1827 Kathryn CirCITY OF EAGAN Remarks
Addition Art Rahn First Addition Lot 3 eik 1 Parcel #10 11900 030 01
Owner P? . f h1a . ?Z, " lU,c{i Street 1827 Kathryn Circle State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. , .
STREET RESTOR. 342.42 C007289 ZO-2-81
GRADING
street i fZ 2 1483.45 296-69 1483.4 C007289 10-241
SAN SEW TRUNK
SEWERLATERAL StU S 1981 04.24 13.6 1$ p,6 A010633 1Q- -81
* s w (P I 5204.1+8 C007289 10-2-81
WATERMAIN
* WATER LATERAL 1982
WATER AREA
STORM SEW TRK (? 13 1982 345.40 69.08 345. 40 C007289 10-2-81
* STORM SEW LAT 1982 S
CURB & GUTTER
SIDEWALK
STREET LIGHT
185.00 2
WATER CONN.
BUILOING PER.
SAC
PARK • . 0 4 9 2 0
ities DiLyital Oualitv Control
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• CASH RECEIPT •
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
R¢ceIvrLo
PROM
AMOUNT $ I
DOLLARS
loe
? CASH ? CHECK
Thank You
BY
n'r
V
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
I CITY QF EA6AN ?
' 3795 Pilot Knob Road Eagon, MN 55122.
'
PHONE: 464-8100
BUILDING PERMIT Receipt #
Te 6e uswd ier - i. F?t Vnln M*e
Site Address !"
Lot Block - Sec/Sub.
Parcel # '
oWC Nome
3 Addre
0
o Name _
?? AddrBSs
? ri..,
Name _
Addreu
I hereby acknowledge that I have read this opplicotion and state that
the informotion is correct ond agree to comply with all appliccble
State of Minnesota Stotutes and City of Eogan Ordinances.
N° 6626
Erect [] Occupanty
,
Alter ? Zoning
Repair ? Fire Zone
Enlarge ? Type of Const,
Move ? # Stories
Demolish ? Front ft.
Grode Q Depth k.
Approvols Fees
Assessment - Permit
Water & Sew. Surcharge
Police Plon chetk
Fire SAC
Eny. Water Conn.
Planner
Woter Meter _ .,
-
Council Road Unit
B Idg. Off.
APC Total , -
Siynature of Permittee I
A Building Permit is issued to: on the express condition that
oll work shall be done in occordance with all applicable Stcte of Minnesoto Stotutes and City of Eagan Ordinances.
Building Officiol
remiM # DaM lawd PW=itfr
Plumbing ,1 i(Q - e ( ? ;tiz - R
Mechanical S ,3 (p f. ? -
E - "?`cQ( "r q Oelc C , T ? ? 1 ??
INSPECTIONS DATE INSP, Raugh-in FirKA
Footings -7-_?
/ f/
Dore
lnsn.
Dota
Insp.
Foundotion Plumbing
rarF- ins. - / Mechanical
Remarks: ?"( ?? f//?( ? ?%u+ts.yA- 4? ? •.
1
?
? ?
7 • Lo,/?
y
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fae fill in numbered spaces S/C
Type or Print /egib/y
Tot.
1. Date 2. Installation Cost
3. Job Address ? lot . Blk. Tract
4. Owner
?
5. Contractor Phone
6. Address ? •
7. City ?/ State Zip
8. Building Type: Residential .13 Commercial O Institutional ?
9. Work Description: New El Add O Alter ? Repair ?
10. Describe Fuel Type
I 11.
No. Eauipment BTU - M. Ea.
Forced Air -• No. Equipment CFM
Ai
li
Mfg. r Hand
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Othe
Air Cond. r
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
i ^ Rough Final
Ipspections: Date Insp. Date Insp.
This is your permit when numbered and approved,
AQproved • CITY OF EAGAN 454-8100
Receipt PLUM8ING PERMIT Permit No. ,
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legib/y Tot. J
1. Date 2. Installation Cost ?
3. Job Address Lot Blk. Tract ?
4. Owner
5. Contractor Phone
6, Address ; ?
7. City State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add IJ Alter ? Repair O
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspoof/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Final
•Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8700
RF-.._? -
Receipt ?_
PLUMBING PERM17 _ . ..
