4367 Metcalf DrCITV OF EAGAN Remarks
ndd?cion River Hills 9th Lot eik 4 ??
parcei ?5 64'?d .-D3O I34
Ownen ? Street 4367 Mptcal £ Tlr State F.agan MFI SSl 29
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK -
*SEWER LATERAL - - -
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK g].Cl thru UYRSVl110
*STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREETLIGHT 11-4.1 1980 67.80 _ 13.56 S 67.80 C006670 10 24 79
WATER CONN. Brriavlle . 205.00. 3252 6-18-76
BUILDING PER.
snc 450.00 6-19-76
PARK
Remnr m...._n ?., fl..__'" ? _ lAl1 !ln
CITY OF EAGAN Remarks
-? -
Addition Ver Hill Lot 1 Blk 4 Parcel jQW64
Owner Street 4367 M- _al f nr State Fa_qn*+.MN S51 2?
Improvement Date Amount Annuai Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK 31d thru urnsville
* STORM SEW LAT
CURB & GUTTER
51DE1MALK
STREET UGHT 1980 ?.: =:b'7.80 13.56 5 67.80 C006670 10 24 79
WATER CONN. Brnsylle 205.00 3252 6-18-76
9UILOING PER.
SAC
PARK
SoWeY m-1_ !ln
INSPECTION REC4RD
CITY OF EAGAN PERMIT TYPE: ?I +"
3830 Pilot Knob Road Permit Number: `Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675
SITE ADDRESS: . , , APPLICANT:
t?? l?.?is i i??: ,, .., •-?i ?;??rr
, ? , Etrti , •+il1 ?, i, .,, ??F.A ?
PERMIT SUBTYPE: TYPE OF 1NORK:
,'nl I
uIs,cF:t11ltON attf 0401-l?,t?I PM Ik AMA I.r
Permit Holder Date Telephone #
PLUMBING
HVAC
Inspection Date Insp. Comments
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
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONOUCTIVITY
TEST
HYOROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
?
CITY of EAGAN
BUILDING PERMIT
?
own.: ........................ .........
Addrese (Presen!)
Huilder .........?..?..t ................ :........... ............... .........................
Addsesa
DESCRSPTION
. j.
N2 3985
3795 Pilot Knob Road
Eagan. Minnesata 55122
454-8300
Dala ta_-f.S...... r.?..?.P.......... _..........
Storias To Se Vsed For Fronf Deplh Heigh! Eei. Cosi Permt! Fse Remu?Cs
? •at5: y"
a
4.6w
?, r5[e L!
o ' LOCATION " wl
Sirea2, Road ar olher Descriprion ot Loce2ion I Lo! Block Addifioa os Trad
L./ y i w /L.il. •?1- n O Jn_.
This permif does not avllkorisa the use of slreefs, roads, alleys or sidewalks nor doea it give the ownes os hle agaat
the righf 2o eseafe anp si2ualion which is a nuisanea or which psesenYs a hasard !o the healih, eately, coaveaienca and
genaral welfare !o anyona in the eommuniip.
THIS PERMIT MUST BE PT ON THE ?P7REMISE WHILE THE WORK IS IN PROGRESS. Thls is So eeriifp, ffia2...?Ae!?.ia wyi ..................has permiesion !o eree! ..........._upen
the above described premise subjec! !o the provisions of all applica6le Ordiaances for fhe Ciiy of Eagaru
.................................................... per ._•?l.P......?...?7._._--°......-..----..
............
Mayar Huilding Impaclor fg1C,
/O ?osLy??p D?D d?
CITY OF E.9G=?.,T
3795 Pilot ICnoh Road
Eav«^., i+i_rne, ots 5,-122
693
The City af Eagar. herery g-raats to T1ilT_mpson Plwnbing Oo_
er 12201 Minnetonka Blvd.
a PLtRMING Permit Yor: (Owneryindsor Dev. Corp.
