2871 Highview Ter
j Permit
City of EI Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 j Date Received: j
Phone: (651) 675-5875 1 staff:
Fax: (651) 675-5694 1 I
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: AQt:1-11 Site Address: off ' l ~Ui Tc. f,(a -e unit
Name:'(. Q 1 q~ Phone:
RESIDENT
OWNER Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description ofwork:X'0XQs u 1 ~LIf1~1{l..l ' "~X s
es No
Construction Cost: 3. Multi-FamihBuilding: (Y
rr
Company- h~~ ~ Contact:
CONTRACTOR Address: _Hao CLJ w 1~ ~~.r~t City: _ ^~'l~~.P'
state( m Zip: 1 Phone: WSt -a (9 "'I -q ~ ?7 _
License M Lead Certificate Q1 ) Ot d g
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 A Water Contractor: Phone:
N Lew ns r~ ! # t + + ri e r Mart ,lre~~ 6`i~tir» ~Ie` ~rf~ldef ee~~ ~ ~ x M cif "
rite frtinrmatlQn fnaY b cfasml non.-pWbtif ylulrovide sprdc+f1~ r; t J lfft
ca ; ~ thaf t . :tCi
CALL. BEFORE YOU DIG. Call Gopher State One Call at (651) 464-000,,2, four ?rotectlon against under round utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. I wwur.oool'+erstateonecall.ora
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 reviewand approval plans.
x ato &e^So,-,
Applicant's Printed Name Applicant's Signature
Page I of 3
T'd 0GT91rL9T99 30IAN3S 1IWM3d a I S th Oft=9T TT02 ZT Bald
.
EAGAN T01INNSHIP Nc 187
BUILDING PERMIT
Ownex -S?/--- t
Addxess (prese i) ?..
Builder _-----..........__..._`.:......----__... -
Address
DESCRIPTION
Eagan Township
Town Hall
'
Dale --
°----- -
Siories To Be Used For Fron! Depih Height EsY. Cos3 PermiiFee Remarks
? ??%??eJ?E3? -/'O ?? ? !/ , ?/kY?? /d ,;Z3
LOCATfON
Slreei, Road/or olher Descripfion of Loaafion ( Lo! I Block I Addifion or 'Craax
This permit does nouthorise !he e of sireeYS, roads, alleys or sidewalks
the right to creafe asiYuation whi a nuisance or which presenls a hasard
general welfare fo anyone in the communiip.
THIS PEAMIT MUST BE ??7
pp?
q? ON T PREMISE WHILE THE WORK IS IN
?
?
/
This is So eeriify, ihaY..!??!.?Lf?..2. .?
..?I ------------- _..has permission Sa erec
the above dssc " ed premis ' he provisions of the Building Ordinanae
1955.
.
................. -- -- --- - - ------°- --- --- -`- - - ------------ Per __.-..---..._------
Chairman of Tow a r
? `I ZIJ'?r L/JlLt9 `./? ?
nor does ii ?ve the awner os his agenf
!o !he heaftfi safeiy, canvenience ?and
PROG
! a ......... ..... .._....' ......._"'.".....__.._._..._upoa
for Eagan Toy/?fChip adopled April 11,
??
Building Inspector
CITY OF EAGAN Aemarks
Addition Valley View Plat 1 Loc 6 aik 5 Parcel 10 81400 060 OS
owner Street Highview Tes?aee stace $agan, N1N 55»1
U .. <.? .__?
Improvement Date Amount Annual Vears Payment Receipt Date
STREET SURF.