Permit No. -
CITY OF EAGAN
Fae
frll in numbered spaces S/C 1
Type or Print legi6ly Tot.
?.
Date ?
2, Installation Cost
3.
Job Address
/l L Y•
/()7 1? i-1"f ?l i Y.v Lot ? Blk. ?
? Tract
i
4. Owner f
f 1 Y u
5. Contractor r? C GPhone
6. Address ( U U ? - / ? ? ?? t i ?' ? ? : J?
7. City t1 u? State
' ?'l
Zlp JJ ?? ?C. ?
8. Building Type: Resideniial Commercial O Institutional ?
9. Work Description: New ? Add ? Alter E!r- Repair ?
10. Describe .1_t„ ?fv- d wR +r r 5 ri ?`
1 11•
No. Fixtures
Water Ctoset No. Fixtures
Cesspool/Drainfield
Bath tubs Se
tic Tank
Lavatory ? p
Softner
Shower Well
Kitchen Sink
Urinat/Bidet Qther
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
? 12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
Rough
for
Final
Inspections: Date Insp. Dete Insp,
This is your permit when numbered and approved.
Approved C17Y OF EAGAN 464$100
INSPECTIUN RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date issued:
(612) 681-4675
SITE ADDRESS: t uY, 3 BtacK e i aPPLICANT:
1821 KAYHRYM CIR HAM:LM
ART RAtIM I8T (612) 990-8367
PERMIT SUBTYPE:
pE(:K
M.P M A k!! tiPt f ?. [= ! 1' T!
TYPE OF WORK:
Control No. 0606
I!lfIIUIMN
aAaJF x6
P?/il/92
CNAitLlS f
.H? .
NIEN
¦
PennR No. Pertnil Holdar Dab Teleptans!
S/1N
PLllMBING
HVAC
ELECTRIC
ELECTRIC
Inrpection Datt Inap. CommeMs
Foowv I
Foundatlon
Framing
Roo(ing
Rouyh Plbp.
RouOh Htfl•
18u1.
Rrep{aoB
Flnel Htg.
Orsat Test
Flnel Plbg. PWp. lnspecW - NotitY Plumber
Conet. Meler
EngrJPlan
81dg. Final
DedcFtg. 17
Deck Fnal
%
weli
Pr. D{ap.
,CITY OF EA6AN
,8795 Pn^.rr Knob Road
.'Eagqn, MN 55122
Zoning:
?Owner.
ddress:
iTe Address:
Plumber;
eter No.:
ize:
eoder No.: ?
agree fo compfy wilh !he City of Eagon
rdinanaet.
v -
Date of Insp.;
Connection Charge:
Account Depos+t:'_
Permit Fee:
Surcharge:
Misc. Charges:
ToYol:
Date Paid:
CITY OF EAGAN SEWER SERYICE PERMIT
3745 P"ar Knob Road PERMIT Na.:
Eagan, MN 55722 DATE;
Zoning; No. of Units:
Owner:
Address:
Siie Address:
'
Plumber.
1 agree to comply wifh tl+e City of Eagcn Connection Charge: '
Ordinontes. Account Deposit:
Permit Fee:
Surcharge:
By Mist
Cho
:
.
rges
Date of Insp.: Total:
Insp.: ' Qote Poid
: WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
CIT'Y OF EAGAN
3795 Pilot Knob Road Eagan, MN S5121 -? NO
PHONE: 454-8100 41?' `6
BUILDING PERMIT APPLICATION Receiot # ?
SF
46.000
Site Address lOL / nauuyii k.tr.
Lot 3 Blxk 1 $ec/Sub.AL't Rdh71 Add
Parcel # 10 11900 030 Ol
w Nome T0112fSOn BuildeYS
3 Address 13816 HOlyOk2 Ln.
o -._ Apple Valley ,,, __ 454-6873
p Nnme _
F
ou Address
? r...
Name _
Address
I hereby acknowledge that I have read this opplicution and state thot
the inTormation is correct and ogree to comply wiTh oll applicoble
State ot Minnesota Statutes and Ciry of Eagan Ordirwnces.
Signoture of Partnittee _
A Building Permit is Issued to:
all work sholl be done in acco
Building Officiol
6626
R3
Erect g] Occupancy
Alter ? Zoning Rl
Repair ? Fire Zon¢ NA
Enlarge ? Type of Const.
