3885 Gibraltar Tr? CASH RECEIPT •
• CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19
RLC61VtO . . , " .
FROM
AMOUNT Is I
8 DOLLARS
?oo
? CASH E] CHECIC
t?t? l? ??I ',?'?'' .'?_ -•; '...?J.`?T/i??x? '? V
? #
FVNO CODE AMOt1NT
Thank You
BY
White-Payers Copy
Yellow-Posting CoDY
Pink-File Copy
- CITY, OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipt # '--• ?-" . r ,?E '?
To be used for - .`aJ
Site Address ? 3!
Lot 4i Block
Parcel No.
W Name ?
3 Address 31
o ..., v i
Name _
Address
Est. Value $i
Phone 456-0286
Phone 431-2221
W W Name
U ; Address
Q W City Phone
i hereby acknowlege 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.
Signature of Permitee . ,
Building
Occupancy
Zoning -
(Actual) Const -
(Ailowable) -
# of stories
Length 341
Dep1h
S. F. Total -
S.F. Footprints -
On 5ite Sewage -
On Site Well -
MWCC System -
City water
PRV Required -
Booster Pump -
APPROVALS
Planner
Gousicil
Bldg. Qif.
Variance
OFFICE USE ONLY
FEES
Bidg. Permit
Surcharge • 50
Plan Review
sac, city
SAC, MCWCC
Waler Conn
Water Meter
Acct. Deposit
S,'W Permit
S/W Surcharge
Treatment PI
Road Unit
Park Ded.
Copies i •Oct
TOTAL Z7"50
Permit No. Permlt Holder Date Telephone #
WATER
SEWEA "
PLUMBING
H.V.A.C.
ELECTRIC
Inspecfion Date Inap. Comments
Foodngsl
Foundation
Framing
Roofing
Rough Pibg.
Rough Htg.
Isul.
Fireplace
Final Ntg.
Final Plbg.
Const, Meter Plbg. Inspector - Notify Plumber
Engr./Plan
Bldg. Final
Deck Ftg.
Deck Final ' DS
weu
Pr. Disp.
' CITY OF EAGAN
••- << 3830 Pibt Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?1
' PHONE:454-8100 ,
BUILDINd PERMIT Recelpt #
Tobeusedfor ?5F D1iG/ GAR Estvalue $66,OU0 Date
ti6
fiEBt;UARY 25 19
Site Address 3885 G I BRAL'1'RaP: `I'fi Erect Occupancy R3
Lot 2 2 Block S SeciSub. LEXINGTorJ SQ Remodel ? Zoning Rl
Parcel No Repair ? Type of Const y
. Addition ? No. Stories
¢
Name E'I'f30 C[3STOA!
HOf?iES Move
? 51
Length
_
o ?' . O. HOX 104
Address
Demolish
9
Int. Impr.
?
?
Depth 46
Sq. Ft
City Blii2P;5VII1110W 4 54-9383 Install ?
Z o Name
?°, ¢ Address Assessment
~ City Phone Water & Sew.
Police
F = Name Fire
u d Address Eng.
i W
Ciry Phone S?'g .- Approvals Fssa
Planner
Permit $ 331.00
Surcharge 33.00
Plan Review 165. 50
sAC 575.00
Water Conn. 500.00
Water Meter 63.50
Road Unit 290. UO
I hereby acknowledge that I have read this application and state thatthe gldg. Off. 2/19 A Tr. PI. 156.00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
Signature ot Permittee ;?.?, V8r. DSte COpieS
" '`" ?' ' Total $2,114.00
A Building Permit is issued to: MBTRO? CUSTOM HOMES on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City ot Eagan Ordinances
11 1 Pa mN No. I PrrmM Nolder I Da" I Td"pho" ! I
?
Plbq.
Htq.
Plbp.
FUaI
Oec.
. PERMIT #
? MECHANICAL PERMIT RECEIPT #
CIT1f OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICL-
Site Address
Lot ;2;? Block
m Name
? Addre
c Ciryl'=
? Name
3 Addre
o city t
TYPE OF WORK
Forced Air
Boller
Unit Heater
Air Cond.
Vent
Gas Piping Outlets #
Other
BLDG.TYPE
, .?
Res.
Mult
Comm.
Other
WORK DESCRIPTION
i
New ?
Add-on
Repair
- FEES
RES. HVAC 0-100 M BTU -$24.00
Phone? -' ` ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU ? 6.00
? GAS OUTLETS 1.50 EA.
M BTU COMMIIND FEE - 1 % OF CONTRACT FEE
M BTU MINIMUM - RESIDENTIAL FEE - 10.00
M BTU MINIMUM - COMM/IND FEE - 20.00
M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
? CFM f BEYOND $1,000.00)
FOR: CITY OF EAGAN
FEE
S/C: SIGNATURE OF PERMITTEE
?
TOTAL ? < <
PERMIT #
PLUMBING PERMIT RECEIPT # '-5 ^
' CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE . PHONE 454-8100
I Site Address BLDC3. TYPE WORK DESCRIPTION
Lot22- Block ? Sec/Sub -K
.,
Res. New
Name Mult Add-on
?
?•?
Address ? Comm. Repair
c City l Phone Other
T
S TOTAL
NO. FIX
URE
Name ?
Water Closet - $3
00 $
?C)
.
.
_LBath Tubs - $3.00 ?
p Cily Phone -L-Lavatory - $3•00
Shower - $3.00
3
=Kitchen Sink - $3.00
a'
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 196 OF CONTRACT FEE =Laundry Tray -$3.00
MINIMJM - RESIDENTIAL FEE - $10.00 _LFloor Drains - $1.50
? ?-
MINIMUM - COMM/IND FEE - 20.00 _-L_yyater Heater - $1.50 j.S ?
STATE SURCHARGE PER PERMIT - .50 Whirlpool -$3.00
(ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping OuUets -$1.50
BEYOND $1,000.00) Softener - $5.00
Well - $10.00
Private Disp. - $10.00
, L .. ?Rough Openings - $1.50 ?-
SIGNATURE OF PERMITTEE FEE
STATE S/C:
FOR CITY OF EAGAN GRAND TOTAL• ? 3, f(.
