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1772 Gabbro Tr Use BLUE or BLACK Ink For Office Usd ICS City of Ea Ed n I Permit j Permit Fee: 3830 Pilot Knob Road I Date Received: Eagan MN 55122 Phone: (651) 675-5675 Staff: Fax: (651) 675-5694 INFLOW NFILTRATION PERMIT APPLICATION Plumbing / Sewer & Water Date: Site Address: Tenant: Suite Name: ~ ~ I 1 h Phone: ws I ~ -1 Jl [u RESIDENT / OWNER - - Address / City / Zip: wJ U 1 1 Name: License CONTRACTOR Address: City: State: Zip: Phone: Contact: Email: PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK Sump Pump Repair Repair t Other: ~ Other: Description of work: I ~Xit t~~ x~y 1 i! )~ayl.y V ` l~ I'J V t y DESCRIPTION ~1 FEES ! $55.00 /Each (includes $5.00 State Surcharge) (Rev. 6-30-10) TOTAL FEE $ 1c) ° o *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.citvofeacian.com/inflow, or City Mall at 3830 Pilot Knob Rd. 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.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 GL~I V1 x Applicant's Printed Name Appllcaff~ Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground Rough-In Final INSPECTION RECORD ' CITY OF EAGAN PERMIT TYPE: i' I I t' I "' ? 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: '" '' ?'' •' (612) 681-4675 SITE ADDRESS: APPLICANT: :o/{S . :tl PERMIT SUBTYPE: TYPE OF WORK: ai ; ? 1+ar1 4) n+ II 14 1 Mr; { , ;}' 71RK5: PA1 trl (o f I ni; ? L V 1 Ni1! (;f M:-IvAl {lf NON Iti A{t 1 Nit l,.lAi I f?;: Parmit No. Pertnft Holdsr Date Te{ephone # ELECTRIC PLUMBING HVAC Inspectlon Date Insp. Commenta FOOTINGS FOUND FRAMING 1-42j'l4 '7 Ae ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUI GYP eOARD FIREPIACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL ? BSMT R.I. BSMT fINAL DECK FfG DECK FINAL 7- INSPECTIDN RECQRD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, MinnesQta 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: .aH RP 1> I 1 f: tiAFr 6R(}'Jf #?, i PERMIT SUBTYPE: 1=+I p1 T NiiB R F Ft R it k Si P l A N {7 t V ? I H f: Ifi I f ,il n, , APPLICANT: TYPE OF WORK: VTh1Ai Mlb:t NA14t F ? fil,r1 14 1 m(; p:? f str>?3 ? ? Permk No. Permk Holdsr Dsts Talephone li ELECTRIC PLUMBING HVAC Inspection Dab Insp. Commenb FOOTINGS FOUND FRAMINQ RODFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYPBOAAO FIREPLACE FIREPLACE AIR TEST FlNAL PLBG FlNAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAI DECKFfG DECK FINAL ' CITY OF EAGAN Remarks Sew & wtr p@T'1TL1t,S 1-13-?9 Addition Cedar Grove #6 Lot 7 sik 9 Parce, 10 16705 970 09 Owp (ner ? ?' A n `??sireet _ 1772 Gabbro Trail State Eagaz1,MN 551221 ffIQ.tI +I04lJ1, Improvement Date Amount Annual Years Payment Recaipt Date STREET SUR F. STREET RESTOR. GRADING I SAN SEW TRUNK 3E SEWER LATERAL 1% 1970 1472.00 20 WATERMAIN * WATER LATERAL 1970 20 WATER AREA # STORM 5EW TRK 1970 20 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 200.00 1160 1-1 -6 SUILDING PER. sAC 200.00 1160 1-1 -6 PARK .4 EAGAN TOWNSHI?P r BUILDING P?RMIT' y i ? Owne: -01-xC.-?"_ .....- "-.._' --- ? ....... ?l ?:t...-?•--•-'- '-?-?-( .._.... Address (Preseni) ---"?.".-°_ . ?h ..'--..:__......---°°----._..._... - Builder ,............................... ----------- ..............-.....--------°---......----....... Addreaa .........._.......:-°---°°----...--°°----°-.---...°---.....---°-°------.---...... DESCRIPTION N° 1934 Eagan Township Town Hall Date .............. -°`--` Stories To Be Used For Fron! Depth Height Esf. Cosf ermi! Fee Remarks '? .. ' LOCATION Streef, Road or o26er Deseripiion o4 Loeafion I LW Slock Atlau3on or 'craci I r, ?? A-r_,,.