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1875 Gold TrCITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 SITE ADDRESS: ' PERMIT SUBTYPE: 0 41 l I Nto ', F L q r.ii,l;.r:: PERMIT TYPE: 1 +'t N41 Permit Number: Ntiv Date Issued: goomas APPLICANT: (hl.') ?+I i •??7H! TYPE OF WORK: f I N A I N i,A,'f It1l•, N1 11 Ptrmit No. Permk Holder Date telephone N ELECTRIC PLUMBING HVAC Inspecdon Data Map. Comments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL GYP BOARD FIREPLACE FIHEPLACE AIR TEST FINAL PLBCi FINAL HTG ORSAT TEST BLDG FINAL BSMT R.I. BSMT FINAL DECK FTG -ZG-? DECK FINAL 7 ?y r CITY OF EAGAN Fiemarks WtT' p@YRq].t8 6-1 9-69 WtY' & Sew Con. Pd_ 6-1 9-69_ Addition Cedar Grove #6 Loc 4 Blk 2 Parcel 10 16705 040 02 ' Owner ?(" ??+'^ - Street 187 5 Gold Trail State Eagan,MN .5.5122 T Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 1968 92.43 3•08 30 Paid # SEWER LATERAL 11- 1970 1472.00 20 P31d WATERMAIN WATER LATERAL 1970 20 WATER AREA STORM SEW TRK 1970 20 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 210.00 1500 6-1 9- 9UILDING PER. sac 200.00 1500 6-1 -6 PARK EAGAN TOWNSHIP BUILDING PERMIT Owner .............. Address IPresenfl ?......... wi`:.-:.....i.T...`.`.i.??........................ Builder ............................... . .... ............... ................... .__....... . . Address -. ...................... ........... ................ .... _---------------- --- -- DESCRIPTION N° 2036 Eagan Township Town Hall Dafe -- .. _............... . _. Siories - - To Be Used For Front _ _- Depih Iieighi - Est. Cos! Permii Fee Remarks _ ? ? ?l?I ? /S ?1 ` U ?ry ?L' / ?,.C.e ?-? /`=-•-?c_ TION Sireet, noaa or oiner uecenpnon ox Locanon I Lot I isiock I naaition or Traet . ??...-. ?: ? ;S 3 This permii dces no2 auShorize the use of slceets, roads, alleys or sidewalks nor does it give the owner or his agent the righ2 to areefe any siluation which is e nuisance or which presen2s a hazard fo the healfh, safefy, aonvenienee and geaeral welfare fa anyone in the community. THIS PERMIT MIIST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is fo cerfify, fhai..?.c?c.n....1??....?v-d--...... has permission to ereet a_ 3..°....... '` .1 .._. . . °?..... ..._ _upon `? . .. . the a6ove descri6ed premise subjecf 10 the provisions of the Suilding Ordinance for Eagan?Township opf .ed ... ...... April 11. 1955. // .--....... . .. . . '""......"""""'""" '" .............. ... ................ ..._ .... Per ...... __ _4:...... Chair an of Tnwn Board ? Ff........ Huilding "Inspecios 4. . ? ? 2004 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Kno6 Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for: single family dwellings & townhomes/condos when permits are required for each unit D-J Date Site Address I V / s (20(1 v- ? Unit # Property Owner n`ar k5-, vo i? ra? Telephone #(-,El )GCFD - 3-7q ? ? - ---- - - - - -- - Contractor Wotilers Southside Htg. & Air, Inc. - 6950 W. 146"' St., 4 106 Street Address Apple Valley, MN 55124 ' CitY (952) 431-7099 State Telephone # ( ) Bond #• Expires: The Applicant is _ Owner !KContractor _ Other Add-on or alteration to existing dwelling unit $ 30.00 ? furnace _Additional Repiacement air exchanger airconditioner _New _Replacement other $ 50 Sta[e Surcharge NUV ? ? a ?004 Totai ?? ? I hereby apply for a Residential Mechanical Pemut and aclrnowledge that the information is complete and accurate; that the wock will be in confommnce with the ordinances and codes of the City of Eagan and with the Mechanica] Codes; that I understand this is not a pernut, but only an application for a pexmit, and woik 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. LGti- riA Appl;e?? Applicaii t's ignature RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB RD, EAGAN MN 55122 651-681-4675 New Constructian Reauirements . 