3430 Hwy 55EAGAN TOWNSHIP
N° 1239
BUILDING PERMIT
/ -?-?- -- ? -- .-'...... .. ..-- ------. ...
Ownex . .-_.--------- _-. Eagan Township
'_1_?C.4?- Town Hail
Address (presenS) ...L.?..L.A1 YA1 --------------------------- :L_.-
"_.?.a./.._....,.?.)..?..'.........__....'_....._"__.__ _.---- ...'
Builder /?r..T..'_'
Address y ? Dafe ' {"-7-'..1... ......._'-"'.
._..1? -----------------------------------------
DESCRIPTION
Stories To Be Used For Front Depih Heigh! Es2. CosY Permi! Fee Remarks
LOCATION
streex, noaa or otner uescripvon ox Locaxion I Lox I?JacK i Rq63230II OI 7I3CI
_I'/L34f Xz? 'Z'r- ? G? U ? t?? ?a_e`?c ?? l--;i,
This permii does nof suihorise the use of sireeis, roads, alleys or sidewalks nor does it give the owner or his ageni
the righ! So cseaie any siYuaiion which is a nuisance ox which presenis a haaard io the healfh, safety, convenience and
general welfare !o anyoae in the communify.
THIS PERMIT MUST BE KEPJT? ON 'F,FIE PREMISE WHIL£ THE WORK IS IN PAOGAESS.
_.... . "
Tbis is So cerlify, !ha!_?,(?------------- ------ has permission 2o ereai a_. ? _ pon
the above desezibed prem?se subjecf !o the provisions of the Building Ordinance foz Eagjfn Tow... hip" ' _ .-.
opie 11.
1855.
..... ? . ' -.--. Per .----._........._ ............. . . ?:: .... ... ...
-------- - - - - - ---- - - - - - ?-?:-. . . . ........ ?. _..m.: ??
' Chaisman of Tnwn Soard Building Inspecior
CITY OF EAGAN Remarks
Addition r?S<yt t i nn 19 Lot elk Parcel 10 0170f1 090 02
Owner Z,iG4ft F' r.i tf! i;? Vltii?:.! Street-3?J30 Ht^.N. 55 State E8g3n,MN 55121
3I51 ?•-S
Improvement Oate Amount Annual Vears Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING I
?
SAN SEW TRUNK 1 25 Paid
SEWER LATERAL - '
WATERMAIN
?
WATER LATERAL i
WATER AREA
STORMSEW TRK 1984 561.00 37.40 15 !
STORM SEW LAT ?
?
CURB & GUTTER ?
SIDEWALK I
STREET LIGHT
WATER CONN.
BUILDING PER. .
SAC
PARK I
I
V3?, -
October 12, 2004
Gift of Mary
Sharing and Caring Hands
Attn: Richard Copeland
525 West 7"' Street
Minneapolis, MN 55405
Dear Mr. Copeland:
,
Iro ?
As agreed to in our telephone conversation yesterday, I am retuming your check 1099 in
the amount of $160,81838.
The assessment notice we mailed you in September proposed utility and street
assessments to the Gift of Mary property. However, 3haring and Caring Hands and the
City had an agreement that utilities would be chazged to the property at the time of
building permit issuance, not at the time of installation by the City. A copy of that
agreement is also enclosed.
The corrected notice for the street and concrete entrances assessments in the amount of
$66,029.73 is enclosed. These amounts were adopted by the City Council following the
final assessment hearing on October 5. Please remit a replacement check to the City for
$66,029.73.
We apologize for the inconvenience caused by the erroneous norice. Please do not
hesitate to/Fontact me if you have additional questions.
