1589 McCarthy RdCITV OF EAGAN Remarks #From
Additio/r? Dierenfield Addn. Lot
Owner /?)"J?('i.l??. ° ?.-r.. -1..?7 1-;? Gi Street 1$0 M
Ik 1 Parce
State Eagan,MN 55121
(mprovement Date Amount Annual Years Payment Receipt ate
T STREET SURF. D 1976 1020.0 102.00 10
STREET RESTOR,
GRADING
SAN SEW TRUNK ? 168 100.00 0 Paid
' iE SEWER LATERAL 1970 PO
WATERMAIN
# WATER LATERAL 1970 2025.52 101 ,2 7 20 P37.C1
WATER AREA
STORM SEW TRK
3f STORM SEW LAT 1970 ZO I
CURB & GUTTER
SIDEWALK
STFEET LIGHT
WATER CONN, 240.00 880 6-1 - 2
BUILDING PER.
snc 260.00 880 6-1 - 2
PARK
? CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eac
PHONE: 454-8100
BUILP11atG OERMIT Re
, cr?aAos $10000
To be used for Est. Value 9
Site Addr ss 1589 l?CA?'['HY ROAD
Lot 07? Block SeclSub. MCW'ERY RiDGB
Parcel No.
W Name DAN ICK
o Address
City Phone
?Z ? ?S
,o Name
?¢ Addres
? City Phone
?
W W Name
H
Address
a W City Phone
I hereby acknowlege that I have read this application and state that the
information is corcect and agree to comply with all pplicabl^of
Minnesota Statules andtity ot Eagan rdi ances.
Signature ot Permitee ?
PZ BaRS
A Building Permit is issued lo:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota SlatWes and City ot Eagan OWinances.
OFFICE U SE ONLY
Occupancy - FEES
Zoning - S117.00
(Acluaq Const - Bldg. Permit
(Allowable) - ?
Surcharge
# ot Stories
-30iJ
Lengih Plan Review
?r
Depth SAC, Cily
S.F. Total - SAC, MCWCC
S.F. Footprints -
On Sile Sewage _ Water Conn
On Site Well - Water Meler
MWCC System -
Acct. Deposit
Ciy Waler _
PRV Required - S/W Permit
Booster Pump
- g/W Surcharge
Treatment PI
APPHOVALS Road Unit
Planner
Council - Park Ded.
BIdg.ON. _ Copies
•
Variance - TOTAL ?
I
Permit No. Permit Holder Date Telephofro #
WATER
SEwER `
PLUMBING
H.V.A.C.
ELECTRIC p
Inapsetion Date Insp. Comments
FoOtirgs I
Foundation
Framing
Roofing
ROUgh Plbg.
Fiough Htg. .
Iwl.
Freplxe
Final Htg.
Final Plbg.
Const. Meter Plbg. Inspector - Notify Plumber
Ergr./Plan
81dg. Final
!' zc-f z
Deck Ftg.
Deck Final . .
Well
Pr. Disp.
,-,?C'ITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
SITE ADDRESS:
PERMIT SUBTYPE:
..? ks1 n? ?
TYPE OF WORK:
A[tf9 C f ! flN
J1N1)V1 fi04NA1:i
INSPECTION D. ON TYPE DA
f2k-`>- f'1 Nh! Ftl`Vll"Wf C3 1
?
7
J
,3vyq Permit Holder Date Telephone 7i
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Commenta
FOOTINGS
FOUND
FRAMING P?:r`QA ?V
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
[
GYPBOARD
FIqEPLACE
FIREPLACE
AIR TEST
FINAL PL6G
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IflRIGATION
METER
FIUSH
MAINS
coNOUCnviTv
TEST
HVDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN Remarks
Addition 1viCU83'T'1}y' h1age Lot
?
Owner Sireet 1589 Mc
k Parcel 10 47700 072 00
State Eagan,MN 55121
Improvement Date Amount Annual Years Payment Receipt Date
* STREETSURF. UZ 1976 106,8 iLLo 6$ 1
STREET RESTOR.
GRADING
SAN SEW TRUNK ?Q 16$ 11 0.60 ,68 o
* SEWER LATERAL 1974 3711.40 2147,42 1
WATERMAIN
* WATER LATERAL 197 1
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 300.00 66 _
BUILDING PER.
SAC 260. O - -
PARK
? RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
:
New Construction Reauirements
• 3 registered site surveys showing sq. ft of bt sq. ft ot house; anchl roofed areas
(20°,6 mazimum bt coverege aibwed)
• 2 copies ot plan showing beam & window s¢es; poured found desyn, etc.)
• 1 set of Energy Calwlations
• 3 copies of Tree Preservation Plan'rf lot platted after 7l1193
• Rim Joist Detail Options setecGon sheet (bldgs with 3 or less unb)
DATE 4?A ?? -49 /
JOB SITE ADdRESS /
u
-z
8/1?/0?