STREETRESTOR.pgV1R 1962 $73$.00 $73.50 10
GRADING
OSAN SEW TRUNK 1968 $100.00 $3.33 30
* SEWERLATERAL 1970 ZO
WATEFMAIN
*1?cWATER LATERAL 1970 $2510.00 $125.50 ZO
* WATEFi AREA 1970 ZQ
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIOEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC $200.00 2019 12-9-69
PARK
.IEALp ?-) 2006 RESIDENTIAL BUILDING PERMiT Arrr.icnTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New Construction ReauiremenGs
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas
(200h macimum btcoverage allowed)
1 Soils Report'rf proposed building is to be placed on disNrbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of EneTy Calculations
3 copies of Tree Preservation Plan if bt platted after 7/153
Rim Joist Detail Options selection sheet (buildirgs wifh 3 or less units)
Minnegasco mechanical venfilafbn form
. RemodeVfieoair Reauirements
V 2 copies oi plan showing footings, b2ams, joisis
1 sel of Energy Cakulations for heated addNOnS
"A site survey for additbns & decks
Addition - indicate Kon-site sepfk system
Telephone # (
Date -7_. _ / $ i Ob 6
Coastruction Cos[ 0'
Site Address o`? g7 ? Nj uh v,10
? W (?//.a c-e UoidSte #
Descriptioa of Work (y/¢rqct9=
Multi-Family Bldg ^ Y---N Fireplace(s) ? _ 1 _ 2
Property Owner Mt421C Telephone #(/,%l ---
?
L
S
e-
Coutractor
Address Cifyl4u /
State Zip Telephone k (`' -') ? -
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category , ftesidential Ventilation Category t Worksheet • New Ertergy Code Worksheet
(? submission type) Submitted Submitted
. Energy Envelope Calculations Su6mitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N It yes, daTe and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
-1 S2-4 -CAO
Ofice VJse Onlv
CertWSOrveyAecd`., _Y N
ShcsRsport- _[d
TreePre"s_PlanRecd Y
TreePreSRequired '-_Y " N
On-srte SePtic System ° -_Y ==: ry
Telephone #( ?
I hereby apply for a Residential Building Permit and aclnowledge 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.
?'IA 21C VD 1,6r
Applicant's Printed ame
el" 1??
Applicant's Signature
DO NOT WRITE BELOW TIIIS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace 6 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex fk 17 Garage ? 22 PorchlAddn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/perola) ? 36 Multi Misc.
? 05 03plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
D 06 D4plex ? 12 12-plex ? 25 Miscellaneous
Work T es
31 New ? 35 Int Impravement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaGement `Demolition (Entire Bldg) - Giva PCA handout to applicant
DeSCriptl00: Water Damage _ Yes
Valuation Occupancy MCES System -
Plan Review 100% or _ 25%
Census Code G! 3?l
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) _ Sheetrock
_ Pootings (deck) FinaUC.O.
_ Footings (addition) ?- FinaUNo C.O.
Foundazion HVAC
Drain Tile Other
Roof Ice & Watec Finai Pool Ftgs Air/Gas Tests Final.
? Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ RI. _ Air Test _ Final _ Windowr
_ Insulation _ Retaining Wall
Approved By: , Buiiding lnspector
--------- -
Base Fee - - ---
---1---??-^- ------------------------------------
- ? --
Surcharge 78?( I?J i7r)T?4Ea2A ?AAN?? 4"6
plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
! •
,. . ..
2006 RESIDENTIAL BUILDING rExivrr aPrLIcnTiorr
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
NewConsWctionReouiremenis -
3 reg'stwed sife surveys showing sq. R of lot, sq. R of house; and all rooted areas
(20%maximumlotcoveragealbwed) 2 mpies of plan showing beam & wlndow s'ves; poured tound design, etc.
1 set o( Enefgy Calwlations
3 copies of Tree Preservation Plan d bt platted aftw 711/93
.
Rim Joist DefaO Optlons sekction sheet (bu8dings w8h 3 or less units)
Minnegasco mechanical venlllation fwm
RemodeLReoair Reauiremenls
2 copies of plan shaxmg fooUngs, beams, joists
1 set of Eneqy Calwlatlwis for heated addiUons
1 site survey for adddions & dedcs
Add'dion - kmqcafe i(orFSRe seAtic SYnem
't + p . oa
Cac.l(" 8'l`l. 4'J
?
