4058 Johnny Cake Ridge RdAddreSS 4e58 Sohnny Cake Ridge Eoad
Lot 14 Blk 5 SUb Oakbrooke
Zip 55122
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: S_3 _()p Yes No Inspector:
Final grade (6" from siding) x
Permanent steps (gazage)
Permanent steps (main entry)
Permanent driveway ?
Peananentgas X
Sod/Seeded grass ?
TraiUcurb damage X
Porch X
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shuboff of water supply a
the outside lawn faucet before freeze potentiat exists.
Confact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ?
White - City Copy Yellow - Resident Copy Pink - Contractor Copy
CI1"Y GF E:AGAN
CA!iil-I:I:Efi- 75 If:i:hMIN(-11_ N(]: 003
UA;:E: 0206/00 '1'ZME.; 09a5505
I[i e
NML.? F'LIL7c M6iS7E:l: ?iUILDi"h
2252 9220 4058 JHNNY Ch; R 30.00
300 9001 4058 ;IFlidi!'`! CI: ii 17010.55
3866 9379 4058 JHNNY CK R 100.00.
3422 9001 405E3 JHNNY L'Fi I\ , 6JFi.tSEr
2275 9220 4058 JHNNY r:E; R 1,,089.00
3446 SbC.)i. 40=9 :7NNhlY CI< 5? 11..C)0
205 9001 4058 JHNNY rl! F 0.50
3743 9220 40513 JHNNY CI; F,. ;O.Qq
'c'.i.:`.::i 9001 405E JHNNY r,l: R 51,50
3868 9220 405E; 1FIidNY L'I: Fi 492.00
Cfi:l.236:16 *?k CONT'INI i!-::
l.lS[::R .T.Dr 7AN v«C CON'T'i:NUF.:
?? ll?l T ? ? ? l0 V
??S??kc?'k•X??CXcX??K:q:i??C4%???X??k??%?X?kk:h?X?:? C:pNTINUL
C:[TY OF EriGAN
CASN:CEh'? JS TE:RFSINAL Mt7: 003
D1'TE;; pc /i.6/00 TIME:; 09:`55:16
ID;,
NAF4c^ i=IJL_TE M(aSTEf't RU:fLLif-=1;
306 9i:'.2C1 4058 JHNNY CI: 12 04.00
370 9220 ao,:,e .,riNNv ci; f` 50.00
3865 9220 4456 JHNNY C;I: k 840.0]
Cafia1 Rear+ip+, Amourti+,: 4,495.41
30360
1SI_R SDc tAN
2000 BUILDING PERMIT APPLICATION (RESIDENTIAL)
crrr oP eRCArr
/-? 3830 PILOT KNOB RD - 55122 ?j ??-I q -j ??
v
851•681-4875 '
D 3 reylaferod tlka wrveYS dwwh0 s4 fR of bf, W. R Of hawe
antl gi rooletl orebt (20% mmdmum lot eoveraae allowadl
D 2 coptes ot Mau (show beam d window aizes; Paured fn4 tlaalyn; etc.)
D 1 f9f d BMrpy CdCWatbrri
a J eopiei o( hee prownalbn plm M bt piolpd afpr 711/93
DATE: A/? (-) G
DESCRIPTION OF WORK:
SiREET ADDRESS:
LOT: P?
C :? ? -iI --d
K@7ffiQ91%R6Dm( RBCUi16IIlOI1?!
Z coPles W Plan
i E9T Of 9n6tyy ocdaAatbni fOr h90T9d Gdd1kM
i airo swver ror exronor aadHoru a aecw
??UCnoNCOST: 1i0, o lic,
C /ClL4L /lt
BLOCK: 3, SUBD./P.I.D.i: m/(00?Jrr-
Name: Phone S:
PROPERT1f tast Rnt
OWNER
Shset Addresa:
citY SMte: Zip:
Company:&We A>'h cs 0'1PXXAI C_o {Phone e: G_s"? k,)-?2 Sb
CONTRACTOR (area code)
f? l
streerAdareas:I /?L6 I?