RemodeVRenairReauirements ?y,_
. 2 copies ot plan l1 ?? Yl
. 1 set of Energy Calwlations for heated addiflons
. 1 site sunrey for exterior additions 8 decks
• Indipte it hane served by septlc system fw addidons
vaLuaioN
IF MULTI-FAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER&,., SA,4w-C?&
TYPE OF WC
APPLICANT
ADDRESS _
PAGER # _
FIREPLACE(S) _ 0 _ 1 _ 2
?A 8'qf1-"-fw PHONE# 4D?-T /a a
A?y , ZIP CODE
CELL PHONE # G/'Z 719 k?.6 FAX #*4Z/ 51V.3ee-
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category MINNESOTA RUL.ES 7670 CATEGOR
(check one) - Residentlal Ventilation Category 1 Worksheet q r?tt? f???1(J ?
- Energy Envelope Calculations Submitted ? ??
MINNESOTA RULES 7672
Plumbing Contractor.
Plumbing System Includes: _
Mechanical Contractor:
Mechanical System Includes: _
Sewer/Water Contractor:
New Energy Code Worksheet Submitted
Phone #:
Water Softener _ Iawn Sprinkler
Water Heater _ No. of R.I. Baths
No. of Baths
Air Condirioning
Heat Recovery System
Phone #
Phone #
Fee: $90.00
Fee: $70.00
All above infortnation must be submitted prior to processing of applicatlon.
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with ail applicable State of Minnesota Statutes and Ciiy of Eagan Ordin es.
Signature of Applicant
?
- Certificates of Survey Received _ Tree Preservation Plan eived _ Not Required _
. ;° Updated 1/01
OFFICE USE ONLY
? 01 Foundation ? 07 05-plex
? 02 SF Dwelling 0 08 06-plex
? 03 01 of _ plex ? 09 07-piex
? 04 02-plex ? 10 OS-plex
0 05 03-plex ? 11 10.plex
O 06 04-plex ? 12 12-plex
?O 31 New O 35
? 32 Addition 0 36
O 33 Alteration O 37
? 34 Replacement
Valuation
Census Code ?
SAC Units ?L
Nbr. of Units _L
Nbr. of Bldgs
Type of Const
? 13 16-plex
? 16 Fireplace
? 17 Garage
O 18 Deck
0 19 Lower Level
Plbg_Y or _ N
y 20 Pool
O 21 Porch (3-sea.)
p 22 PorchlAddn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
.
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
Int Improvement ? 38 Demolish (Interior) ? 44 Siding
Move Bldg. O 42 Demolish (Foundation) ? 45 Fire Repair
Demolish (Bldg)" O 43 Reroof O 46 WindowslDoors
•Demolltion (Entire Bidg only) - Glve PCA handout to applicant
Occupancy 4C?v? MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
W idth
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
Foundarion
Drain Tile
Roof Ice & Water Final Other
Framing ?j Pool ? Ftgs ir/Gas Tests inal
Fireplace _ R.I. _ Air Test _ Final _ Siding
Stucco Stone
Insularion _ Windows (new/replacement)
Approved By (?L8C7 , Building Inspector
Base Fee
Surcharge
Plan Review
MClES SAC
City SAC
Water Supply & Storage
S&W Permit 8 Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
.? Other
Total
FinaUC.O.
_ FinaUNo C.O.
_ Plumbing
HVAC
?"?JG?Gwff/?
,
?.
;?; .
BUILDING PERMIT
4
To be used for GARAGE
CITY OF EAGAN NO 17966
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 ? O I ??
Receipt #
Est.Value $10,000 Date JUNE 5 , ig 90
Site Address 1589 MCCARTHY ROAD
LOt 072 BIoCk 00 SeC/Sub. MC^ARTHY RTOGF.
Parcel No.
W Name _
3 Address
DAN SPRICK
SAME
° City Phone 688-2093
,a Name FIRST LANDMARK BLDRS
?Q Address 611 SNELLING
? City ST PAUL Phane 699-3135
?
w Q W Name
Address
<w City Phone '
I hereby acknowlege ihat I have read [his applica[ion and state ihat ihe
information is correct and agree to comply with all applicable State of
Minnesota Statutes an ity of Eaga, Or ances. ?'??
Signature of Permite ? ? 2?-
A Building Permit is issued to: FI T LANDMARK BLDRS
on the express condition that all work shall be done in accordance wilh all
applicable Sta[e of Minnesota Stal t?nd City of?dinances.
Building Official
?
Occupancy
Zoning
(Actuap Const
(Allowable)
# or stories
Length
Depfh
S.F. Total
S.F. Footprints
On Sile Sewage
On Site Well
MWCC System
City Waler
PRV Required
Booster Pump
APPROVALS
Planner
Council
Bldg. Of1.
Variance
OFFICE USE ONLY
30
21
FEFS
Bldg. Permit
Surcharge
Plan Review
snC, city
SAC,MCWCC
Water Conn
Waler Meter
Accl. Deposil
S!W Permit
SIW Surcharge
Treatment PI
Road Unit
Park Ded.