Move ? # Storles
Demolish ? Front 59 k.
Grade ? Depth 26 ft.
Avorovals Feet
AssesXnA'1-81 Permit 130.50
Water & Sew. Surcharge 23.00
Police Plan check 65.25
Fire SAC 525: f 0
Eng. Water Conn. 335.00
Planner WaterMeter 60•00
Council Road Unit 185.00
Off
Bldg
.
.
APC
Total 1,323.751
Tollefson Bui.lders on tha expreu mndiiion that
UI appliyoqle State of Minnesoto $tatutes and Ciry of Eagon Ordinances.
mmnesoca aiace noara or eiecnlCrty
Griggs Midway Bldg. - Room N191
1821 University Ave., St. Paul, Minn. 55104 - PFwne 297-2111
= REQUEST FOR ELECTR{CAL INSPECTI011f
CHECK'BELOW WORK COVEREB BY THIS REQUEST
gg-00001-02
ozs(i ?
T 40005
Type of BuAding New Add. Rep. Check Appliances Wired Foi Check Equipment Wired For
Home ? ? Range 704.00 Temporary Wiring ?
Duplex ? ? ? Water Heatec ? Lighting Fixwces $
Apt. Bldg, ? ? ? Dryex ? Electric Heating ?
Commercial Bldg. El ? ? Fucnace XE 240 Silo Unloadec ?
Industnal Bldg. ? ? ? Air Conditioner El 8ulk Milk Tank ?
Farm E] ? ? L's' na ..,, ? n. ?1, ?
nn Lis[
Othei
?
?
?
?
Here Others) Other
s?
Hexe )
COMPUTE INSPECTION FEE BELOW
Secvice Enhance Size: # Fee Feedecs&Subfeedets: * e
F l
Circuits: # Fee
0 to 100 Am s. 0 to 30 Am eres - 0 to 30 Am eres
1 •
101 to 200 Amps. 31 to 100 Amperes 1 31 ta 100 Am ies
Above 20 p 1 - A6ove 100 Amps. $
; Above 100 Amps.
Transfor s. emoteControlCSrc. Partialoro[hextee •
Signs pecial Inspection Minimum fee
Remarks Jeff p? TOTALFEE 0O 8-50
I, the Electrical [nspectoc, hezeby ceztify
(Final)
This xequest void
18 months from
has bee mada.
?te
fe
Tfii? ? quest voia '? Lz7 r. A t4- kcth w.9--lcL , 3 8, o d
18 months from 2 sV? 7 ?
Date of thtis Re?uest 6»11-1981 Fire No. ^ v40005
I, as Micensed Electrical Contractor ? Owner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 1827 SathrYn Circle City Ea&n
Section Township
Range County ?ota
Which is occupied by TOllefaori
(Name of Occupant)
Is a roughin inspection required on this job? No ? Yes Ek Ready Now ? Will Call Fxc
Power Supplier Dalcota Cty. pddress Farmixlgton
Electrical Contractor O.B. Thonioeon Fleatrio Qo. Contractor's License NoA40602
(COmpany Name)
Mailing Add
Authorized
??Q?? [?OQL3D QOo p? This inspecvon request will not he aecepted 6y the
State Board unless proper inspectian fee is enclosed.
? .14er#ifirttte uf, (ocrixv ttttrg .
:. ;
Citp of (Eagart
, 39rpxrtmrnt nf Vuitaing Nsprrium ,
'Tbir Ccrlificatt irrurd purruant 1o the requiranrntt of Settion 306 of tht Uniform BuiJding
Code cntifying that at thr timt of iuuance thic rtrutture wat in corrsplianre iuith the variout
ordrnanar of the City rrgulatrng buildirsg tonn+urtiott or urr. For sbe following:
u.cw".n. • S3IIgla Fami 1 y Dwg/('.BragP B,d, Nm„, Ha. 6626
??TYa-R3-'heec?u._J?eilvzo? !SA zo? m.m« R7
ow.orMamg T[1llPfRf111 RlljTR. Addlea 1,3$1A Hf1IY-OkP ZA , Appl
n X0?? ?17? BY:
eWam9omlR1?°',-?? Auguet 27,-1981 .e., ?., . w......o......?.