IVl?nc%? +7??5 oGj ucenaer 1291 Exp.
cny ly1 c ndPc, Ats srcre: 19il I np: Ss I? b
ARC
ENIGIN ER / ComPany: SAME t-ls AbUI/f- Name:
Telephone li: ( )
Sfreet Address: Replsfratlon #:
citY State: Lp:
Sewer/water licensed plumbar (H Installino sawer/wster): ??L4( Phone #: (^?
f Mnesota Stalufea a Nia? ? Eread Ihk aPPlicattlon, s? Nfallhe iMortnaNOn b cared, and apree b comply wHh aI app6cabfe Sfafe
o pan Ordirwnees. ,,,?
. Siprwhire of Applieant vv14'YI d?-La&
OFFlCE USE ONLY
Certificates of Survey Received ?l Yes _ No
Tree Preservatlon Plan Received ` Yes No ," Required
F? - a 2??:;
?
OFF{CE USE ONLY
.
BUILDING PERMIT SUBTYPES
O 01 Foundatlon 13 07 OSpiex O 13 16-plex ? 21 Porch(3-sea.) O 31 Exf.Att - Multl
A 02 SF Dwelpng 0 08 08-plex O 17 Garage 0 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
O 03 01 of _ plex ? 09 07-plex O 18 Deck p 23 Porch (screened) O 36 Muld
O 04 02-plex p 10 08-plex p 19 Lower Level 0 24 Storm Damage
O OS 03-piex 0.11 10-ptex Plbp Yor_N 0 25 Miscellaneous
? 06 04-plex O 12 12-plex O 20 Pooi O' 30 Axessory Bldg. WORK TYPE
)1i 31 New O 38 Move Bidg. p 43 Reroof
O 32 Addition 0 37 Demolish (Bldg)' 0 44 Siding
O 33 Alteration 0 38 Demolish (interior) O 45 Fire Repair
O 34 Repair E3 42 Demolish (Foundation) ? 46 Windows/Doors
• Give PCA handout to applicant fcr demolition permit
GENERAL INFORMATION
SAC Code __j2L # of Stories sq. ft.
No. of Units _11 Length G ' sq. ft.
No. of Buildings I Width Footprint sq. ft.
Const. (Actual) Basement sq. ft. ' Census Code i 1`>J
(Allowable) ain level sq. ft. a'rz/ MC/ES System
UBC Occupancy ?I?'t sq. ft. City Water
Zoning sq. ft. Booster Pump ?
PRV
Fire Sprinklered
?SCELLANEOUS IN,$PECTIONS
Stucco/Stone 0?
APPROVALS
Planning Building Engineering Variance
Permit Fee Valuation: $ roo
Surcharge
Plan Review
License ?/ ??
MC/ES SAC t y3, /?/ L?
Water Conn. f?':?t! / ?
Water Meter
AccL
SM ermit Deposit 5vv
S/W 5urcharge
Treatment Pi. Park Ded. '
Trails Ded.
Other
Copies
TotaL' ''' S-- L4? [ ???I;???T?-p a tr
?
. SAC Units
% SAC
?
• J4B INITIATION ORDER
Pulte Hoines of
Minnesota Corporation
1355 Mendota Heights Road, Suile 300
Mendota Heghfs, MN 55720.1112
Phone: (651) 452-5200 Fax: (651) 452-5727
CONTRACTOWSUPPLIER:
JOBNO.. ?• ? ? r? v /? ? 1 f ? C LEGALDESCRIPTION:
COmmUNITY: Dca,?.? l?- ADDITION:
DR
euaouao nnoaess• ??? <? Ap1?fJ QU ?
MODELNPME: Rl,cs-I MIF-?-2- NpDELNlM16ER: IR? ? )
BWER'S NAME: L?-N Uf-n r(IK?
CURRENTADDRESS:
HOME PHONE: BUSINESS PHONE:
SALES REPRESEN7ATIVE- / Lf I? ?/ Mi!
i
LOT 14 9LOCK ? UNfT
crrr: ' c?- srnTE:f? zm:55(??
ELEVATION: OARAGE: (L?EF"f RIGHT
`_J Y - I
DATE OF ORDER: -
CffY: STATE: ZIP:
BUSINESS PHONE:
IELEVATION# I-'2,5 I
'L?
200
f
TOTAL ?? qo
? APPROVED BY BUYER (5): ?