Copies TOTAL
$117.00
5.00
1.00
$123.00
8`/io/s o ' 98??o
(?b 27249 ? '-,*8°°
Request Dale
? Fire o. ough-in Inspection
Requiretl? 17
? Reatly Now ill Nolify Inspector
?
?U ? Ves No 'Nhen Readyl
I&V licensed contractor IJ owner hereby request inspection of above electrical work at:
Job Atldress (Street, Boz or Rouie No.)
L 5 a? Yn c, C'?,,?}h City
EQ an
Seqion No- 7ownship Name or No. Renge No. County
Occupant(PRINT) )
I..? W/ 1 ? f i'`-l\ Phone No.
Power Su lier _//,?
? r Address
Electrical Contracror (COmpany Name) `
Al2 12ti eEe drt? ?
ec?al ? Contracror5 Gcense No.
Mailing Address ICo
3151 ? trector o Owner Making Installalion
adl ?k
In
55'6g
Authorize ure (ContractorlOwner Making Instal 6on) Phone Numb ???
7-7
MINNESO7A STA7E BOARD OF ELECTRICITY THIS INSPECTION REOUEST WILL NOT
Grfgge-Mitlway Bldg. - Room 5773 BE ACCEPTED BY THE STATE BOARD
1821 Universlty Ave., SI. Paul, MN 55704 U4 ESS PROPER INSPECTION FEE IS
Phone (812) 602-0800 ELOSED.
D/'/0/rjD REQUEST FOR ELECTRICAL INSPECTION ?4'" N$, es-ooom-m
? See instmctions br compieting this torm on back ot yellow copy.
,
n
?/ 7249 , %"X" Below Work Covered by This Request
ew Add Rep. Type of Building AppliancesWired EquipmentWired
nme Range Temporary Service
Duplex Water Heater Electric Heating
Apt Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) Coniractorb Remarks:
Compute Inspection Fee Below:
# Other Fee # Service ENranceSize Fee # Circuits/Feeders Fee
Swimming Pool D to 200 Amps .QCf 0 to 100 Amps
Transformers Above 200 AmpS Above 100 _ Amps
Si9f1S Inspector'S Use Only: TOTAL
Irrigation Booms I ?.0 ?
m
Special Inspection '
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rough-in oate
certi(y that the above inspection has
been made. F,,,ai at
OFFICE USE ONLV
This request void 18 monihs from
RESIDENTIAL
S BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New ConeVUCtlon ReauiremeMS RemodeUHeqalr Heauiremerrts
• 3 registered site surveys showing sq. ft. of lot, sq. ft of house; and aII roofed areas • 2 copies of plan
(20°k maximum lot coverage albwed) . 1 set of Energy Caiculations for heated add'A'rons
. 2 copies M plan showing beam & window sizes; poured tound design, etc.) • 1 site survey for exterior additions & decks
• t set o1 Energy Calculatbns • Indicate if home served by septic system lor additbns
• 3 copies of Trse Presenratbn Plan K bt platted atter 711/93
• Rim ,bist Detall Optbns selectbn sheet (bldgs wilh 3 or less units)
DATE 5II'71021
SITE ADC
TYPE OF WORK]
APPLICANT I ?
STREET ADDRESS
TELEPHONE # 0
4ULTI-FAMILY BLDG _ Y ?N
FIREPLACE(S) ._ 0 _ 1 _ 2
JE
CELL PHONE #
FAX # fGL71' OW d "
PROPERTY OWNER ZW ?5gIft--, TELEPHONE # (dD1' &02bt
-----------------------------------------------------------------------------------------------
COMPLETE THIS SECTION FOR ••NEWH RESIDENTIAL BUILDINGS ONLY
',E
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 f?i7CIfAt
submission
type) . Residential Ventilation Category 1 Worksheet Submitted ergy t Submitted
. Energy Envelope Calculations Submitted ?d?H 1 5 ZoUz
By
Plumbing Contractor: Phone
Plumbing system includes: _ Water Softener , Lawn Sprinkler Fee: 0A0
_ Water Heater _ No. of R.I. Baths
_ No. of Baths
MechaMcal Contractor: _
Mechanical system includes:
Sewer/Water Conhactor:
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
Fee: $70.00
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply
with all applicable 5tate of Minnesota Statutes and City of Eagan Or ' ances. `??
Signature o} Applicant
OFFICE USE ONLY
VALUATION I40o `
Certificates of Sunrey Received _ Tree Preservation Plan Received _ Not Required _
Updated 4102
.:
i '
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
Q 05 0&plex
? 06 04plex
? 07 05-plex ? 13 16-plex
? 08 06-plex ? 16 Fireplace .
? 09 07-plex ? 17 Garage
? 10 08-plex ? 18 Deck
Q 11 10-plex ? 19 Lower Levet
? 12 12-plex Plbg_Y or_ N
? 20 Pool
? 21 Porch (3sea.)