Tom Pep
Chief Financial Officer
Enc: Assessment Agreement
September 17, 2004 Notice
October 11, 2004 Notice
CITY OF EAGAN
NOTICE OF SPECIAL A55ESSMENT HEARING
Project #I0P874
September 17, 2004
The EAGAN CITY COUNCIL will meet at 630 PM on the 5th day of October, 2004, at the Eagan City
Hall, 3830 Pilot Knob Road, Eagan MN, to approve and adopt the listed special assessments against the
following described property:
10-29800-010-01
GIFT OF MARY
SHARING & CARING HANDS
R.COPELAND
525 W 7TH ST
MINNEAPOLIS MN 55405
The spec;al assessments µre:
Special Annual First Year First Year
Type of Improvement SA No. Assessment , Principal Interest Installment
Sanitary Sewer Lateral 3517 $11,040.00 $ 736.00 $ 621.00 $1,357.00
WaterLateral 3519 11,155.0? 743.67 627.47 1,37114
Water Trunk 3518 69,752.7 4,650.18 3,923.59 8,573.77
ServicePair 3520 2,8 9.?. . 189.40 159.80 349.20
Concrete Entrance 3521 3 3 358.58 302.55 66114
Street 3522 6 65 .00 4,043.40 5,799.75 7,455.02
Total $1 18.38 $10,721.23 $11,434.16 $19,767.27
The City of Eagan will accept payment for any p rtion of these special assessments free of interest charges
for a period of 30 (thirty) days. The interest e riod begins October 6 and ends November 4, 2004. If
you choose to pay after November 4, 2004, 'nt est will be chazged from October 6, 2004 to the date of
payment. The First Year Interest is calculated fr,2jki the date of the assessment hearing through December 31,
of the following year.
Please make your check payable to "City of agan". Mail your payment to, or pay in person at, the Eagan
Municipal Center, 3830 Pilot Knob Road, gan, N[N. 55122.
tlny unpaid portion wili be collecte t ual installments of principal and interest for the next 15 YEARS
on your future properry tax tateme ts, w ich will be issued through the Dakota County Auditor's office.
The annual installments inc ude inter t at the rate of 4.5 PER CENT per year on the unpaid balance.
Please turn over.
CITY OF EAGAN
NOTICE OF SPECIAL ASSESSMENT HEARING
Project#1OP874
October 11, 2004
The EAGAN CITY COIINCIL will meet at 6:30 PM on the Sth day of October, 2004, at the Eagan City
Hall, 3830 Pilot Knob Road, Eagan MN, to approve and adopt the listed special assessments against the
following described property:
10-29800-010-01
GIFT OF MARY
SHARING & CARING HANDS
R.COPELAND
525 W 7TH ST
MINNEAPOLIS MN 55405
The special assessments aze:
Special Annual First Year First Year
Type of Improvement SA No. Assessment Principal Interest Installment
Sanitary Sewer Lateral 3517 $ 0.00 $ 0.00 $ 0.00 $ 0.00
Water Lateral 3519 0.00 0.00 0.00 0.00
Water Tnmk 3518 0.00 0.00 0.00 0.00
Service Pair 3520 0.00 0.00 0.00 0.00
Concrete Entrance 3521 5,378.73 358.58 302.55 661.14
Street 3522 60,651.00 4,043.40 5,799.75 7,455.02
Total $66,029.73 $4,401.98 $6,10230 $8,11616
The City of Eagan will accept payment for any portion of these special assessments free of interest charges
for a period of 30 (thirty) days. The interest free period begins October 6 and ends November 4, 2004. If
you choose to pay after November 4, 2004, interest will be charged from October 6, 2004 to the date of
payment. The First Yeaz Interest is calculated from the date of the assessment hearing through December 31,
of the following yeaz.
Please make your check payable to "City of Eagan". Mail your payment to, or pay in person at, the Eagan
Municipal Center, 3830 Pilot Knob Road, Eagan, MN. 55122.
Any unpaid portion will be collected in annual installments of principal and interest for the next 15 YEARS
on your future property tax staiements, which will be issued through the Dakota County Auditor's office.
The annual installments include interest at the rate of 4.5 PER CENT per yeaz on the unpaid balance.
Please turn over.
Notice of Specia] Assessment Page-2-
The proposed assessment roll is on file with the City Clerk. The assessments related to this project total
$237,947 and the area is as follows:
The area within the Northeast 1/4 of Section 12, North of Truak Highway 55 in the City of Eagan,
County oF Dakota, Minnesota.