36 Metca
`
2297 Clark pursuant to application dated 6/18/76
billed
Fee)Ba6da __ $an_nn dated tnia 7-1 d&J of T1mo
1.00 s/C StBtambRt 878
Building Insp2etoil
PRechanical Permits:
Bic. TocaL^
.? -LI R1J9
czT^r oF ac>A.v
3795 Pilct Ifnob Road
Eall?--i, i+i_r.ncaota 55122
F,?,FC4IT NO.: 859 --
The City of Ea.gan her°by g. aiits to Ray N. Welter Aea ttin iG C
oP 4637 Chicago Ave
a Heatina 1 Permit for: (Owner) Windsor Dev. Cora.
at 4367 Metcnlf Dr. _, Pursuant to application dated 7/6/76 .
Fee Paid: $20.00 dated this 9 da;,r cf Julv , ?9 Z6
.50 e/c
Building Inspector
Mechanical Permits:
Bid Tota.l:
VILLAGE OF EAGAN WATER SERYICE PERMIT
3795 Pilof 1[nob Raad PERMIT NO.: 2093
Eogan, MN 55122 DATE: 6/18/76
Zoning: RI No. of Units: 1
Owner; W1ndS0! DCV. COLp.
Address:
Site Address: 4367 Metcalf Dr.
Plumber: 771omDSOn P1tIDlbinq Co.
Mete No°2'S? Connection Charge: 205.00 pd
Si Account Deposit
Re er No.: _7 7 Y-%.l-?9 O Permit Fee: 10.00 billed 878
cy mplr with t6e Villoye ol Eagan Surcharge: •50 billed 878
I agr
_
Ordi ?ie?/ Misc. Charges: 60.00 pd
Total:
By Date Paid:
llate of Insp.: [nsp.:
SEWER SERVICE PERM{T
VIL'J1IiEOF EA6AN 2756
3795 Pibt Knob Rood PERMIT NO.:
(?? /76
Eogan, MN S5172 DATE:
1
RI
7.onin8:
No. of Units:
Owner: Windsor Dev. Cor .
Address:
4367 Metcalf
Dr.
Site Addreas:
?omspon Plwnbing Cb.
Plumber:
6/18/76 #3252 100.00 pd
1 agrea fo eomDlY with rha Vilioga of Eagan Connection Charge3. 50. 00 Pd
Ordinances. Account Deposit:
10.00 billed 878
permit Fee:
• 50 b111ed 678
Succhaxge:
By. Miea Chazgea: _
Date of I»ap.: Total:
Date Paid:
Insp.:
PERMIT# /:;- I 'J ?? -.I,?
RECEIPT DATE:
2008 USIDENTIAL PLUM$IN6 PEfiMTT ?PPLICATION
crrY oF EAetkx
3$30 PILOT KNOB RD
EAHAN, MN 55122
651-6$1-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITE ADDRESS: ?(-Q I N efC wt7' DY_i Ve)
OWNERNAME:??YI?, ?IM?VI. (? TELEPHONE??Sp?^Qg??
T (AREA CODE)
INSTALLER NAME:
STREET ADDRESS:
CITY:
tJorb ldYV1 IA.WLbIV\.CA TELEPHONE#: (OIZ'927" 4I'033
2010,,?j G60rfieLd spW141 (aREAGOCE)
LS
STATE: Mt? Zip. 55L40$
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license)
includes $40.00 County fee $ 100.00
Note: Additional consultant fees may apply .
?
• MODIFICATIONIALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ W ater turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irriqation system
ReplacemenUadditional: _ water softener X water heater $ 15.00
State Surcharge $ 50
Total $ 15.50
I hereby acknowledge thal I have read this application, stale lhat the information is correct, and agree to comply with all applicable City of Eagan ordinances. It
is lhe applicanCs responsi6ilily to no6fy the properly owner thaf the City of Eagan assumes no lia6ility for any damages caused by the Cily during its normal
operatlonal and malntenance activities to lhe facilities constructed under this permit wilhin nq erty/ri t-of-way/easement.