OFEAGAN
Pilot 1Knob Road
Bnx 21199
?, i1AN 55121
SEVVER SERYlCE PERMIT
PERMIT NO.:
DATE:
No. of Unita:
/lddrcss:
iber:
w to emwpll? wNM /M CNy d Lepw Cafnrctton Chor'Dr.
of Irop.:
30 Pilot Knob Road
0. Brx 21199
gan, MN 55121
Aecourrt Depasit:
Permlt Fw:
5urcfiarpe:
Misc. Charpex
Tatal:
Dote Poid:
WpTER SERVICE PERMR
PERMIT NO.:
D/1TE:
. No. of Units:
Addresx
Site Address:
Plumber. -
Meter No.: Connection Chorye: .
Sfu: Account Deposit: ?
Reoder No.: Permlt Fee:
I y-- w eeaply wkli tl» Gry oi Epi¦ Surcfio?ga:
OrJimeam Mlsc. Chorpes:
By
Dote of Insp.:
CITY OF EAGAN
Totoi: .fi t er
_ Dote Paid:
_ Irop.:
3830 Pilcit Knob Road -
P. O. 3ox 21199 PERMIT NO.:
Eagsn, MN 55121 DATE:
Zoninp: No. of Units: ;-
Owner:
Addross:
Site Address:
Plumber: 1 ? -
Metar No.. 70 /8 ? Cho,, r C: J OOp l
stze:
Readar No. ys ?"?°{? .. ,,?, ;
1 y? fo oyr wili? 11w Gnp'??r'
5'?
?1i1?bFal_AJ
gy A,- ?? Dote Patd:
Date Insp.: 1^"p-' ?
C1TY OF EAGAN Remarks
Addition LEXINGTON SQUARE Lot 22 Bik 5 Parcel 10 45475 220 6
Eagan, MN 55123
Owner Street ?.$a5 v??lta--.?i} State
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTdR.
GRADING
SAN SEW TRUNK 254.53 C009787 10-12-84
q7jSEWER LATERAL ben tY'LC 173
65 11-58 15 173.6$ C010132 1-2$-85
.
WATERMAIN 1986 68.3 4.56 15 68.33 C010132 1-28-85
WATER LATERAL
W,4TER AREA 1986 286.4 19.10 15 286.43 C010132 1-28-85
?
? STORMSEW TRK 501-2 33-42 19 501.29 C0I0I32 1-28-55
STORM SEW LAT 1986 513.81 34.25 513.81 COI.O132 1-Z8-8S
CURB & GUTTER
SIDEWALK
STFiEET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
RESIDENTIAL )O!D -a- 3e,10-7
.t l l3. 75
BUILDING PERMIT APPLICATION
57 a-- cm oR eaw?x
3830 PILOT KNOB RD • 95122
851-881-4875
New Corofnutlon ReoulnmMls . . . . RamodaURawlrRaaWrsmeMa
. 3 repbWed sb smwYe atwaMA cQ. ft M Wt eQ. fL of hause; mNg9 iaoled a?eas • 2 copies W plan .
(10%mwftn btmvew aOWed) . : . 1aetMEneryyCelcAetlwnlorhea0adaddftlons
• 2 oopies o1 pan ahoWiig heem 8 rhqow sRes: Daued bund design, e0c) . 1 aite surveY laebfor addi6ons & dedo
. 7aeto(EnaryyCakulaUons ' . trdra6eahomsanvedMseptlesYStemtwadd'Abrre
. 3 copbs of TMe Preamvetlon Plan B Ipt pIaW almr 711193
. RMnJobtDet80pGaieaobcibneheet(bldpawqA3aleasunib) , . .
DATE
.VALU/[ION 'k LA„J 2?
JOB SITE
TYPE OF
af)COCELL PHONE #
FIREPLACE(S) 0 _ 1 _ 2
PHONE# /n1a.r7c7.? ? DO--,0
Fax#1n1 a-7a I^ R-7(c?3
NEW RESiDENTIAI BUILDING ONLY- FILL OUT.COMPLETELY.
Energy Code Category MINNESOTA RUI.F.S 7670 CATEGORY 1?
(check one) - Residemlal Ventllation Category rM ??1 Worksheet S u .-" Energy Envelope Calculatlons Submitted `MINNFSOTARULES7672•?; '? ?? New Energy Code Worksheet Subm'dted L
Plumbtng Conhactor. Phone t---
Pluiribmg System Includes: - • •. _ ? "Water Sofrener _ Lawn Sprinkler Fee: $90.00
Water Heater No:`of R: .-B s ` No. ef BaLhs
Mechanical Contraetor. Phone B
Mechurical System Includes: Air Conditioning Fee: $70.00
_ ,.
_ Heat Recovery 5ystem ' ? -- Sewer/Water Conhactor. ._.---.Phone # =-.All above information must be submtCed pdor to processinp of applicatbn.. ..,..._. ... ".. , ??
. . ; . . } ..
I hereby acknowledge that I have read this appliCation, state that ttie information is correci, and agree to comply
with all applicable Stdfe of Minnesota Statutes and City of Eagan Ordinances. • •• • '"?''d "?? ?? ?°'
Signchirbof Appllcarik . __ - ? ? X:hm
CertiHcates ot Survey Received _ Tree PreservaUon Plan Received _ Not Required _ ri,?,?
, .. _.. . w u??3+ed iroi
: ' ? _ _,.....,_». .... ... . ' ir.2,: S
IF MUITI-fAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNERsS FYI Vle- 6-e0,iAdi V1
? OFFICE USE ONLY
??I.?; . - s?t: ? `...1•r7::.Fa??'k?r?,i:?'`... ?.?:?? ?'': ;E?.;1,,,F' .