? CITI( OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT C°"t °"°. 0606
PERMITTYPE: euILDiNG -
Perm it Number: 0 0 0 7 7 6
Date Issued: 06 J 11 /92
SITE ADDRESS:
1627 KATHRYN CIR
LOT: 3 BLOCK: 1
ART RAHN 1ST
DESCRIPTION:
..?.B.uilding Permit Type DECK.
Buildin9 Work Type NEW
Building.Length 20
Building Widtfi.- 18
.
?.. r:
REMARKS:
RECEIPT # 0,bYa33a
FEE SUMMARY:
Base Fee $25.00
Surchar9e $.60
Total Fee ;25.58
CONTRACTOR: OWNER: - Applicant -
HANSEN CHARIES
1827 KATHRYN CIR
EACAN 19N
(612)890-8367
I hereby acknowledge that I have read this application and state that the
information is corract and agree to comply with all applicable State of Mn.
Statutes end City of Eagan Ordinances.
l ' R,.Q..r2S c-? Ssr.v1
APPLICANT/PERMI EE GNATUR-?
SUED SIGNATURE
PERMIT M ,. 7-2 I _
REACTIVAtE _ ?o
CITY OF EAGAN I °p `s- ° s- 6
1992 BUILDING PERMIT APPLICATION ?UN 4$ RECo
681-4675 toll oo C
?''u_v ?K
SINGLE & MULTI-FAMILV 2 sets af plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date 4?- / 'ES / 7 Z Valuation of work ? 7_ W?•?
Site Address: l g2l K?kT+I ?y,J Ci (z?-l.t
STREET SUITE /
Tenant Name: (commercial only)
IAT -3 BLOCK / SUBD. qg-'T- 24?4^)
I P.I.D. #
/ RST DDi'fl ?nJ
Descri tion of work: D?c-l?
The applicant is: 1?f_Owner ? Contractor O Other (Deseribe)
Name 0- -9 A2LES Phone 45-z-1v7Z 4oiz
Property LAST FIRST g9o-?7 wU,ui
Owner address 1R"2_7 1<Ar?4,2y,,i CrrL?L-C
STREET STE M
City E1k?l14 rJ State MrJ Zip S-5-1 ZZ
Company Phone
Contractor Address License # Exp.
City State Zip
Company Phone
ArchitecU
Engineer Name Registration q
Address
City State Zip
Sewer 3 water licensed plumber . Processing time for
sewer & water permits is two days ance area has been appraved.
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.
Signature of Applicant: V ??5 ? ? (??"ls?"L
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
? 04 SF Porch
? 05 SF Misc.
WORK TYPE
31 New
32 Addition
? 06 Duplex
? 07 4-Plex
O 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
GENERAL INFORMATION
? 11 Apt./Lodging
? 12 Mult9. Misc.
? 13 Garage/Accessory
? 14 Fireplace
F 15 Deck
? 35 Tenant Finish
O 36 Move
? 16 Basement Finish
? 17 Swim Pool
O 18 Comm./Ind.
O 19 Comm./Ind. Misc.
O 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
Const. (Actual) Basement sq. ft.
(Allowable) lst F1. sq. ft.
UBC Occupancy ? 2nd F1. sq. ft.
Zoning Sq. Ft. total
?Y of Stories Footprin t Sq. ft.
Length _'zp On-site well
Depth ?g, On-site sewage
APPROVALS
Planning Building
Engineering Yariance
REQUIRED INSPECTIONS
? Site
? Wallboard
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Nater Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
? Footing
Final
veluattoo: $
g?
MWCC System
City Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
O Framing
? Draintile
Assessments
4431 f
? Insulat9on
? Fireplace
. ,
SAC %
SAC Units
Cities Digital
itv Control
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F. C. JACKSON
--'°? LAND fURVEYOR
PaaIarIEnio Uhoga LAwS OI RTAT[ or rIMr+notA
LIG[NOfD fl' ORDIMANC[ OI CITY OF MIMMIArOIlG
Or.1119!
183-64
3616 6A5T 66TN iTREET 55417 727-3484
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Dakat• County,Minneeota.
21t1i. Occ. 1980
At oURV[V[O MY M[ TMI_ DAY ?-- A.D•-
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7 r?? CITY CF E'.AGAN Include 2 sets of plans,
1 site p].a.-? w/elevatians &
l9 ?nac r?rr n?rIc?ct? i set of energy cat.aulatiana.
Zb Be ueed Fbr, aluatioai nate
i Site AddL+Bes CF'FICE USE ONR,Y
I.ot t2 Hlack ? Sec./Sub4.*?.n Erect pccupancy
; Paroel t: /(Z 11020 n-A n 0 ,1 A1ter zoninq ?J
Orlner:
' - AddLess:
! atiY/ZiP Oode:
?
Phone #. --774.
' Addreas ???
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; City+/Zip Oucte
; Plxtte #:
Ardl./ghg. . .
Addresa: •
City/Zip Code:
prane #: --
y
"k
,? -i/-8A'
Pepair Fue Zone 0/h-
Ynla=ge _ 7ype of Const.
Nlove k Stories
Derolist? Fmnt 15 9 ft.
Grade Depth 96 ft.
Asaessrnnts
Water/Sewer Pe.smi.t
Surdmxc3e _
Fblice Plan Qieck
Fire SAL'
IIx3. wates Conn.
Planner Water Meter
Council 17oad Unit
Bldy. Off.
AF'C
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183-69 ,
P. C. JACKSON //
LAND SURVEYOR " • -: ?/
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T^' Rtd1YT[RtD VNDlR LA1Nt Of R11T[ M MINNEWTA ?
LIC[N/[D BY OpCINANC[ OI pTY OF YIMN[A!'OLIi
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BEA BLOMpUIST
MAYOF
TMOMASEGNN
JAMES A. SMITM
JERRVTMOMHS
THEODORE WACNTER
COUNGIL MEMBEFS
March 19, 1982
Dakota County Government
o Auditors Office
Hastings, hW 55033
Attention: Peg
Dear Peg:
CITYOF EAGAN
,- y. , ? -}?'°?+(? •, ? ,
,.u i195 PILDT KNOB ROAD
:A'';?4F. "P.O. BO% 31199 a.
EAGAN,MINNESOTA
." 55122y
' '\ ... .
vHOr+e 454-8100
.,?.
?.3r •-:-x'x=: ,W
`,''`-r??' ??'? .
Center
l?ri- RR?n,r?
THOMASHEDGES
CIiY pOMIN15TPAi0P
EUGENEVwNOVENBEKE
CITV cLEPN
This letter is to inform you of the corrections that need to be made
regarding assessment payments. The following is a listing of these corrections:
Parcel 10 11900 030 O1; Paid Oct. 2, 1981 Coo7289
? needs to be deleted from 1982 tax statement and amount paid
on the 1981 tax statement needs to be refunded.
Parcel 10 22750 230 O1, Paid Sept. 4, 1931 Coo7220
needs to be deleted from the 1982 tax statement
Parcel 10 48050 095 O1, Paid June 9, 1980 Coo5399
needs to be deleted from the 1982 tax statement $ am4t paid
on the 1981 tax statement needs to be refunded.
Parcel 10 84353 270 OS, Paid Oct.6, 1980 Coo5541
needs to be eleted from the 1982 tax statement and amount.paid
on the 1981 tax statement needs to be refunded.
Parcel 10 48050 094 O1, Paid Oct. 3, 1980 Coo5553
Needs to be deleted from the 1982 tax statement and amount paid
on the 1981 tax statement rieeds to be refunded.
Parcel 10 75950 180 07, Paid Jan. 11, 1982 A010858
ASSESStdENT was paid at the County Uut 1952 installment still
needs to be posted
Parcel 10 16701 470 O1 DP#166
We have no record of payment and should be posted on tax
statement. Check to see why assessments has been deleted.
If you need any additional information please contact me.
Sincerely,
Ann Goers
Assessment Clerk
TME LONE OAK TREE ... THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY.
I o Office US----------
City of Eajan Permit I t
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff:
a._
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: F -Of Site Address:
Tenant: Suite
RESIDENT/ OWNER Name: Phone
Address / City / Zip:
Applicant is: Owner !,b contractor
TYPE OF WORK Description of work: Z~~
Construction Cost: 7 -2 Multi-Family Building: (Yes /No
CONTRACTOR Name: r License i3
Address
City: State: Zip:
Phone:~~ ~~g 42~Contact Person: 2~r~~L
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
N submission type) • 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?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
i
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.
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 pla
X X
Ap ican 's Printed Name Applicant' gnature
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