1037 Kenneth St?Fj'/g /9 e,[ REQUEST FOR ELECTRICAL INSPECTION
p ( / ? See inslmctions br compleling ihis brm on pack oi yellow cropy.
Cv O 2 5 46 . 'X` Be/ow Work Covered by This Request
dc?sgq? EB-00001-08
?ro
ew Add Rep. TypeolBuiltling AppliancesWired EquipmentWired
Home Pange Temporery Service
Dup?ex Water Heater Eleciric Heating
Apt. Building Dryer Load Management -
j
Comm./Industrial Furnace Other (SpeCily)
Farm Air Contlitioner
Ofiei (syecify) GonVaclorS Remarks' Compufe Inspection Fee Below:
•
# Other Fee # ServiceEmranceSize Fee # Circuits/Feeders Fae
Swimming Pool 0 to 200 Amps ¢to 100 Amps
Transformers Above 200 _ Amps bove-7 _ Amps
Signs Inspectors Use only:
UC? TOTA
.S m
Irriga[ion Booms ?? ?
Speciai Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITNIN 18 MONTHS.
I, the Eledrical Inspector, hereby
certify that the above inspection has
been made. Rouyn-m
F,,,ai oe?e
oste
OFFICE USE ONLY
This request void 18 months Imm
C? 02546 a e ;
Request oate
.
? Fire Nti- . Rou9h-In Inpsedion Required Inspecfion Otnar Tn?Y ougn-In
?
?/
? au cell inSpa or when reatly) ? Reatly Naw?'?,Will Notlly Inzpector
Ves N. Oate ReeE
10 licensed contractor A owner hereby request inspection of above electrical work at:
Job Atldre
(Streel. Box or F t No.?
n
Ciy
( L/n
V/7 • r
od
$eciion No. Townshlp Name or No. Range No. County
Ocw am (PRINT? Ppone No.
ein ? ?A 0 w
P,?I''
Pawer SuppAer Mtlress
Electnwl Gon rac t (COmpany Name? ConVadorS License No.
o a?e-oc?.ner-
Mailing AOar ss fGOnlraclor or Owner Making Instelialionl
Dv
AW ignaWlp ICONrInStdlld I PhOnB NumD
Bf
`J
G.l?,
?
Y
I ESOTAOATE BOAFD OF ELECTRICITY THIS INSPECTION fiEQUEST WILL NOT
I s-Midway BIdB, - Ream 5-173 BE ACCEPTEO BV THE STATE 90ARD
62/ University Ave.. St. Paul. MN SStOC UNLESS PROPER INSPECTIpN FEE IS
Phone161P)602-0800 ENCLOSED.
Ae, q- - a-p 7I
EAGAN TOWNSHIP
BUILDING PERMIT
Ownex ..............
.....
Address (Presen2) --'A3''--..A,-?-'-C..^..?: ....... "--"---
Builder ---- - 4? '''-'`--?-- ------ -------- ------- ---------------------------------------------- --
[
Address ----------------------------------------------------- -----'_.....__----.....--`----....
DESCRIPTION
N° 856
Eagan Township
Town Hall
?/`Yllo Z.?
Dale ............ ..........-°------..
5tories To Be Used For Fron! Depih HeigHi Esi. Cosi ermi! Fee Remarks
+?"'?.A w a? O . o?-G
C/ LOCATION SlreeS. Road oi oiher Descs3p2ion of Locafion I Lo! Block Addiiion oz Tiaci
This permif does no3 aufhorise the use of sixeets, soads, alleys or sidewalks nor does it give the owxer os his ageni
the righf fo ereaSe any situazion which is a nuisance or whieh presents a haaard !o the healih, safeYy, convenienee and
general welfare !o anyone in the communiiq.
THIS PEAMIT MUST BE KEPT On TfiE PREMISE WHILE THE WOAK IS IN PROGAESS.