0 01 Foundatlon
O 02 SF Dwelling
O 03 01 of _ plex
0 04 02-plex
0 OS 03-plex
D 06 04plex
O 31 New
O 32 Additlon
O 33 Alteratlon
0. 34 Replacemerrt
dh« ...;•:
0 07 OSplex O 13°- c'I`6'e O 20 Pool O' 30 Accesaory 91dg
'•.??.bnz S?.?? .... 44f-.i?'O OS 06-plexi O 18:` -t ?l?r?ace ;`• F''YH7 Porch (3sea.) 0 1 31 Ext. Alt - Multl
?r O2
O 09 07-plex O 17 Gerage O 22 Poroh/Addn. (4sea.) O 33 Ext Ait - SF
O 10 08-plex '. • O''tA"'Dedc O 23 Porch (screened) ' 0'" 36 Mutd
0 11 10-piex O' 19 Lower Level ? 24 Stortn Damage
O 12 12-plex . Plbg_Y or _ N ? 25 Miscellaneous
O 35 Int Improvement O 38 Demolish (Interior) " 0 44`
0 38 AAove Bidg. O 42 Demolish (FoundaNon) O 45
- O 37 ' : `- `Demolieh (BId9)' O 43. . . Reroof _.... . _,._. O. . 46.
_ 'DemoliNor (Entlre Bldg only) - lilve PCA handout to appllcaM
Valuation Occupancy MC/ES System
CensLls Code ' Zoning _._._,. _. _._. City Water
SAC Unit§ - Stories -• Booster Pump
Ntx. of Units- Sq.,Ft •---PRV.. - -
Nbr. of Bldgs ' LenAth. Fire Sprinklered
Type ui Const . Width ,
REQUtRED INSPECTlONS
Footings (new bldg) .
Foodngs(deck)' "
Footings(additian) Pluailsing
Foundarion
Diain Tile
Roof Ice & Water Final
Framing
Fireplace _ R.I. _ Air Test _ Final
Insuisuon
I
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Pertnit & Surcharge
Treatment Piant
Plumbing Pertnit
Mechanical Permit
License Search
Copies
oe,er
Total
5iding. '
Fire Repair
Windows/Doors ..
OPbei
_ Poo] _ Ftgs _ Air/Gas Tests _ Final
_ Siding' Stucco Stone
Windaw; (aew/replacement)
.?
.Approved By Building Inspector
FinallC.O.
FIDaU1tiTO, C.O.
HVAC:`i ?
14[4
?q6d'7
BUILDING PERMIT
To be used for DECK
CITY OF EAGAN N? 16575
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 /„
Receipt # ??
$1,000
SrteAddress 3885 GIBRALTAR TR
Lot 22 Block 5 Sec/Sub. LEXINGTON SOUAR
PefC01 NO. Oaupancy
Zoning
W Name STEVE & CAROL DRAKE (ACtual)Const
; Address 3855 GIBRALTAR TR (nllowable)
° City EAGAN Phone 456-0286 # of stories
Length
o Name MIDWEST REMODLERS Depth
,
c"¢ Address 525 E VILLAl1ME AVE S.F 7otal
? City S ST PAUL Phone 451-2221 S.F Fooryrints
On Site Sewage
ww Name on stte weii
? Address MWCC System
,
¢w City PhOl18 CiryWater
PRV Required
I hereby acknowlege that I have read ihis applic on and state that [he BoosterPump
mforrnahon is conect and q ee to co ply wi II applicable State of
Minnesota Stalutes and C' 6 inan .,
Signalure of Permrte APPROVALS
A Building Permit is issued t. NIIDWEST REMODLERS Planner
on the ezpress condition tha a11 work shall be done in accordance wrth all Council
applicable State of Minnesota Staiutes and Ciry of Eagan Ordmances. BIdg.OH
Building Otficial ?D d 1 v Variance
OFFICE USE ONLY
-3 4-'
4141
Bldg Permit
1
FEES
Surcharge . 50
Plan Fieview
snc, ciry
SAC,MCWCC
Water Conn
Wafer Meter
Acct. Deposn
SiW Permit
SNJ Surcharge
Treatment PI
Roatl Unit
Park Ded.
Copies 1.00
TOTAL 27.50
CITY OF EAGAN N o 11539
3830 Pilof Kno6 Road, P.O. Box 21-199, Eagan, MN 55121 -„
' PHONE: 454-8100 S
BUILDING PERMIT Receiptu l
7obe usedlor 'SF DWG/GAR Est.Value $66.000 Date FEBRUARY 25 19 86
Site A 3885 GIBRALTAR TR Erect C? Occupancy R3
d
Lot ?Lrgss Block Sec/Sub. LEXINGTON SQ Remodel ? Zoni Rl
ng
Parcel No. Repair ? 7ype oi Const ?
Addnion ? No. Stories
? METRO CUSTOM HOMES Move ? Length
Name
w 6
4
a Address P• O. BOX 1049 Demolish Int Impr. ? ? Sq. Ft Depth
ciry BURNSV4" 454-9383 nstal, ?
a
o SAME
Name
APProw
i
r0j i
Address
Assessment _
?
`
City Phone
Water & Sew.
Police -
Name Fir
F i e
Address En
g.
w
a City Phone
Planner-
Council-
Ihere6yacknowledgethatlhavereadthisapplicationandstatethatthe gldg.Off.??
information is correct and agree to comply with all applicable State ot
- Minnesota Statutes and City of Eagan Ordinances. APC
? ? ?1 Var. Date-
Signature of Perm'naa ? p am,
A 8uilding Permit is i METRO USTOM HOMES
ssued to:
all work shall be done in accordance w,ittr-all ap$Iicable.State o4 Minnes ta SI
Fees
Permit 331.00
Surcharge
- 33-00
Plan Review ? 5 0
SAC 575.00
Water Conn. 500 . 00
WaterMeter 63.50
Road Unit 290.00
Tr.PI. 156_00
Copies
Total $2,114.00
on ihe ezpress condition that
and Ciry of Eagan Ordinances.