3 registered sile surveys showing sq. ft of lot, sq. ft. of house; and all roofetl areas (20% macimum lot cove2ge allowed) • 2 copies ot plan shaxing beam & window sizes; poured found desgn, etc.) • lsetofEnergyCalculations • 3 copies of Trce Preservation Plan if lot platted after 711/93 • Rim Joist DetalOptions selection sheet (bldgs wilh 3 or less unils) DATE (O- r?D - 07 _ Water Softener Water Heater No. of 13aths SITE ADDRESS I S7 S (_-) o ?(1 r 1f G: \ MULTI-PAMILY BLDG _Y _ N TYPEOFWORKG4r"c _ Si(?', l?) g?vA \-\ 1?%..dOt_.1 FIREPLACE(S) _0_1 _2 APPLICANT ? \Q`?? Vp? ?,c }1,? _.I_Q,??STATEMV?ZIPsS l9- STREET ADDRESS 1!?G1 CITY. TELEPHONE # C?SI ? 9?5-3?? 7 CELL PHONE # FAX # PROPERTYOWNER Y ' \(]Tc V0Vs c\-\TELEPHONE# (0S1H99S-3-ion W __ (oSl: a? St??ib COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RLTI,ES 7670 CATEGORY 1 MINNESO'1'A RLJI.ES 7672 (J submission lype) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: __ Plumbing systcm includes: Mechanical Contractor. Mechanical system includes: Sewer/Water Contractor: _ Air Condiaoning Heat Recovcry System I hereby acknowledge that I have read this application, state that the with all applicable State of Minnesota Statutes and City of Eagan Qrc Signature of Appllcant OFFICE USE ONLY RemodelfRevairReauirements . 2 wpies of plan - f v`?`?•"" d? • 1 set ot Eneyy Calculations for heated additbns ? • lsitesurveyfireacterioraddNons&decks ,- ?p ` a . Indicate if home served by septic system foraddNons VALUATION 1 -?- o U 0 _ Pltone # Lawn Sprinkler No. of R.I. Baths Phone # Fce: $90.00 Fee: $70.00 #J Utd1 611? is correct anc`aare? to comply Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _ Updated 4/02 OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling ? 03 01 of _ plex ? 04 02-plex ? 05 03-plex ? 06 04-plex ? 07 05-plex ? 13 16-plex ? OS 06-plex ? 16 Fireplace ? 09 07-plex *Ad 0,' 17 Garage ? 10 OS-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous . ? 30 r . Accessory Bldj ? 31 EM. Alt - Multi ? 33 Ext. Alt - SF ? 36 Mul6 ? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) A 44 Siding ,X 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof A 46 Windows/Doors ? 34 Replacement "Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code y 3? Zoning ?- I City Water SAC Units -? Stories 1 Booster Pump Nbr. of Units - Sq. Ft. PRV Nbr. of Bldgs - Length Fire Sprinklered Type of Const ? W idth ? REQUIRED INSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) ? FinallNo C.O. y Footings (addition) _ Plumbing X Foundation HVAC _ Drain Tile Other Roof _ Ice & Water _ Final Pool _ Ftgs _ Air/Gas Tests _ Final X Framing Siding Stucco Stone _ Fireplace _ R.I. _ Au Test _ Final ? Windows (new/replacement) _ Insularion _ Retaining Wall Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Piumbing Permit Mechanical Permit License Search Copies Other ?. ? Approved By Building Inspector Total '-? _?I-2 , C) ?, • ? ? r ? ay M? M°`y _. a Ke4'aA'ue"? /? / , ,-94.q6? 1 i ?S J 1 ?3'• -^??e?Z.l4 ?84 ?19 °12=3 ? c 12 S? N 09" 3\.K1 I _- GOLD $S 8'. ? S N 0 10 ---?--8s---- ?ne e{?'(,?a? ?arove AlO. S -- _ ?.1 !=? C-' 1'11 ? S Sso YZ, _ 347 96 ?" 9 3 a ? a a ? ? .e .. I2o 395 _ -?- T ] as g5 86.44 _ 1 S N - 8 ao I a' oC 6 ¢N e ie o II ?arf6eosf co?ner o?'?r . '. .. ? • ft .,.ft w 1 _?