Written or oral objections will be considered; no appeal may be taken as to the amount of any assessment
unless a signed, written objection is filed with the Clerk prior to the hearing or presented to the presiding
officer at the heazing. An appeal to district court may be made by serving notice upon the Mayor or Clerk of
the City within 30 days after adoption of the assessment and filing such notice with the district court within
ten days after service upon the Mayor or Clerk.
Under Section 2.75 of the Eagan Code of Ordinances, adopted pursuant to Sections 435.193-.195 of the
Minnesota Statues, the council may, in its discretion, defer the payment of this special assessment for any
homestead property owned by a person 65 years of age or older or retired by virtue of a permanent and total
disability for whom it would be a hazdship to make payments. Any homeowner meeting the requirements of
the ordinance must apply for the deferment not later than 30 days afrer the adoption of the assessment.
The City of Eagan is committed to the policy that all persons have equal access to its programs, services,
activities, facilities, and employment without regazd to race, color, creed, religion, national origin, sex,
disability, age, marital status, or status with regazd to public assistance. Atixiliary aids for persons with
disabilities will be provided upon advance notice of at least 96 hours. If a notice of less than 96 hours is
received the City will attempt to provide such aid.
Please note that you wi11 receive additional notice on this matter only if the amount due is amended_ If
you have any questions about this statement, please call Special Assessments at the Ciry of Eagan 651-675-
5020 or TDD Number: 651-454-8535.
/S/Mira B. McGarvey
Deputy City Clerk
3830 Pilot Knob Road
Eagan, Minnesota 55122
,
CITY OF EAGAN AND GIF°T OF MARY
ASSESSMENT AGREEMENT
THIS AGREEMENT, made and entered into this/?ay of -Pr?4?°r• , 2002, by
and between the CITY OF EAGAN, a Minnesota municipal corporation (hereinafter "the City");
and GIFT OF MARY, a Minnesota non-pmfit corporarion (hereinafter "Developer") (collectively
referred to as the "Parties").
WHEREAS, the Developer has made applicarion for a Final Planned Development
affecting property located in the Northeast Quarter (NE1l4) of Section Twelve (12) in the City of
Eagan, State of Minnesota and which will be legally described as Lot 1, Block 1, Gift of Mary
(the "Property"); and
WHEREAS, as a condition for the approval of the Final Planned Development,
Developer was required to be responsible for costs associated with certain public improvements
in connection with the construction of a frontage road along Highway 55 and corresponding
utiliries as well as the potential expansion of Lone Oak Road; and
WHEREAS, prior to awazding the contracu for the public improvements, the City
requires that the Developer waive its right to object to any special assessments that may be levied
in connecrion with the proposed improvements.
NOW, WHEREFORE, in consideration of One Dollar And Nol100 Dollars ($1.00) and
other good and valuable consideration, the receipt and sufficiency of which is hereby
acknowledged, the Parties hereby agree as follows:
1. HIGHWAY SS FRONTAGE ROAD (PHASE I) - PUBLIC IMPROVEMENT
PRO1ECr 874. Developer hereby accepts an assessment against the
Property for roadway improvements at a cost not to exceed One Hundred
Thirty-one Thousand Eight Hundred Fifty and no/100 Dollars
($131,850.00). Any chazges associated with utility services for this
Project shall be treated as connection chazges payable by Developer upon
connection.
2. HIGHWAY 55 FRONTAGE ROAD (PHASE II). In the event the City
undertakes a public improvement project to extend the Highway 55
frontage road along the southerly border of the Property to the Inver Grove
Heights border, Developer agrees to accept its proportionate shaze of the
costs of constructing the roadway, wluch shall be based on proportionate
footage at a cost not to exceed One Hundred Seventy-four Thousand
Seven Hundred Sixty-seven And No/100 Dollars ($174,767.00). In the
event the wetland on the Property is impacted by the roadway easement,
Developer further agrees to participate in the proportionate share of the
costs incurred by the City to provide wetland mitigarion (based on the
percentage of wetland affected on, or adjacent to the frontage of, its
Property).