8uilding
5 99ao RESIDENTIAL BUII,DING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
,!?'ru,?-7s
New Construdion Reauiremenfs RemodellReoair Reauiremenis Offce Use OnN
3 registered sNe surveys showing sq. ff. of lot, sq. ft. of house; and all roofed areas 2 oopies of plan Cert M Survey Recd
(20% maximum lot coverage allowed) 1 set of Energy Calcul26ons for heated addNOns Tree Pres Plan Recd
2 copies of plan showing beam 8 window sizes; poured found design, etc. 1 site survey for addi0ons 8 decks Tree Pres Not Reqd
lsetofEnergyCalalalions AddNOn - irMiceteBonsResepticsystem _On-siteSepticSystem
3 copies of Tree Preservation Plan i( bt platted after 711193
Rim Joist Detail Options seleclion sheet (bldgs with 3 orless unils
Date (o_ / JUKR,/ 63 Coustruction Cost WI ??-
SiteAddress M$ S Unit/Ste#
Description of Work 1*4QC 0 T LkrCAft .? CLf1TY\ 1r- .. .Q_3X?`? ??CJ?l?'(?t? •
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner '? ;v(?? -b-eqwA?S Telephoni ) (O?p • 9 0??
Contractor RENEWAL BY ANDERSEN
1920 COLN"CY ROAD "C" WEST
Address
ROSEVILLE, MN 55113 C`ty
State 651) 264-4777 _ Telephone # ( )
LICENSF. 9 20130983
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Su6mitted
. Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
_•-
Telephone # (
Telephone # (
'Tet IQ hDn??# (
I hereby apply for a Residential Building Permit and ac owledge that the information is complete and accurate;
that the work will be in conformance with the ordinance ? d codes of the City of Eagan and the State of MN
Statutes; I understand this is not a pernut, but only an application for a permit, and work is not to start without a
permit; that the work wi11 be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
AGuG. ??So fv //Fl A & As.,r\?
Applicant's Printed Name ApplicanYs Signature
vviv, ,iv^.a LLLV LG.JV . • 1
rna r " a 11 waoo tttsnunAe, !sr enuritttJisn
re .Z
June 7, 2oal
38 6 PIIut Baob Road
EaM MN 55122
To Whom It May COn?:
ffider 7ones is aathoriz¢d to pWl builcHng ponits Por Ranewsl by Mdeisaa Ptease aUow
Alder Jones to pmvide this sefvicc for na in Hagan. Ilia emthocfuticm ig vatid fnr ery
date bcyond 616101: untii aRrnewa! by Andersaa manap?r ezpmdY navolaas it in wiitiug
to the Glty-
I requcst this sutiiorizatiaa be acoepted-expedt@oualy, as to not delay in the-
our baildin8 P?b unY fusfhcr. Plcaac caII mc if dmc u+c wy quenttona.. I? 6f
conbicted at 763-502 47U6. 4,
Your immqdiatc mmtion to Wis mattcr is alp?
SinceYely,
vnd R. Rau
stallation Manager
Renewa( by Andastn Caipotativn
C'c: Karn-F,l?tex Tnnee
.?'??.....C4 ?•??.,.Z4p
?d
my
0 uu:
Received Time Jun. l. 1:07PM
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConsVUCtion Reauiremante
• 7 registere0 site surveys showing sq. ft of lot, sq. ft of house; and all mofed areas
(209'o masunum lol coverage allowed)
. 2 copies of plan showing beam 8 wuMow saes; poured found desgn, etc.)
• t set of Energy Calculatians
• 3 copies of Tree Pmservation %an if lot plafted after 7!1193
• Rim Jaist Detail OpGOns selecdon sheet (WEgs with ] or less unds)
DATE I}_Sf ?OT•U?o
/as? a-? -
RemodeORewir Reauiremenls
• 2 copies of plan
• 1 set ol Energy Calculatrons;or heated aCtlitions
. 1 vte survey for eztenor additions 8 decks
. Intlicate if home served by septic system for a0ddions
VALUATION
SITEADDRE55 C-,1UCAA?-TCO:?? MUL11-FAMILY BLDG _Y X N
TYPE Of WORK),?QC..Q y ."itirbraA FIREPLACE(S) _ 0_ 1_ 2
- -- - ??'-?' - - APPLICANT
RENEWAL BY ANDERSEN, INC.
STREET ADDRESS 1920 CoU1vTY RoAD "C" wEST iTATE _ZIP
TELEPHONE # CEIL PHC RoSEVILLE, MN 55113
PROPERTY OWNER TELEPHONE # (DS) -(o%Q • 9a9?-
-----------------------------------------------------------------------------------------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNLSO'CA RliLk;S 7670 CA"CEGORY 1 1tINNESOTA RL;L1S 7672
(J submission type) • Residential Ventllatlon Category 1 Worksheet Submitted • New Energy Code Worksheel Submitted
• Energy Envelope Calcula6ons Submitted
Plumbing Contractor:
Plumbing sys[em includes:
Mechanieal Contractor:
Mcchuiical svstem incluclcs:
Sewer/Water Contractor:
_ Water Softener _
_ Water Heater _
No. of Baths
air Conditioning
Heat Rccovcn• Systcm
Phone #
Pec: 570.00
------------°--------------°----------------------------°-°---------°--------------------•-----°---------°----°---
I hereby acknowledge that I have read this application, state that the 'nformation is correct, and agree to comply
with all applicable State of Minnesofa Statutes and City of Eagan dinances.
Slgnature ot Applica
OFFICE USE ONLY
_ Phone 4
Iaini Sprinkler
No. of R.I. Baths
Phone #
Fee: SkOiO"
_ i acP 2 3 2002
?
?
" -?
Certificates of Survey Received - Tree Preservation Plan Received - Not ReGuired _
Updated 4102
?°.°•.`"•,? „"' ;°.ou r? 100 0 r1 aaoo "nrtt nranu=un
re Eal
IWAM?
au„e 7, 2001
City of Eagan
3836 PiInt Bnob Road
Eagan, MI+T 55122
To Whom It May Concxrn;
Elder Jones ie authotized to pull bniIding permits for Renewal by Andezaen_ Pleaso allow
Slder Jones to provide this service for us in Eagen. 'Ihin eithorizaticm is valid fnr any
date beyond 616101; until atenewal by Andersen manam wpxewy revokes it in anidng
to the City-
I rcquest this suthocization bc aacepted axpedidously, av to not delay in the proeessing of
our baildinS Pcaatta uay fusthcr. Plcaac caIl mc If thcco am eny qucattona. I can be
cotttawtod at 763-502-4706.