This is 2o cerlify, fhai_.?V-------- .??----------------------- haspermission Yo erect a_._......_ .... ........."""... .t............._"'..upon
3he above d scribed premisa subjec! !o the pxovisions ot the Building Ordinance for Eag Townshi adopled April 11,
1955. Q f ? . `
...-_...... .........
....'--...............°--------....... '-'. ..-??.??..----------..... Per ...._....._........---- - t..?? .---?._... ?-?._....
Chairman awn Soard Suilding Inspec3or
61.6.
INSPECTION RECORD
. , „
CITY OF EAGAN PERMIT TYPE: ?'r
3830 Pilot Knob Road Permit Number: ? .' •> >..' 4
I Eagan, Minnesota 55122-1897 Date Issued: r fa / 26 / u6
(612) 681-4675
? SITE ADDRESS:
? ?? ? . . ??? u?. ? :
PERMIT SUBTYPE:
APPLICANT:
?t.i -1 aha
TYPE OF WORK:
iIi I,rVIPTr1,1;
I I f .ilNil I N
?.
NFU ? -
( rnS
>
Permk No. Permft Holder Date Telephona k
ELEC7RIC
PLUMBING
HVAC
Inapection Dsts Insp. Commenb
FOOTiNGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS•
'
1 1 IJW t i; . I
4fi
ON RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
fs i ?? ?. ?, ' , APPLICANT:
riil rI (I ra6
*:I N>>I'l.
0 4) /A'1/96
PERIIAIT SUBTYPE: TYPE OF WORK:
i r t kA i t fIN
INSPECTION DA • D•
?AM i Flt.
; iitl(yfl ! N li 1I 1 NA I
?. ?
Permit No. Permft Hotder Date Telephone M
ELECTRIC
PLUMBING
HVAC
Inspectlon Date Inep. Commenta
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARO
FIREPLAC i
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTCa
ORSAT
TEST
BLDG FINAL
[
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
I
CITY OF EAGAN Remarks
Addition McKee Addition 4k1 Lot Z Bik 1 Parcel 10 47750 020 01
Ownert street 1037 Kenneth St. State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR, paViIIg
-ui 1969 $311.50 $31.15 10 PAID
GRADING
SAN SEW TRUNK 1968 $100.00 3.33 30 PAID
* SEWERLATERAL 1968 20
WATERMAIN
* WATER LATERAL 1968 85?.?0 .5 20 P ID
WATER AREA
STORM 5EW TRK 1984 403.00 26.87 15
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
sAC 200.00 520 11-21-67
PARK
- _ -
- • ?
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City of Eakan Memo
To: Inspections Personel
From: Jeff Munsterteiger- Code Enforcement
Date: 10/24/2008
Subject: Non-Conforming Structure
On an inspection of the premises because of a foreclosure, I discovered an addition had
been added to the back of the garage. The addition had no visible foundation and
appeared not to be constructed to code.
Working from aerial photos, the structure appeazed to have been modified somewhere
between 1997 and 2000.
c:r.rY or !:rAC,'r?.r,
C.1::i,!-!2I:::R- MIG; T;:::R:tirA+(`:!... Np1" ._;.sg
i.f;/'.'...';!.':)r_, '1:1'.M;F e i.:I.
n?
ir 9001. :i.rz';r i=;!=NWF...,.,_?? 'i ;7100
,
?, ,
„..,i. n:: ., -.????...,. r;.,, ? 50,
.......,..? :; . .. ? •,•.i.,.::.. ? i.,
PERMIT
` CIYY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Num6er:
Date Issued:
BUTLDING
029124
10/25/96
SITE ADDRESS:
1037 KENNETH ST
LOT: 2 BLOCK: 1
MCKEE
P.I.N.: 10-47750-020-01
DESCRIPTION:
(GA5)
rmit Type FIREPLACE
r}s Type NEW
494 AL7. RESSDENTIAL
' a. ?a
F ??1? ?`??'' '?,a
i
we ??-,.. F -rm§t?s ?.?
?