3. LorrE OnK RoAD ExrnNStoN - PRO?FCT 886. Developer hereby accepts
an assessment against the Property for roadway impmvements in the
amount not to exceed Two Hundred Thirteen Thousand Seven Hundred
Seventy-three And No/100 Dollazs ($213,773.00). Any chazges associated
with urility services for this Project shall be treated as connection charges
payable by Developer upon connection.
3. REPRESEN'fATIONS AND WARRANTIES. Developer represents that it is the
owner of the Property and it possesses the requisite authority to enter into
this Agreement. In the event the City discovers that additional
signature(s) are needed, Developer agrees to use its best efforts to obtain
the signature of any other party necessary to effectuate the terms of this
Agreement.
4. WAIVER OF NOTICE OF HEARING. Developer heieby waives its right to
object or appeal the assessments described in this Agreement that shall be
levied against the Property. This objection is made pursuant to MuNN.
STAT. §429.081. Developer hereby further waives notice of hearing on this
Agreement.
5. GovERNING Lnw. This Agreement shall in all respects be subject to, and
governed by, the laws of the State of Minnesota.
IN WITNESS WHEREOF, the Parties executed this Agreement on the day and
yeaz first written above.
(The remainder of this page has been intentionally left blank.)
2
City of Eagan and Gift of Mary
Assessment Agreement
Signature Page for the City
CTTY OF EAGAN
a Minnesota munix
Sy: Patricia E. Awada
Its: Mayor
By: 'a Karels
Its: City Clerk
APPROVED AS TO CONTENT:
By: blic Work's Department
APPROVED AS TO FORM:
? ? /- - ?.. ' 4,
By: City Attorney
STATE OF MINNESOTA )
) ss
COUNTY OF DAKOTA
a
On this /a77'%'? day of A ??'??'? 2002, before me a Notary
Public within and for said County personally appeared PATRICIA E. AWADA and MARIA
KARELS to me personally known, who being each by me duly sworn, each did say that they aze
respecdvely the Mayor and Clerk of the City of Eagan, the municipality named in the foregoing
instrument, and that the seal affixed in behalf of said municipality by authority of its City
Council and said Mayor and Clerk acknowledged said instrument to be the free act and deed of
said municipality. \
.ww,.,r;..
?; x? -•:5°' PUELlC
City of Eagan and Gift of Mary
Assessment Agreement
Signature Page for the Developer
GIFT OF MARY
a Minnesota non-proft organization
y: Richaz . Cop and
Its: V e President
STATE OF MINNESOTA )
) ss
COUNTY OF HENNEPIN )
On this ? day of , 2002, before me a Notary Public wittun and for said
County personally appeared Richazd Y. Copeland, who being by me duly sworn, did say that he
is the Vice President of GIFT OF MARY, a Minnesota non-profit corporation, the organization
named in the foregoing instnunent, and acknowledged said insmiment to be the free act and deed
of 7,44v zat ion.
j
Notary Public
SARA A. JORDAN
y? Ndary Publk
Minnesota
W Cam?ulan 6?ira+iovp 7t.3A05
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON, SHELDON, DOUGHERTY & MOLENDA, P.A.
7300 West 174h Street, Suite 600
Apple Valley, Minnesota 55124
(952) 432-3136
(RBB: 206-20051)
SHARING AND CARING HANDS
c% Mary Jo Copeland
545 North 7th Street
Minneapolis MN 55405
??
- ?.
City of Eagan
3830 Pilot Knob Road
Eagan, MN 55122-1897
`? . " _ . i •??ti a's- iI lI )I I II lI I I I liI I lI i„lt l,I ,Nl„i,lI 1 11 1 111 11 1 1 11 i,l,I „II II
? _
CITY USE ONLY ?y
L BL a2 RECEIPT#: /3G
SUBD. %? RECEIPT DATE:
1997 PLUMBING PERMIT (REaIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 681d675
Please complete for: . sin e famil dwellings
• townhomes and condos when pertnits are required for each unit
• backflow preventer for underground sprinkler system
FIXTURES Ep,CH N?( TOTAL
Shower 3.00 x =
Water Closet 3.00 x =
Bath Tub 3.00 x =
Lavatory 3.00 x =
KRchen Sink 3:00 x =
Laundry Tray 3.00 x =
Hot Tub/Spa 3.00 x =
Water Heater 3.00 x =
Floor Drain 3.00 x =
Gas Piping Outlet ' minimum - 1 3.00 x =
Rough Openings 1.50 x =
Water Softener ' Por dwellings under construdion 5.00 x =
WaterSoRener 'rorexisring awening 20-00 x =
U.G. Spflnkl@f ' for dwelling under conat. 1.00 =
U.G. Sprinkler 'torexistingdwelling 20.00 =
Alterations 'toexistingresidence 20.00
=
Water Turn Around
P
i
' 20:00
?