? APPROVED BY SALES: A
.
PELEASED TO START CONST.: enuni Housuuc
OPPORTUNITY
Builder's License 90001371 This constitutes a contract between ihe Seller and the Purchaser(s) for the above items.
EXTERI08 ENVELOPE AVERAGE "U';? COMPUTATION
OU1tIER: , u ?
? .
(
?C.L c4 .? Il 0 .
S ITE AOORE55:
'DATEe ?
?
'? PNONE: ySz -SLOo
'
•
CONTRACTOR: ? rG ffe C ? °tf /
i
` DETEAMINE NORKIHG SOUARE F007AGfi OF EACN: _
`TOTAL EXPOSED WAIL AAEA,,,,,,., 1-41`1 sq ft x"U"
1 ?
.
-
7-- sq ft x"U"
y, TOTAL ft00F/CEIl1NG AREA,,,...., ??0
TOTAI EXPOSEO NALL AREA CALCULAT10N5:
Total exposed wall ?
4
' sq ft
area a6ove floar,,,,,,,. Z 2
a) Total wall v+inda+.area: • ,
DOLBI.E 9lazed...... sq ft x??U" 6O
`
?_ glazed...... SQ ft
" ??
.lU
X l
3q ft x ?????.
6) 'Total door area ,,,,,,.., _ ; • „ .
c) Tota] slidfiig glass door area: ' " ' • '
(?p?JRLG. g 1 azed. . : . . . ? sq f t x "U" e 50
° • ?
':?"."
` ? t }7 • ~? SIy fC
glazed..... X uVil a -.
S .
d) .Total f(replace wall area sq ft
x"U"
e) Total wal l framing area sq ft
2 ? x"U" .?92 ° ZD
?
, (Average 109.).....,..:.. -
;
?
; •
?
f f) Total net wail area above •
. .
"
"
lated)
flo
'(I
Sa f} x'
u
r,.. ...
nsu
or
..•
sq ft
Total rim Joist area...... x "U„
;.
;.
Total foundatlan
7 b s
ft
•.
y
area (Exposed).......•
h) Total foundatfan g
ft x"U" ' ' ?• ?
q
wfndoW area .............
`' - I) Totat net foundation
ft x "U" •??? °
-=?
gq
area above grade........ _.
TOTAL a) thru I)
3
.
If (tem ,43 fs the same as, or less than ftem 11, yau have me t the inten[ oF
2 EIC.1R 1:16008 A and 0. •
. ?,
, paRo 1
CONS7RUCT10N R VALUC• !
CEILIIIG SEL71nN (IIlSUL11TED): ' -
I Inter(ar air f(ltn ' p fT
2
, 4 Exterlor air Pllm (stlll) n.F?
, TOTAU R a
U- 1/R?
r I 2L-6 4 5
VENTED
CEILING FRANING SELTIUN:
2
3
4
5
CEILIIJG SEf,TION (INSULA7ED):
1' Interior air film n.Fl
2
3
4 Exterior air iim sti11 07 I
TOTAL R =
U? 1/R?
CEILfNr, FRN1111r, SECT10N:
1• Inter(or alr film n.61
z
3
4 Exterlar alr lm still 0.61-
5 ittches so t wood
TOTAI R n
U= I/R
Insfde atr Film n-F]
2
3 ••
4
S Outs(de air film 57 7
TOTAL R
U - I/R
??a..?.,..svY.w?o.n?erL?ne e.n ../1? a?. .?+..
?
7
. U .. 1/R ° ?OZ-7
X
A
?,I vLfvv -t vwlV
tOllSTRUCTfUN R VALUE
NALL FRAMING SECTION:
1 Interlor alr fllm'° ... ?.6R
?
u
u-t/a
B
?
L?J
wAIL SECTiON (INSULATED)
-? 1
3
4
RIH JOIST SECTION:
?1 lnterfor
?•A. ?'d
6
.- ,. -_ •.S r
0,? A.,
L•A.:J'e4
4
FOUNDATION INSULATIOtI REqUIREU:
Min. R-5 on entire wall OR U? 1/R a
Min. R-10 down to frast.d'epth -
FOUNDATION SECTION:
1 Interior afr fiTm .n.FFi
2 fL-1 1 Fid'r' I IILILK_ lD -?-t3 ?zrn?e ??oc« - . i.z?