LL,
REMARKS:
FEE SUMMARY:
Base Fee
Surcharge
Tota] Fee
$25.00
$.60
$25.50
FCONTRACTOR: OWNER: - Applicant -
BARLOW GEORGENE
1037 KENNETH 57
EAGAN MN 55121-1413 '
(612)454-2145
I her'sby a
inform:atica
?Staiutes°a
?? ?? ?
-?? -
SSUED B SIG TUR
CTfY OF EAGAN
3-qi ? 3830 PILOT KNOB RD - 55122
1996 FIREPLACE PERMIT APPLICATION
681-4675
DATE: C2
DESCRIPTION OF WORK:
3 J? ,?o
?CONSTRUCT NEW FIREPLACE: WOOD Bi1RNING ?GAS
INSTALL GAS INSERT OPILY IN EXISTING FIREPLACE
_ INSTALL GAS LINE ONLY IN EXISTING FIREPLACE
O'CHER:
ROOM TO BE INSTALLED IN:
STREET ADDRESS: / L4 f l
LOT ? BLOCK .?-
SUBD./P.I.D. #: r?C koL
APPLICANT: (circle one only) OWNER CONTRACTOR
I hereby acknowledge that I have read this application and state that the informarion is correct and agree to comply with
all applicable 5tate of Minnesota Statutes and City of Eagan Ordinances.
PROPERTY
OWNER
FIREPLACE
INSTALLER
Name:
Signature:
? /
Street Address: .? '?7 ?i ei?ilE`/ ?"h J`T -
.?
City: CV G.??
Company: _
Signature: _
Street Address:
Ciry:
GAS LINE Company:
INSTALLER
Name:
Signahxre: -
Street Address:
City:
Phone #:
State: i •AI Zip:
Phone #:
5tate:
License #:
State: Zip:
Zip:
. r i- : . . ..
m;ki'F?k>X>kAu?k??k7K>X1h?k??k?K?%?kok# 'M$! N('%Y6X?}kkCVF?%?k?8>X:i??7KY,:
rITV 01=
CA.'.:iN:C!F:Fta S ff'.RMT_NAl. N(Jr 74
DA1'F=;; 09/09/96 'T'7:riE; 15;;1.9:03
M.,
?i?AME: I...ANLi L HCIME: :I:NC;
300 9001 1037 ECENNI3:TH 5'T 199a7;
34;i.'.2 `)OO:L :IA37 IiEPlNl..';'41 51 99.518
205 9001 1.03'7 KE:NNI::TI-1 5'f 6.50
3430 9001 W37 KE:NNL:1'H f3T 5.00
2210 9001 057 N!;Y.I?:L S'1 212.25
3422 9001 'LQS'r t'iCF;fi:lE: SC 9.Ofr,.:l.3
MJ;J 90(]1 ±.057 NiCKi=-: s?r 7„00
'1'otal. 1"ter_er:ipi; Amouni: e c;3t'?. ;1
r.Rf l64Q}"i,
I_!SI'_:fi .T.fl:; NRiN?IY
?X<?k?K%:XtN::d?kYF%?>X?, ?kXc%<1F;n ?k?k???k?X>X>k?k?k',M:$W 'h<7k%k?%%i:*yFkz
E :. • _
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-47750-020-01
DESCRIPTION:
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
1037 KENNETH ST
LOT: 2 BLOCK: 1
MCKEE
(MAC SOUND INSUL)
8uildinq:?Permit Type 5F (MISC.)
8uilding l3g.rk Type ALTERATION
Census Gode 434 ALT. RE5IDENTIAL
f
j;,,^"'
ti..3f. . ?+a..
BUILDING
/
028776
@9J@9/96
REMARKS:
FEE SUMMARY:
VALUA7ION $13,000
Base Fee $199.75
Plan Review ` $99.88
Surcharge $6.50
Lic. Search Fee $5.00
Total Fee $311.13
CONTRACTOR: - Applicant - sT. IIC.OWNER:
LANp & HOMES INC 14216868 26011121 BARLOW CHRIS
13001 REVERE LN N 1037 KENNETH ST
MINNEAPOLIS MN 55316 EAGAN MN 55121
(612) 421-6868 (612)454-2145
I here6y acknewledge that I have read thzs application and st'ate that the
informatAo'n is correct and agre:e to comply with all applicabl;e State of Mn.