- "b, . 'A G This permit dces not euthorise the use of slreeis, zoads, alleys or sidewalks nor does it give the owner oe his agen! the righS !o cseate anp siYUation which is a nuisance or which presenfs a hazaxd !o the heallh, safefy, convenience and genera] welfare io anpoae in the community. THIS PERMIT MUST BE KEPT ON yT?HE PREMISE WHILE THE WORK IS IN PROGRESS. ..... . ... ..... .... ... . ...... .. . . . .... ..._ This is !o cerfifp. ...has permission !o erect a._ ......... ' upoa the ebove described premise subjec! !o the provisions o! the Building Osdinanee for Eagan Township dopled April 11, 1955. ,. --°.°-°-.....---9-------'-°-- ................... Per .............ku:-.t- .??-Gf>,..., ...°......... ............. Chairi4an of Tnwn Soard Suilding Inspecfor C.. f3 ?Q CITY QF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: BUILpING 031853 04J23/98 SITE ADDRESS: 1772 GABBRO TR LOT: 7 BLOCK: 9 CEDAR GROVE #6 P.S.N.: 10-16705-070-09 DESCRIPTION: f, ..._ f3U31tling.,Permit Type DECK !Building ?"0ork Type NEW Cansu's Code "434 ALT. RESIDENTIAL ,% ? r ? . . .. ?..r? - ? S r j+?i n ,, N ` \..5 ? af ! . Y R ? g 3 (': ? , k, L? L3 REMARKS: PLAN REVIEWED BY MIKE BARCK FEE SUMMARY: Base Fee $50.00 Surcharge $.50 7ota1 Fee $50.50 CONTRACTOR: - Applicant - sT. I.IC.OWNER: DEVANY CONST 15373070 2003727 HURD DOUGLAS 3827 PERRY AVE N 1772 GABBRO TR ROBBINSpALE MN 55422 EAGAN MN 55122 (612) 537-3070 (612)454-7971 r ri f T hereby acknowle'dge thaC I havs read-thie appi,ication and state that the informat£on is•correct and a4'r"'ee`."to° ccinpky t?'iCh? all a'ppI 3.cabl0 3-Eate of Mn . Statutes and Cityl cf Eagan Orcfinanc'e s. rf ? APPLICANT/PERMITEE SIGNATURE -IPSU D B. SIGNATU E 5im 998 BUILDING New Construdion Reauirements PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PII.OT KNOB RD - 55122 681-4675 ? 3 registered site surveys ? 2 capies of plans (include beam 8 window sizes; poured fnd. design; etc.) ? 1 energy calculations ? 3 copies of tree preservation plan H lot platted after 7/7/93 required: _ Yes _ No DATE: R v RemodeVReoair Reauirements ? 2 copies of plan ? 2 site surveys (exterior additions & dedcs) ? 1 energy wlculaGons for heatetl addftions CONSTRUCTION COST; 3S/?v DESCRIPTION OF WORK: I ? ?/ -rj' ' I ?) -e c /< STREETADDRESS: 1 77 ?- (9q-Ab(Lo T/L LOT: _I BLOCK: r_ SUBD./P.I.D. #: ?PU(Ul,I1hmK."G t/ u/Z ? -7? Name: /?os /A S Phone #: ys7 7 9 7/ PROPERTY Nst Firs OWNER Street Address: / 77 vZ G og 66,&, ?T? City <-'q GA --j State: !'/ ?? Zip: 5S1,1 7- CONTRACTOR Company: -jD2?19'jy c4? / Phone #: J-3 7 30 7,D StreetAddress: 3 d 2 7 >e2 /) City ?ab,?s ?q ie state: ARCHITECT/ ENGINEER Company: Phone #: Registration #: Street CiTy Sewer & water licensed plumber (new construction onty): and lot change is requested once permit is issued. State: Zip: Penaity applies when address chang I hereby acknowledge that I have read this appiication and state that the information is correct and agree to compty with all applicabl State of Minnesota Statutes and City of Eagan Ordinances. ? D ._r? Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Plan Received Yes No License # ac? a 3 7 a-2 e- ? ziP: 63-?1,2- ? T.¢ c /l --F, (L-1 ? l+°,s ? C ? or O„ ?- ql °{? 177.,D, G466ro ?. _,5 - ?- CITY OF EAGAN PERMIT 3830 Pilot Knob Road PERMIT TYPE: B U I L D I N G Eagan, Minnesota 55122-1897 Permit Number: 031016 (612) 681-4675 Date Issued: 10 / 2 7/ 9 7 S1TE ADDRESS: 1772 GABBRO TR LOT: 7 BLOCK: 9 CEDAR GROVE N6 P.I.N.: 10-16705-070--09 DESCRIPTION: ?IaRil,i?4nt}6Rermit Type SF (MISC.) zi n 'Iy dzng l? T y p e ALTERATION ?'-k, 434 ALT. RESTpENTIAL 4?4 a k r ?z t; ne_a Po??? ? ?i .p4 % 4g0ii§ 3 u"' 7sai ° s .!.?- +ar'.d . ? sra§? ?6 ?ai?' ff 9 REMARKS: PATIO DOOR REMOVAL OF NON-BEARING.WALL FEE SUMMARY: VALUA7ION Base Fee 3urcharge 7ota1 Fee $74.75 ? $1.50 $76.25 $3,000 CONTRACTOR: _ p,pplicant - sr. Lxc OWNER: f$EUANY CONST 15373070 2003727 HURO DOUGLAS 3827 PERRY AVE N 1772 GABBRO TR ROBBINSDALE MN' 55422 EAGAN MN (612) 537-3070 1 (612)454-7971 i _. ? ;j ? c I m,4 Roit?. j 1YIA- ' ISSUED B SIG TURE 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL) ? CITY OF EAGAN 5830 PILOT KN06 RD - 55122 681 -d675 New Construction Reavirements RemodeVReoeir Reauirements ? 3 registered site surveys ? 2 eopies of plan • 2 eopies aT plans (inGude beam & window saes; poured ind. design; etc.) • 2 sRe surveys (exterior addiGons & dedcs) ? 1 errergy calculations • 1 energy calculations far heatetl additions ? 3 eopies oP tree preservation plan 'rf lot platted aRer 711I93 required: _Yes _ No DATE: 7 CONSTRUCTION COST: / DESCRIPTION OF WORK: wl/1I' N?•f ?A?i-?s'M" STREE7ADDRESS: /72J- &dbt? Tf?R? l LOT ? BLOCK SUBD./P.I.D. #: LAN) l4UYZD c PROPERTY Name: ? ?I?,u4?1r?s Phone #: !•-5 L? 77 7? OWNER ? Fl.,. V T?2 Street Address: _I ra4z•-1 Cih+: ? -j State: MA.) Zi P:- coN7tz4c7oR Company: Dre4JV CONs`L??e-hPhone#: z`' 2 e) Street Address: 6,57 36'7c?> License #-2QC3 `3727 G City: /Cr?G iwsr.?.v/e State: Zip: '1- ARCHITECT/ Company: Phone ENGlNEER Name; Registration Street Address: CitY: State: Zip: Sewer & water licer?ed plumber (new construction only): Penalty applies when address change and lot change are, equested once permit is issued. I hereby acknowiedge that I have read this appiication and state that the information is correct a agree to compiy with all appiicable State of Minnesota Statutes and City of Eagan Ordinances. r1 ? Signature of Applicant: OFFICE USE ONLY e/ Certifcates of Survey Received _ Yes _ No w? ? 2? Tree Preservation Plan Received _ Yes - No - Not Requir OFFICE USE ONLY BUlLDlNG PERMIT TYPE « ? 01 Foundation o 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish ? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex n 13 Garage/Accessory ? 20 Public Facility 0 04 SF Porch ? 09 12-plex ? 14 Fireplace p' 21 Misceilaneous 0 05 SF Misc. ? 10 _-plex ? 15 Deck WORK TYPE ? 31 New Z33 Alterations ? 36 Move ? 32 Addition ? 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System ? (Allowable) Main level sq. ft. City Water ? UBC Occupancy sq. ft. Fire Sprinklered Zoning sq, ft. PRV # of 5tories sq. ft. Booster Pump Length sq. ft. Census Code. . y3H Depth Footprint sq. ft. SAC Code pr Census Bldg I_ Census Unit p APPROVALS Planning Building ffil?; Engineering Variance Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies %`SAC `?.?„r SAC Units ' ?.?,,.a,.?.?.-- ?.. ... valuation: $ 30? . ._ _ .. ; $AGF:N TOWNSHIP 3795 Pilot Knob Roud St. Paul, Minnesota 55111 Telephone 454-5242 PER19IT FOR WATER SERVIC$ CONNECTION Date: Number: Billing Name: Site Addreas: 7-9-/0 77,2 Owner: &Air_, A.,zw , Silling Address--- Plumber: .?Cyd.?;? e%r.t . O Building is a: Residence„1 Multiple No, Comihercial IndusCriai Qther ? ?ct Meter No. ? Permit Fee / 3 V ?`r Meter Readiag IMeter Dep. Meter Sealed: Yea- lAdd'1 Ch$. NO I Total Chg. Inspected by Date Remarks: By: Chief Inspector In cansideration of the isaue and delivery to me of the above permit, I hereby agree to do tte proposed work in accordance with the rales and regulations of 8agan Tovmship, DakoCa County, Pi eaoCa. By: Please notify the above office when ready for inepection and connection. EAGFiN TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION DATE• NUMBER OGINER: 6t'ti /on,s+?Ut1. Address 7'`?'(o 1779 ?'v?'jit0' `1.c?eLj PLUMBER TYpE OF PIPE ?-,_.(1zeyJ DESCRIPTION OF BUILDING IndusYriall Comarerciall Residential I Multiple Dwelling I No. of units Zocation of Connections: Total Inspected by: Da Remarks• Connection Charge G Permit Fee 7 `? << SCreet Repairs By Chief Inspector In consideratioa ot the fssue and delivery to me of the above pexmit, I here6y agree to do the proposed work in accordance wfth the rules and regulatians of Eagan Township, Dakota County, Minneaota BY Please notify when ready far iaspection and connection and before any portion of the work is covered. MEMO TQ: DIANE DOWTiS, UTil1TY 81LL1NG CLERK FROM: ED KlRSCHT, SR. ENGINEERING TECH DATE: AUGUST 25, 1993 SUBJECT; STREETLIGHT ENERGY COSTS CEDAR GROVE NO. 6(141 LOTS) This memo is to inforrn your department to begin to invoice the energy costs at the single family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition as listed below: Block 1, Lots 1 1 Block 2, Lots 1-8 8 BloCk 3, Lots 1-18 1$ BloCk 4, Lots 1-11 11 Block 5, Lots 1-9 9 Block 6, Lots 1-53 53 (Lots 54 through 61, Block 6, should not be bilfed at this time) BloCk 7, Lots 1-12 12 Block 8, Lots 1-18 18 Block 9, Lots 1-11 11 TOTAL 141 The City is currently being billed by Dakota Electric for streetlighting in the above listed subdivision. c`I Ed Kirscht ' Sr. Engineering Tech cc: Mike Foertsch, Asst. City Eng. EK/je ?a731 Reaulremenh 2000 STORM DAMAGE PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD - 55122 657-681-4675 ? 2 copiea ot plan DATE: P 1 CONSTRUCTION COST: ?'u r DESCRIPTION OF WORK: C?f ?SJo-?? ?- t ` If mulfi-family bldg., INDICAiE THE FOLIOWIN6 EQUIPAAEtdT TO BE REPLACED AfVD BY WHOPA: _ Plumbing _ Homeowner 2r Contractor Name _ Mechanical _ Homeowner QE Coniractor Name "NOte: If somebody otherthan the homeowner is performing piumbing or mechanical work mey must apply for appropriate permit. Only licensed plumbing contractor or homeowner may complete plumbing work. STREET ADDRESS: 0-A LOT: -1 BLOCK: 1 SUBD./P.I.D. #: Cf6 N_-?_ (-_)d VU ` 4y (P Name:J`1V1X ?1 ,(A'S Phone.#:IS?J?-???.? 1C?1QC) PROPERTY Last Flrst OWNER Street Address: ? --?-1? City State: Zip: S I J Company: V?? 1 Phone #: (area code) CONTRACTOR Shesf Address: License # Exp. City Stafe: 2ip: I hereby acknowledi "aRthavhe:rea ,di?apipGcation, sFpte that }hg information of Minnesota Statute5 ?i d' Eity of'Er??gZYn-inb ces. SEEt g - 2000 Signaiure of Applicant;_ ?-_- ?--70co. 00 / how many unlts? and agree fo compty wilh all appl'icable State PERMIT City of Eagan Permit Type: Building Eagan. Permit Number: EA101713 Date Issued: 10/21/2011 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 1772 Gabbro Tr Lot: 7 Block: 9 Addition: Cedar Grove 6th PID: 10-16705-09-070 Use: Description: Sub Type: e-Windows iDoors Construction Type: Work Type: Windows Doors-New ; Replacement Description: House Census Code: 434- Occupancy : Zonin,: Square Feet: 0 Comments: Improvements to the home require smoke detectors in all bedrooms. If altering window openin,s, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee S3K $88.50 0801.4085 Valuation: 3.000.00 Surcharge - Based on Valuation S3K $1.50 9001.2195 Total: $90.00 Contractor: - Applicant - Owner: American Exteriors of Minnesota LLC Senn Greenlee 1408 Northland Drive =106 1772 Gabbro Tr Mendota Heights MN 55120 Eagan MN 55122 (303) 86-3328 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature Use BLUE or BLACK Ink For Office Use(, I Permit Win City of Ea I Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 w a i Date Received: Phone: (651) 675-5675 J 1 I Fax: (651) 675-5694 I Staff: I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION $1111 Date: via Site Address: 1Cs 7 ? A //``GtbDII__ fIci / ~'U ~ I Unit Name: _qn GCe~e 4 tet Phone:(6 S 02 C)6 ` 16 s y Resident/ / Owner Address / City / Zip: 17 ? 2 VGA bhro Tro r Applicant is: X_ Owner Contractor Type of Work Description of work: E f~SS W , A d o tn/ ~1 S TGt ~ct i 6 n Construction Cost: 0 Multi-Family Building: (Yes / No Company: Contact: Contractor Address: City: State: Zip: Phone: License Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) The CIE Puo 15 /No ~ A M ~'mf y d v1'm I ~ e e ~s ec~ fic s; J (p t (wi (A 6-f o r- 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 maybe classified as non-public if you provide specific reasons that would permit the City to _ w r conclude that the 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.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 State Building Code must be completed within 180 days of permit issuance. X _.5e-,PA 61-ct/)1ft. Applicant's Printed Name Applicant's Signature Page 1 of 3 1 DO NOT WRITE BELOW THIS LINE ~1,PO Z3 SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Exterior Alteration (Single Family) Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Multi) Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Miscellaneous 01 of _ Plex _ Lower Level _ Pool _ Accessory Building WORK TYPES New _ Interior Improvement _ Siding Demolish Building* _ Addition Move Building Reroof _ Demolish Interior Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace Repair x Egress Window _ Water Damage Retaining Wall ~*Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation )eo 0 Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100%-) Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction Ifff, Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final / C.O. Required Footings (Addition) Final / No C.O. Required Foundation HVAC _ Gas Service Test Gas Line Air Test Drain Tile Other: Roof: -Ice & Water -Final Pool: -Footings -Air/Gas Tests -Final Framing Siding: cco Lath -Stone Lath -Brick Fireplace: -Rough In -Air Test -Final ( Windows Insulation Retaining Wall: _ Footings _ Backfill _ Final Sheathing Radon Control Sheetrock II Erosion Control Reviewed By: I , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant 04,90 Copies TOTAL Page 2 of 3 104777 Use BLUE or BLACK Ink for Offce,Use 41111~ / al. j Permit y of Eap I Permit Fee: as I 3830 Pilot Knob Road I I Eagan MN 55122 I Date Received: 5 h,~- j Phone: (651) 675-5675 I I Staff: Fax: (651) 675-5694 1 1 4L 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address:~ / / Unit M Name: ~~iV 4- JUA1 9 y (I Phone: RESIDENT / /C- OWNER Address/ City/Zip: Applicant is: Owner _y_ Contractor TYPE OF WORK Description of work: r /I/ zw Construction Cost: Multi-Family Building: (Yes / No ) Iff Company: '7ru - Contact: GGsj/_GL / Address: 2 96 O ~ City: CONTRACTOR % State: /4'"_ip: 05 d11 ~i Phone: -70 7-6 c~ ~9 License* 6d 1&X_6O3 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: 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 the 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.aopherstateonecall.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 review and approval of plans. X _<1511W 6_'W6PS0A-1) x Applicant's Printed Name Applica 's Signature Page 1 of 3