_ Iti _ . ...46 , ?? INSPECTION RECORD CITYOFEAGAN PERMITTYPE: eurLozrvc 3830 Pilot Knob Road Permit Number: 026080 Eagan, Minnesota 55122-1897 Date Issued: 0 7/ 2 5/ 9 5 (612) 681-4675 SITEADDRESS:P•z.N.: 1e-167e5-e4e-e2 APPLICANT: LOT: 4 BLQCK: 2 1875 GOLD TR RENSLOW'S DECKS-N-GAZE605 CEDAR GROVE 6TH (612) 773-9707 PERMIT SUBTYPE: DECK TYPE OF WORK: NEW ? ? ? ? PERMIT C!TX OF EAGAN 3830 Pilot Knob Road Eagan. Minnesota 55122-1897 (612) 681-4675 PERMIT TYPE: Permit Number: Date Issued: mto949 BUILDING 026080 07/25/95 SITE ADDRESS: 1$75 GOLD 7R LOT: 4 BLOCK: 2 CEOAR 6ROVE 6TH P.I.N.: 10-16705-040-02 DESCRIPTION: Building'-Permit Type DECK Building Wdr,k::hType NEW _.._ ._ ?-? _ _ . a •,a .. ?a?_=_4.:s REMARKS: FEE SUMMARY: Base Fee $30.00 Surcharge $.50 Total Fee $30.50 CONTRACTOR: - Applicant - sT. LTC. OWNER: RENSLOW'S DECK9-N-6A2EBOS 17739797 0006209 FREUND AMY 1746 E COUNTY ROAD B 1875 GOLD TR MAPLEWOOD MN 55109 EAGAN MN (612) 773-9707 (612)452-5677 Z hereby acknowledg hat I have read this application and state that the informaCion is r ct end agree to comply with all applicable StaCe o$ Mn. StaCutes an t of Eagan Qrdinances_ ` ?. ? tma, PPLICANT/PERMI7EE RE ISSUED BV: I ATURE CITY OF E{`+GAN ? 3830 PILOT KNOB RD - 55122 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 ? 0 -? cAIJ ? 3 repkrored si[e cuneys ? 2 eopiea ot plan ? 2 copies of plans (indutle beam 6 wintlow sizes; poured fid. design; etc.) ? 2 si[e surveys (exterior addRions & decks) ? 7 anergy ealaletions ? Y enerpy ealcuiatlons for heated additions ? 3 mpies of hae pressrvetion pUn if lot piatted aRer 7l1193 iequired: _ Yes _ No DATE: DESCRIPTION OF WORI STREET ADDRESS: L07 ? BLOCK SUBD./P.I.D. #: PROPERnr Name: jr?2eON 0 ArrtY Phone #: OWNER ""1 Street Address? ?? lel 1'"r'c., I City: '6-,4 G a? State: .47 A.? Zip• -S's ?-Z22 coNrnACTOR Company: s/xs r G42rhar Phone #: ?2,3 `9 ?422 Street Address: i 74/1, E. rl„A?;, &4d A License #• 9206 ., Clty:AU2e State: '41a Zip- d?l / `'` ARCHITECT! Company: Phone #- ENGINEER Name: Registration #• Street Address, City: State: Zip: Sewer 8 water licensed plumber: Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this applicadon and state that the information is correct and agree to comply with all appiiqble 5tate of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY ??COVED Certificates of Survey Received _ Yes _ No J u l,? Tree Preservadon Pian Received _ Yes _ No CONSTRUCTION COST: 3S OFFICE USE ONLY BUILDING PERMIT TYPE 0 01 Foundation a 06 Duplex 0 02 SF Dwelling ? 07 4-plex 0 03 SF Addition a 08 8-plex 0 04 SF Porch o 09 12-plex 0 05 SF Misc. 0 10 _-plex WORK TYPE ,k' 31 New o 33 Alterations 6?- n 32 Addition a 34 Repair GENERAL INFORMATION Const. (Actual) (Allowable) UBC Occupancy 2oning # of Stories Length Depth APPROVALS Planning Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. DeposR S/W Permit S/W 5urcharge Treatment PI. Road Unit Park Ded. Trails Ded. Other Copies Total: ? 11 Apt./Lodging o 0 12 MuRi Repair/Rem. o 0 13 Garage/Accessory o ? 14 Fireplace o --W--l 5 Deck ? 36 Move ? 37 Demolition ?. . 16 Basement Finish 17 Swim Pool 20 Public Facility 21 Miscellaneous _ Basement sq. ft. MC/WS System _ Main level sq. ft. City Water _ sq. ft. Fire 5prinklered _ sq, ft. PRV _ sq. ft. Booster Pump _ sq. ft. Census Code. 5'SY _ Footprint sq. ft. SAC Code Census Bldg i Census Unit o Building Engineering Variance Valuation: $ % SAC SAC Units F 2 EUr-v0 L?0qfb 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) cinr oF eacani 3830 PILOT KNOB RD - 55122 > 851-881-4875 C Q? q RenwdeURaoair Rerndremenl? 