4230 Malmo Lane NCITY OF EAGAN
3745 Pitot K+wb Rosd
Eogon, Minnesota 55122
Phoete: 454-8100
PLtME PERMIT
Dnte: 10-26-78
Site Address:
4230 W. Ea.lmO LsYu
' r,? F
Lot ?` ?? Block 9 Sub/Sec. WP, 6 th
No, 1254
Receipt No.:
12192
Multi
x
Nome T31sen How3, Inc.
New/Alter./Repair
9 0 Address 627 SO. St=ellirtg
Cost of Installotian
City 99' p8Ul Phone: 698-73,04 Permit Fee 20'00
Name `Alpb rs plumbfng Surchorge .50
? Address 1?? V. e?awick Aw.
e
City Phone: <F _ , !1• ? ?
Total
This Permit is issued on the express condition thot all work shali be done in accordance with oll oppliwble State of
Minnesoto Statutes ond City of Eagan Ordinances.
Building Officiol
CITY OF EAGAN Remarks
Addition WILDERNESS RUN 6TH ADDITION Lot 10 Blk 4 Parcel 10 84355 100 04
Owner 1??' J A !' ? street 4230 North Malmo Lane State Eagatt, Minnesota 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1
973
.
•
104.79
A007163
I2-7-78
SEWER LATERAL
WATERMAIiV
WATER LATERAL
WATER AREA 162-14 ,&d • A007163 12-7-78
STORM SEW TRK ],9..59 ?,r)_ 254 76 • 07I 12-7-78
SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 25a 00 lj']']$ 9-22-78
BUILDING PER.
SAC 9-22-7$
PARK :5-9 - 77
BUILDING PERMIT
CITY OF EAGAN
3830 Wlot Knob Road, P.O. Box 21-199, Eagan, MN 55127
PHON E: 454-8100
Receipf
Site Address Erect L.,J, Occupsncy
?Y 1 1, `.-
Lo2 I j Block eC/Sub f I N Remodel ? 2oning
.
Perc;el No. Repair ? Type of Consc,
Addkion ? No. Storiea
Move ? Length
•? ? rs i . .?. ;
s Name ?
Demolish
?
Depth
?
Address Int Impr. ? 5q. Ft.
City Phone - - Install ?
A Nams
?? Addrea
1- City Phone
Neme
Addross
City Phone
( hercby acknowledge that 1 haw reod this application ond stote thot
fhe inforrr?otion is torrect ond oqree to comply with all opplicoble
State of Minnssoto Stotutes and City of Eayon Ordira??us.
Sipnature of PennittM
A Buildinq Partnit Is Issusd to: "?'--- ;3'•
all work shall be dorw in oooordonce with oll applitobls Stott of Mfr
Buildinp Offitiol ?
Assessment
Woter 3 Sew.
Poliu
Fin
Eny.
Plonner
C,ouncil
Bldg. Off.
Permit
Suroha?ge
Plan Revlew
SAC
Water Conn.
Water Meter
Road Unit
APC I Parks
Var. Date
J /??p
- CoP+es
Total
_ on fM -xpro- oonditlon fMi
City of Eaqon Ordinoncss.
Plumbioq
H.VA.C.
I Inspeetion Date I Intp. I Other I
Framing
Final Htg.
Final Plby
Flnal
Cert/Occ.
Water
WNI
Sowor
Pr. Dlsp.
CITY OF EAGAN 94R(;
3830 Pilot Knob Road, P.O..Box 21•199, Eagan, MN 55121
PHONE: 454-8100
QUILDING PERMIT RKe+vt #
Te M w"d fer DECK Esf. Value -Dote _- -_ • , 19 `S 4 --
Site Ad 4 2 3 0 NO N1ALM0 LN
Lot To Block Seclsub. WILD RUN b
Parcel No.
l Name -.,-- ? ,.,..t,."
; Address A}IE
b City ----Phone Z, o Nane _
ul Address
F- Citv
Name
Address
City Phone
I hereby ocknowledge that I hove
the informotion is corretf ond o
Stote of Minnesoto Stotutes ond
Sipnoturo of Permiftee
A Buildinfl Permit Is Issued to:
all work shall be done in atoa
\
Buildinp Offidol
oll
;f •
ond state thot
oll opplicable
Erect ? Occupancy R3
Remodel ? Zonfng
Repair ? Type of Conat. V
Enlarge ? No. Storiejj
Move ? Length J
Demolish ? Depth 16
Grade ? Sq, Ft.
Appro rals fess
Assesvnent
Woter 3 $ew.
Police
Firo
Enp.
Planner
Countil
eiay. otf. 8/21/84
APC
Var. Date
Pennit " `
Su?chorya • 5 0
Plon check
SAC
Wcter Conn.
Water Meter
Rood Unit
Parka
Total
on the lxpress condition Ihat
Stotutes a.+d Ciry of Eagon Ordinorxes.
Permlt No. Pwmit HoWer Dsto
Plumbiny
H.V.A.C.
Ebctrie
Soheosr
Impection Date Insp. Other
Footingt
Foundation
Fnming
Rough Plbq.
Rouqh HVAC
Inwlation
Final Plbq.