? 22 Porch/Addn. (4sea.)
? 23 Poroh (screened)
Q 24 Stortn Damage
? 25 Miscellaneous
? 30 Accessory Bidg
? 31 Ext. Att - MuIN
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ?. 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45"' Fire Repair
? 33 Alteration ? 37 Demolish (Bidg)* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement •bemolition (EMire Bidg only) - Give,PCA handout to applicant .
Valuation Occupancy ?' ` ? . d , ? ' • MClES Sysfe?i '
Census Code Zoning , City Water.
SAC Units Stories , Booster Pump
Nbr, of Units , ?,? ? ' ' °
. ? ?•' ' Sq. Ft.
• • , ?RRV -?- ` .
.,
Nbr. of Bldgs Length `Fir,e`Spririklered °. '
Type of Const Width ,
. . ? .
' •
REQUIRED ? , .. ,
INSPECTION9 -'-
_ Footings (new bldg) _ Final/C.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Llrain Tile pther
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Fina1
_ Framing _ Siding Stucco 5tone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit •
Mechanical Permit ' ?• :p License Search
Copies
Other
Total
.,
'
. .
Y .
: •
?--?-
Building Inspector
Cities Diaital
ity Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
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?
?
,
?
1990 BUILDING PERMIT APPLICATION
CITY OF EAGAN
?
?
SINGLE FAMILY DWELLIN6S MULTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT ZS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MiIST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
.R 7`t"Ac-H c`o
To Be Used For: Valuation: Date:.J
Site Address io OFFICE USE ONLY
Lot Block FEES
?'Y?G6??
Parcel/Sub 'd -/q'? ,?700"
Ocane r
Address1 -4
City/Zip Code
Phone
Contractor
Address (Ql ? ? ?,ry?g,/??y
City/Zip Code,/?
Phone (f
•-'-
Arch./Engr.
Address
City/Zip Code
Occupancy
Zoning R -t
Actual Const
Allowable y-N
# of stories
Length
Depth !2.3'
S.F. Total
Footprint S.F.
On site sewage_
On site well _
MWCC System _
City water _
PRV _
Booster Pump _
APPROVALS
PlanneY
Council
Bldg. Off. t9&/1
Variance
Bldg. Permit O a
Surcharge .S.Oo
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Copies
SUBTOTAL
Penalty
TOTAL
Phone #
??75xz 3 = C-yD xi.s= /0 3 s?
?, kl? ? Cc-ll) ? / >= ( 9 7
?6 3 c' e>r / O0
c2?
Cities Digital
itv Control
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?. ?:. ..i.. ?
Cl: T'1' (:)r 1:::AGe;N
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Cn.->t . ._ . `? ? ,.: .?..;, ... Y.,...I" ?' k ?s 1g 7r _...:
?_, ,.:.;. ?:r. ??;?.. r ::.
nc,lE;, i.:f.!':i.l:1:98 t.'.ME.. .I."F63505
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f•1.AM;`.-..ti !-il.1N.l..F.i.f' Cf1;1S';_'Ri..!f:7":['1?;!
300 900i 1589 Ml._7.;AK,,-HY D.
3. n<:+ r•1 r,.? i589 ?:• • ?I?:?,:t?ii':1 i???Y ?
. ..i... .. 4..??..?.i. D
i. e:.c. 900i r_.v ?.?.li:)9 q r,..,? ?.. . ?? s_
1_i
`?IL,?.?7"i:\ ? ?'?'i ?
i.:..?.?.J.1
403.75
{'>i'?r} 4A.
0.5Q
'+
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r. ,.r.,:_,._,1i ?
C?i.•..7 _).:[ f.. i'
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C`I:
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ll.r ?.1? '.?1: . H: 1' ?,I M.fle'1t??al?Jt?le..b? litt? .?e?l:vl:v4?:/'1:?f..::t1e.1..L
PERMIT
? CITYPOF EAGAN
34330 Pilot Knob Road PERMIT TYPE: $ u z Lo z NG
Eagan, Minnesota 55122-1897 Permit Number: 033984
(651) 681-4675 Date Issued: 11 f10/g8
SITE ADDRESS:
1589 MCCFiRTHY R()
LG7- 72 BLOCKa
MCCARTMY RIDGE
DESCRIPTION:
- RBfJVF GARflGE
Buildii7q'-P,erinit Type SF ADDSTIUN
Ei?uildi.ng Wo'Mlt Tvpe ADDITION
Census CocJe , 434 ALTa RESIDENTIAL.
,
,
?. -
- -. ??
?:. .
? '.
C ,
REMARKS:
PI.AN HEVTEWED BY CRFl7G NOVACZYk.