Date --/ ConstrucNon Cost ?, . 4? 00 .ov
SiteAddress 91 4,2 7/ /?-%4?r?eln/ / 2lP.aC-P? Unit/Ste #
Descripriou of Work D f u?u ! l9 v,4!1? 1.,IU ?
Multi-FamilyBldg _ Y4N Fireplace(s) *90 _ 1 _ 2/VO 00d4lp4 I'YZft-
Property Owoer IA i d ? Telephone # (/r37 )
Contractor f/ D i ?
Address f fi-trr City F q
?
State ell rJ Zip Telephone #(65/) y87- 8_S?
%h
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category - Minnesota Rules 7670 Cateeorv 1
. • Residential Ventilation Category 1 Worksheet
(Jsubmissiontype) Submiried .
. Energy Envelope Calwlations Submitted
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a
_ Y _ N If yes, date and address of masTer plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone #(
1pp6
I hereby apply for a Residential Building.Permit and acknowledge that the informarion 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.
j? c
?AD?7?lL b O / A?-it-'/'A 1
"ApplicanYs Printed NarrA pliant's Signahue
,-
Minnesota Rules 7672
. New Energy Code Worksheet
O ted
4 2006 RESIDENTIAL BUILDING rERMIT nrrLicaTioN
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Nza Construc6on Reauirements
3 reg'stered site surveys shaxing sq. ft. of lot, sq. ft. of house; and all roofed areas
(20°k maximum lot coverege allowed)
1 Soils Report'rf pmposed building is to be placed on dislurbed soil
2 copies o( plan showing beam 8 window sizes; poured found desgn, etc.
t set of Energy CalcuWtions
3 copies of Tree Preserva6on Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (build'mgs wifh 3 or less units)
Minnegasco mechanical ventilatlon (ortn
RemodeVReoair Reauiremenls
2 copies of plan showing foo6ngs, beams, joists
7 set of Energy Calalations for healed addNons
1 site survey for additions 8 decks
Adddion - irMkate 'rf oo-sde septic system
Office Use OnN
CeAofSurveyRecd -,. _Y. _N
SoilsRepoR. - -- _Y _N
Tree Pres Plan Recd .' .- _ Y. ? _ N,
Tree PresRequired_.!: -.. _Y - _N
On-sdeSepticSystem „r -Y _N
Date
Site Address Construction Cost
UniUSte #
Description of Work
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner Telephone # ( )
Contractor
Address
State City
Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
EnO?gy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
submission type) Submitted Submitted
• Energy Envelope Calculations Suhmitted
In The last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of masier plan:
Licensed Plumber Telephone #( )
Mechanical Contractor Telephone #( )
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 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.
luplicanYs Printed Name
ApplicanYs Signature
?
-
? DO NOT WRITE BELOW THIS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ?NN 17 Gsrage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo/perola) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvoes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
'27( 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement •Demolitlon (Entire Bldg) - Give PCA handout to appliwnt D@SCriptlOtl: Water Damage _ Yes
'
Valuation (
'!y
d
Occupancy
MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
_ Footings (new bldg)
Footings (deck)
? Footings (addition)
Founda[ion
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
REQUIRED INSPECTIONS
_ Sheetrock
Final/C.O.
Final/No C.O.
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Smne Lath _Brick
_ Windows
_ Retaining Wall
Approved By: T -2, , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
, .
?M,6
5???
?PI-y
2l opb
?. . I f
? 14o?