Final HVAC
E Final
Cert/OCC.
Waar De?ibe Location:
YVell
5swer
Pr. Dbp.
; Site Address
' Lot Block
?
,.
? Name
? Address
c City
L
c Name
Address
p City
TYPE OF WORK
Forced Air
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN
?3830 PILOT KNOB ROAD, EA(3AN, MN 55122 DATE: '
PHONE: 454-8100
' BLDG. TYPE WORK DESCRIPTION
A"' Sec/-§ub
Res. New
? r -~- Mult Add-on
. Comm. Repair
•
Phone Other
FEES
RES
HVAC 0-100 M BTU
.
ADDITIONAL 50 M 8TU
Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - i PER PEFiMln
COMM/IND FEE - 196 OF CONTRACT FEE
M BTU
M BTU APT. BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
MINfMUM RESIDENTIAL FEE - ALL ADD-ON &
M BTU REMODELS
- $24.00
- 6.00
- 1.50 EA.
- 12.00
- 20.00
_ 5(1
fi' r
CASH RECEIPT
, CITY OF EAGAN ?
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
RcciIvao
19
AMOUNT $ 1
i
4't v ? Ek oa?L.nRs
?oo
p cASH ? cHEetc
Thank You
sY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
3795 Pilot Keo6 Road Eagee, MN 55122 N2 4974
PHONE: 454-8100
BUILDING PERMIT
$ite /lddress ?+c .; v iw. . . _ ....
Lot Block?Sec/Sub.
Paroel #
0: Nome i:ber
z llddress 1052 i;eete.c
Reteipt #
_i..,. ' n..&- CntC;;f?ET 1` , 10 78
? PIpmC 'i ann H?g,, ]iy,? :
0' Address 1 isig
,48-5501
Name _
/lddress
I hereby acknowledge that I hove reod this application and state thot
the information is oorrect ond ugree to mmply with ell oppliwble
State of Minnesota Stotutes and City of Eagon Ordinonces.
Signoture of Pem,ittee
A Building Permit is issued to: ,.-
otl work sholl be done In uccordance with oll applicable Stote of Mir
Buildirg Official
Erect Q Occuponcy
Alter ? Zoning '
Repair ? Fire Zone
Enlarge Q Type of Corrst.
Move ? # Stories
Demolish ? Front ft.
Grode ? Depth ft.
Apvrovah Fees
Assessment _
Water & Sew.
Pol ite
Fim
Eng.
Plonner
Council
Bldg. Off. _
APC
Permit _
Surcharge
Plan check
SAC
Water Conn.
Water Meter
Total • 51
on the express condition thot
5tatutes and City of Eagan Ordirances.
Pensk # poh Inuad PermMfM
Plumbing ! ?S ? rp •,z?> - 7 $
(,
T
Mechanicol
?-t?-
INSPECTIONS DATE INSP• Rouph-In Final
Footings Dote Date Inaa.
Foundotion Plumbing 0-
Frame/ins. ? /j- , Mechnnical
Firwl
Remarks:
' SE
c
, r EACAN WER SERVICE PERMIT
9195 Pitot Knob Rood PERMIT NO.:
Eogan. MN 55122 DATE:
Zoning: No. of Units: ,
ner:
._:. . - ., ..
? -
.
ddress:
ite Address: -? 'LL} ! .n
Jumber: '+? ,??rn,r• ..r,?.?.,
. . . , .., ,
,•
_
-
ogree to eomplp with the City of Eogae y
.
.
is
Connection Charge: ^e4!:
:???,
dinances. _
?
Account Deposit:
- Permit Fee:
Surchqrge:
BY Misc
Ch
.
orges:
Date of Insp.: ToYal:
Insp.: D
t
P
d
a
e
:
oi
'Amp-
r EAGAN
P
l
'9
WATER SERVICE PERMIT
6
i
ot Knob Road PERMIT NO.:
gon, MN 55122 DATE:
oning: - No. of Units:
ner: 7.8G- `i - -
Address:
Site Address: F ' . r •
Piumber:
Meter No.: Connection Charge: _
dbLEize: Account Deposit;
der No.: Permit Fee:
grae to eomplp wilh the Citq of Eagan
ta Surcharge:
dinances. Misc. Charges:
Total:
By Dote Poid:
Dote of I nsp.: - I nsp.:
CITY OF EAGAN
3795 Pilot Kno6 Rmd fuean, MN 55123 N? 4974
' PHONEs 454-8100 j17? ?
BUILDING PER MIT APPLICATION Receipt #-_
$51,
000.
ba used ior
T Volue
Est
SF D
S G
T
1 Date September 19, 19 78
-
o .
e.
w
P
a
Site Address 4230 No, Malmo Ln
Erect
Occupancy I
4
10 WR 6th Alter ? Zoning RL
Block
Lot Sec/Sub.
oir ?
Re Fire Zone ?
Parcel # p
Enlorge ? Type of Const. V
? Name Robert J 0'Brien µove ? .#Srories
3 Addrew 1052 Keefe pemolish ? Front 64 ft.
?
Grode ?
Depth .
40 fr.