? Statutes antl Ci'ty of Eagan Ordinances. J
APPL CANT/PERMITEE SIGNATURE ISSUED B': 51 NATUR
loqqL CITY OF EAGAN
3830 PILOT KNOB RD - 55122
1996 BUILDING PERMIT APPLICATION (RESIDENTIAL)
681-4675
New Conslruction Reauiremenls
RemodeVReoair Reauirements
4m• 1J
ea..Q?".? 4-L
? 3 registered site surveys ? 2 copies of plan
? 2 copies of pians (include beam 8 window sizes; poured fnd. desiqn; etc.) ? 2 site surveys (exterior additions & decks)
? 1 energy calculatlons ? 1 energy caleulations for heated additions
? 3 copies of tree preservation plan if lot pladed after 7/11193
required: _ Yes _ No
DATE: f'afil'?lO CONSTRUCTION COST: l°?, 7?
DESCRIPTION OF WORK:
STREET ADDRESS: A2 77
LOT I BLOCK SUBD./P.I.D. #:
PROPERTY
OWNER
CON7RACTOR
Name: a44ud L?L Phone #: yS`?'aiS?S
U9i fiRSi
Street
City: State: 'Ty"/z Zip:
Company: Phone 27°2'1 '
Street Address: ?.u? z-- ? License #: oV7,!9111-21
City: je?,a,?ti-. State: /0?t Zip:
ARCHITECT! Company:
ENGINEER
Name:
Street
City:
Sewer 8 water licensed plumber:
change are requested once permit is issued.
State:
Zip:
Penalry applies when address change and 6d
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply witla aiA
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: ?
OFFICE USE ONLY RECEOMED
Certificates of Survey Received Yes _ No .? SON
Tree Preservation Plan Received Yes No --
Phone
Registration #:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ?
? 02 SF Dwelling ? 07 4-plex ? 12 Multi RepairlRem. ?
? 03 SF Addition o OS 8-plex ? 13 Garage/Accessory ?
? 04 SF Porch o 09 12-plex ? 14 Fireplace ?
,,o?05 SF Misc. ? 10 = plex ? 15 Deck
11VORK TYPE
? 31 New ?k-33 Alterations ? 36 Move
? 32 Addition ? 34 Repair ? 37 Demolition
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
5/W Permit
5/W Surcharge
Treatment PI.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
+R 4., 0' ..
'1 r 4' ?"' 3 •. ly,, ^4
,
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
_ Basement sq. ft. MC/WS System ?
Main Ievel sq. ft. City Water ?
_ sq. ft. Fire Sprinklered
_ sq. ft. PRV
_ sq. ft. Booster Pump
_ sq. ft. Census Code. LI??I
_ Footprint sq. ft. SAC Code or
Census Bldg ?
Census Unit o
Building m? Engineering Variance
Valuation: $ '3. 0 ci 0 -?-
% SAC
SAC Units
CITY OF EAGAN
Log Bn?fJ/ MECHANICAL PERMIT
SUBD. f?-- (612) 681-4675
RESIDENTiAL
RECEIPT # /Oe
DATE i? as 9?-
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELI.iNGS. ALSO, COMPLETE FOR
TOR'NHOMES/CONDOS WHEN SEPARATE PERMITS ARE REQUIRED FOR EACH DR'ELI.WG UNIT.
pWNEg; ?UGE0.?E <, I(?Mc`I HAUow' ADD-ON A/C ADD-ON FURNACE
STTE ADDRESS: 1037 KfNrJ6TH 57YLE6f
EA6 44?f ADD ON/REMODEL (EX[STING
CONSTBUCfION ONLI) S 15.00
INSTALLER: RtRS T2f*m jiTk G(e0LF'l4 lel[: HVAC: 0-100 M BTU 24.00
PHONE #: y0-na2?5 ADDITIONAL 50 M BTU 6.00
ADDRESS: j147(e IZt?ER-wc?%o DRWE, $?RNf5UtuE GAS OU1'LEl'S • MINIMUM 1@ $3 EA.
crrY: zrn: ??7 suitcanxc& $ so
SIGNATURE: TOTAL: $ JS, SO
NO PERMIT REQUIRED FOR DUCTWOKK ONLY!