0 t' D S repltasretl tlte wrveys showinp aq. (L Of lot. W. fl. of house 5?a 2 coPles of plan aW gn rooled areas C10% mmcimum bt covemae c9lowedf 1 set of eneryy ca7aAaHOns for heated addiMOns * 2 coplea of plana (show beam a wlndow slses; poured hftl. tledyn: elc.) 1 tite wrvey lor extedor atlcOHOns & Cecka > i sef 016ner0y cdaAallons D J ooWea o1 hae PretenaMOn plan H lot plaMed aHer 7/1/99 7 ? c300 ? DATE: CONSTRU ON COST: - DESCRIPTION OF WORK: tero V Q?? Cab? STREET ADDRESS: ,1?j ?S -7S &W LOT: q BLOCK: ? SUBD./P.I.D.0: G2ollxy- Name: V6 l l([p Mc(? e. Phone #:CoS/- '79) S3 277 PRoaErm Losr Rrsr owNee Sfreet Address: CX""?p ciy `1???.?.-, sta? . zip: SSl ZZ SELA RAOFING 8c REMODELING, INC. Company: 4100 EXCEISIOR BLVD. Phone #: '?a t Z 3-2 ?-KQ C/ (4;, $T. LOUIS PARK, MN 56416 (area code) COMRACTOR ID q0001060 SheefAddreas: Llcense0 / D S??> ExP?"3(-d( ciy State: ARCHITECT/ Name: ENGINEER Company: Telephone #: ( Sheet Address: ReglslraNOn M: CNy State: Sewedwater licensed plumber (if installirw sawerlwater): PFane #: Lp: Zip: 1 hereby acknowledpe Mwf I have read this applicalbn, dafe Mw1 the WortriaMon ts corteet, and opree to comPN wiM a0 apP60able State of MinneaoM Stakles and CMy of Eagan Ordirwnces. Signalure of OFFiCE USE ONLY Certificates of Survey Received _ Tree Preservat(on Plan Received _ Yes _ No Yes _ No - Not Required .?-,i G ? EAGFN TOWNSHIP 3795 Pilot Knob RoAd St. Paul, Minnesota 55111 Telephone 454-5242 PERt•1IT FOR WATER SERVZCE CONNECTION Date: June 16, 1969 Number: 291 Billing Name:Cedar Grove Const. Co. Owner: Cedar Grove Const. Co. Plumber: Stein, Inc. Site Address;1875 Gald Trail 1}_2_(9, Silling A.ddress7343 Concord Blvd. E. 11 1 Connec jX-67d I Permit Fee 7•50 Pd• Meter No,46A Meter Reading?? Meter Dep. Meter Sealed: Yes_ Add'1 Chg. NO f Total Chg. Building is a: Residence % tiultiple no. Cammercial Industrial Other Inspected by Date Remarks: By: Chief Inspector In conaideration of the issue and delivery to me of Che abave permit, I hereby agree to do the proposed iaork in accordance with the rules and regulations of Eagan Township, Dakota County Mianesota. ? By: Plea:;e aotify the above office when ready for inspection and connection. .? E/,`GEiN TOtdNSHIP 3795 Pilot Itnob Road St, Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR S&7ER SERVICE CONNECTION DATE: June 16, 1969 OWNER:Cedar Grove Const. Co. NUMBER 419 t?ddress 1875 Gold Trail y---R - G PLUMBER Stein, Inc TyPE OF PIPv Cast Iron DESCRIPTION OF BIIILDInG Industrial+ Commerciall Residential I Aiultiple Dwelling i No. of units Location of Connections: Date Remarks• Connectfon Charge 200.00 pd. Permit Fee 7.50 pd. SYreet Repairs Total Inspected by: By Chief Inspector In consideration of the issue and delivery Co me of the above permit, I hereby agree Co do the proposed work in accordaace with the rules and regulations of Eagan Tocenship, Daicota County, Minnesota By fC Please notify when ready for inspection and conneceion and before any portion of the work is covered. 'i ?pPiiYFx _ city of eagan MEMO TO: DIANE DOWNS, UTILITY BILLING CLERK FROM: ED KIRSCHT, SR. ENGINEERING TECH DATE: AUGUST 25, 1993 SUBJECT: STREETLIGHT ENERGY COSTS CEDAR GROVE NO. 6(141 LOTS) This memo is to inform 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 18 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 bilied at this time) Block 7, Lots 1-12 12 Block 8, Lots 1-18 18 Block 9, LOts 1-11 71 TOTAL 141 The City is currently being billed by Dakota Electric for streetlighting in the above listed subdivision. Ed Kirscht Sr. Engineering Tech cC: Mike Foertsch, Asst. City Eng. EK/je Use BLUE or BLACK Ink I For Office Use 1 j Permit City I 3 I Eakan I Permit Fee: 1 3830 Pilot Knob Road Eagan MN 55122 s j Date Received: 7 Z- j Phone: (651) 675-5675 Fax: (651) 675-5694 i Staff: 1 I P 2012 - - J C RESIDENTIAL BUILDING PERMIT APPLICATION `f "73T~ -3 Date: Site Address: Unit Name: Phone: RESIDENT / OWNER Address / City / Zip: CfAJ frwl wy f/ 551A;;), JI Applicant is: ' Owner Contractor / t I g t~l', r1 TYPE OF WORK Description of work: 00 d Construction Cost' 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) 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 ~L!Nlo 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.