Ci Eagan phone 454-7304
u Avvro"y Fees
g Name mt1 STIR6
?? Address 622 o Sn 9ng
? ,.;,,, St. Paul Pti,,,,, 698-5501
Assessment _
Water & Sew.
Police -
Fire
Eng.
Planner _
Cauncil _
Bldg. Off. _
APC _
Nome
Puldress
I hereby acknowledge that I have read this appiication and sMte thot
the infortnotion is correct and agree to comply with oll applicable
State of Minnesota Stakutes and City of Eegan Ordirwnces.
Signoture of Permittee
A Building Permit is issued to: Tils Homes, Inc
nll xrork shall be done in acw (nf? w?i all p' able State of inrv
Buildinp Official ?a G-
Permit 14L.UU
surcha.ge 25.50
Plan check
ye,C 500.00
Water Conn. 25? • ?
WaterMeter 60, 0
Total 977, 50
on the express rnndition that
Statutes and City of Eagan Ordirwnces
.
BUILDING PERMIT
SiteAddress 4230 NO MAI,MO LANE
Lot10_Block4-sec/Sub. WILD RUN 6
Parcel No.
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8700
ReceipT # -
? I Narne ROBERT O' BRIEN
? Address SAML''
city Pnone 454-8544
rc
s0
u
f
Neme _
Address
City -
Phane
LW Name
FW
i? Address
u
tw City Phone
I hercby ackrwwiedga rFwt 1 hove road this cpDlication cnd stote thaf
Nq inlormotion is Correct and oy ,ree to wmply wioh, all appliwble
State of Minnewta Stctutes an9 Qihnof Eaaan CKdihancas.
Siprwturo of Permittee r v?i
A Building Permif Is issued to: ' BhIEN
dl work sMll be done in occordance witlrall a oobla Stafe of
N_ 9y?8
J ?/OV
Erect ? Occupancy
Remodel 2oning
flepair ? Type of Const.
Addition ? No.Stories
Move ? Length
Demolish ? Dep2h
Int. Impr. ? Sq. Ft.
Instell O
Approvab Feas
Asuument Permit ?c nn
Wofer d$ew. Surcharge 1? n n
Police Plan Review
Fin SAC
Erq. WaterConn.
Plunrxr Water Meter
Council Road Unit
Bldg. Off.7 / 76 /8 S Tr. PI.
APC Parks
Var. Data Copies
Total
on ths axpreaf eonditlon thot
xs9t1_t utea and Ciry o£ Eapan Ordirances.
BuilNrq Official
. . .
? ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
#I t INCLUDE 19 SETS OF PLANS,
/6 CERTIFICATES OF SURVEY
p ? Q SET OF ENERGY CALCULATIONS
To Be Used For: Q.c?fL Valuation: Date: o'?
site Address: L?23a k,p ?nd:,"'? ?- • •
Lot: Id B1ock:?Sect/Sub: bda Erect: x Occupancy: ?-3
Parcel #: /o Remodel: 2oninq: (Z-I
Repair- Type Of Const:
Owner: Enlarge: # Stories:
-- - Move: Length: 3n
Address: Demolish: Depth: ?
City/Zip Code: &Va. ? JnZ ? Grade: _ Sq. Ft.:
Phone # : y !N? F)V?
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./Eng:
Address:
City/Zip Code:
Phone#:
Assessments:
Water/Sewer:
Police:
Fire:
Engr.:
Planner:
Council:
Bldg. Off.:
APC:
Variance:
?
Permit:
Surcharge: ,?25
Plan Rev.:
SAC:
Water Conn:
Water Meter
? Road Unit:
/.l/z? Parks:
? /s,0?)
CITY OF EAGAN N9 9486
- '? 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454•8100 &
BUILDING PERMIT Receipt # 3 3
Te M wad lor DECK Fst. Value $1,000 pate SEPTEMBER 7, lq 84
SiteAddress 4230 NO MALMD LN Erect N Occupancy R3 •
-
lot 10 Block 4 ?ec/Suh. WILD RtTN f Remodel ? Zoning ?
Parcel No. Repair ? Type of Const. V
Enlarge ? No. Stories
? ROBERT O'BRIEN
Name Mave ? Lemgth 3? ^
Z S?E
Address Demolish ? Depth 16
9 ?
454-8544 Grade
Sq. Ft.
• citv vhone
o Name SAME
Address
? City Phone
?w Name
?W
20 Address
= City Phone
°L<W
I hereby acknowiedge thot I have reod this applicotion ond stote that
the intormotion is corrett and agree to comply with all applicoble
State of Minnewro Stotutes City of oyon Ordino.
i Z?r
Sipnoture of Permittee A'
?
Approrob Faes
Assessment
Water & Sew.
Police
Fire
Enq.
Vlonner
Council
BIdg.Off. g 21 84
APC
Var. oate
Permit Y1 I . JV
SurcFarge • 50
Plon check
SAC
Wafer Conn.