SIGNAT RE PERMITTEE 1102
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMITTYPE: euzLozrvG
Permit Number: 0 3 3 0 5 2
Date Issued: 0 8/ 2 7/ 9 8
SITE ADDRESS:
P.I.N.: 10-64400-030-04
4367 METCALF DR
10T: 3 BLOCK: 4
RIVER HILLS 9TH
DESCRIPTION:
REROOP/STORM
Bui'ld"zn;g Permit Type
B;Uilding W'a>rk Type
Ec??ensus fiode 434
?
?- ?
DAMAGE
STORM qAMAGE
REPAIR
ALT. RESIDENTIAL
l ?.. ? . _ .? i= ..
REMARKS:
FEE SUMMARY:
CONTRACTOR: OWNER: - Applicant -
WILLAIMSON RON
4367 METCALF DR
EAGAN MN 55122
(651)894-9464
Z her•ab;y,acknouLedge thatI haveread t3i3s appSiaat3rrn andstate that t'hc information is correct and agree to comply with all spplicaple State of hln.
Statutes andr City iafi Eagari Ordinances. J
L _
A 4 h-?CJ I ?
APPLICANT/PERMITEE SIGNATURE IS UED BY: SIGNATURE
- " 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII. S ?7RD - 55122 ?/
New Canstruction Requirements
? 3 registered sde surveys
? 2 copies of plans (inGude beam & window sizes; pouratl fid. design; etc.)
? 1 energy calculations
? 3 copies ot tree preservation plan if lot pWtted after 7/1/93
required: Yes _ No
DATE: LJ75 ?( ? g
DESCRIPTION WORK:
STREE ADDT RESS: L 36? 7W??& 66
RemodeVReoaii Reauirements
? 2 copies atplen
? 2 site surveya (exterior add'RionS 8 tlecks)
? t energy caleuletions for heated adddions
CONSTRUCTION COST? ? L s?D 0`(, o
vv,
LOT: ? BLOCK: SUBD./P.I.D. #: Q?v -e(
PROPERTY
OWNER
Name: -/a/v Phone #: 9"/ ?4??6 T
Last First
?
14,
City ? State: Zip:
Company: 94 Phone #:
CONTRACTOR
Street
City
ARCHITECT/
ENGINEER ComF
Name
Street
City
License #
State: Zip:
Phone
Registration
State:
Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this appliCabon and state that the inforsnation is cortect and agree to camply with all applipbl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: 95i6 4/^111??
OFFICE USE ONLY
CeRificates of Survey Received _ Yes
_ No
AUG 2 7 1998
Tree Preservation Plan Received _ Yes - No - Not
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-piex
O 05 SF Misc. ? 10 = plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
CiYy SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
? 11 Apt./Lodging p
O 12 Multi RepaidRem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
0 15 Deck
? 38 Move
? 37 Demolition
16 Basement Finish
17 Swim Poof
20 Public Facility
21 Miscellaneous
Basement sq. ft. MC/WS System
_ Main level sq. ft. City Water
_ sq. ft. Fire Sprinkiered
_ sq. ft. PRV
_ sq. ft. Booster Pump
_ sq. ft. Census Code.
_ Footprint sq. ft. SAC Code
Census Bldg
Census Unit
Building Engineering Variance
Valuation: $
% SAC
SAC Units
MASTER CARD
STRUCTURE AND
LAND USED AS
Permit
No.
Issued IssUed To
Con}ractor Owner
BUILDING 3 986 G /S
-?G
PLUMBING
CESSPOOL - SEPTIC TANK _/ _Q?- i
??J•7
WELL
ELECTRICAL
HEATING
7
J -? yL
GAS INSTALLING --
SANITARY SEWER I
OTHER
OTHER I I
Items Approved
(Initial)
Date
Remark5
Distance From Well
FGOTI NG SEPTIC
FOUNDATION CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTRICAL
HE,OTING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING 7 // _1?
? ` ^7
WELL
SANIiARY SEWER
?Q 1 G
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOWTIONS
PERMIT NO.