? =
r
vate Disposal System
oak cry iia ? _
(new and refurbished systems) ,
Private Disposal Systems Abandonment 2D.00 =
STATE. SURCIiALRGE .60
?-
TOTAL 115
1 hereby acknowledge thet I have read fhis epplication, state that the infortnation a cortect, and egree to wmpty wRh allapplicable Ciry
of Eegan ordinances. It is the appliceM's responsiblliry to notify [he property owner that the City of Eegan assumesnoJiability for any
damages caused by The City during its nortnaloperationel and maintenance aciNities M the faalities consW ded under Mis partnit within
Ciry pmparty/rightof-wey/easement.
SITE ADDRESS:
OWNER NAME:
INSTALLER NAME:
STREET ADDRESS: 6,
CITY:
' TELEPHONE#: _7 Sl 3?•ze?
?
STATE: iA ZIP: S'rIA3
--?CG'
SIGNvTURE OF PERMII?EE
'162- o/? oo - o?'o _ a?----
? NumberofLaOeials
? xocxunder r;? (6-?24-)
J?CLatecdl I.enBths (loo' msx)
.
Z9 Rock Over PiPa (Z')
OrTital Trench Depth
iacha
Va Total Sq. FL Trench Area
-?L6 TrencnwUUbS (Ir aim -36-
?.>
4 2 IS COVCICd (wiOwNa
poraua m+w4
0
I,ateial Spacing (71 m cema
Pcfifrc)
0 stope orpipc
Site Drawino-
Bottom of Treach W Water •
ind- Table or Hedmck
A?I011 OVCt I.8t8I81S (6^ min. - 36"
? m?c)
V Siu of Washed Rock pia^ w
275')
SCALE:
?
q
?
Installer.
Signature:
Designer: z?,zy Approved: ' es o
el?
ON-SITE SEWAGE TREATMENT SYSTEM - INSPECTIONREPORT
Applicantand Pecmit#:
UspecWd br.
17 t1 son Eorings
? # Perc Test
Avetage Perc Rate
Reserve Area: 'e No
_/L Number of Sepiic Tanks
/s capaciry(l.?&mi,)
Pie-fab Tank Model: gNo
L"'?utlet Baffie (35x oe raat 4yota
- depiM 6^ a6ove hquid aufaoe)
.iquid Depth (3c^ mm.)
? !-- Depth to Restriction
(?SCha)
'r}+j)C: Motlliog Hcdmdc Watertable
_ AccePtance Rate
(ut Ftlgpd)
a min. 3" below inlet
c24° nlima
` Tank is level
= 7n1aBaffie(e^betowsyuiai°
? K'atertight Canstructioa
nau of Inspxt;on:
ParcelID:
sioe naarm: ? y30 S? S>?
House Type:?II III
Gaibage Disposal: YeQ
_1 # ofBedrooms
----W Yotential Bedrooms
? onPipes(4°mia)
" MaLtt010 (24"mia)
Pomping tank6L)/ No
1f3l Capacity
,25 ProPertY Lines po7
?WellAIDj-
?!? Buildings (to)
,5_0 Recrralion 8c Tnbutazy (fs)
JD Buried Wazer Pmssure Pipes
(10-)
All others eaccept Rec. & Tnb.
- (tso•) .
30 BuildinSs (2u'
L LargeT?wl
_af Pzope:ty Lines (to•)
J'U Reaeation &Tnbutary ps)
52) weu c3o-wnV5
?'-?All others expect Rec. & Trib.