CALL 445-2480 REGARD7NG ELEC7RICAL WERMIT ANp INSF'ECTSOiVS>
FEE SUMMARY
VALUATION $31,000
Base Fee $403.75
Plan fteview $262.44
Suroharge $15._50
Total Fee $681.69
CONTRACTOR: - Applicant - sl-. LIc. OWNER:
HUNTER CQNSTRUCT70N 17472218 3$29 SF'RICK DAN
56415 ASHER CT 1589 MCCARTHY RD
SNVER GROVE HGTS MN 55977 EAGAN MN 55121
(Fj12) 747-2218 (651)
I hereby acknawledqe that T have read rhis applicata.on and state thar_ Che
information is corrpct and aqrec to comply with all appliGabl.e State of Mra.
L 5tatutes and City of Eagan Qrcii,nances. ?
APPLICANT/PERMITEE SIGNATURE SSUED BY: SIGNA URE -V
; .. ?? 1998 BUILDING PERMIT APPLICATION
CITY OF EAGAN
-? ?-?-- 3830 PII.OT KNOB RD - 55122
,KA t _"75
New Construction Reauirements
? 3 registered site surveys
? 2 copies of plans (inGude beam & window sizes; pourad fid. design; etc.)
4 1 energy wiculations
? 3 copies of tree preservation plan 'rf lot platted after 7/1193
required: _ Yes _ No
DATE: II Cl" ? $
DESCRIPTION OF WORK:
STREET ADDRESS: I S C
(RESIDENTIAL)
-1 ? . V??9
ejJ,,,?L I l- l 0*
RemodeURepair Reauirements
0 2 copies of plan
0 Z site surveys (exterior addftions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; ? L ????
LOT: BLOCK: SUBD./P.I.D. #:
PROPERTY
OWNER
Name: ?p r i G lf [J p 7 Phone #:
Latt First
Street Address: Ay
City EA es R ti State: ? h Zip:
?
'-l T`7 "DOS?
Company: ?ya /i?• eo„ Phone 7 U-vl ot /4'
CONTRACTOR
3treet Address: 6'0 e," C f' License # 3 tf oZ 2
City 1- - G. N State: ? h Zip: 7 7
ARCHITECT/
ENGINEER Company: Phone #:
Name: Registration #:
Street Address:
Ciry State: Zip:
Sewer 8 water licensed plumber (new construction onty):
and lot change is requested once permit is issued.
Penalty applies when address chang
I hereby acknowledge that I have read this applip6on and state that the infortnation is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: / l.? "/Y?V
OFFICE USE ONLY
Certificates of Survey Received _ Yes _ No
Tree Preservation Pian Received _ Yes _ No _ Not Required
19 o
NOV °° 9
BUILDING PERMIT TYPE
? 01 Foundation 0 06 Duplex
? 02 SF Dwelling ? 07 4-plex
0, 03 SF Addition ? 08 S-plex
0 04 SF Porch ? 09 12-plex
O 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New 0 33 Alterations
14 32 Addition ? 34 Repair
OFFICE USE ONLY
? 11 Apt./Lodging ?
? 12 Multi Repair/Rem. ?
? 13 Garage/Accessory ?
0 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
GENERAL INFORMATION
Const. (Actual) ? Basement sq. ft.
(Allowable) J? - Main level sq. ft.
UBC Occupancy t2?3 sq. ft.
Zoning sq. ft.
# of Stories 2 sq. ft.
Length ? sq. ft.
Depth rL2 Footprint sq. ft.
APPROVALS
.
,
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump ?
Census Code.
SAC Code ?
Census Bldg
Census Unit b ( Planning Building Engineering Variance
Permit Fee Valuation: $
Suroharge
Plan Review
License MC/WS SAC City SAC
Water Conn.
Water Meter
Acct. Deposit
S1W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies •
Total:
% SAC
SAC Units
? w
? ?
MNcheck COMPLIANCE REPORT
Minnesota Energy Code Permit #
MNcheck Software Version 2.0
Minnesota Department of Public Service
1-612-296-5175 1-800-657-3710 Checked by/Date
COUNTY: Dakota
&TATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 11-9-1998
DATE OF PLANS:
TITLE
COMPLIANCE: PASSES
Required UA = 172
Your Home = 171
Area or Insul Sheath Glazing/Door
Perimeter R-Value R-Value U-Value UA
CEILINGS: Raised Truss 616
WALLS: Wood Frame, 16" O.C. 208
WALLS: Wood Frame, 24" O.C. 894
GLAZING: Windows or poors 137
GLAZING: Skylights 26
DOO125 170
HVAC EFFICIENCY: Air Conditioner, 12.0 SEER
44.0 1.0 13
12.0 1.0 16
21.0 3.0 40
0.300 41
0.370 10
0.300 51
COMPLIANCE STATEMENT: The proposed building design represented in these
documents is consistent with the building plans, specifications, and other
calculations submitted with the permit application. The proposed building
has been designed to meet the requirements of the Minnesota Energy Code.
Builder/Designer /`?.? 1 '-?r Date l/- /0 - ??
EAGAN TOjdNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE COIdNECTiON
DATE: October 24, 1972
OWNER•Frank Haas
NUMBER 1171
Address*k589 McCarthy Road ^ 73 _ /yC(`, ,?,ci I?.-
pLUMBER Wenzel Plumbing & Heating TypE OF PIPE Heavy Cast Iron
DBSCRIPTION OF BUILUING
Industriall Commercfal` Residentiel I Multiple Dwellingf No. of units
Location of Connections:
Connection Charge 260.00 pd 10/13/72
Acct. Dep. 15.00 pd 10/13/72
Permit Fee 10,00 pd 10/19/72
.50 pd 10/19/72
Street Repairs
Total
Inspected by:
Date
Remarks:
Sy.
Chief Inspector
In consideration of the issue aad delivery to me of the above permit, I
hereby agree eo do the proposed work in accordance with the rules and
regulationa of Eagan Tormship, Dakota-CounCy, Minneaota
By
Wenzel Plumbing & Heating Inc.
Please notify when ready for inspection and connection and before any porti.on
of the work is covered.
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minaesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: October 24
, 1972 Idumber: 1013 U,j '
Billing Name: Frank Haas Site Address; 1589 McCarth,y Road
owner: same
Plumber: Wenzel Plizmb'nff D. C.
Connection
Biiling Address
Meter SConnectioa Chg. Juu-uu P 10/13/72
j?
Meter No. 22272492 Permit Fee 10.00 pd 10/19/72
Acct. 0 pd 10/19/ 2
Meter Reading 41aigr Dep. 15.00 pd 70/13/?2
MeCer Sealed: Yes Add'1 Chg.
NO + Total Chg.
Building is a:
Residence Xx
t2ultiple A'o.
Commercial
Industrial
Other
Inspected by
Date
Remarks:
?
By:
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulatioas of Eagan Township, Dakota County, Minuesota.
By:
Wenzel Plumbing & Heatine Tnr:_
Please notify the above office when ready for inspection and connecYion.
??.
:?7??Y
1?3 aj. 3 g
2007 RESIDENTIAL BUILDING PERMIT APPLICATI3P, City Of Eagan r
3830 Pilot Knob Road, Eagan NIN 55122 ?l -1 1
y
Telephone # 651-675-5675 FAX # 651-675-5694 SS
New ConsWc6on Requiremenfs Remodel/Reoair Reauirements Office Use OnN o 7
3 registered site surveys showing sq. ft. of lol, sq. fl. oF house; and all roofed areas 2 copies of plan showing footings, beams, joists Cert of Survey Recd Y_ N
(20%mazimum lot coverage allowed) 1 set of Energy Calcula6ons for heated addiGons Soils Report . Y_ N
1 Soils Repod if proposed building is lo be placed on disWrbed soil 1 site survey for addi6ons & decks Tree Pres Plan Recd Y_ N.
2 copies of plan showing 6eam 8 window sizes; poured found design, etc. Addition -indicafe iionsde sepfic sysfem Tree Pres Required Y N
1 set of Energy CalculaUOns On-site Septic System N
3 copies of Tree Preservafion Plan if lot platted after 711l93
Rim Joist Detail Options selec6on sheet (buldings with 3 or less units)
Minnegasco mechanicai ventila6on form
,SL'cI'l qd Ol?? C???C?M/Yl?l
J
Plans are considered public information uniess vou state they are trade secret and #he reason.
Date
Site Address I
IF u.
S8 q M C t..q^?r.?
V%A A) • S'SI z1 Construction Cost C5? 7, oo(D
1?004A. Unit/Ste #
Description of Work (?FAPa 4? t?Lg lflQ Y'?l.ay? 2r Cck r ? u Cu ? s4a ?Lr.
Multi-Family Sldg _ Y)? N Fireplace(s) _ 0 _ 1 _ 2
Property Owner DQ,n te,\ Telephone #(Q,$1) 7 3 3- 35 46
Contractor i4 O?L Ov,:)?%2? `,S qrvNe 0.4 0..60%t_& ]
-
Address
State ?
City
Zip Tefephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING-.A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Veniilation Calegory 1 Worksheet • New Energy Code Worksheet
(d submission type) Submitled Submit[ed
• Energy Envelope Calculations Submitted
In the Iast 12 months, has the City of Eagan issued a permiT for a similar pian based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone #(
Mechanical Contractor Telephone #? J_
Sewer/Water Contractor
Telephone #(
1)
I hereby apply for a Residential Building Permit and acknowledge that the information 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 wo[,k 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 lans. -,( S?Orick
Applicant's Pr' ted Name ApplicanYs Sign re
! ,?v
Sub Tvpes
? 01 Foundation
? 02 SF Dwelling
? 03 01 of_plex
? 04 02-plex
? OS D3-plex
? 06 04-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
? 07 05-plex
? OS 06-plex
? 09 07-plex
? 10 08-plex
? 11 10-plex
? 12 12-plex
DO NOT WRITE BELOW THIS LINE
? 13 16-plex
? 16 Fireplace
? 17 Garage
? 18 Dedc
? 19 Lower Level
? 20 Pool ? 30 Accessory Bldg
? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 24 Storm Damage
? 25 Miscellaneous
? 35 Int improvement ? 38 Demolish Interior ? 44 Siding .
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof 0 46 WindowslDoors
'Demolition (Entire Bidg) - Give PCA handout to appiicant .Descl'IptiOn: Water Damaga _ Yes
Valuation
Plan Review -)L 100% or _ 25%
Census Code _g'd
t?
5AC Units
# of Units
# of Bldgs
Type of Const V ai?
Occupancy " VI?
Zoning
Stories
Sq. Ft.
Length
Width
_ Footings (new bldg)
Footings (deck)
? Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
? Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insufation
MCES System
City Water
Booster Pump
PRV
Fire Sprinkl,ered
REQUIRED INSPECTIONS
_ Sheetrock
Final/C.O.
FinaUNo C.O. .
HVAC
Other
_ Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
_ Windows
_ Retaining Wall
Approved By: 1 !/ , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
citY sAC
Utility Connection Charge
S&W Permit & Surcharge ,
Treatment Plant
License Search
Copies
Other
Tota I
Cities Digital Quality Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
City of Eagan
Municipal Center
3830 Pilot Knob Road
Eagan, MN 55122-1810
Subject: Permit for Garage Addition
Date: Apri120, 2009
Permit EA77839
Terry Zelenka;
I regret that I inadvertently let the permit for adding an additional stall onto my existing
Garage expire. The concrete work was completed last fall and I had hoped to finish the
framing during the winter.
I have now resumed the project and hope to complete the framing, roofing, and siding
within the next 45 days, at which time I'd be ready for a final inspection. I hope you can
extend the time frame on my existing permit to allow me to finish the project.
Sincerely
?-? c?
i
i
Daniel Sprick
2?.?.._:.?._....._?_?.
"?,?SG( 4mc- C?Jk'? ,
?
? U
AP2 2 0 Za09
City of Ea an
?
Mike Maguire
Mayor
Paul Bakken
Cyndee Fields
Gary Hansen
Meg Tilley
Council Members '
Thomas Hedges
City Administrator
Municipal Center
3830 Pifot Kno6 Road
Eagan, MN 55122-1810
651.675.5000 phone
651.675.5012fax
651.454.8535 TDD
Maintenance Facility
3501 Coachman Point
Eagan, MN 55122
651.675.5300 phone
651.675.5360 fax
651.454.8535 TDD
www.cityofeagan.com
The Lone Oak Tree
The symb?l of
\
strength and growth
in our community.
April 14, 2009
Daniel Sprick
1589 Mccarthy Rd
Eagan, MN 55121
Dear Permit Applicant:
LA J yo s+
3
?0(::8
Our records indicate that the permit(s) listed above have not received the required
inspections or final inspection as required by Section 108 of the Minnesota State
Building Code. Inspections are necessary to ensure that the work for which the permit
was issued meets all life safety requirements of the Minnesota State Building Code.
Please call (651) 675-5675 within the next 30 davs to schedule an inspection. Be sure
to provide the permit number at the time of scheduling. Failure to schedule the
required inspection(s) will cause the permit to be voided.
We want to thank you in advance for your anticipated cooperation in this matter. Please
do not hesitate to call if you have any questions or concerns.
Sincerely,
Protective Inspections Division
C L- "` ? C'V Fr
14 c:
, '.. F., t
GT?
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?
A?
//?? U` k- 1q -X S ?'
-----------------------
?q 3? Z- 4`75- 2A 40
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA132963
Date Issued:09/14/2015
Permit Category:ePermit
Site Address: 1589 Mccarthy Rd
Lot:072 Block: 0 Addition: Mccarthy Ridge
PID:10-47700-00-072
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
Daniel K Sprick
71244435 Metavante Way
Sioux Falls SD 57186
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA132964
Date Issued:09/14/2015
Permit Category:ePermit
Site Address: 1589 Mccarthy Rd
Lot:072 Block: 0 Addition: Mccarthy Ridge
PID:10-47700-00-072
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:Two or More Windows/Doors
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Daniel K Sprick
71244435 Metavante Way
Sioux Falls SD 57186
Sela Roofing Remodeling
4100 Excelsior Blvd
St. Louis Park MN 55416
(612) 823-8046
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink ,6
441.1,10•• r For Office Use
Permit#:City of pil Permit Fee: `
3830 Pilot Knob Road
Eagan MN 55122 wtVEO Date Received: "/'r M/
Phone: (651)675-5675 R7.
Fax: (651)675-5694 Staff: .i►i
MAY 1 61017
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ,2 ie 12C/7 Site Address: i 5♦ K - Unit#:
je$AjS i
zM C��� �� � Name: v1 t�r �t,G Phone: 65( 605-I 78
esident/
Owner Address/City/Zip: 1569 Ca-v- y
K
Applicant is: Owner Contractor
/ ym( P �y >" Irk 7 }Y/ 1 ) ♦�'
Description of work:
of Work .