Exterior air ilm n.17
le _ fS
(F
TDTAL R a +il
U - I/R ° IV 7b
SLAB ON GRADE
E
-- 4, ?
• '• Heated Slahs:
.a?'',•'Q, Minimum R = 8:5
Uhheated Slabs:
'?.•4; Minimum R = 6.2
Q.?a ,.•a?• J+. q ?
•, ?, . o • •,. .. . •? ,a
/a ? ; ; :
a
•' "? '• ti Vi ? 4'?, `L• •d ' q•
? '? f??1 • /• ?(_ • ? ?? ? '?• `?
,', ? , •G , r, •..d
???? ?•''?; ?..??;.,•4_'. ??.. •
'. .. - • `??
, 4k 4• Q'?•)9•
. d?• , . , .?
Page 3
U=1/Rapkr-1?44-
35fi4t s . . , •. . .
?: . ?? ? . • . •• I •
OtAL EXPOSEO ROOF/CEILINR CALCULATItlIlSa
Tata) exposed
Z?-sq ft
lli
f
.
/ce
ng atea......
roo
.
J) Total skyllaht xrea....... sq ft x "U" °
k) Total roof/ceillnq framing
D
"
"
O-Z 6
° 31
sq ft x
area (Averaqe 109,) ..... r% U ?
1) Total net Insulated
ft x
"U"
OZZ
rooF/ce(linq area....... sq
TOTAL J) thru 1 ) -7i(
??.
If total of O4 is the same as, or less than.R2. Yau have met the tnteni of
2 i1C.1R 1.16008 A and 0.
.. . ?
ALTERt1ATE BUILDitIG EN4ELOPE DESIfN
Ta utillze the total envetope system methad, the vilues established by the sum
nf items P3 and R4 shall,nat oe greacer than tfie sum af items A1 and ?2.
• 1. + 2. °
3, a' 4• e "
?
:. C c ? T I F I_ L A T I 0 Il
1 herehy cartlfy that l havtl ealndlated the "U" faetors and "R'i
values herr.ln artd tFat the buildlHn heP,e..descrlbed meets or exceeds.the 5tate ,
af Hlnnesata Energy Conservatton Act.'?
SlqnatUre)
?: 19 `7
,
. (Da[e) r, g„ 2
)JJ
n
H
?
W
?
C
0
0
O? ¢
? ?
? cl
0
2??
. ?
?
?
? a
C3
?
a ?
LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL L"T
DATE OF SURVEY: LATEST REVISION:
DOCUMENT STANDARDS
? Registered Land Surveyor signature and company
• 8uilding PermitApplicant
• Legal description
• Address
• North arrow aad scale
• House type (rembler, walkout, split w/o, split entry, lookoK etc.)
• Directional drainage arrows with slope/gredient °r6
• Proposed/exdstlng sewer and water services & invert eleva6on
• Streetname
• Driveway
• Lot Square Footage
• Lot Coverage
ELEVATIONS
Exis4n9
V/10 ? ? Sewer service (or Proposed)
?zd ? Property corners
y? • Top of curb at the driveway
dY? y • Elevations of any epsting adjacent homes
? G? ? Adequate footing depth of structures due to adjacent u61iry Venches
Prooosed
/
V" 0 ? • Garage floor
v ? ? . Firstfloor
v/ ? ? • Lowest exposed elevatian (walkoutlwindow)
? Praperty corners
?? :
Frbnt and rear of home at the foundation
/ PONDING AREA (if aodicable)
? 0
o • Easement line
? 9/o • HWL
? m?? • Pond # designation
? ?' ? • Emergency OveAlow Elevation
?g" o
a/a o
¢?y ?
rY o e?
? ??a
DIMENSIONS
• Lot IinesBearings S dimenaions
• Right-of-way and street width (to back of curb)
• Proposed home dimensians induding any proposed decks, overhangs greaterthan 2', porches, etc.
(i.e, all structures requiring permanentfootings)
• Show all easemeMs of record and any Ciry utifih'es within those easements
• Setbacks of propased atructure and sideyard aetback of adjacent ewsUng structures
• Retaining wall requirements, if any
Reviewed;
March 1999
cruicreLocvnMr.FM
.
?
Surveyor's Certificate
' SURVEY FOR :PULTE
DESCRIBED AS : Loc tA, Block S. OAKBROOKE, City oi Eagan, Dakota County, Minnsota and
reserving easements of record.
qya?
v
` O .?.
1-? 11
j OH%
?
r=
?
? 93
C 6
.
.
q32.4 ?
SSLT
JrjeNegl
/ q3?, v6 Zg Z2 . ? ? ?,
O? .
„?g t 33. o ?
<O 00 0/?? 1 32 ?? ed 933.3 Cn
Pc°S?ory p N ?
Q) N???
\\ 030.
? ? g2A ?283 GIObe00 4333
58 SQ ???+ 06?' s?o q33•
lS w Go?o4e
?,?NNy 9335 0 `° ---
??
q
`
3 o w___-----
OD
N = ----- oT>
IDGD N84?09'36"E 131 28 ,
9307 r _
O?
i ?
?
i Exrst Honie I? =?
? toe = q3???
,
? -
? L 0 T SQ. F00 TAGE
HSE. SQ. F00 TA GE
LOT COVERAGE _
Plan # 18201
PROPOSED ELEVATIONS
Top of Foundotion = 93q,0
Garoqe Floor = 933•tv
Bosement Floor =q2b,o
Aprox. Sewer Service = 423.os
Proposed Elev. _ C=D
Existing Elev. - -
Droinage Directions = -
Denotes Offset Stake = •
JOB N0:
OOR-O51
BODH:
OAKBROOKE
Q
; ,.
t
? -
= 9, 485 DMr4,RjvG DE Fr,
= 1, 680
177o
BENCHMARK. TNH@ 7, e/3
Eleu= q31,59
MIN. SETBACK REQUIREMENTS
LJ Front-25 House Side -
SCALE: 1 incn e 30 feet Rear -15 Garage Side-
HEDL?JND I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION
OF THE BOUNDARIES OF THE ABOVE DESCRIBED PROPERTY AS $URVE7ED
BY ME OR UNDER MY DIRECT SUPERVISION AND DOES NOT PURPORT TO
PLANN/NC ENG/NEER/NC SURV6Y/NC SHOW IMPROVEMENTS Oft ENCROACHMENTS, EXCEPT A SHOWN.
2005 Pin Ook Drive 7 ?
Eagon, MN 55122 DATE (_/0?0
Phone: (651) 405-6600 F EY . LINOGREN, LAN RVE70R
Fox: (651) 405-6606 _ INN TA LICENSE NUMBER 14376
CITY USE ONLY
L I B1L' ? RECEIPT#: '7?vI
SUBD. O?1Y1 CJ'C-OAP/ RECEIPT DATE: a' dy?00
PERMIT# 3°I(0g3
2000 PLUMBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IQNOB RD
EAGP.N, hAT 55122 ?
651-681-4675
Please complete for: ? single family dwellings
? townhomes and condos when permfts are required for each unit
? backflow preventer for underground sprinklersystem
FIXTURES EACH # TOTAL
Alterations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x 2 = $
Floor drain 3.00 x = $
Gas piping ouUet ' minimum -1 3.00 x = $
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x = $
Laundry tray 3.00 x = $
Lavato 3.00 x = $
Septic S stem new/refurnisned • requires MPC Iie. 75.00 x = $
Septic System abandonment 30.00 x = $
RPZ new installationlrepaidrebuild 30.00 X = $
Rou h opening 1.50 x = $ L?
Shower 3.00 x = $
Under round s rinkler if dwelling is under construcGOn 3.00 x = $
Under roundsprinkler ifexistlngdwelling 30.00 x = $
Water closet 3.00 x = $
Water heater 3.00 x = $
Water softener 'rf dweiling under construcuon 5.00 x = $
Water softener If existlng dwelling 30.00 x = $
Waterturnaround 30.00 x --- _ $
State Surchar e .50 -> -> -> $ .50
Total -> -> -> --' $.