Your immpdieto sticntion to ibis matter is appreciated.
Sinoeiely,
ymond R. Rau
as?tallation Manager
Ronowal by Andason Corporatian
('r.: Ksna-F.i?ier 7nnea Publio
gu::O:n
auuzi u
Received Time Jun. 7. 1:01PM
F O R C I T Y U S E O N L Y ,
PER-MIT °- ISSUED
272 y 312- 6./76
FEES: $ SS:'7LR n°BMZT (I`ICLUDE SUAC?i?RGc)
$ WATER PERh1IT (INCi,IIDE SURC:iARGi)
$ WATER METER/COPPERHORN/OUTSIDi READER
$ WAT°R TAP (INCLUDE CORPORATION STOP)
$ SE:GER TAP
$ =C?Ci;:i'I' :_?GSI=
$ ACCOUNT DEPOSIT - WATER
$ .S D c' • ?'t WAC
$ 7s- spc
$ TRliVK T4ATER ASSESSi?E\T
$ TRiiNK SE:vER aSSESS:IE:iT
$ Lr1TE?..,L BENEFIT/TRUVK SE:•iE4
$ LATc.RAL BENEFIT/TRUNK NATz'R
$ WATER TREATMENT PLANT SURCHARGE
$ OTHER:
$ TOTAL
8 p.A1OLfiT PAZD/RECEI2T
'i
,
G ej
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGi-IT OF WAY?
YES IF YES, THEN n"PERMIT FQR *AORK WITF2IN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
? NO ENGINEE RING DIVISION. LIST AS A COVDI-
TION.
SUBJECT TO THE FOI•LOWING CONDITIONS:
APPROVED BY: ?(,!L 1&-t'u '1v
TI:LE:
i
DATr: ???"<<` /? ?
s i •.51ti I p • i o• o iaI• 7 i5 r. 5 . .Di .
!j Di • i •oW i• •?? • r ?? • ?? • ? ?? ? • • :
•0 o o
CITY OF EAGAN
APPLICATION FOR PERNffT SEWER ADID/OR WATII2 CONPIECTION
1) PROPII2TY ADDRFSS: ; , ; '„' l i , l . l ,
iBSAL DESCRIPIZON:
(Lot/Block/Subdivision or Tax Parcel I.D. Number)
IF EXISTING STRCCiLRE, DATE OF ORIGINAL BUILDIW, PERMIT ISSL?ANCE:
l?nth Year)
PRESENP ZONING/PROPOSID USE: R-1 SINGLE FAMILY (N
R-2 D['PLEX (ZGro IInits)
R-3 TOWNHOC'SE (Three + Units) ( Lnits)
R-4 APARTMENT/COAIDOMINIL'M ( Onits)
CO6'IMERCIAL/RETAIL/OFFICE
IAIDC'STRIAL
INSTITL'TIONAL/GOVERND'lEN'I'
2)
NAME: iJ'",";
ADDRESS:
CZTY, STATE, ZIP:
PHONE:
3) • ra?•
NAME:
ADDRESS: /`?i'?S l'. ?,-li?/ r'??• /
CITY, STATE, ZIP: q
PHONE: MASTER LICENSE #?
4) ? • m
ADDRESS: `? - .. , _ . • ,
CITY, STATE, ZIP:
PHONE:
For City Ose
Plumbers License
t= Active
C7 Expired
O Not Recor(
Staff Initial
.5) ?? ?• •a• ??
COiVNECTION TO CITY SEWER ? CONNECTION 'IC) CITY WATII2
? 0 OTHER (Please Describe) _
6) jff?• I
? PLEASE HOLD APPROVED PERN1iT FOR PICK-C'P BY ONE OF ABOVE
?I P?E MAIL APPROVED PERMZT Z+U 1. 2, 3) 4, ABOVE
? (Circ e one)
7)
11r3
1985 BUILDING PERMIT APPLICATION - CITY
NOTE: ALL CONTRACTORS NUSY BE LICENSED IiITH TF
ENE2GV C?tLS. orJ Pt-n,ti.l
COMQIERCIAL
SINGLE FAM
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFIC
SPECIFICATIONS AND 1 SET OF 1 SET OF E
ENERGY CALCULATIONS $2,000 LANDSCAPE BOND
/ i
? Valuation: ?- Date: _
To Be llsed For: , .b.
? .,?. ?r
Site Address
Lot 2,z- Hloek f-?
i
Parcel/Sub y; ?.;r. i/,a f'
Owner 5fJm,k4-aFi?'
Address 12?tJC?
r
City/2ip Code
Phone
Contractor
Address
City/Zip Code
Phone
Arch,/Engr.
Address
City/Zip Code
Phone A
Erect X
Remodel ?
Repair ?
Addition
Move ?
Demolish ?
Int,Impr.
Install
APPROYALS
USE
0° * 1
331>'_0 +
3^?0+
16.=50+
?75°00+
5.. J> j0 +
63=50+
29:,- '0+
156=:0+
21 :14=i`0 *
Occupancy
Zoning
Type of Const
I! of Stories
Length
Depth
Sq Ft
FEES
Assessments Permit
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off 2 Treatment P1
APC Parks
Variance Copies
TOTAL
c?
?
?
?\
0
-;-,.. .
6004 3l PA. 30
/AOSE
ii1NG CDN31fL71H6 EJi61HEEflS
PLAHNEflS nod LAHD gUAYEYOIlS
ENGiNEf
COMPANY, INC, w
1000 Ex.`.7 1461h 57RE_T, EUAH=vILLE, 1fIHNES0U1 t.w7 P`! 'i?2-?000
CeTzZACtZze O? e [.?
Z.socl ??cr??ie?z • Lo? zZ, B1..oGK 5, ?x1Qt,-ro,? sQu,A¢e, ba,corA
. [o?i,1TY? M WN?SoTA .
`c- F 2? 1:R r l i
nir.1°1nE 7? vT1LlTy
Ff+3.o) ?iEMF_,.lT
C ? n189°oo'oo"v.i
.'??IZ.81 13(0.57 s.c
LCl?
• _ i - /'_
?
N?
0
?
?
,
?
?
1
C 84;
I t^i `? ??
L0T 22
?
?
1
z3.-tr
L _?--
?OR?sE? ? i
Nr"h? ?--
?
r y--i
I3559
. AI $Q °00 00? vV
a-rc.? S
In (
9
?9 S93J ' I
? . w
o ?
.ol o o°
e'! Sy3.'31 l? o
? ?
3.
4,o ? 10
.
_ N
Cggq. C99
30FKa?
SuiLDiu?-, SET-
BdtK ur.lE ?
?$9Ti?)v5.lo'rr-5 -txi,?iTi"t, .Ee.EVaT1o?J .
? 6ys.o ? ?ores , rtw?a F[.E?aripnJ .
'F-IrJD1(6qTES DfKEGTiorJ OF Sk?i,LE nRAinlpE,iE.
P10SNFA LAec41-? R-002 rctVATIW= 894,33
o -P
? No?TH
)
I hereby eartify that thia ia a trse and car:ect rspreaent:tion of a traet of
land as shown'and deeeriDed henon.. Aa praparnd by me on thi: /2r./ day o!
??WA*-j s 19 S46 . '
Minn. 1les. No. /Gav,
. ./.?
3INGLE F9MILY DiiELLIAGS
2 3EfS OF PLiNS
3 REGI3TERED SITE 3DAVEYS
1 3ET UF ENEAGY Cli.C3.
1989 H[1ILDI6a PERMTT APPLICATION
CITY OF EAGAN
14 9'1ff
lIDLTIPLE DiiELLINGS
2 3ETS OF PLAN3
fiEGISTfiRED SITE SOAVEY3 -
(CHECH WITH BLDG DIV.)
1 SET OF E9ERGY ClLC3.
MULTIPLB DWELLING3 HENTAL DNITS FOH SALE UNITS # OF UHTTS
BQTEt EDDRESSFS F08 CDRNER LOT3 - 0ORtAACfOR1HOMEOi1NEA !lOST ffi3SIGNATfi iiHICH ADDRESS
IS DESIRED. HO C9ANGE4 W'II.L BE ALLOtiiED OiCE HOILDING PERMIT I3 I33QED.,
SEiiER 6 AATEA PERMIT FEES 6PD ACCOONT DE40SIT FEES int.L BE INCLODED fiITH THE BOILDINfi
PEMlIT FEE. PAOCFSSING TIlE AOR SEiiER ARD W9TEA PE&lI15 IS TWO DAYS ONCE A PEAMIT HAS
BEEN COMPLETED INDICITING A LICENSED PLOlBER.
PENALTY APPLIFS iifiENs PERHIT IS NOT PAID FOR IN S&ME MONTH IT IS REQfTESTED.
LOT CHANGE IS AEQDESTED OIdCE PERMIT IS ISSUED.
tVAY $ 11989
To He Used For: Yaluation: ? Date:
Site Address ?? G.'bex(,4a/, TQ.
LoL ZL Block -q
Pareel/Sub 40INNi1b11
Owner 15?ev e -4- ccwoL T?-I%L4 (z-
9ddress -i5-'if'S Co;?Lkav- 12_
City/Zip Code
Phone `?S ?n - OoZ a'Cp
Contractor muCuesf ?ew?cn?EJ`?
Address !-;,;)v5 E • (), L1 Ai,Me 1?1?L
Citq/Zip Code ? s. _
Phone 45-1 a-0, (
Arch./Eng^. C9r2?i C?w-
Address a`lS?%
City/Zip Code jwt5 /vwC ?
/OW vrravu wc
Oceupancy
Zoning
Aetual Const
Allowable
9 of stories
Length 3 ?-
Depth
S.F. Total
Footprint S.F.
On site aexage
On aite well _
MWCC System _
City water _
PRV required _
Booster Pump _
Council
Bldg. Off.
Varianee
COFMERCIAL
2 SfiTS OF AACHISECTUR9L
i ST80CTIIRAL PLANS
1 SET OF SPECIFICATIONS
1 3ET OF ENERGY CALC3.
FFFC
Bldg. Permit .c(0•00
Sureharge
Plan Review
SAC, City
SAC, MWCC
Nater Conn
Bater Meter
Acot. Deposit
S/{i Permit
S/41 Sureharge
Treatment P1.
Road Unit
Park Ded.
Copies ?OG!
3QBTOTAL '
Penaltq
TOT9L '1q. 10
Phone 9 ??2 - 2z? 7
. . . ...? =5.1. ?. 1 . ..
8004 3'7 PA. 30
E
80 B -•,
EE'?iNE??ING C pLAHHEBS end?tL?AlID SUaYEYOllS
?CCMPANY, INC. •
? 1000 IAS7 146A STfiE:71 pUpt{„ryILLf . YIHH£SG7a 51w7 p:2 532-3000
C,erzz-AcrMze o? ?SzL?Ye t?
?eocl ??cri 2ie?z' Lo? Z.Z, BLo(,K. 5, LexiNt,mal SQuAM, )AKOTA
. 401AJTY, MiOnIESoTA , ??---
_ .. i ?
<:7 ?
???? i * ?.
$;
Ni
a
Z
i-JL 1 %?i
t?au.l°?nE ? vT?LITy
EM7EMewtT Ij gq °oo' oo" W
:??Z3.??
93
L i4.
1 I L._OT 22'" ?
? I
I ?¢ I ? ?
Z
?
?nor. u-? o
i
`
`
1
1
(?r
10
135•59 1 ?88?•
,/.1 $q °00"00"N/ ?840.7?
I - ?
? (i I l
30?FRa?
?wLD1UC? `aET-
O"K u?.tE
W
o°
?'lr9? ) DGl OTES EX 1'jT o1(n ELEvdT10W
E BySO ? CE.007-ES Rr?ORr?ED FLE%/ATIOAJ .
"? 1?.1DI(,el7fS DIREGTioI.J OF 5u9Fi,6E D941kJA67E
FINiSHED &Ag4&,E RAop cLEVATiOnl= 894,33
o -P
? Nof-rH
. :
4¢}
I henby eartify that thia ie a trse and car.?eci reprzsentitioa of a tract of
land as •hown'and deecribed herzoa.• As prsparnd by me oa tliis i2*d day ot
FeS AaAA4 , 19 846 . ' .
. - ? Ninn. 1les. Ho. /GO?
CITY USE ONLY
L BL RECEIPT #:
SUBO. n r RECEIPTDATE: ?U?
PERMIT # 469 °IN
8000 PLUM$IN6 PEiiMTl' (mID£NTIAL)
crrY oF E?sm
S$SO PIIAT KNOB RD
BAHAA, 31N 55122
651-6$1-4875
Please complete for. ? singie family dwellings
D townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
0?vrIieec
cnrH
TOTAL
r?/?? V\VV
Alterations to existing dwelling - minimum fee
Describe: ?
$ 30.00
Bath tub $ 3.00 x = $
Fioor drain 3.00 x = $
Ga5 i in ouUet ' minimum -1 3.00 X = $
Hot tub/s a 3.00 x = $
Kitchen sink 3.00 x = $
Laund tra = $
Lavato = $
Se t S stem new/retumisned • reulres MPC IIe.
ic = $
C S Stefn abandonment
Se t M = $
$
RpZ new insfallatbNreaidrebuild 30.00 x
Rou h o enin
= $
$
Shower .
Under round s rinkier ifdwalling is underconstrucdon 3.00 x =
= $
$
Under round s rinkler if existing dwellin 30.00 x = $ ?
Watercloset 3.00 x = $
Water heater 3.00 x =
Water softener if dwentn underconstruction 5.00 x
W ater softener ?f exisan awemn 30.00 x =
Waterturnaround 30.00 x >
State Surchar e .50 --> --> ---
-> --> -
Total Reminder: Call for inspections of alterations, i.e. water heaters, water softaners, etc.
- •is --••--- correct, ---- and -••--- agree -- to ----• --- compiy •-- with --- all •----••---...--ot ••--•-------------
tio• applip ble City Eagan° ordinancas
n-------••••----••-•--•-•-------------ti.. _ ... - •-
- this ap-pli•caon,_ state- that° - M- -e•--••--infortna--
I he-reby- acknowledge-ihat I have-read -
It is the applicant's responsibility to nofify 1he property owner lhat lhe City of Eagan assumes no IiaDility (or any damages caused by t?e Ciry duAng its nortnai
operaGOnal and maintenance aaivi6es lo the fa?ciyliGes consWcted under ihis permit wr ifhin City properrylrightof-way/easement.
SITE ADDRESS: 14t ??
'??
OWNERNAME:: TEIEPHONE#: (A RFA coDE)
INSTALLER NAME: KLJ W&- /09O?TELEPHONE #: C _7?'?
?? ?L ?O (AREACODE)
STREET AQDRESS: y{
CITY: ?JLY,('Zptrc ? STATE: ZiP: ?
SIGNATURE OF PE ITTEE
oF
3830 PILOT KNOB ROAD, P.O. BOX 27799
EAGAN. MINNESOTA 55121
PHONE: (612) 454-8100
January 22, 1988
SUE BETTENGA, EDITOR
EAGAN CHRONICLE
1209 CLIFF ROAD
BURNSVILLE MN 55337
Dear Sue:
wcEUxon,
Ma,o,
THOMAS EGAIJ
DAVID K. GUSTAFSOIV
PP7v1EfA McCRFA
THEODORE WACHTER
Courial Memben
1H(AMS HEDGES
atyAdminlaholm
EUGENE VAN OVERBC#
Crcy Cienc
Mr. Steve Drake of 3885 Gibraltar Trail, called my office today
to ask our assistance in resolving a long-running problem with
the delivery service that delivers the Eagan Chronicle in his
neighborhood.
Mr. Drake has filed a complaint about this before and part of the
solution was that the Chronicle no longer be delivered to his
home. Unfortunately, this has not solved the problem. The
people who work for the delivery service continue to walk through
his landscaping and flower beds and Mr. Drake would like it to
stop.
While we recognize the public service the Chronicle provides to
those in the community, we also recognize Mr. Drake's right to
protect his property from trespassing. We would appreciate your
speaking to the delivery service again about this matter. Please
remind them not to cut across yards but rather to stay to
sidewal3cs and roadways.
If you have any questions,
me.
Sincerely,
\1
Thomas L. Hedges
City Administrator
TLH/kf
cc: Mr. Steve Drake
gs
Sue, please do not hesitate to call
THE LONE OAK TREE. ..THE SVMBOL OF STRENGTH AND GROWfH IN OUR COMMUNIIY
OF
3830 PILOT KNOB ROAD, P.O BOx 27199
EAGAN, MINNESOTA 55121
PHONE, (612) 454-8100
January 22, 1988
BRENDA GUDERIAN
THIS WEEK NEWS
2501 E 115TH ST
BURNSVILLE MN 55337
Dear Brenda:
V1C ELLISON
Mra
TFiOhVS FGMI
DAVID K GUSTAFSON
PNv1ElA McCREA
hIEODORE WACFifER
CaMCIIMembers
THOMAS HEOGES
cny ?wmaior
EUGENEVPN OVERBEKE
aN aSA
Mr. Steve Drake of 3885 Gibraltar Trail, called my office today
to ask our assistance in resolving a long-running problem with
the delivery service that delivers This Week News in his
neighborhood.
Mr. Drake has filed a complaint about this before and part of the
solution was that This Week no longer be delivered to his home.
Unfortunately, this has not solved the problem. The people who
work for the delivery service continue to walk through his
landscaping and flower beds and Mr. Drake would like it to stop.
While we recognize the public service Th
in the community, we also recognize Mr.
his property from trespassing. We would
to the delivery service again about this
them not to cut across yards but rather
roadways.
is Week provides to those
Drake's right to protect
appreciate your speaking
matter. Please remind
to stay to sidewalks and
If you have any questions, Brenda, please do not hesitate to call
me.
Sincerely,
`1?
Thomas L. Hedges
City Administrator
cc: Mr. Steve Drake
TLH/kf
THE LONE OAK TREE. ..THE SYMBOI OF STRENGTH AND GROWfH IN OUR COMMUNIN
3/6?1` REQUEST FOR ELECTRICAL INSPECTION EB-00?1?0,
< ? Sae instn.ctions lor completinq this form on back of vellow copy.
420 12 "X" Belnw Work Covered by 7his Request
[NeAAddi XaD. TVPe o1 Bi Appliancee Wiretl EqufUment Wred
Fi
10
I I I I Industrial Bldo. 1 I Air Condrtioner I I 6uik Milk Tenk I
p Fee ServiceEntrenmSize f1 Fee Fenders/5ubfeetlera k Fee Cvcurta
j 0 to 200
Am s 0 30 Am s
ro 0 to 30 Am
Above 20
0 qmps 31
to 700 Amps 31 to 700 A s
Swinuning Pool Above 700_Am s Above 100_Am s
Transformers Irrigation Booms ? Partial,'Other Fee
Signs ? I ISpecial InspecLOn '$ ?
e? T?Ta
? I, the Elactrical
Insoector, hereby
cerhfy that Iha above
6 ins0action hea been
mada.
This repuest void ?/ /? / q 2 3
18 nwmhs fmm ?S d ?? l
C 2312 NxqueSt Deteti Fire No. Rough- n In er.uon
Repu?red? eatly Nuw, [] Will NoIrty, Insoec-
? ?Yes No ??r When Ready
icensed Elec[ncal Convactor I herebv repuest maoaction ai ebove
Owner electrical work ins[alled at
Slreet Address, Boz or floute No. City
3q<35 G? 6 R?4r ?a T??a-- FAg r+rv
ecllon o. Township Neme or No. Range No. Cowrty
Akv'r!+
OccuOanc IPRINTI Phone No.
p'l-rtb il 5" 1 -?13?3
Power SupOlier Adtlress
Fw94VN??v .
o . ?.
T
Elechical Convactor (COm
anv Na
me)
O ontr,artor's Lic
en
se No.
/
-
q
?
b 1
L
F t
?
!:??(?
J•.7 F
.
`
^1?
Y' 4 1
Madine Address IConvactor or Owner Making Instailauonl
,3 ? % F (Z Y 6 D 4c R. r-- !M. N
Author ed S?gnature 1 nhactodOwner Makong Installauonl Phone Number n'`
???' ?F.1
MINNESOTA STATE BOAND OF E(LJEC'fNICITY THIS INSPECTION REQUEST WILL NOT
Grie9s-Midwey Bldg. - Noom N•791 BE ACCEPTED BY THE STATE BOARD
UNLESS PPOPER INSPECTION iEE IS
1821 University Ava., St. Paul, MN 55106
Phone 16121 297.2117 ENCLOSED.
?9 ` REQUEST POR ELECTRICAL INSPECTION EB-OOIHII-M
1 See imtrvctiona tor comoleLng th,s torm on 6eek o1 Yellow copy.
? - 359 X" Below Wark Covered by lhis Request
vwv??n?eo. + Type ol Building AOpli onces Wired EQUiVmen, Wired
Y Fee SBrviceEntrenceSize a Fee Feeders/5ubfaxtlere ? Fee Grcarts
OU 0 to200Am s 0 to30qm S 33? 0 m30Am s
Above 200 qm ?s 31 ta 100 qinps 31 to 100 qm s
Swinaning Pool Abave 100-Amps Above 100_Am 5
TranStormers Irrigation Booms Partial,'Other Fee
Signs Special li'spection g/
.j,<. 54 TOTAL
I, the ElacVical
Inspector, hereby
certify thnt tha above
inspection has been
mede.
Thie request volO
This repuesl void
18 months from
??"13 5 9
Pequast Daie fire No. fl
oup f
nl nsNer,bon
3-6 ?
e? peady Now 0 WiII Noufy, losoe?-
tor Wh
n R
d
Yes ?NO e
ea
y
?p Licansetl Electncal Con[ractor - 1 hereby request ms0ec4on of ebava
LJ Owner electrical work inatalled eC
Street Atldress, Bo. or Foute No.
3295- bra, -?rcz. 7rar 1 Crtv
Cct a'o
ection a. Townshi0 Name or No. Renge No. Cov(nt
Occvoant(PRINT)
0 -forn om ? ` Phone No.
45-L/ - a?P.3
Po.yer SupDlier Atltlress
f
a
Electncal Contract r (COmpanv Nemel
/1'I id lana? Conl actor's Lio;nse No.
1610 -,;L
Madinp AdJress (Comrecmr or Owner Making Ins,aflaboN
?
)d
13&? B
! E
P
a a.v
e?
l
o
Aulhonzed natu
r O akin0 liistallation) , Phone Number
? r/
L7JG?-J(?W
MINNESOTA STATE BOANO OF ELECTRICITY 1 11 THIS INSPECTION pEQUEST WILL NOT
Gli99s-MidwaY Alde. - Hoom N•191 BE ACCEVTED BV THE STpTE BOARD
11N1.ESS PNOPEP INSPECTION FEE IS
1921 Universicy Ava., St Peul. MN 55704
PAnne IRVI 197.9111 ENCLOSED.
r For Office Use
1 i ; • Permit#: L V 1-
EAGAN
s-o
Permit Fee: 1 )-0,
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections@cityofeagan.com
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: frt m Y C 9V 1 . Phone: 1 S 1 970
Resident!
Owner Address/City/Zip: 3 S l h tett 1 ( 1(),r f" . -E ion
Applicant is: Owner f/Contractor
Type of WorkDescription of work: (c-Y 06
Construction Cost: Multi-Family Building: (Yes /No )
Company: QYG t�L�S-t01/ t Y1 Contact: L-07--- !'e YISY h
Address: g LCI YC 5-i- Cit O✓V'l r�l-t Q9
ContractoC Y
State:10/Zip: Phone: 4 / ESS cy/ maii: 1J e u 7 1 . 6:yalloo,c0
License#: C l h Q Q f Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of the Information may be
classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets.
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.citvofeaaan.com/subscribe.
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.
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
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 tart with ut 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.
Luz fey) X .. .. .
r
Applicant's Printed Name Applicant's Signature