GONDITIONS Of CONSTRUCTION AT THIS INSPECTION
NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REINSPECTION REVEAIED
DATE OF REINSPECTION
CERTI FICATION -I certify that I have carefully inspected the a6ove in which I have no interest presant or prospective, and that I have reported herein
all significant conditions observed to 6e at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvemencs relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BU
DATE OF INSPECTION
DATE
WINDSOR
DEVELOPMENT CORPORATION
June 17, 1976
Mr. Dale Peterson
City of Eagan
3795 Pilot Road
Dear Mr. Peterson:
RE: Lot 3 B1ock 4
4367 Metcalf Drive
Eagan, MN
Enclosed please find a check for building permit application
and fees as allocated on the check stub in the amount of
$1027.50.
This home will be a Model 76-52 Elevation A, and will contain
the following:
- Rear walkout patio doors w/10x12 slab.
- Patio door dining room - no deck
- Appliances (gas range)
Attached also find a copy of the proposed plat plan.
Sincerely,
WINDSOR DEVELOPMENT CORPORATION
kat?',' q 04?
Warren R. Anderson
Vice President
WRA/cs
Enclosure
v ?
`FfFNE?'
JUN 1S 19?
W
00
?
SUITE 192, 4660 WEST 77TH STREET, EDINA, MINNESOTA 55435 • PHONE (612) 831-0717
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' f
?_ -t '?
,M -e}-? I ?- ov
For Low SIops Dscks -
'b 2" in 12" to 4" in 12"
Application of underlaXment, metal drip
eQpee, end eaves 8eshmg: ,
? IA1 Apply 19" sterter strip o( undurlaymant
.? over metel drip edge at aeves. Use only ??? ? pelu
enough faatensrs to hold in place, psndNen
(8) Use 36' atrip o1 underlaymanf for IB?
remainin coursea, overlepping eaeh course
19'. Side9aps aro ta be staggered 6'apart.
{C) AOdY metel drip edge over .
underleymer,t et raka. _
Nots: Where eavea Flashinp ia required,
apply Owens-Corning WeeMerlack or
equivelent specielry eaves flashing product_
or apply a continuoua layer of asphalt plastic
cement beRVeer. the plies of underlayment at teast 24" beyond the inside
wail lina.
?1°?1?.'?I+??1 ?11.?`!?! .S't1o ?'l? I?1j.+$'?1`'it"ill
for ??prqMP"A?.spha)t ApIicacic
Fib,ergl?s It Shir????? ?ibergias'
atros Materielas da Taehado
Othar Roofin9 Metariels You Mey Nesd rake and eaves edges of all decks.
l Drip Edges are recommertded alon9 over any bare deck, and is Los Goterones son recomenda,
techos. EI Contrapiso as recom?
Meta
Underleyment is recammended fc, roofin9
ind for a UL Ciass A fue ret?ny. l?se o^?Y "breather type material such as
Prepare
requerido?7are una Clasificaci6r
pe" tales c
materiales breather
t
ifi
d
U
A
'
g
requ
qsphalt Saturated Ft pBSU.h?iss A.`;re p tformance aed wst rtight
sory oFor
como
ca
cc
ejasc
>>
a?uaci6n como resistente al fue5
-
Roofmg Acces
__ .....4mmwind•driven rein. h„gds at leasf A?in dieTBt¢!- viento. Lot Clavo? deben
por ,i
required must
ton
uso
en la
Deck Praparotion
1a For Stenderd Sioye Oacks -
4' In 72" or mon
qpplication of underlakment, meta
edgea, end aevea fleshing:
(pl qpply one leyer of underlayme
metel drip edge at eaves. Use only
tastenars to hold in plece.
IBI Overlap aucceesive cau-ses 2'•
aoune er.de 11. S'ide laps era to be
suB9ered 8' apert.
(q qpply metel drip edge aver um
leyment et rake.
