1227 Flicker CirCITY OF EAGAN Remarks
Addition ST. FRANCIS WOOD Lot 12 Blk 1 Parcel 10 65900 120 Ol
owner,-? 1?1 L e??}J he hL (- ' ' Street 1227 FliekeY' CiY'cIe State Eagalla NIlV 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. .3 ;4 175 10-10-79
STREET RESTOR. jm ,
1, 19 ']$ QQ 005 98 1? 15 8?
1
GRADING
SAN SEW TRUNK 3658 57 C0 617 10-10-79
*6EWER LATERAL
WATERMAIN
JANATER LATERAI.
;N/ATER AREA
* qtprvi r-a 1980 1 S
*6TORM SEW TRK
*6TORM SEW LAT 1980
1S
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 75.00 14722 6-12-79
13UILDING PER.
SAC 25,00 14727 _ 6-12-79
PARK
BUILDiNG PERMIT
Tw I.a .....1 f... - -
cIrY oF EAG?N
3795 Pilot Knob Road Eogon, MN 55122 Ng 5263
PHONE: 454-8100
Receipt #
& r'm-' `' Est. Value \ W)•
Site Address
Erect
?
Occupnncy
Lot Block Set/Sub. Aiter ? Zoning
Parce) # Repoir ? Fire Zone
N , Entorge ? Type of Const.
W
ome Move p .#' Stories
3 Address Demolish ? Front fr.
° Cirv DMn..o Grode r1 Depth ft.
? Name
,o
?? Address
F- !":?.. DL...??
Nome
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council
Permit
Surchorge
Rlan check
SAC
Water Conn.
Water Meter
1 hereby acknowiedge that I have tead this applicotion and stote that gldg. Off.
the information is correct and agree to comply with all applicable APC Total
State of Minnesoto'Statutes ond City of Eagan Ordinances.
Signoture of Permittee
A Building Permit is issued to: on !he express condition that
cl( work shall be done in nccordance with efl applicable Stote of Minnesotu Stctuies and Ctty of Eagcn Ordinnnces.
Building Official
Pennk # DaM laoed Paw(ffN
Plumbin9 36
Mechonical 1.),
7
INSPECTIONS DATE
- SP. Z
Rough-ln
Finat
Footings &- t a -I? j Date Inap. Date Insp.
Foundation Plumbing
Frnme/ins. "- Mechanical
Final 7-7-7
Remarics: 4,04Ce-,
<a.
q •??- ? 9 ..?n? ? " -
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesotn 55122
Phone: 454-8100
J^ 9"79
Date:
PERMIT
Site Address;
-
?27 F1feJOet Ci=cM
1.1 7 St. r-"r8T2C,1.3 ,'b[7G
Lot Block Sub/Sec.
:ii.ll,
oomtLZ)G`t1Ql
Nome
j.C3'`
?Y'?.
c Address
3
° r:«:? 45Q--14?
City Phone:
Nome ,`YbZ THnlp Ii1C`
?
? ddress 'ii 1
S City '6':S;-..E'r Phone: 4C.1-.`.:1,-
This Permit is issued on the express condition that all work shall be
Minnesota Statutes and Ciry of Eogon Ordinances.
OCr?b??CI`3 AIR ROD-[TlM
No. 1492
Receipt No.:
Singte I ?
Residential
Multi Res., Comm./Ind. I
New/After. / Repai r
Cost of Installation
20.00
Permit Fee
c.. ,.i.,..., . 54)
?;? r, n
Tota I . ? . J
done in accordance with all applicable State of
Building Officiol
CITY OP EAGAN
3795 Pilot Knob Rood
, - Eogon, Minnesota 55122
P6one: 454-8100
FTA"II10 PERMIT
Dote: • -ZO-?9 - ---
Site Address: '1`.'"7 r?il'`?eT' CirCle
Lot " `1 Block Sub/Sec. ?±' ?'s ?ds
Name f'liL.E'.
c Address C. 'A SLJp''7.C.C Cn,1z''?
3
O
154-1 A_I,,4
City Phone:
' '? iZ-ic,' ,Tt
Nome
?
? ' ?745 Sc>. T?c?x=?'^t'
g Address ?
e
0
? Cify Phone: r . ".
This Permit is issued on the express condition that all work sholl be
Minnesota Stotutes ond City of Eagan Ordinances.
No. 1391
1492r,
Receipt No.:
$ingle I
Residential
Multi Res., Comm./Ind. I
New/Alter./Repair.
Cost of (nstollation
2^. ?(?
Permit Fee _
?
$urcharge
Total
done in accordance with af l appliwble State of
Building Officiol
OF EAGAN WATER SERVICE PERMIT
Pilof Kno6 Road PERMIT NO.:
, MN 55122 DATE:
No. of Units:
No..
to tornply wilh the Cify of Eagae
Connedion Chorge:
Acwunt Deposit: _
Permit Fee:
Surchurge:
Miu. Charges: -
Total:
Dote Paid:
, ? 'r:C?Or1U
ite Address: -
lumben --
ogeee to eomply with the City of Eagan Connection Charge:
Irdinanees. Account Deposit:
Permit Fee:
5urchorge:
y Misc. Chorges:
ate of Insp.: Total:
isp.: Date Paid:
CITY OF EAGAN SEVNER SERVICE PERMIT
3795 Pilot Knob Rood PERMIT NO.:
Eagon, MN 55122 DATE:
Zo-ing: No. of Units:
CITY OF EAGAN
BUILDINC PERMIT APPLICATION
'7 i ?
To be used for S? ?i (1?,,,_ T, Pt? _ Valuation S?? o ?
Alter
Repair
Enlarge
Move
Demolish
Grade
? , i--
Site Address (5 -pE ??.
Lot /,'-7 Block ? Sec./Sub.i.? Erect x
G ? f
Parcel ffi fP '43400 A9 D D /
Owner: J&rk.
Address: 64y
Phone Il:
Cositractor:
Address:
Phone 11: (-{ S Ll - i,4 38
Arch/Eng.: --
Address: -
Inc 2 sets of plans,
1 e plan w/elevations 6
1 set of energy calculations
Date 1Y\t?r?n ? . / ? r? -
OFFICE USE ONLY
Occupancy .3
Zoning _
Fire Zone -?
Type of Const. t/
6 Stories
Front (?>O ft.
Depth (?0 ft.
Approvals Fees
Assessmen[ o?
Yermit
Water/Sewer Surcharge
Police Plan Check 7/
Fire SAC S?? `-?
Eng. Water Conn. 02 70 QO
Planner Water Meter dD
Council _ Road Unit /?V;G
Bldg. Off.
APC
Phone 11:
TOTAL "
CITY OF EAGAN
3795 Pllot Kno6 Road Eagan, MN 55122 N? 5 Z 6 3
?PHONB: 4548100
BUILDING PERMIT APPLICATION Receipt #
To ba uud for SF Dwlg & Garage est. Volue 59,000. Dote 6-12 , 1 q 79
5ire Address 1227 Flicker Circle Erect N ouuponcv R3
Lot 12 Blttk 1 Sec/Sub. St. FYdriC]-S WOOdS Alter ? Zoning RI
Parcel # 10 65900 120 Ol Repair ? Fire Zone 3
rc Nume Blilie (bnstruction
Z Address 644 Superiox' Couxt
Eagan ,,, 54- 43
a Name
ug Addre
? r;...
Nume
Address
I hereby acknowledge that I have read this applicotion and state that
the information is correct and agree ro comply with all opplicable
State of Minnewto Statutes nd City of Eagan Or inoncg,s. .
Signature of Permittee """ '
A Building Permit is issued to: 1110 C07LS CtlOri
all work shall be done in ccwrllol wit all icable Stote of
Building Offitiol
Enlorge ? Type of Const. V
Move ? # $TOries
Demolish ? Front 60 ft.
Grade p Depth SO ff.
Approvals ' Fees
Assessment _
Water & Sew.
Police -
Fire
Eng.
Planner _
Council -
Bldg. Off. _
APC
Permit LJJ V V
Surcharge 29 • 50
Plan check 76.50
snc 525.00
Water Conn. 270•00
WaterMeter 60•00
Total 1,114.00
on the express rnndition that
Statutes ond City ot Eagan Ordinances.