Construction Cost: 2C 7c'6 Multi-Family Building:(Yes /No 2 )
Company: 170 t k)v1'€..)\., Contact:
i
Address: City:
Contractor
State: Zip: Phone: Email:
fin.. License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
A'c Pet/ IL-
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:
Fire Suppression Contractor: Phone:
NOTE: I r d docume ' at you ubmit are pu®lac informatron Porter
th o "a to d •e cla �t r® a n:public if you provide s"pec1 'mato' K e`pe t
conclude that they are tradesecrets. � .
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 V etoie1 cI dC L x
Applicant's Printed Name Applicant's Signature
Page 1 of 3
/- . 7 //7 (( f 144 /2 DO NOT WRITE BELOW THIS LINE /q // 7/
SUB TYPES
Foundation _ Fireplace Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family GaragePorch(4-Season) _ Exterior Alteration (Multi)
_
Multi X 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
__
)C, Replace Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation 2 u0 Occupancy t� MCES System
Plan Review Code Edition yjvp /945r SAC Units
(25% 100%)1 ) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction V "✓ Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
jFootings (Deck) Final/C.O. Required
Footings (Addition) 1 Final/No C.O. Required
Foundation Foundation Before Backfill HVAC Gas Service Test Gas Line Air Test
Roof: Ice &Water Final Pool: Footings Air/Gas Tests _Final
Framing r., 30 Minutes 1 Hour Drain Tile
Fireplace: Rough In Air Test Final Siding: _Stucco Lath _Stone Lath Brick_EFIS
Insulation Windows
Sheathing Retaining Wall: _Footings_Backfill Final
Sheetrock Radon Control
Fire Walls Fire Suppression: Rough In_Final
Braced Walls Erosion Control
Shower Pan , Other:
,�;'"�
Reviewed By: u , Building Inspector
RESIDENTIAL FEES
Base Fee /
li
Surcharge
pivtit-/ its/ li
Plan Review ( . GPS I
MCES SAC
If'-'0 :"
A
City SAC
Utility Connection Charge
S&W Permit&Surcharge 9 (/ D y [ // ' if / (p PO
Treatment Plant "�
Copies
TOTAL
Page 2 of 3
r
J 6 981
T
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co:t iycp,c13114iiiii:77111 --.. . '"----:—._________________________
47
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For Office Use
, h, ‘ a r° , ri � • _ 4v Permit 8:
E
J 't f. p = DECy # - _.. _Permit Fee:
•. -. D 1 20I9 '`f -//–� '
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-56751 TDD: (651)454-8535 I FAX: (651)675-5694 Staff: i
buildinginspections(@cityofeagan.com –•_,
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date:it-a' , 1 1 Site Address:_571 '" ' Otrit__ 'adi
Tenant: -+��� �,- _ Suite #:
��.s�14�. _. _._....._.Phone: ., l a .___�_
-Residerjtl0wner,; '
• r `t,s , ft Address/City/Zip: (I
_ ..d.. � '
t<
.............
Name: MILBERT COMPANY dba CULLIGAN WATER
License#: WC641376
• Address: 1801 50TH STREET EAST City: INVER GROVE HEIGHTS
Cer.t'raCtOr, - i
•1i
State: _to Zip:- 55071 Phone: 651-451-2241
Contact: BILL MILBERT Email: gloria.abas@culligan4water.com
Tyip:e=;O;f iVV;::, —New —Replacement ,Repair _Rebuild _Modify Space Work in R.O.W.
Description of work:
T Water Heater •
Lawn Irrigation( RPZ/_PVB): ►
x Water Softener
DeS.CI Iptle.tl Add Plumbing Fixtures (_Main/ Lower_ Level)•
Septic System
Description:New
Connection to City Water from Well
Abandonment t
.
RESIDENTIAL FEES •>>
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
$60.00 Lawn Irrigation(includes State Surcharge) 1
$60.00 New fixtures, adding or removing piping (includes State Surcharge)
$60.00 Septic System Abandonment
$100.00 New Residential (fee collected with Building Permit)
- $115.00 New Septic System (includes County fee and State Surcharge)
i
$60.00 Connecting to City Water from Well* + $290 for Meter and $190 for Radio Read = $540
`Sewer&Water Permit also required for connection charges
60.00
FEES
(CALL BEFORE YOU DIG. Call Gopher State Ono Call at(051)454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www.gopherstaleonecall.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email updato on tho CIty's i
wobsito at www.cityofoagan.comisubscrlbo. i
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 I
actor once with 1e approved pan In the se of work which requires a review and appro al of plaannss..� i
(
x l ( x �' / _ M176----‘ .
Applicant's Printed Nab Applicant's Signature
i
Page 1 of-2 i
t
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