COMMERCIAL
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIALINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR
APARTMENT BUILDINGS OR OTHER MULTI•FAMILY BUII.DINGS R'fiEN SEPARATE PERMITS ARE NOT REQUIRED FOR
EACH DWELLING UNIT.
R'ORK DFSCRIPTION: CONTRACT PRIC& FEES
,
1% OF CONTRACf FEE.
STATE SURCHARGE IS $.50 FOR EACH
$1,000 OF PERMIT FEE a
PROCFSSED PIPING - $25.00
$
MIIIIMUM FEE - S25.00
OR'NER: TOTAL: $
SITE ADDRFSS:
TENANT:
SUI1'E #:
WSTAI.LER:
ADDRESS:
CITY: ZIP:
PHONE #: CITY SIGNATURE:
SIGNATURE.
EAGHN TO'v1NSHSP
3795 Pilot Knob P.oad
St. Paul, Minnesota 5J111
Telephocte 454-5242
Pr?tMIT FOR SEWER SERVICE CONPd^C:IOPI
DATE: Nov. 21, 1967 NUMER 71
0ldNER: Glalter Fletcher Address 1037 F?* ? iC. _17?
PLL??BER Al1 State Plbg. TypE OF PIPE Ext. heavy cast iron
DESCRIPTION OF BU73AING
Industriail Cmimercial` Residential Multiple Dweiling No. of nnits N
X
Location of Connections:
Connection Charge $200.00 Pd. 11/21
Permit Fee 7•50 /t
SCreet Repairs
Tota 1 $207.50
Inspected by:
DaCe
Remarke•
By.
Chief Irw^eector
In consideration of the issuP and delivery to me of the above pc*r:Et, I
hereby agree to do the prePosed work in accordance with the rules aad
reguiations of Eagan Tocroship, Dakota County, Minneaota
8y
PIeepe r.otiFy vhen resdy for irspection and corn:ctioa as.: bQiore an.y port:vn
ez cria w_rk is cevered.
I ? t ? r
J
EAGAPt TOWNSHIP
3795 Pilor Knob Roud
St. Paul, MinnesoCa 55111
Telephone 454-5242
PERFILT FOR WATER SLRVICE CONNSGTION
Date:Nov. 21, 1967
Billing Name: Walter Fletcher
Owner• above
Plumber: All State Plbg.
Meter
Number• 44
Site Addreas: 1037 Kenneth
Billing Address
Meter No. ?Permit Fee ?•50_
Meter Reading Meter Dep. 15.00
Meter Sealed: Yes ?Add'l Chg,
NO ' Tota1 Chg. $222'50
Building is a:
Residence X
Multiple Hq,
Commerc ia 1
Industrial
Other
Inspected by
Aate
Remarka:
By:
Chief 7.nspector
In consideration of the 3ssue and delivery to me of the above permit, I
hereby agree to do ttn proposed work fu accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
sv:
Pd. 11/21
Rd ?.
Pd. 11/21
Flease notify the above office when ready for fnspection and connection.