Note: Where ice-damming mey ca
epply0wens-Corning WeetherLoc
eqmvelant eaves flashinp at least i
beyond the inaide wgall li?ney, lNhen
eaves flashing p o?ductPf o lllow the
m crown -aiet, "'
or ;hrough A?A rated roof
LO33yo 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION ?155"D
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residential dwellings.
Date -17 Il Uv 'I`
Site Street Address 4?3LY -7 Unit#
Property Owner LQ 1)6, ?&jljj ^ Telephone # 651) gP a"D3azl
ContractdF,2 L.'C-UI X 01,11L/ t:0-17L?O&E Telephone #-V/5)f ? -
ndarsss5l3 aZ?zZ ??3&J LOc!ty 4Lr aCWYI_ state_14}I zip .?
The Applicant is: _ Owner V Contractor _Other
Aiterations to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other: $ 50.00
? Water Softener _ Water Heater
-1 replacement _ additional $ 15.00
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
cra!e Sur=hara.a $ .50
Total ?23
I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a
permit, work is not to start without a permit and work will be in accordance with the approved plan in
the event a plan is required to be reviewed and
ApplicanYs Printed Name
?I
J
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4367 Metcalf Dr
Lot: 003 Block: 004 Addition: River Hills 9th
PID:10- 64400 - 030 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 2,000.00
Contractor:
Window World AKA Probuilt America
2211 1lth Ave E, #130
N St. Paul MN 55109
(651) 770-5570
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
If altering the opening size, a framing inspection is required. Smoke detec tors are required in all sleeping rooms prior to
final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required Bat tery operated types
are acceptable if the wall/ceiling finish (i.e. sheetroc k ) has t o be removed t o install a smoke detector. Esther 1 1 Dahl 2211 1 1
h Ave E North St. Paul, MN 55109 651- 770 -5570 estherd @probuiltam.com
Surcharge - Based on Valuation $2K
BL - Base Fee $2K
- Applicant -
Construction Type:
Occupancy:
$1.00
$69.00
$70.00
Owner:
Gregorio 0 Gutierrez
4367 Metcalf Dr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
9001
0801
Issued By: Signature
Building
EA075797
11/07/2006
ePermit
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.
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4367 Metcalf Dr
Lot: 3 Block: 4 Addition: River Hills 9th
PID:10- 64400 - 030 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Window World AKA Probuilt America
2211 1lth Ave E, #130
N St. Paul MN 55109
(651) 770-5570
PERMIT
City of Eaan
A framing inspection is required when installing a Bay or Bow window or if the opening is altered. Smoke detectors are
required in all sleeping rooms prior to final
inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are
acceptable if the wall/ceiling finish (i.e. sheetrock) has to be removed to install a smoke detector.
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total: $90.00
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
Owner:
Gregorio 0 Gutierrez
4367 Metcalf Dr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
Building
EA078888
07/19/2007
ePermit
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.
Issued By: Signature
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Use BLUE or BLACK Ink
r
I For Office Use
Permit '
City of Ea I Permit Fee:
3830 Pilot Knob Road I / I
Eagan MN 55122 Date Received: ! ~3
Phone: (651) 675-5675 Irk
Fax: (651) 675-5694 I Staff: S
I ~T. I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: ay a~F°~r CS'(G U ~t F Vo&e&e _ Phone:
Resident/ I
Owner I Address / City / Zip: L( (r /1 J C Gt D-C
Applicant is: Owner Contractor
Type of Work Description of work: QoC) Et /1)Q
Construction Cost: Multi-Family Building: (Yes / No )
I 1 Company: Contact:
1 Address: City:
Contractor
State: Zip: Phone:
I License Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _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
i conclude that the are trade secrets. i
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.
Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
C 7
xj x ,C
Applicant's Printed Name Appli is Si re
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA141664
Date Issued:03/23/2017
Permit Category:ePermit
Site Address: 4367 Metcalf Dr
Lot:3 Block: 4 Addition: River Hills 9th
PID:10-64400-04-030
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Gregorio O Gutierrez
4367 Metcalf Dr
Eagan MN 55122
(763) 301-9453
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature