4245 Malmo Lane NCITY UF EAGAN Remarks
Addition WILDERNESS RUN 6th ADDITION Lot 2 81k 2 Parcel 10 84355 020 02
Owner street 4245 No. Malmo I,ane state Eagan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 1973 161.21 8.04 20 112.85 A006687 9-15-78
SEWER IATERAL
WATERMAIN
WATER LATERAL
WATER AREA 1977 162.14 ? 15 140.54 006687 9-15-78
STORM SEW TRK J Yd, 97 300.33 - 280.31 006687 9-15-78
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATERCONN. 250.00 10487 6-16-78
BUILDING PER. #4845
sAC 504.00 10487 6-16-78
PARK aV
cirY oF EAGAN
3796 Pilo! Knob Rwd Eagan, M!! 55122
PHONE: 4548100
BUILDING PERMIT
To 6e wed For Est. Value Receipt #
Date , 19
?
Site Address
Erect
Occuponcy
Lat Btock Sec/Sub. Alter ? Zoning
Percel # Repair ? Fire Zone ?
'
Entarge Q Type of Const.
a Nome
Move ?
# Stories
W
z Address
'`ld `yS' ?"
r`
Demolish ?
Front
ft.
.-:.., oL., 1- 7920
i°n
,__ `l Grode ? Depth ft.
o Name
F-
0 a Address
°C S t .
r- r:...
I hereby ackrwwledge that I hove read this application ond stcte that
the information is correct and agree to comply with oll opplicable
State of Minnesota Statutes ond City of Eegan Ordinances.
Signature of Permittee
A Building Permit is issued to:
nll work shull be done in acca
Building Official
Assessment
Woter & Sew.
Pol ite
Fire
-
Eng.
Pianner
Counci I
Bldg. Off.
APC
N° 4848
Fees I
Permit _
Surchorge
Plon check
SAC .
Water Conn. '
Water Meter I
I
Total
on the express condition thnt
applicable 5tate of Minnesota Statutes and City of Ecgan Ordinances.
Parmk # I DeFe lawd I ?wr?Mtk
Date
Finol
Remarks_
CITY OF EAGAN
' 3795 Pilot Keob Rosd
?
Eagon, Minwesota 55122
Pbonr 4548100
HEATING _ PERMIT
Date: !;ePt@]Ilbel' 16, 1',178
Site Address:
Lot Block Sub/Sec. _ ? ?t?
CoMBosTiop aIxA xLIQuiREY
No. 128S
Receipt No.:
Single
Residentlol x
Name ? y=?en Homes Inr. New/Alter./Repoir n` `
.
; Address'27 Sflellinc. Ave.L-o. Cost of Instollotion
O
City St• Paul 55116 phone; Permit Fee 20'nr
No A. Binder & Son, Inc.
Surcharge
?
Address `Je.
e
s
City _ Phone: Totol
This Permit is issued on the express condition that all work shall be done in accordance with all applicable Stote of
Minnesota Stotutes ond City of Eagon Ordinances.
Building Offitiol
cirir oF EA"N
. ` 3795 Pilot Knob Road
w Eegaw, Minaesoro 55122
Phona: 454-e100
r , . . _ PERMIT
Date:
/ 25/78
Site Address:
4245 Malmo Lane
Lot Block Sub/Sec.
WR 6th
Nome iilsen C:onstruction
? Address 627 So. a'nellir ?
-A. Paul
City Phone:
Name cialph' s ?luruting
?
? 9900 ?:es,•,i c?: ,., _. ;t.
Address
e
c?J !- -:?_ 1-• -City Phone:
This Permit is issued on the express condition that all work shall be
Minnesoto Stotutes ond City of Eognn Ordinonces.
No. - 174
Receipt No.:
Single
Residentia l X
Multi Res., Comm./Ind. I
New/Alter./Repair nE
Cost of Installation
20•C'l
Permit Fee
Surcharge . :?.;
Totol . r
done in aaordonce wlth all applicoble Stote of
Building
EWER SERVICE PERMIT
S
cirr aF EAGAN
3795 Pilot Knob Road PERMIT NO.:
Ecgon, MN 55122 DATE: ?
Zoning: No. of Units:
O
wner.
Address:
Site Address: -
Plumber.
I agree to comply with tbe Cilr of Eagan Connection Charge: - --
Qrdinanees. Account Deposit:
Permit Fee:
Surcharge: ---
g Misc. C}wrges:
y
Data of Insp.: Totol:
Insp.: - Dote Paid
CITY OF EAC?AN VUATER SERYICE PERMIT
3799 Pilnt Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: - No. of Units:
pwner:
Address:
5ite Address: -
Plumber.
Meter No.: _ Connection Charge;
5ize: Account Deposit;
Reader No.: Permit Fee:
1 agree to eomply with the Ciry of Eagan Surcharge:
Ordieances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.: Insp.:
This request void 18 months from
_.?,
.1,0 959
P 87906
Date of this Request_ 7-12-1978 °
I, as]U Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at:
.?Oa h ;Z wk'
Street Address or Route No. 4245 Malmo Circlat CityEa_gan
Section Township
Range County Dakota
Wluch is occupied 6y Tilson HoatQa
(Name af Occupant)
Is a roughin inspection required on this job? No ? YesM Ready Now ? Will Calpo
Power Supplier Dakota Cts-. Address Faxr?ington
Electrical Contractor O.B. Thompson Eloctrio Co. Contractor's License W3735
(Campany Name)
Mailing Address 12201 2Jltka Blyd. 94tka 5 3
(EleCtr 1 C tractor 9PXwnff aking Thls Installatlon)
Authorized Signature / ?".+/ •- 'Phone No. 933-?52I.
(Electrlcal Gontra eT'or Owner Making This Installatlon)
????? ? ???? ?p??? This inspection request will not be accepted 6y the
? State BoarQ unless proper inspeetion fee is enclosed.
minnesoca state noara ot tiectncity
79V Lniveraity Ave., St. Paul, Minn. 55104-Phone 645-7703
siw` ? REQUEST FOR ELECTRICAL INSPECTION
CHECK BELOW WOAK COVERED BY THIS REQUEST
P 87906
7ype of Building New Add. Rep. Check Apptiances W'ved For Check Equipment Wired Foi
Home :U ? ? Range le Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fixtures oc
Apt. Bldg. ? ? ? Dryex ? F.lectric Heating ?
Commercial Bldg. ? ? ? Fumace xm Silo Unloader ?
Industrial Bidg. ? ? ? Air Condi[ioner El Buik Milk Tank ?
Farm ? ? ? List ) List )
O[her
?
?
? }
Hehersf 16'?7.
18 . p
}
HeferS1
COMPUTE INSPECTION PEE BELOW
Seivice Entnnce Size: # Fce Feeders&Subfeeders: # Fee Cixcuits: # Fce
U to 100 Am s. 0 td -JECAmpoM 0 to 30 Am exes 10
101 to 200 Amps. 31 t ' 31 [0 100 Am eres
Above 200_Amps. Abo ff00 'Vkks
An Above I OQ_Am s.
Transformexs Rem =
oeCa oIC . Partialoxo[herfee
Signs Special lns ection Minvnum fe
Remarks H2a1
f TOTALF E*r•V 0r50
I, the Electrical Inspector, hereby cer? at t e a4 i s e n has bee?,g?a?o ?
(Rough-in) (./?' w Date
(Final) ? , < ?., !71 Date
This request void 18 months from "
cinr oF eaonN
: 3795 Pilof Knab Road Eogan, MN 55132 N? 4848
_ PXONB: 454-8100
10487
BUILDING PERMIT APPLICATION $41,000. Receipt #
5 f Dw1g, d Gatg• June16 19 78
To be uaed for Esr. Volue Dare
Site Address 4245 Malmo„Ln Erect [i Occupancy i
Lot 2 Biock z $ec/Sub. W 6th Alrer ? Zoning Rl
parcel # 10 84355 020 02 Repalr ? Fire Zone 3
Enlarge ? Type of Const. V
z Name ChaTlES Go15oII Move ? * Stories
z ?d?? 2526 Portland Ave, pe,,,olish {7 Front 65 rr.
p 8/1- 920 One
S Grode p Depth ft.
Ci Phone
? sen Homes, Inc. Avvrovals Fees
o Name
i? Address 627 So Snelling Ave
t. ?-... St. Paul o?....., 698-5501
Name _
Address
1 hereby ackrrowledge thot I have reod this application ond stote thot
the information is correct and agree to comply with GII opplicable
Smte af Minnewta Statutes and City of Eogan Ordinances.
Signature of Permittee _
A Building Permit fs issued
nll work shall 6e done in
Building Official
Assessment Permit 118.00 _
Water & Sew. Surcharge 20. 50
Police Plan check
Fire yqC 500.00
Eng. Water Conn. 250.00
Plonner Water Merer 60.00
Coundi oad [Jnit 75.00
Off
Bldg
.
.
APC
Tmol
HOmes, Inc on the express condition thet
ooplicable Sture of Minnesota Statutes and Ciry of Eagan Ordinances.
RESIDENTIAL BUII.DING
Permit Application
City Of Eagan
lf3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Constnuction Reauiremenis RemodeVReoair Reouirements
3 registered site surveys showirg sq. tl. of l06 sq. ft, of house; and all roofed areas 2 copies of plan
(20% maximum lot coverage allaxed) 1 set oi Energy Cakulafions for heated addifions
2 copies of pWn sMwing beam & wirxbw sizes; poured found design, etc 1 site survey for addiGons & decks
7 set of Energy Calculations Addr6on - indicefe d on-site sepfic system
3 capies of Tree Presenation Plan If lol plat[ed after 717l93
Rim Joist Detail Oplions selection shcet (bldgs with 3 or less units
? 3F5. 3c?
Office Use OnN
CeROfSurveyRecd _Y _N
Tree Pres Plan Recd _ Y_ N
TreePresReqd _Y _N
On-sHeSepticSystem _Y _N
Date -Q%-4
Site Address Ll Z`y `? Y'k,?? Construction Cost w
Unit/Ste #
Description of Work l.t/Rrj?a /?l9A?ni ?/L /) /ZA19 //L
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner ( l2;r;q ?Z t E S C,? Ci L S O? Telephone #((jSh C,
Contractar t%Z-! ti?-- r 14
Address
State
Zip City
Telephone # ( )
t
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 Submitted
• Energy Envelope Calculahons Su6mitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Coniractor
Sewer/Water Contractor
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.
Applicant's Printed Name
Applicant's Sign ture
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling ? 08 06-plex
? 03 01 of _ plex ? 09 07-plex
? 04 02-plex ? 10 08-plex
? 05 03-plex ? 11 10-plex
? 06 04-plex ? 12 12-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
x 34 Replacement
Valuation k02
Census Code y. S !?(
SAC Units -
Nbr. of Units ?
Nbr. of Bldgs "-
Type of Const 7a
W idth
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addirion)
Foundarion
Drain Tile
? Roof _ Ice & Water _ Final
Framing
Fueplace R.I. Air Test Final
Insulation
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 33 Ext.Alt - SF
? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 19 Lower Level ? 24 Storm Damage
Plbg_Y or _ N X 25 Miscellaneous ?grr'L ???M?ya
/Litpq?N
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
'Demolition (Entire BIdO) - Give PC A handout to applicant
Occupancy A ° 3 MC/ES System ?--
Zoning City Water "
Stories ? Booster Pump -
Sq. Ft. - PRV -?
Length l Fire Sprinklered -
REQUIRED INSPECTIONS
FinaUC.O.
? Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool Ftgs Air/Gas Tests _ Final
_ Siding Stucco Stone
_ Windows (new/replacement)
_ Retaining Wall ,
Approved By
Building Inspector
41
nATE V-iq-7AI
HUILDING PERMIT APFLICATION
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
7b be used far al .36Lr Vaiuation
Site Address; IvD• YJ'Jci,(i+z't,0
a
Lot Block Sec. Sub. Parcel Number pa O O?
OHmer
Address oPSaCo !J-Zt,Pallrt '
??hh.GUt ``l2z-42E,? 55?U. -
1 -R {
Contractor 91- ?DC) Address (or,2' ?.Cc%r? CC.C
Arch./Eng.
Address
Telephone
Telephone
Telephone
OFFICE USE
Erect
Alter
Repair
Enlarge
Move
nerrolish
Grade
OPFICE USE
pate of A roval & Initial
Assessment ?.
U?ater/Sevier
Police
Fire
Fng.
Planner
Council
Bldg. Off.
A.P.C.
Occupancy ?
2,oning -
Fire Zone
Type of Const.
# of Stories
Front s
Depth
FEES
vv
sPermit
Surcharge
Plan Check
sAC 4`no•oD_
rlater ('onn. ??., . /JO _
G7 ter Meter 60 • O!?
or?d vn,T 7s •o
l ?
T02AI,
D ;e
Yr
,
o I
?
?
E?
AaPE.e ry
LiN?
?
?
?
=i
AiPvAe2TY LWE
?
W
UNE'
5 -- ?? ?2 6 ------?
- Q
1
\ I
NovcE
\\ ?
36
?
\ 0
f ?
I. i
c7\
LoT ? BLOCK ?
& -?-? ?
?
rRoraT__PROi?Ff?iTY LI.NG =I
-\
4- LC]T _ -P L AN
, . RESIDENTIAL BUILDING
Permit Application
City Of Eagan ? ? v •? ?
3830 Pilot Knob Road, Eagan MN 55122
?G Q Ot Telep6one # 651-675-5675 FAX # 651-675-5694
NewConsWctlonReauiremenis RemodeUReoairReauirements OfficeUs&a? `03
3 registereU site surveys showirg sq. ft of lot, sq ft. of house; and all raofed amas 2 copias of plan CeR of Survey Recd _ Y_ N
(20% maximum lot coverage allowed) lsetofEnergyCalcula6onsiorheatedaddi6ons TreePresPlanRecd _Y _N
2 copies of plan showing beam 8 window sizes; poured found desgn, atc. 7 site survey for addi6ons & deGcs Trce Pres Not Reqd _ Y_ N
7 set of Energy CalculaUons Add'NOn - indicate don-site sep6c system On-srte Septic System _ Y_ N
3 wpies of Tree Preservatbn PWn'rf lot platted aker 1/1/93
Rim Joist Defail Options selecGOn sheet (bldgs with 3 or less units
Date d O / a.S / .2oG3
Site Address r{Z /q L
.E A aa N / 2 3 ConstructionCost
L, NK. UnitlSte #
Description of Work
Multi-Family Bldg _ Y= N Fireplace(s) _ 0_ 1_ 2
Property Owner Cj4pjeLES Telephone #(r.5 () y$ 2^4..Sl' 71-!
Con[racror U
Address
State City
Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
' - Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventliation Category 1 Worksheet . New Energy Code Worksheet
(J su6mission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan2 _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone #(
? L?, i i
Mechanical Contractor Telephone _I If: ? ?nrin
I ? ' ? _?JJ I I I
Sewer/Water Contractor 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 pernut, 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/4 a2L(C 5 GOLSOd
Applicant's Printed Name
Applicant's Signature
OFFICE USE ONLY
Sub Types '
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwalling ? OS 06-plex ? 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 OS-plex IX 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 ? 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
?
"DO 34 ReplaCement
? ? •Demolition (Entire Bidg) • Give PCA handout to applicant
Valuation ,f.ryGG Occupancy R-3 MC/ES System -
CensusCode LY3?/ Zoning A? -i CityWater ?
SAC Units - Stories - Booster Pump -
Nbr. of Units - Sq. Ft. ? JT PRV ` ' -
Nbr. of Bldgs Length / i Fire Sprinklered -
Type of Const ? Width
REQLTIRED INSPECTIONS
Foorings(new bldg) . . ? FinaUC.O.
y? Footings (deck) //Rns,?tl ,£ K/jrtv?l FinaUNo C.O.
_ Footings (addition) ? ? _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ AidGas Tesu _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
?
Approved By
Building Inspector
I l', ?-
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?
I '
a I
?
?
I
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?
??oPE,e rv
LINE
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ED
, C,O_E/?,e. ORooEie r r LwE ?,??
1 ?
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1
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6
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Lor
?
i
?on?T' r?RBi?F(?LTY .LI.NE
?`?i nT -D1 Lnt
Use BLUE or BLACK Ink
r I
I For Office Use
I / [~~7
Permit f 42-lV~I
City of Ea; Permit Fee:^ CAD . D
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
2012 MECHANICAL PERMIT APPLICATION
Dater SOY// Site Address:
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip: Name: G' ' rz_24~~,/,License
CONTRACTOR Address: City: (5_1a
State/~k~ Zip: Phone:
Contact: Email:
New Replacement Additional Alteration Demolition
TYPE OF WORK Description of work: f1lfAze- l f~ pCr~k ~~s~
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
PERMIT TYPE XAir Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install Remove)
Other
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) = $ TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x1%
$60.00 Minimum (includes State Surcharge) Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00 Surcharge
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee
(i.e. a $10,010-$11,010 Permit Fee requires a$ 5.50 surcharge) TOTAL FEE
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.popherstateonecall.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.
x ®iJ~hnL~ x may,
Applicant's Printed Name A licant's Signature
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
Underground Rough In Air Test Gas Service Test In-floor Heat Final HVAC Screening
Use BLUE or BLACK Ink
For Office Use- -__--A-^-
I 1
Permit I
~ I
City C off Eantain I Permit Fee I
1
3830 Pilot Knob Road r
I Eagan MN 55122 PECEOVE0 Date Received: I I
l
Phone: (651) 675-5675 2 J 2012 1 Staff:
Fax: (651) 675-5694 APR 1
2012 RESIDENTIAL BUILDING PERMIT APPLICATION ~d'l66---s / ~
f I I L, Date: I ~7 ~ Site Address: ~ ~ S"- )V*~ N Unit
-
C Phone:
Name:i G C . 0,
RESIDENT
OWNER Address/ City/ Zip: (9-_(p
Applicant is: Owner Contractor
Description of work: J r k ~4~
TYPE OF WORK ~ cp
Construction Cost: I_ Multi-Family Building: (Yes / No ?
.J
Contact: I can , v
Company: ~Pc
Address: '1Z 1(n V'Z~,C i s_ L&,,I-.- City: A la6j m k A
CONTRACTOR
State: IrPV Zip: Phone: ~02~ 3~`► `1
License fiC (P-S I 1~ 46q) Lead Certificate 11`0 V]
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
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.ao herstateonecail.ora nces
perm t; that odes ofkhe Cbity e o the will in
and I hereby acknowledge that this information is complete and accuratethat the work will be in wconforma
is to start w not n e with th ordina
Eagan; that I understand this is not a permit, but only an application
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
X ZZ
d Applicant's Signature
Appi1 a'nt's Printed Name Page 1 of 3
Gl
1"60 NOT WRITE BELOW THIS LINE /n
SUB TYPES
Foundation _ Fireplace - Porch (3-Season) - Storm Damage
Single Family Garage - Porch (4-Season) - Exterior Alteration (Single Family)
_ Multi - Deck _ Porch (Screen/Gazebo/Pergola) - Exterior Alteration (Multi)
_ 01 of _ Plex - Lower Level _ Pool Miscellaneous
_ Accessory Building
WORK TYPES U- rave n-0 0rl
New Interior Improvefient Siding - Demolish Buildings
T Addition Move Building _ Reroof _ Demolish' Interior
X Alteration - Fire Repair _ Windows - Demolish Foundation
t" Replace _ Repair _ Egress Window - Water Damage
T Retaining Wall `Demolition of entire building - give PCA handout to applicant
DESCRIPTION r ~j~
Valuation A Occupancy 1n ' Af- _ MCES System
Plan Review Code Edition -04 „g,) 7 SAC Units
(25%_ 100%-) Zoning City Water
Census Code / ` Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
p~o Width
Type of Construction
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Final / G.O. Required
Footings (Deck)
Footings (Addition) Final ! No G.O. Required
Foundation HVAC Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final
Siding: -Stucco Lath -Stone Lath Brick
Framing
Fireplace: -Rough In -Air Test Final Windows
Insulation Retaining Wall: Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee/ y 22 t~
Surcharge
Plan Review r~
MCES SAC
City SAC '
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
/ge2of3
Use BLUE or BLACK Ink
r I
I For Office Use
Permit L c~.3 II
City of Ea~a~ I .0
I Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 I Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 L Staff:
2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 5 -7-2c, /2 Site Address: ~/V < 5~~~
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City/ Zip:
Name:. ~J- License #c
tow-
Address: old L r~.i ~6~ ~ City: bllnaklk, Ple CONTRACTOR
State: j1 r~ Zip: yT Phone: 1 (g mn~G
Contact: V r i'1 ce.wf ! oAe Z~ Email: C b r n tga,1 f cot,
TYPE OF WORK New - Replacement Repair Rebuild Modify Spa e _ Work in R.O.W.
Description of work:. AU J.L - t I Sir Uc
RESIDENTIAL
Water Heater
Water Softener
PERMIT Lawn Irrigation RPZ / _ PVB) TYPE
Septic System dd Plumbing Fixtures Main / Lower Level)
New Water Turnaround
Abandonment
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $189.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
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.aopherstateonecall.or
I hereby acknowledge that this information is complete and accurate; that the work will be i conformance 'th the or ances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and w rk is not to s rt witho a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and app v of plans.
t,
x~ a i.± C (~Ae x
Applicant's Printed Name A is is Signat e
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final