Woter Meter
Rood Unit
Parks
Total ?I8.00
A Building Permit is issued to: ROBERT O BRZEN on the exprcss tondifion thal
oll work shall be done in ac once w h all applic ble Slote of Minnewta Stotutes and City of Eugan Ordirwnces. '
/
Bulldinp Otficial
This request wid
18 nwnths from
E 318 0 4
9/15/88 "?YeS°> ?No glReatly Now Q W,II NoUfy InY ec-
?or When pead
? Licensed Electncal Convactor I herabv reauest insoaction ot above
? Owner electrical work inatalled a[.
Street Atldress, Boa ar Pome Na. (Liry
4230 North Malmo Lane Ea an
ei o. TownShiD Name or No. Range o. Counly
Dakota
OccupentlPNINTI Phone No.
O'Brien
Power Supulier AAdress
Dakota Farmin ton
Eleeincal Con[ractor (Comoany Name) Convactur"s Llcense No.
Hilite Electric, Inc. 040445
Matmg AAJress IConiractor or Owner Makin9 Installavonl
953 Shawnee Road
Au )ed S,8^atur n ctor/0 ner Makiny Installationl Phone N um0er
MINNESOTA STqTE BOAND OF ELECi11tICITY THIS INSPECTION REQUEST WILL NOT
Grigps-Mudway BIAg. - Room N-091 eE ACCEPTEU BY THE STATE BOAPD
1821 Universilv Ave.. Sc Paul. MN 55104 UNLESS PPOPEP INSPEGTION FEE IS
o......e oa»1 ana_nnnn ENC LOSEO.
REQUEST FOR ELECTHICAL INSPECTION pee-ooaoi-os
See insirucnons tor co ? ??
? mpletiny t`is form on back of Vellow coOK
r?3180 4 "'X?' Below Work Covered by 7his Request
pdd ReO TVPe of Bwldinp ApDliancea WireA EquiUmem WveA
Home Range Tem{wrary Service
Duplex Water Heater Liyhtiny Fixtures
Apt. BwIAmg Dryer Electric HeaUn
Commercial 81dy. Fumace Silo Unlonder
Industrial Bldg. X Air COndrtionfr Bulk Milk Tenk
Farm Othet Peu v Other ISne,1y1
, .. sveoiiv me, ntn.,
omaute lnsnection fee Below -
M Fee ServiceEnvaneeSIxa k Fee Feadees/SUbfexders k Fer Circwts
U to 200 qm s 0 to 30 Am s 0 tn 30 Am
20
A6ove 0 qmps 31 to 100 Amps 31 to 100 Am s
Swinmi
ng Pool Above 700_Amps Above 100_AmPy
Transformers Irrigation Booms U Partial-'Other Fee
$igns Special Inspection
5 i
O/
r
TOTAL FE
xemarks J
_
.. ?
19352
Pough-in. D1Le I.the Elac 'ca
InsDectoq M1ereby
cartdy lhet 1he above
Final peclian has baen
mede.
myrepuealvoidl8monihsirom --. ?'?• --•
Minnesota State Board of Electricity
10947Jniversity Ave., St. Paul, Minn. 55104-Phone 645-7703
' ABMJLST FOR ELECTRICAL INSPECTION
CHECK fsi.RK COVERED BY THIS REQUEST
R 28251
Type of Building New Add. Rep. Check Apptiances W'ved For Check Fquipment Wired For
Homc 3M ? ? Range pgx Tcmporary Wiring ?
Duplex ? ? ? Watcr Hea[er ? Lighting Fixtures kk
Apl. Bldg. ? ? ? Dryer ? Electric Heating ?
Commercial Bldg. ? ? ? Furnace oC Silo UNoade[ ?
Indus[rial Bldg. ? ? ? Ait Condi[ionet„, ? Bulk Milk Tank ?
Farm ? ? ? L?? ' 4 List
Other ? ? ranz.' o
Fjt thers#
R
ere
COMPUTEINSPECTION F
0 to lU0 Am s. 0 l0 30 Amperes ?? 0 to 30 Amperes 11111
I
101 to 200 Am G 31 to 100 Amneies 3] to 100 Amoeres ?
Remarks
H811 I TOTAL FEf 6.0?) I406
I, the Elec[rical Inspector, hereby certi?f the ' mspection has been maae.
(Rough•in) ?Date
(Final) Date
This request void 18 months from
*As CequeSi 4oid 18 months from
.
!0 • 4- / d[ / vG
w /2-G oH R 28251
Date of this Request 10-17-1978
I, as M Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 4230 North Malmo City ? _
Section Township Range County Dakota
Which is occupied by Tilsen Homea
fName oi OccuDant)
Is a roughin inspection required on this job? No ? Yes g; Ready Now ? Will Call EX
Power Supplier Dakota Cty. Address I''armi.ngton
Electrical Contractor O.B. Thomgeon IIectric Co. Contractor's License No. A3?W5
(COmpany Name)
Mailing Address 12201 Mtka Blvd. 9 Mtka 55343
Authorized
(ElactHCal Contra4l11 or }Owner
C/-VElllVE MOM C VIl ?p fJ
No. _ 933
This inspection request will nat 6e accepted 6y the
State Board unlas proper inspection fee is enclosed.
50S2-2 BUILDINCRPERMIT PPLICATION 70 CEI
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
New Conawdion Raauiremenb RemodaVRaoair RauuiremeMs
• 3 registered sRe surveys shoxhng sq. (f. of lot sq, fl. of house; and all roofed areas • 2 coPbs nf Wea
(20% maximum bt coverage allowed) • 7 set of Eneigy Cakvlations fw heated addiGons
• 2 copies of Man showirg beam & window sizes, paured (ound Oesign, etc.) • i srte survey fa extarior additiore & decks
• 1 set ol Energy Calculalions • Indicate if home Served by septw system Por additions
. 3 copies of Tree Preserva6on Plan rf lol platted aRer 1/1/93
. Rim Joml Detail OpUOns seleCion sheet (ddgs wAh 3 or less unifs)
DATE VALUATION */ ? (D0 O
SITE ADDRESS '12-30H0.I Ghp L.ati o? MULTI-FAMILY BLDG _Y _ N
TYPE OF WORK IiP /nrs ,0 1 AlL FaDno 40C) mn fIREPLACE(S) _ 0_ 1_ 2
? 3?5 ??C?rcl??a•? ?e,
feSe (-v i
APPLICANT Qo-
'
STREET ADDRESS I3$ 3 6 C Cc1/`vo,%. (?i lr?(1-e CITY ntosewvu 4eh STATE H!?ZIP 5'20 eN
TELEPHONE # 6S'(-Y23^7163 CELL PHONE # Sgi /-751S =L-2V1t . FAX # 65`f -YZ!3-7/6 s
PROPERTYOWNER (ZO 6eir-tii/LDS-e O f6G4e x) TELEPHONE# 651- `/5'Y-9541 y
---------------------------°---°-----------------------°--------°-----------°-------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ yfINNESOTA RULES 7670 CATEGORY I M?I?nC?U?77l
(J submission type) • ResidenUal VentilaUon Category 1 Worksheet Submitted • ?E?y e??'Ja???s
• Energy Envelope Calculations Submitted II ? MAY 2 2 2002
Plumbing Conhactor:
Plumbing system includes:
Mechanical Conhactor.
Mechanical system includes:
Sewer/Water Contractor:
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
--------------------°----°-----------°-----------°-----------°-----------------°-----------------°------°--.._._..
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicanf
OFFICE USE ONLY
_ Water SoFtener _
_ Water Heater _
_ No. of Baths
_ Phone #
Lawn Sprinkler
No. oF R.I. Baths
Certificates of Survey Received - Tree Preservation Pian Received _ Not Required _
Updated 4l02
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex O 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 Sf Dwelling 0 OB 06-plex O 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) C3 36 Multi
? OS 03-plex ? 11 10-plex A 19 lower l.evel ? 24 Stortn Damage
? 06 04-plex ? 12 12-plex Plhg_Y or kN ? 25 Miscellaneous
0 31 New x 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •Demolition (Entire 81dg only) - Give PCA handout to applicant
Valuation M2 Occupancy 2`3 MC/ES System
Census Code 434 Zoning k-I City Water
SAC Units ? Stories - Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs ? Length ? Fire Sprinklered
Type of Const JF? Width "
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinallNo C.O.
_ Footings (addirion) Plumbing
_ Foundarion ? HVAC
Drain Tile Other
Roof
Ice & Water Final Ftgs _ AirlGas Tesu
Pool _ Final
_
)t Framing _ _ _
Siding Stucco Stone
Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
y? Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
.J.ros97 RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
657-681-4675
New Conetructlon BeouhemaMa HemodelRieoslr ReaulremeMs
• 3 regisiered ste surreys showing sq. tl. of bt, sq. tt. of house; and ?II roofed areas • 2 copies of plan
(20qamexinumhtcoveragealbwed) • lsetafEnergyCekulatlonsforheatedatldlGOns
• 2 copies ot plen showing beam & window sizes; poured tound design, etc.) • 1 stte survey for ezterbr addAions & decks
• lsetofEnergyCakuletbns • Indicetetlhomeservedbyseptksystemforadditions
• 3 copies of Tree PreServatbn Plan it bt platled after 711/93
. RM Joist Defall Optbns selection sheet (bMgs wM 3 or less unils)
DATE S- 2? - 0 Z VALUATION
SITE ADDRESS `1 Z 3 0 ?w ?+'vt--b ? f V MULTI-FAMILY BLDG _ Y _ N
TYPE OF
FIREPLACE(S) _ 0 _ 1 _ 2
SELA ROOFING & f?EMODELiNC v
APPLICANT 4100 EXCELSIOR 8LV0
. STREETADDRESS ID#UO01o5o CITY STATE_ZIP
TELEPHONE # CQ12-`6Z3-`?j'Dy(oCELL PHONE #
FAX #
PROPERNOWNER C?d?) CJ l'a,rrc.?..i. TELEPHONE#e4-?
COMPLETE THIS SECTION FOR uNEW° RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1
(4 submission type) . Residential Ventilation Category 1 Worksheet Submitted
• Energy Envelope Calculatians Submitted
Plumbing Conhactor:
Plumbing system includes:
Mechanical ConhacMr: _
Mechanical system includes:
Sewer/Water Conhactor:
Air Conditioning
Heat Recovery System
Phone #
Lawn Sprinkler
No. of R.I. Baths
Phone #
Phone #
MAY 2 1 2002
S
Fee: $70.00
I hereby acknowledge that I have read this application, state ihat the information is correct and agree to comply
with all applicable State of MinnesoTa Statutes and City of Eagan Ord),nances. / n
Signalure of Applieant
OFFICE USE ONLY
_ Water Softener _
_ Water Heater _
No. of Baths
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4l02
??i -7 1
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Constructian Reouirementa RamodellReaair Requirements
• 3 registered site surveys shaxing sq, ft. of lot, sq tt of house, and all roofed areas • 2 copies of plan
(20% manimum lot coverage allowed) • 1 set of Energy Calculations for heated additions
• 2 copies of plan showing beam & window s¢es; pou2d found design, elc.) • 1 site survey tor e#enor add'N'ons & decks
• 1 set of Energy Calculations • Indicate if home served by seplic system for additions
• 3 coples of Tree Preservahon Plan it lot platted aNer 7l1193
• Rim Joist Defail Options selection sheet (bldgs wAh 3 or less uniGS)
DATE b. '?4'aa VALUATION $0?(10() ?'
JOB SITE ADDRESS ya 13 () 19). h`7q.11Lt (1 /- Qyl
IF MULTI-FAMILY
PROPERTY OWNI
TYPE OP WORK]
APPLICANT PiO
ADDRESS 3 k
PAGER #
CELL PHONE #
FAX #
NEW RESIDENTIAL BUILDING ONLY - FILL OUT COM
Energy Code Category _ MINNESO'1'A RULLS 7670 CATl.('>ORY
(check one) - Residential Ventilation Category t Worksheet S
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
New Energy Cade Worksheet Submitted
Plumbing Confractor: _
Plumbing System Includes:
HOW MANY UNITS?
Walcr Softencr
Watcr IIeater
No. of Batlis
T 0 dm
13 2002
SN
Phone #:
Lawn Sprink]er Fee: $90.00
No. of R.I. I3:dhs
Mechanical Contractor. Fl ?l G' S/' L) c.-Oryl A1n
Mechanical System Includes: _ Air Conditionitig
_ Heal Recovery Systcm
Sewer/Water Contractor:
Phone #
Fee: 470.00
Phone #
All above information must be submitted prior to processing of application.
I hereby acknowiedge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan OyiJinances.
Slgnature of Applicant
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 2002
ay°'"FIREPLACE(S) _ 0 '1 _ 2
2 PHONE# 45? ?qD- J7?
CODE?
I !
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
[iOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
lJa
To Be Used For: Valuation: Sst Date: ?_IS-$J'
Site Address: ?a?p }ip ?p.Qy,ti,p, OFFICE USE ONLY
Lot: ? vBlock ? Sect/Sub?r,Jtc? Erect
? Remodel
Parcel # Repair
Enlarge
Owner Move
? rt Demolish
Address Grade
City/Zip Code trv, ,
Phone
Contraetor
Address
a
City/Zip Code
Phone & -? - as-o 7
Areh,/Engr. _
Address
City/Zip Code
Phone 1!
APPROVALS
X Occupancy
_ Zoning
_ Type of Const
Il of Stories
_ Length
_ Depth
Sq Ft
2
5
Assessments Permit -
.
Water/Sewer Surcharge
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council oad Unit
Bldg Off? Parks
APC Treatment P1
Variance
TOTAL a[ C'? , (7?
? ?
qi ?
?
nnTE rl 14r, '1 e)
BUILDIPdG PERMIT APPLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
-4?'(,o'j- fd"
To be used foz Valuation `j J,C?0C7 ?
site Address: {/9- 30 A!
/U sl
Lat Block Sec. Sub.
Owner `n..C1-tJ??hl. ?'
Address /p?-?
Parcel Number
Telephone 4G4-7&0,V
Contractor t,Cn.e? 5??-r.?d, c?c? •
Address (o a 9 ,40,
.Q.?
0:55/
Arch./Enq.
Address
EZ'BCt v
Alter
Repair
Enlarge
Nbve
ber.iolish
Grade
OFPICE USE
Date of Approval & Initial
Assessment water/Sewer `
Police
Fire
Eng.
Planner
Council
Rldg. Off.
A.P.C.
Telephone & C! ?' sod /
Telephone
OFFICE USE
Occupancy ?
Zoning
Fire Zone .4
Type of Const.
11 of Stories
Front
Depth N
FEES
ad?
Permit
Surcharge
Plan Check
SAC ?DO (
Ulater 4bnn.
Water Meter 40
TOTAL
??
i
?
?
? I
?
I I ?
?
,
1?
? 1-
??oP?e rv
Liwc
:
M
?
_Fq-o7 ?
f
" ,v_Er?? All&70ERTY LaVE ?
i
?
?
??
UNc
y ?Q
NovSE I
s'
? --? --- ? ? ?
Y ?/ (
.
??`-
Waw N'l"`ma-? A,-I,--- ?