09i15 '93 15:45 ID:IIAKOTA CO-WSC FAX:6128917031
MUNxCIPAL NMYCg pg WELL PMWIT APPLICATTON
DAKOTA C0UNTy ENVIgpNNENTAL HANAGEMBNT DEPARTM$NT NA7ER 14955 Gt1laXie AVEnuW?B?t,?Ap?Tpa118yI? HN 55124
Te1 (612) 891-7011 Pax (612) 891-7031
DATBs Septembex 15, 1993
TO: Tom Colbert/Wayne Sahwana
FRVHt water and Land Nanagemant
RBt Nell Permit ;; 93-8221
14un3.cipalitX : 1sAgan
PAGE 1
Fbst-It" brend fax trens htal memo 7B71 +?m peye. w I
llb /6'Yh COUKAV ?°"' /?.
0191
on.
l
Nail Type; Sealing
Reviewer z Rutken
xoTicE:
The Water end I,anc] Managament saotion cf the Ua.kote County Snvironmental
Hanagement bepartment has received the followinq permit applioation for
the well deserlbed. If you xeqtlire Puther review of the 8ppliaatiol? or
if you heve pny questiotts pr contserns aboub it, contact the Bnvironmenta]
speoial.fst listed abovg pr our oPfice at (612) 891-7011. If there is np
reappnsa from your ofPice within 24 HOURS (exOYuding wee?kends gnd
holidas
the ) we will asau?pe that y4u hava no objeotions to the iesupnce of
x pe y nni?., pleaBS nnte that permit iesuance is ai?raps Conditioned on
he permit appllaant's observance of and aompli?ance with all applicable
officonwhendoomple?.edPy °f the aell psrmit mi11 be forwarded to your
WSLL CONTRACTpR TNFp72MATION:
Garp 'e Well Drilli
n
n
tioipated Drilling/?•Sea]inA ?1Date it known:
Ti1he t :
IACATION pF WF;r,L;
PIS Coordinates
Well Loaation 2037 Kenneih Btreet ?• sec , Tawn , Range
Property owmer Eugene Har2oW
W@11 Owner Eugene Harlow
FtD Number 10,47780-02-001
i98LL INFOIiMl?TION:
biameber q
casing depth 123
Total Qepth 127
$wL 97
Aquifer Unooneolidated Bedimente
CoMAlBN'ts :
R=96% 6128917031 09-15-93 03:45PM P001 #02
City of Eapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
------------------------------------------
? Case Number: 09-004328 ;
, ,
FORECLOSURE / PROPERTYDAMAGE REPORT
Date: 3/6/2009
Complaint Taken By: Terry Zelenka
Type of Building: Single Family Home
Name:
Address: 1037 Kenneth Street
Legal Description:
Phone Number:
Complaint:
Water off
Gas Off X Water Off
Electrical Off X Home is Unoccupied
Action Taken: Inspection
Comments: Home has had a Sheriff's Sale. The property is for sale. Home appears to be in
good exterior condition and has no apparent water damage to date.
Entered in PIMS 3I11/09 (SB)
Signature: 226
G:IBuilding InspectionslFORMS
k
Use BLUE or BLACK Ink
For Office Used ,
Permit
~ My of Ealan
Permit Fee:
3830 Pilot Knob Road I
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 i I
Fax: (651) 675-5694 Staff: I
-----------------i
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 'r L / 4t Site Address: 1037 `5 -
Tenant:: Suite 8:
RESIDENT / OWNER ASS Name: CW2_3s lie Phone: 1-1 7~ 6 - 1266
Address/City/Zip: '1
Applicant is: Owner 2SContractor
TYPE OF WORK Description of work: ®v"'j s Sn/ ^ t"" s
Construction Cost 'K./ 00 - Multi-Family Building: (Yes I No k }
CONTRACTOR Name: 4 f" ~-•`f"~ S ITV ` 1 r~ L d `f Z
Address: l br7 ~c~. * 2 .
City: 4-pri-e- Vt t 4f state: MA Zip: S-5-r?-'y
Phone: R~ _SPC r_ *oo Contact Person:
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. ~A,-N r.gopherstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the YMDrk WIN be i rrrance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a pemrt, and rk rat t a permit; that the work will be in
accordance with the approved pan in the /'of workwhich requires a review and a of
2/~N~c9N+/t Zit 6CG.1
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Applicant's Printed Name is
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