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
. .---•-----------•------------------••-•---------------- --- -• -
I hereby adinowledge that I have read this application, slate that the irrformatlon is correet, anC agree to eompty with alI epplip6k City of Eagan ordinances.
It is the appliwnt's responsibilky to notify the propeRy owner that the City of Eagan assumes no liability for any damages pused by the City during its
normal operatlanal and maintenance activities to the facilities constructed under this permit within City propedy/right-of-way/easement.
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
TELEPHONE#:
(AREA CODE)
TELEPHONE #:
(AREA CODE)
STREETADDRESS: /J(l/( ) ?( /.L?/.i/1ILI
CITY: ? STATE' ZIP:
SIGNATURE OF PERMITTEE
CITY USE ONLY
LOT __tq BL C _ PERMIT #:
SUBD. 091 rJy dOYlk? RECEIPT #:
RECEIPT DATE:
2000 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PIIAT IQ70H RD
EAC,AN M 55122
2'a)'-po 651-681-4675
Date: J
Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
construction and not ownedoccuoied.
• HVAC: 0-100 M B T U
ADDITIONAL 50 M BN
• Gas outlets (minimum of one required @$3.00 ea.)
State Surcharge
Total
$ 30.00
6.00
3.0?
38,00
.50
Complete this section onlv if you aze remodeline, adding to, or re airin an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repa'v.
New _ Alteration
? Furnace
_ Repa'v _ Other
Air conditioning
(
_ Air exchanger
Other
Fee $ 30.00
State Surchazge .50
Total $ 30.50
Reminder: Cal! for inspectrons
SITEADDRESS:
OWNER NAME:
INSTALLER NAME.?
S'I'REETADDRESS: ?a4X,
CITY:
PHONE #: CP'O
(nREn
PHONE #: _49-1-
(AREA
S.
- ti a-saoa
. 39q
co
3q.s°
S STATE: VAh ) ZIP: C5 7
O ? zLf,'_h?)
SIG ANRE OF PE 7TEE
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA111695
Date Issued:07/08/2013
Permit Category:ePermit
Site Address: 4058 Johnny Cake Ridge Rd
Lot:14 Block: 5 Addition: Oakbrooke
PID:10-53760-05-140
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes .
tony nguyen
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
John Hoang
4124 Oakbrooke Rd
Eagan MN 55122
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
r-----------------+
I For Office Use �
' � Permit#: �L���� j
Clty of ����� � PermitFee: ��� I
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I 1
Fax: (651)675-5694 I Staff: I
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
, Name: i�"�'►"� � �°',°"�' Phone: �^,S I^ �q7- .��yy
Resident,l, � � ��t��cf J�tin� C�.ICe � ,� — � �� SS"(L�.
'Qyy��r ; Address/City/Zip: `� 7
' Applicant is: Owner � Contractor
Description of work: � � �e 8� �"" �``���k'� �����
'�yp�r�f Work
' � � : Construction Cost: � �����"�� Multi-Family Building: (Yes /No�
°���j� Company ��''�� �,�a'� ���o�',S LLC Contact ��� � � �� h
� ..
" .
CO#�'kt'���0�' ;, Address: �LC�,3I �o I A S� �-� c�ty: �f��r��
State:�� Zip: S��-�Y Phone: ���-`�yB`p���EmaiL
; License#: L�� ��� ��� Lead Certificate#: I
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
�r� ��7�
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:
� }�f��`;�fi��Pl�n�ar��i��r"_�p;p�r#r,n,���' �uir�snt�tt�� �d,�k���"u�iir�i���e�orr�iatered t�l�e pubfic rnfc�rmatrvrr� Pu���rr�s uf
#f�e�n��rmaft�irt�������b�"�c���sr���t��as�bt��='��i�r�li�h��u��1.��7�Q1���@ S�l�C���G"`�'�3c�"SV11� `�c"��`iA!3�1�C#�f�@1'C)`!l�':���CI�,��'fl
��:! ��a : _�a� wi�Iiti�F.r . : �Cf#IC��C� �� #�78� r�#i3 2`ts�t���5�"�i`@f�.�',_ :
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.org
I hereby acknowledge that this information is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
� e
X �f5d� � � "� x
Applica t's Printed Name Appl'cant' ig ture
Page 1 of 3