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 Minn sota State Buildin Code must be completed within 180 days of permit issu rice. i x x Applicant's Print- N e / App cant's i at e ~~K Page 1 of 3 DO NOT WRITE BELOW THIS LINE - /D7 33D SUB TYPES ) ~ / T(, 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 7y- Accessory Building WORK TYPES New _ Interior Improvement _ Siding _ Demolish Building* Addition _ Move Building _ Reroof _ Demolish Interior _ Alteration _ Fire Repair _ Windows _ Demolish Foundation Replace _ Repair _ Egress Window _ Water Damage Retaining Wall *Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation 3606 Occupancy MCES System Plan Review Code Edition SAC Units (25%_ 100%,,V) Zoning City Water Census Code Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction 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: -Stucco Lath -Stone Lath -Brick 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 l2~ Surcharge l2 's Plan Review MCES SAC L~ 6 City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL Page 2 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA109885 Date Issued:04/11/2013 Permit Category:ePermit Site Address: 1875 Gold Tr Lot:4 Block: 2 Addition: Cedar Grove 6th PID:10-16705-02-040 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Amanda Rivard 308 Sw 15th St. Ste 25 Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 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 - Scott R Kupczak 1875 Gold Tr Eagan MN 55122--162 Upland Heating & Cooling DBA Aspenair 308 SW 15th Street, Suite 25 Forest Lake MN 55025 (651) 982-2626 Applicant/Permitee: Signature Issued By: Signature Use BLUE or BLACK Ink � r------------------� I For Office Use � � � Permit#: %��lL� f�'1 I Clty of �� /A �5 ; i Permit Fee: � (!�. � 3830 Pilot Knob Road Eagan MN 55122 � Date Received: �CJ �� Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: f�� l / Site Address: ��l � C 7d C� �� Unit#: � �� , �E � Na � a'�> Name: Phone: Residen�l ,�� ____— _— _�______ ��,:;C1W,t1�1' ,i,,�� Address/City/Zip: _��a_ �._'.�_��.�=~= �;-�- - c � ri�, , ; � � �'��' �`��. Applicant is: Owner �'C ontractor Type of Work ; Description of work: /'�-� Yvtr� --� � ��u�'J Construction Cost:`�a`� �� Multi-Family Building: (Yes /No� � ',';�� ., ,7 a , Company: ��S`Z� Ya� ��1'Ll�6h Contacfi �L�� Q��`i-�PJS ,wp�`M� � � �" �Address: Contr�ctor �� v�G �-3�"�� S� � c�ty: _ ��-�' �-e_ ��'-�� ,.5,�� :� � � State: Y1�1/�Zip; SS�1(� Phone: ��a'�'��/��4Email: S rv�'c�ns'�'��-�,•�^. t��c� /�" .�-'� � o�+�t �icense#: I�C-6 7/lS3 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: ` M�TE:Plans:anal supparting d'ocuments thaf ya�`submit-are`conSidered:to ke�ublic'information. Portions of � �#he�n�ormatlon rr��y b�classifiec��s no;�publrc�f�rbu Rrvvcde-0.specifi�r��sc�ns that woultl permifthe,�ity��o ��: ��: ..ri.� „cor�clr�de,th�t t�e ar�e:trade�ecrets 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.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. 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 /�t^c-�-- /�i'1f�J`Z�-ros" X _ ApplicanYs Printed Name Applicant's Signature Page 1 of 3