- (1so•)
? Buried Water Pressure Lines
(lo•)
Constnction
7nlet Inverts (1^ .bm oWn
ven).
_ Pipe Cowection
?7 """Pipc to Drop Box ompokaotr---
,,WUCtIRVC[f3(4^abow8oa)
"x is Level
Distn'butio : Gra ' / Pressure
RESIDENTIAL
BUILDING PERMIT APPLICATION
`'1 U CITY OF EAGAN
3830 PILOT KNOB RD - 55122 ? I I?J•? C
651-687•4675 J
New Construction Reauirements
• 3 registered site surveys showing sa. ft of lot, sq, ft. of house; and all roofetl areas
(20% maximum lot coverage allcwed)
. 2 wpies of plan showing beam & window sizes; poured found design, etc.)
• t set of Energy Cakulations
• 3 copies o( Tree Preserva6on Plan i( lot platted after 711193
. Rim Joist Detail Op6ons seieclion sheet (bldgs with 3 or less units)
DATE
JOB SITE ADDR
D -
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER ? ?_ ?-0- M I
RemodellReoair Reauirements
. 2 copies ol plan
• 1 set of Energy Calculations for heated addiUOns
. 1 site survey for extenor addi6ons & decks
?3G
VALUATION (EXCLUDING LAND)
t k
TYPEOF WORK a - I2_ ' 1lDVS£ UNInf ct FIREPLACE(S) _0 _1 _2 _3
APPLICANT 1Z v aT An {2a E' i ? PHONE # 4/S7 ' 20-2
ADDRESS 203 I'' I3 L'? ?C_z 'Z- ZIPCODE .S"j o> f
PAGER # CELL PHONE # 6i-? ?.3?? ?lpk3 Fax # 1s 7?03 s- ?
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilation Category t Worksheet Submitted
- Energy Envelope Calculations Submitted
_ MINNFSOTA RULES 7672
New Energy Cade Worksheet Submitted
Plumbing i;ontractor:
Plumbing Systein Includes:
Mechanical Contractor:
N[cclcmir<d Systcm Includes:
Sewer/Water Contractor:
_ Wafer SoFtener _
Water Healer
No. oF 13aths
Air Conditioning
_ Hcat Recovcry Systetti
Phone #
Phone #
Fce: $90.00
Pee: $7Q00
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that ihe informa ' n is c c, d agree to comply with
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Slgnature of Applicant
Certificates of Survey Received _ Tree Preservation Pian Received _ Not Required _
Phone #:
I.awn Sprinklcr
No, of R.I. Baclis
Updated 1lOt
Use BLUE or BLACK Ink
~Tr 1-----------------i
-Zo
City of Eaian ; Permit#: z5cl
3830 Pilot Knob Road , Permit Fee:
Eagan MN 55122 I I
Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 staff.
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date'
Site Address.® g L
:;ZL
Tenant:
Suite
RESIDENT! OWNER Name: a- L4 r Phone:
Address / City / Zip: J I
CONTRACTOR Name:.MILBERT COMPANY IN .dba CULLIGAN 'WATER
Address: 1801 50TH ST EAST city. INVER GROVE HGTS
State'' MN Zip: 55.077' Phone: 651 :45 -2241
Contact: BILL.MILBE[Zf, . Email:
TYPE OF WORK _ Nevin Replacement -Repair _Rebuild _ ModifySpace _ Work in.R.O.W.
Description of work: ,
PERMIT TYPE RESIDENTIAL
Water Heater Water Softener
Lawn Irrigation RPZ PVB) Add Plumbing Fixtures C_ Main Louver Level)
Septic System Water Tumaround
New
-Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater an Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtutes, Septic System Abandonment, Water Turnaround' (Includes $5.00 State Surcharge)
`Water Tumaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
$95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ S~. L
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 454-0002 for protectlon against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities.- www.oooherstateonecall.oro
1 hereby acknowledge that this in6rmation 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 plans in the case of work which requires a .review, and approval of plans.
v/ IY1 r l
Applicant's Printed Name Applican s.Signatuf
dFOR OFFICE°IJSE Y 4~ RevI w d By, 'c . Rat
Regiredelnspey s, UUd -~110 9.' a
Use UEor ELA Ink ( ,J
Office Use a
eiritve For o
[ F�crmit it'.. f —'
i!e ---1. City of Eala
llrrIit f ee; l -0 V
3830 Pilot Knob Road
Eagan MN 55122 Date Receive&
Phone:(651)675 15
l i irk iris a; asci rfe artPorr� start.