LoT /D BLack ?
rkoNT._?ROpFrLTY _LI_Nt O
F`?LOT -PLAN
2004 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan
? ?? 3830 Pilot I{nob Road, Eagan MN 55122
Tclephone # 651-675-5675 FAX # 651-675-5694
% Tj 0_C?U
NewConsWctionReauiremenis RemodebReoairReauiremeMs _
3 regisle2d site surveys ahowing sq. ft of b4 sq. ft of house; and ell roofed areas 2 copies of plan ?? n', z ??_ '?•`'??'?` ri??
r. ;? .'+ aw
? r s€?=+ :'"'?
(20% maximum lot cov?age allowed) 7 set of Energy Calculations for heated additions r? =:x
??.. ?;s?,???•-
2 copies of plan shairing heam & window sizes; poured fou? design, etc. 7 sde survey for add?ions & decks '?,
1 set o( Enetgy Calculations AddRiar ? Ndicafe Non-s7te sepfk system
3 copies of Tree Presenation Plan if bt platted aker 711/93
Rim Joist Detail Options selection sheet (Wdgs wifh 3 or less unifs
Date ?_ I? 0 l64? Construction Cost
Site Address eyZ 3 D /16-?Q f
tts•t o -? ?2- UniUSte #
Malmu Ldne N
Description of Work f9 ?//??C Y/ / n s e4- WC ltiGt d W S
Muiii-Family Bidg _ Y & N Fireplace(s) _ 0 _ 1 _ 2
Property Owner E4 1P tn Telephone #
CODlI'8Ct07 C- Q Y? E Y e r
/? /
Address City 6\.p Setl f C( C
State ?p? Telephone # ?`?I' S ?6RQ
r? r zooa I II ?I
COMPLETE TF113?-ii4RREA=0NIL1f°iF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 Minnesota Rules 7672
Energy CAde Category , Residential Venfila6on Ca[egory t Worksheet • New Energy Code Worksheet
(J submission type) Submitted Submitted
• Energy Envelope Calculafions Submitted
Have you previously constructed a building in Eagan with a similar planZ _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
N If so, 25% plan review
Telephone #(
Telephone #(
Telephone # (
I hereby apply for a Residential Building Permit 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 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.
S"Peve 6Arlsoot
Applicant's Printed Name
i?? ?a/?'K
Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement 0 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation Q 45 Fire Repair
? 33 Alteration ? 37 Demolish Building• ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement "Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump •
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing _ Siding , Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test ` Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
---------------------------
Base Fee ---- -----------------,-?--,-?i -?-- - -----
?B -v V ----------------°----------------------------- -----------------------
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge '
5&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
??
Total •
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsUuction Reauirements RemodeVReoair Reauiremenls Otfice Use Onlv
3 registered site surveys showing sq. ft. of lat, sq. ft. of house; and all roofed areas 2 capies of plan Cert M Survey Recd Y N
(20% maximum lof coverage allaxed) 1 set of Energy CalculaGons for heated additians Tree Pras Plan Recd _ Y_ N.
2 cropies of plan showing beam & wiMow sizes: poured found design, etc. 1 site survey foraddNOns & decks Tree Pres Requlred _Y _N
1 set of Energy CalcuWtlons AddMbn - indicate ilon-site sepfic system Dn•site Septic System _Y _ N
3 copies of Tree Preservation Plan if lo( platted after 111193 '
Rim Joist Defail Options seleclion sheet (bugdiigs with 3 or, less units)
Date i / l 7
105 ?'
Constraction Cost -Ygy
(7 . C317
SiteAddress 14z30 tVoe,? Malr»a 1" l V UnidSte #
? acL m iv s I z3
Description of Work a Pafi-o dbOYS
Muiti-FamityBldg _ Y_ N rirep3ace(s) _ 0 _ 1 _ 2
Property Owner &b Ob{' j y.n Telephone # ( > !05/ - `15 ?l- ?5 y?
Contractor l?Il*"
Address a F r U(e' City &rr2iJ( ((,.g
State /Y? N z;p 5 5/13 Teiephone #( ??O5/- ? 95 -3?S-0
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
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Galwlations Submitted
Have you previously
fee applies.
Licensed Plumber /
.
Mechanical Contractor"'
SeweNWater Cant-racto
.. : <;
Telephone #(
Telephone #(
Telephone #(
I hereby apply far a Residential Building Permit 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
5tatutes; I understand this is not a permit, but only an application for a permit, and wark 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.