2005 RESIDENTIAL BUII..DING PERNII'T APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Conshuction Reauiremenls RemodeVReoair Reouiremen4s Otfica Use Onlv
3 registe2d sAe surreys shawing sq. ft. of lot, sq. h. of house; and all roofid areas 2 copies of plan CeA of Survey Recd _Y _ N
(20%mazimumlotcoverageallowed) 1 setofEneyyCalculationslorheatedadditlons TreePresPlanRecd? _Y _N,
2 copies of plan slqwmg beam 8 window sizes; poured found design, etc. 1 sRe survey for addifions & decks Tree Pres Required .. _ Y_ N
7 set of Energy Calculations Addition • irMicete tlon-Oe sepfie system Onsfle Septic Sykein _Y _ N
3 coples of Tree Preservatlon Plan'rf lo[ platted after 711/93
Rim Joisl DeWil Options selecGOn sheet (buildings with 3 or less uni4a)
Date /0 //S-/
Site Address 2-87 1 '?? l
j4) (Tf4V )? Coostruction Cost /1 RI 213S
7r-?G69_ Unit/Ste #
Description of Work
Multi-Family Bldg _ Y)( N Fireplace(s) X, 0 _ 1 _ 2
Property Owner MOKJD 16V Telephone tt ((tS7 ) q87- 59&S
Contractor SC,Orc x W' Ni$T- tg i?1 IN C-
Address rz-o2-`I
State nA (\j 1_0(:A(_? P-Q
Zip S5 3?7q City
Telep6one #(b )2 ) Z, g2"6SI S?
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
(4 submissiontype) Submitted Submitted
. Energy Envelope Calculatfons Submiqed
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Tetephone #(
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 applicat on for a permit, and work is not to start without a
permit; that the work will be in accordance with the appro d pl in the case of work which requires a review and
approval of plans.
&-Nr&L 14 &ock
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool
? 02 SF Dwelling ? OS OB-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 Ot of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.)
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screenJgazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-piex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45
? 33 Alteration ? 37 Demolish Building' A, 43 Reroof ? 46
? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to appllcant
Valuatfon 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
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
REQUIRED INSPECTIONS
_ FinaUC.O.
_ FinaVNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S8W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 30 Accessory Bldg
? 31 E#. Alt - Multi
O 33 Ext. Alt - S F
0 36 Multi Misc.
Siding
Fire Repafr
Windows/Doors
RESIDENTIAL BUII.DING
? Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
% ? ? --?J ,1!?
C:I d . f3
New Canstruction ReauiremenLs RemodeVReoairReauirements 9tfice UseOnN
3 regisffired site surveys shawing sq. R of lot, sq. ft of frouse; aM LR roofed areas 2 copies of pYan CeA of Survey Recd _ Y _ N
(20°k maximum lot coverage allowed) 1 set o} Eneryy Calculations for heated addNons Tree Pies PWn Recd _ Y _ N
2 copies of plan showing heam 8 window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Reqd _ Y _ N
1 set of Energy Cakulafbns Addition - inditate i(on-site septic system On-site SepGC System _ Y _ N
3 wpies of Tree Preservalion Plan if lot platted after 711193
Rim Joist Defail Optbns selection sheet (bldgs with 3 or less units
rI
? ?
Date /? / O3
Site Address ?b
b17? ,
Construction Cost 5?
631 lV`; Q1_ j ?ry,ca c.r UnidSte #
DescripHonofWork S7 4 ?? Wi.acjoW oC doo ???
Multi-Family Bldg _ Y-$-1V Fireplace(s) Y-0 _ 1 _ 2
Property Owner A ")Z / /&7? Telephone # ( (?S/ ) ?jS7' S '78-5
Contractor ?-Q ? ? ?to d'Y?Ty 6 wN-?rL - M??J? V d 1 q 1
Address -7
1 4,
State ^1/
? E?7 7P,,,,.q Cy
Zip S$?/ -2- 1
City
Telephone #( Gr/ ) 7- .f783?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(J submission type) Submitted Su6mitted
• Energy Envelope CalculaUOns 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 #(
Mechanica) Contractor
Sewer/Water Contractor
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.
1?_4z 4 g K /' °?-
Applicant's Printed Name ?
o `
App 'can's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
O 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N;K 25 Miscellaneous
Wark Types
? 31 New
? 32 Addition
X 33 AlteraGon
O 34 Replacement
Valuation
f7?
CensusCode y3y
SAC Units
Nbr. of Units
Nbr. of Bldgs -
Type of Const Zz_
_ Footings (new bldg)
_ Footings (deck)
_ Fooungs(addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
Fireplace R.I. Air Test Final
? Insularion
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 30 Accessory Bldg
? 37 Ext. Alt - Multi
? 33 6ct. Alt - SF
? 36 Multi Misc.
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundatlon) ? 45 Fire Repair
? 37 Demolish (Bldg)• ? 43 Reroof J;` 46 Windows/Doors
'Demolition (EMire Bldg) - Give PCA handout to applicant
Occupancy /? '3 MC/ES System
Zoning City Water -
Stories Booster Pump -
Sq. Ft. PRV -
length - Fire Sprinklered
Width
REQUIRED INSPECTIONS
FinallC.O.
FinaUNo C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ A'u/Gas Tests _ Final
Siding Stucco Stone
? Windows (new/replacement)
_ Retaining Wall
Approved By , Building Inspector
1116PERMIT # I Slb
RECEIPT DATE: II ^ b- lJ /
?
itE.SIDERTI!!L PLUM$Iftfi PEOiT Af 'PI1CATION
crrYoFFAsm
S$SO fILOT Kft06 RD
i:ASAA, Mft 551 E8
651-8$1-4675
Please complete for:
SITE ADDRESS:
?
OWNERNAME::
\L
INSTALLER NAME:
STREET ADDRESS:
C/-) '
sm' • . -c.-c-, c? r"' .- ,rY, NJ
TELEPHONE #: (a51_"I62.- UU_j I
(AREA CODE)
TELEPHONE #:JJ ? ? 33`t -(O 11 L
(AREA CODE)
cirv: ?? ?- G a vrro r?a
Place a check mark next to the oermit work tvue
ZIP:
New residential dwelling unit under construction and not owner/occupied $ 90.00
Add-on, modification or alteration to existinp dwelling unit, including: $ 50.00
• abandonment of septic system
• new installation/repairlrebuild of RPZ
• lawn irrigation system
• water turnaround
Nature of work:'
°eptic °ys:em, new/teiuroisned - - $ 225.00
• includes County & Consulting Inspector fees
• requires MPC license
State Surcharge $ 50
Total $_.5L_'5_0
Reminder. Be sure to schedule inspections of alterations, i.e. water heaters, water softeners, etc.
I herebyacknowledge that I have read this applicatlon, state ihat the infortnation is correct, and agree to complywith all applicable Cityof Eagan ordinances. I[
is the applicanl's responsibility to notiy Ihe property owner that the City of Eagan assumes no liabilily for any damages caused b the Cityduring ils normal
operatlonal and maintenance ac6vities to ihe facilities rqnstructed under this pe ' "in City property/right-of-way easeme
SIGNATURE RMITTEE
? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for irrigation system
STATE: rr?
Updated 1101
EAGHN TOWNSffiP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PEIMT FOR SE+TER SERVICB CONNECTION
DATE• lO /j 31,6 S NUMBER 539
OWNER; & ,.(.?Laa'uJ Address
PLUMBER W ,GL TYPB OF PIPE ?
?
DESCRIPTION OF BUILUING
Induatriail Commerciali Resr/
ide?ntrY81 I Multiple Dwelliag I No. of units
Location of Connectione:
Connection Charge 200.00 pd 12/9/69
Account Dep. 15. Q pd 1269
Permit Pee ?. ? ??
Street Repairs
Total
Iaspected by:
Date
Remarka:
By
Chief Inspector
In consideration of the issue atrd delivery to me of the above pe=mit, I
hereby agree to do the proposed wor& in accordance with the rules and
regulatione of Eagan 1bs•mship, Dakota County, eaota
By. - ?
1955 SHAWNEE ROAD
51r_ a ..
Please notifq mhen ready for inspection and connection and before any portion
oE the work is cavered.
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