2017 RESIDENTIAL BUILDING PERMIT APPLICATIO
Date: Site.Address: ..` • Unit 8:
L . . L .-% -C *,,,; .. ..Gnu
Phtine;
Iesidei'tt/:
:-:::::::::::--:-:,::--.-:.01N-11-0-6..,.. 'Address t-City 7 Zip:
Applicant.is: Owner Contractor
Type Of WarIC
Description of work_ -ca 5 " r , ,.
Construction Cosf. ?C c Haiti-Femiiy Building.(Yes 1 NVo )
Company; tic Confact: /tet, ;. „ . r' r
Address `s t • City. v i"' �'
state:!" • Zip: 3' Phone: Email: ; - ( '/./.. ;0•
/-, 5- :• / ,
License - t `* 2 Lead Certificate : ��' �1 �`� p�JJ
If the-project is exempt from lead certification,please explain why:
--
COMPLETETHIS 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 Plurrmber..` :: " Phone:..
Mechanical ContractorR Phone:,
Sewer&Water:Contractor: iii
Fire,Suppression Contractor ?; . .. .. Phone:
NOTE Tans anal s a a n 'nt r tha , trbmit onsidere d to.be public informa#ion. 'P`oriforr sof the
nfor c rr rn be R t< • + , eclflc reasons that woultfP it the City to conclude that they
a
may'subs ''e to receive'�ian electronic notification/from the City of proposed ordinances by signing up for en emailupdate•on
the*City's website at cltvofeaQart+com!sulbscribe
Exterioxrwq��d bya bui�rng permit issued Inaaccofdance I the Minnesota State Building Carle must be completed within 180
days of permit issuance 2; �� ..:"
LL BEFORE Yt?t1'E ,z A °�-
�, �� s l at(tt5t)45�►it fur pr�xte�rt against ar�erground utility damage, Civil 48 boars before
�.�.s ou int d 't: .W a q ®9 ._@ a a %i-�R !aii:t.$`i Wyk W WIN
, - W r R => a 4-(tie iH t fcrrmance witic the ordinances a W cosies of : Crty of
n, a R a.,; W< W for a is not to scarf�t a permit; at.the wo will be in -
^a.MERtthar7maW a %,e,,W -B ® .,.a • ♦. & it a u are 'approval off p`l ns. i
.f
'.� s ignatureW R
`�W 11. Page 1;of
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Use BLUE or BLACK Ink
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For Office Use41`1
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City of Eaaan ::::e:
_c()((;)04"--
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 Staff:
buildinginspectionsacityofeagan.com
2017 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 2-7'" I3. Site Address: ?j V 0 IA -if
5
Tenant: Suite#:
Resident/Owner .
Name: 3. ... b -'`® ✓` C___ Phone:
Address/City/Zip:ff t�
Name: ( �s l I; , 51 S License#: i" i3 CLI (LI 17-3
Contractor Address: 11t1 0 ( C o (1 City: 1'1
State: M&) Zip: 3 1 3 Phone: 1 S - c73 8 Li / 3
Contact: / "�• 5v1 Email: Ca�C�:Y
Type of Work —New —Replacement _Repair —Rebuild —Modify Space _Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Water Softener
Lawn Irrigation ( RPZ/—PVB)
Permit Type Add Plumbing Fixtures( Main/—Lower Level)
le Septic System
New Water Turnaround
bandonment
RESIDENTIAL FEES:
$60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround*(includes State Surcharge)
*Water Turnaround (add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES $
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.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeagan.com/subscribe.
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 t. -tart without a rmit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans. r
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
Meter Related Items: Meter Size Radio Read Manometer Staff:
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