This request void 18 months f:om
/?-r'D/ 3
? P 96973
llate of his Request
I, as Licensed Electrical Contractor O Owner, do hereby request inspection of the above electri•
cal winng installed at:
?
Street Address or Route No.
Section
Which is occupied by
Range County
C6 1
Is a roughin inspec/t?ion ?equired on this job? No ? Yes Ready Now ? Will Call
Power Supplier Address 4 V'
? 3ss3 ? f
Electrical Contractor Contractor's License No. _
(COmpa -y nNa.me)
Mailing Address l ( 3 ? _ _ J?L?'x,?' k
Authorized Signature
{cr^"! S_?CTOf DI V W
NQM p URD Q0H
Phone No.
This inspection request will not be accepted hy the
State Boa? unless praper insp¢?tion fee is enclosad.
/s/ /- _ SS !v G ? '7 S
minnesota atate uoara or tiectncity
195KUniversity Ave., St. Paul, Minn. 55104-Phone 645J703
' REQUEST FOR ELECTRICAL INSPECTION
CHM BELOW WORK COVERED BY THIS REQUEST
/-6-o / 3
P 96973
7ype of Building New Add. Rep. Check Appliances W'ved For Check Equipment Wired Foi
Home ? ? Range Temporary Wving ?
Duplex ? ? ? Water Heater ? Lighting F?ctures ?
Ap[. Bldg. ? ? ? Dryer liK. Elec[ric Heating ?
Comme:cial Bldg. ? ? ? Fumace ? Silo Unloader ?
Indus[rial Bldg. ? ? 0 Air Conditioner ? Bulk MIlk Tank ?
Faim ? 0 El Ot ? th
Othet
?
?
? her
He:e p
ers
Here ?
COMPUTE INSPECTION FEE BELOW
Service Entrance Size: n Fce Feeders&Subfeeders: u C¢cuits: tt Fee
0 to 100 Am s. 0[0 30 Am eres - 0 to 30 Am eres ?
101 to 200 Amps. p 00 g 31 to 100 Am eres
Above 200 Amps. 1 A Above lO_Amps.
Transfocmers 1 1 mot Partial or other fee
S' ns 1 1 $ ecial ns ec ?on Minimum fee E5.00
Remazks
TOTAL FEE
I, the Electrical Inspector, hereby certif?} the-,ajfgV,s,pec i has been mad
c% w/
(Rough•in) Date
(Final) ?/Date
This request void 18 months from ?
_ ...,u irs months from
` /? ?
Date o this Request tp °- ?- Z- f r 96970
I, as Licensed Electrical Contractor 0 Owner, do hereby request inspection of the above electri-
cal wiring installed at: (-I a Bf ,d. .) A..e?.a) ?-p-?
Street Address or Route No. /a2 7 .&? Ct-i? City.
C
Section Township Range County
Which is occupied by
• irvame or uccupanp
Is a roughin inspection required on this job? No ? Yes ? Ready Nowx Will Call ?
Power Supplier d??PJL Address -Qi!>Y+i?
?
Electrical Contractor (? ??/?f?, /- IAe-L ? Contractor's License No. _
Mailing Address
Authorized
(EIeTliY.AL.f-ontractor or ow
t????E WL=ClEI?D COETY
No. Eclo
This inspection request will nat he accepted by the
State Board unless proper inspection fee is endosed. j-
. +uLa Jlate ooaro or cleCiflGiy
...w unlversity Ave., St. Paul, Minn. 55104-Phone 645-7703
RE(1dEST FOR ELECTRICAL INSPECTION
CHEGK BELOW WOAK COVERED BY THIS REOUF.ST
P QRq7(1
Ty'pe of Building New Add. Rep. Check Applisnces Wired Fox Check Fquipment W'ved For
Home ? ? ? Range ? Temporary Wiring ?
Duplex ? ? ? Water Heater ? Lighting Fixtures ?
Apt. Bldg. ? ? ? Dryer ? Elec[ric Heating ?
Commercial Bldg. ? ? ? Fumace ? Silo Unloader ?
Industtial Bldg. ? ? ? A'v Conditioner Bulk Milk Tank ?
Fazm 0 ? ? List )
1Ak
-` List
Othe[ ? ? ? p
}
He[ersl ?
7ehers
COMPUTE INSPECTION FEE BELOW `
Seivice Entrance Size: # Fee Feedecs&Subfeedeis: # Fee Circuits: # Fee
0 to 100 Am s. 0 to 30 Am eres 0 to 30 Am eres
101 to 200 Amps. 00 er 31 to 100 Am res
Above 200 Amps. 0 Above 100 Amps.
Transformers ote Pac[ial or o[her fee
Signs cial pect Minimum fee S
Remarks
?
?
TOTALF r
1, the Electricaf Inspector, hereby certify that the above inspection has been made.
(Rough-in) r Date
(Final) ) Date
This request void 18 months from
:
?i-o,?ae ?n?zneeriizq Cor
LPO/ Tr-czzo-eZca%°s ?'rczzZ
, BurJtsv-iI
pli ossdr 890-4704- - ? "': I
- ---•---1--
J
?_ .• i
,n
- ,,
?- M
?
Los
?aD?c?4te `?t'p'"?
- ? 14
GqRAle FlomR IS
4Pf I ax 24" A'bmv-q-
eueb,
?
t:l
1
yo`
, 1. 4JW' , ')oI:nt iuu;t \I
? ? -
ANp lJT1?IrS? FA:fI
? T
a ?
. G E „J
A _. .1
\ ?f y
?«gi,?)C uuE
E ? ? v-r?rtV ?EASC?+tuT
ny
?
ot ..
e?y}1'- ?+
? I .
NOf-' i
SCA LE.
uoiE aLL FVARJN4?
APf 4Sl? A-1LG
'FrU-
? r? ? r .Tc
L hf•rcb y rI - rLifv lh:1 t tliic i:; n frur nnr l (•orn•ct 1,(! 1) ro:,enlnlion af' :I tra"'i nf
l.fud n!t ?.hovn nnd dc:;rrilwtl lirn nr pnpp.n't'tl Iry rv Llii:; 2ftth tl.ry uf Dcerfn!•r,
1 )7'.
. ? i.?
i `
?
---- -----------• ----
;
?. i
4
IZ,Z•7' FL# eKE2
L0 r
ST r
C?i?lc
PY f9'3" PW tlBU
la???,i? C.o?Jb`r y5`I -1q 3 8
1 inrh -?(1 iPPt
AAust show Iccatios: of s'.ree.s, !ct ;nd pro; cscel buildinys, giv=: io: dirnensions. (I..o[ cor;:ers and building sitc
are [o ti?e tifaked bcfore, apyira;sa9 is rer2resteei j .
/$9.0 y ,Y- ,. ?pn?r?6?/ts
S?. yJLOs LL ] l.L Htf ,f
ExTERIOR ENVEL'OPE AYERAGE "U" COMPUTA7lON
6 p ? ?
0WNER
P.
SITE AOORESS r4e'TI2 8l0??
CONTRACTOR T I v
(dl?f?jn,? ?t/G1Y DATE PNONE 4 5 y'?2-7vS?fi
Determine working square footage of each.
1. Total exposed wall area ...,,, l?C Y-71(o sq. ft. x >17 a
2. Total roof/ceiling area ...... -L.j?A.Q$ sq. ft, x ,05' a .ed
Total exposed wal l area above floor =/s 14006'
a. Total wall window area,,,,,,,,,,,,,,,,,,,,,,,,,,, [;t?/,(&/
b, Total door area ................................. 1-7.sl
c. Total sliding 91ass door area ................... 4e.cz
d, Total fireplace wall area........................
e, Total wall framing area (average 10%)...,...,..,, k; 9.71
f, Totai net watl area above floor ,,,,,,,,,,,,,,,,, r cIr,2C
g. Totai rim joist area ,,,,,,,,,,,,,,,,,,,,,,,,,,,, 1?c c,
Total exposed foundation area = 9y /?
h, Tota1 foundation window area..................... ff? 37
i. Toat net foundation area above grade ,,.,........ 0-7
Determine "U" value of each wait segment,
8. 0 ?s?6 X nUn . 5?I a "'7S-??r'
b, 70/ X nUn r 13 ° 4'9l
c. 40.e?Z z„u^ - 53? ,
d. X ??uft ? -
e. CCC'??7,/ x nUa /I Z s t 7i70.
r, (PV-2r x °un a7 .
g. . 13740 X "U° - dG • LZ_
h. ty 37 z"U° *!6'./ 0
i.• ?11•7f X ^U^ . V7 . 37
3 .............. 7.16 ...,.,..,,....Tota1 • 2s'c.
If item 13 is the same as, or less than ttem 01, you have met the inttnt
of S8C 6006(t)2. .
7ota1 exposed roof/ceiling area = 1;??•0 0
j.? 1ota1 skyliqht area.............................
?
k. Total roof/ceiling framing area (average 10%),..
1. Total net insulated roof/ceiling area........... / 5'tip.o??
Determine "U" value for each roof/ceilirtq segment.
; X ,iusi a
k. X „U" a
1, l ,S'v4-UU x Ilu„ ,o,(' _ '?aoo
4 ................ .......... Total = ? 7-od
If total of 44 _is the saine as, or less than 02, you have met the intent of
SBC 6006(c)1.
Alternate euilding Envelope Design
To utili2e the total envelope system method, the values established Ey the
sum of ltems A3 and #4 sha11 not be greater than the sum of items /1 and $2.
1, ?Sp.o/ + 2, 7700 = ?5?7,0,'
3, ZSL'. 23 + 4, ?7-ed = 3 z7:Z3
5864 Melody Lane 89P3063
Burnsville, Mfnnesota.
WEPJA CO. PLAN SERVICE
EO ANDER30N
AflCNITECTURAL OESIGNING ANO PLqNNING
QffICB:
1129 Cliff Road Office:
Burnsville, Minnesota 89G4636
RESIDENTIAL
BUILDINC PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD • 55122
651-681-4675
?Qb# yy2?-?
NewConstruetlon Reauiremenks RamodellReoalr Reaulrementa
• 3 registered site surveys showing sq. ft. of bt, sq. iL of house; and all roofed areas • 2 copies oT plan
(20% macimum lot coverage allowed) . 1 set of Energy CalculaGoris for heated additions
• 2 copies of plan showing beam & window s¢es; poured found desgn, etc.) . 1 sile survey far enterior additions & decks
• 1 set W Energy CalcWatlons . Indicale if home served hy septic system Por additions
• 3 copies of Tree Pieservalion Poan if lot platled after 7/1193
• Rim Joist Delail Options selection sheet (bidgs with 3 or lass unils)
DATE _ 1D"1-0? VALUATION *?c7??IO'?
JOB SITE ADDRESS Q?-1 -?-r IC,KPr Ck u'0p.
IF MULTI-FAMILY BUILDING, HOW MANY UNITS? I"?'-`tC
PROPERTYOWNERPW ?,DYYlU.1W,
m ,
TYPE OF WORK Y???'t?,t ?i
APPLICANT F3AC Construction Services LLC
, 2309 Snellin Aven S h
FIREPLACE(S) ? 0 _ 1 _ 2
PHONE# I!'?Ia-1al
g ue out ??
ADDRESS Minneapolis, MN 55404 ZIPCODE
PAGER # I CELL PHONE # ? FAX # Ua--a?- S`7(03
NE1V RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY
Energy Code Category
(check one)
MINNESOTA RULES 7670 CATEGORY 1
- Residential Ventilation Category t Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNESOTA RULFS 7672
New Energy Code Worksheet Submitted
Plumbing Contractor: _
Plumbing System Includes:
Mechanical Contractor:
Mechaiucal Systcm Includes:
Sewer/Water Contractor.
Air Conditioninc•
Heat Recovery System
Iawn Sprinkler
No. of R.I. Baths
_ Phone #
Phone #
? (1CT 1 0 2002
, Fee:_
Fee: $70.00
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant ; Aa i1 \ /1 thn
Certifcates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 2002
Phone #:
_ Watcr SoRener _
Watcr Heater
No. of Baths
2004 RESIDENTIAL MECHAIVICAL PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
lrJ
Please complete for. single family dwellings & townhomesJcondos when permits are required for each unit
Date L(
Sit
Add
?CJk
r C( i
/ U
#
Tc
[
ress
e
? n
t
,
,r
Property Owner ? ?
Telephone # ( ?5r t. ) (Z Q
? ?4:1
C011t1'nCt01'
STANDAAD HEATIN6 8 AfR CONDITIONIN6 •
F qTREE'(
Street Address 419 YAfEAT 1 A
' City
MINNEAPOLIS, MN 55?-?
"
-
State 6ig-824.260 Zip Telephone # ( )
Bond #• Expires:
The Applicant is _ Owner Contractor _ Other
Add-on or alteration to eais[ing dwelling unit $ 30.00
? furnace _Additional XReplacement
air exchanger
? airconditioner _New ?KReplacement
other
State Surcharge FEB 2e04
?. $ .50
Total $
I hereby apply for a Residential Mechanical Perniit and aclaowledge that the infoimation is complete and accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a
permit, but only an applicarion for a pernrit, and wor`` s not to start without a at the work will cordance with the
appr ed plan in the case of or,
h requires a revie d approval of p]
_, . , , ? _ Te? ,
Applicant's Printed Name Applicant's Sigpetm'c-
( 2006 RESIDENTIAL BUILDING PERNIIT APPLICATION
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 9 651-675-5675 FAX # 651-675-5694
New GonsWction Reauiremenis
3 2gistered siie surveys showirg sq. ft of Io1 sq. ft. of house; and all mofed areas
(20°h maximum bt coverage allowed)
1 Soils RepoA il pmposed buildin9 is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found desigq etc.
1 set W Energy Calculations
3 copies of Tree Presenatbn Plan'rf lot plaHed after 71153
Rim Joist Dehil Options selection shcet (buildings witli 3 or less units)
Minnegasco mechanical ventilation fortn
RemodeVReoair Reaviremenis
2 copies of plan showing footings, beams, joisGs
9 set ot Enemy Cakulations for heated additions
1 site survey for additbns & decks
Addrfioo - indicafe H on-sRe septic system
, o-o
Off?ce Use OnN
CeAoiSurveyRerd .. _Y _N
SoilsReport _Y _N
Tree Pres Plan Reod _Y _N,
Tree P2s Required _Y _N
On3iteSepticSystem- _Y _N
Date Jz o(D Construction Cost
Site Address V? (? ,, r
` leijrUX UniUSte #
Description of Zrk M Y ?
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 2
Property Owner k?T_ 1i f I lllY 1 Telephone #(( ?!a) d- ? JI
?x
Contractor
Address ?
City ll;,)
--
«
# is n
?
State ( )
_ ,
Zip Telephone
)
AU;a r
?lv
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDtNG,
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Su6mitted Submitted
• Energy Envelope Calculations Submitted
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 master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone # (
I hereby app]y for a Residential Building Permit and acknowledge that the inforxnation 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 Pr- i?Name
Applicant's Sig ture
Use BLUE or BLACK Ink
r - - - - - - - - - - - - - - - - -
I For Office Use
Permit / j
City of Ea
I Permit Fee:
3830 Pilot Knob Road
I Z / I
Eagan MN 55122 ~ Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff: )
- - - - - - - - - - - - - - - -
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: ► c~vl _ u~ Phone:
RESIDENT /
OWNER Address/ City/ Zip: C f
Applicant is: Owner Az--c-ontractor
n
TYPE OF WORK Description of work: q + c 0
Construction Cost: l 600 Multi-Family Building: (Yes / No )
Company: - -Vw "f - Contact: cr U F]-cA,
Address: J City: - (ia✓~
CONTRACTOR
State: i V 140 Zip: a5 Phone:
License " Lead Certificate C4 . i L ~ '
t 3- 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.oopherstateonecall.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. Y'
X"- x Applicant's rinted Name Applic is Signature
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