)IniP_ile V nWuGhe?-
Applicant's Printed Name.J
a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
pplicanYs Signature
City otEapu
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit #:
Resident/
Owner
Name:
�Qdl./ Phone:
Address / City / Zip: -340 //4L40 L,i-14/k'
Applicant is: Owner ontractor
Type of Work
Description of work:
Construction Cost: ? /DQe�-Co
Multi -Family Building: (Yes / No
Company: QV -F at -R-L Contact: Deja u p k /
Address: 1 �p LOCI �iL9Si: 11 IrCity: -9,44,1041Z5
State: NA/ i Zip: S-5-3 7' Phone: 40/O — 0 / 4) — /
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:
Mechanical Contractor:
Phone:
Phone:
Sewer & Water Contractor: Phone:
NOTE; Plans and supporting documents you submit are `considere
the information may be classified as non-public if you provide specific
conclude.:that the are trade Seer
ublrc information
.... 'arms
rio
CALL BEFORE YOU DIG. Call Gopher State One CaII 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.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 S uilding Code must be com • • ted within 180
days of permit issuance. �j
x /2 nJ / `��U�' �ly/119
Applicant's Printed Name / Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
r
For Office Use
Ill0- 7City of Eaaall :::e:
6- 0o
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675
Staff:
Fax: (651) 675-5694 L
2017 RESIDENTIAL PLUMBING� ) /hUMBINGnPERMIT APP ICATION
Dater 1 Site Address: �d (9 , /' D
Tenant: Suite#:
£ ..� Name: /44/
V`,,� J" v C I
/ � � $4(Resident/Owner I1(iy7J41S'G1
y-7, Phone: ev- 3
Address/City/Zip
A0 YY/4/i/vo LA/
g Name: A)70/C)5i/C.)W1 Piin License#: l /'
COntraCtOr 7 i
Address:
n 066ft i o(-- ^ J City: 5r0°le/Y-4 �7/
State: �` ` IV Zip: ������ Phone: L�� ^ <�7��� �� /
i
Contact 4 IU O's'7/"Email
Type Of Work )( New 1` Replacement Repair _Rebuild _Modify Space _Work in R.O.W.
lDescription of work: �-t�/j0 (� ' � `"1 t�I �'11► �OUd� �CE��I�( ��u''���
RESIDENTIAL CF~ i._ ..~
t Water Heater
Water Softener
Lawn Irrigation ( RPZ/_PVB) ;'
Permit Type Add Plumbing Fixtures( Main/_Lower Level) li
Septic System i
_New Water Turnaround
Abandonment e
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
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. f
x 79V' p fU Y C) '7/O ' x /1I��
Applicants Printed Name Applica • 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:
Use BLUE or BLACK Ink
r
For Office Use
*' City of Eaaall ::::
/17/ 9/6
: I c`+ `j -3=-5-
3830 Pilot Knob Road
Eagan MN 55122 Date Received: `6' `l7
Phone: (651)675-5675
Fax: (651)675-5694 Staff: ni ....
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 44 270 MAL-P-4' t-"' N £A' rr,ZT Unit#:
Name: ►,�� C1+aur€NI Phone:
Resident/
i Owner Address/City/Zip: LI a•70 Ara/N.0 Lev ^, r CAN rbiev f7/2-7
I
Applicant is: Owner k Contractor
Description of work: I Ni^"' /LEA.,,. ^T
Type of Work x
4
Construction Cost: ?oo Multi Family Building: (Yes /No >c )
r
Company: Igf"14. Qu fl fric Contact: 1?(Lb1 V 2A°+,vg.
I
Contractor g Address: 2-Cp7 LAO fiefrrr,F q„( City: Sr_ (A -
i
State: Zip: rrl11 Phone: C[2-uo--� Email: bride, e grr'.e.bwiVeiin,.><,c„�.
€
License#: t C Cq$fi.o Lead Certificate#: NAr-ft;7( pf—1
If the project is exempt from lead certification, please explain why:
1
I
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
1 In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
I
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. M
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.
x Pt(A' 2A01. x ! ?______
Applicant's Printed Name Applicant's Signature
Page 1 of 3
Use BLUE or BLACK Ink
r -.
For Office Use y
::::e:
)*0 Clty of Ea�a� LO
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: 42 TO f7A c.•-lo LN N- Unit#:
Name: /yjlki CH/t.1rFNikebe �. a.�u,,. .,.. ,�.�,-.-.�...,.�....�.Phone: .21P- 2.7.4 'Nye
Resident/
Owneri Address/City/Zip: 14,2.L MAIC Liv N-
I t
i Applicant is: Owner ?c- Contractor
Description of work: r�l�c.q no.
Type of Work
Construction Cost: *to,- Multi-Family Building: (Yes /No )r )
�•� �Company:. . m ft�fPr.� 9(441,00.-^,f ��/G��. e...�..n r
Contact: U nry 2-4
Contractor i Address: 2CF3 Lkir fit : 04+,K City: Sr. PAti.,
I State: Jae✓ Zip: -Jit) Phone: 6,t -245 2.1 mail: 1124A,Y e 1:41PovfQur ,,,f`gN_C,,,te
z
1 License#: Oc c,5:(2.0 Lead Certificate#: PIA'r Fire)yFT-1
If the project is exempt from lead certification, please explain why:
i
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
IIn the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
i Yes No If yes, date and address of master plan:
i
1 Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor:
i 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
s
conclude that fit are trade secrets. _ ___ __ _ _ _
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48hoursbefore 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.
x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA159176
Date Issued:11/26/2019
Permit Category:ePermit
Site Address: 4230 Malmo Lane N
Lot:010 Block: 004 Addition: Wilderness Run 6th
PID:10-84355-04-100
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace & Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
James M Christensen
4230 Malmo Lane N
Eagan MN 55123
(218) 234-9448
Home Energy Center
2415 Annapolis Lane N #170
Plymouth MN 55441
(763) 476-1990
Applicant/Permitee: Signature Issued By: Signature