or�t�trt� l�ort�fl��<:��' '
tf���ti�orm�t�or►�r�y�e cl�s�if�l as�rt��pub��c i�,�au pro�icie s{�ec��reasons tha�►�r�tl pe;rr�t��a�Cf�r��
c�nc�r�de that t� , are tra�ale s�Eret�. ;
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.aopherstateonecall.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 Build' must be completed within 180
days of permit issuance.
X S�i� �JVIf'NS6N X
Applicant's Printed Name Ap " anYs Sign ture
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