3961 Mica TrCITY OF EAGAN
Owner
Remarks * Cedar Grove Acuuisition
Lot 15 elk 6 Parcel 10 16704 150 06
S,rRP, 3961 Mica Trai1 G,a*P Eagan, MN 55122
om
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK Z. 1967 100.00 5.00 20 Paid
SEWERLATERAL 1967 460.00 28.00 2 Paid
WATERMAIN
* WATERLATERAL 1972 607.00 24.28 ZS
WATER AREA
STORM SEW TRK Z 1974 70.00 4.66 15
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER. 1-67
sAC 200.00 452 10-25-67
PARK
BUILDING PERMIT
Receipt
N_° 13113
To be used tor f'IRE REPAIR Est. Value $15,000 Date JANUARX 14 ?g 87
Site Address 3961 MICA TR Erect ? Occupancy
Lot 15 Block 6 Sec/Sub. CEDAR GROVF. 5 Remodel ? Zoning
Parcel No. R rg T f C t
¢
10
OV
UQ
?
U ¢
W WZ
?
Un
?z
? W
ep
i ype o ons
Addition ? No. Stories
Move ? Length
Demolish ? Depth
Int. Impr. ? Sq. Ft
Install ? a
r
Assessment
Water 8 Sew.
Police
Name Fire
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
Eng.
Planner
Council
I hereby acknowledgethat I have read this application and state thatthe gidg. Off.
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eaga,n Ordinances. APC
Signature of Permittee Var. Date
-
Permit q
Surcharge _
Plan Review
Water Conn.
Water Meter
Road Unit
Tr. P I.
Parks
Copies
Total ' 00
A Building Permit is issued to: +•LnuD1nvr1- D w+r,eiir li'Vu • a.VIVJ L on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Pendt Mo. Prmrt HoldW DaN TNophonm 11
PlumMny
N.V.A.C.
Ekcbk ?/.E26`7
Solt or
Inspectloe Dah Inp. Commenb
Foo1N?y+ I
Foollnys 11
Foumldioo
Fnaminq
Roolny
Rouyh PIbQ.
Rauyh Mlp.
ImuL
Fkeplaq
Flnal FIil. ? e
FNW P16p.
?. FMM ML /i & L C'4? ?lCV l:0•7?/C.C?D.?
CiML OCI.'.
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P?. DisP.
• ,.... > , ..... .
?
, . , ? PERMIT #
MECHANICAL PERMIT RECEIPT # -<-
C1TY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:??(j'i j(
CONTRACT PRICE: .`?. ?''' PHONE: 454-8100
Site Address '
BLDG. TYPE WORK DESCRIPTION
Lot11 ?_L Block Sec/Sub
?r
' Res. New
Name Mult. Add-on
? AddressG A?" Cd•
older 4't?? Camm. Repair
c City _
'"`':
honj?
?
Other
.,
I
Phone ' 5-2juo
FEES
Name RES
HVAC 0
1o0 M BTU 2
00
? .
- - $
4,
c Address ADDITIONAL 50 M BTU - 6.00
p City ?;???? Phone (RES. HVAC INCLUDES A/G ON NEW
J • CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air C-A) M BTU APT BLDGS. - COMM. RATE APPLIES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU $ MINIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent. CFM $ (ADD $.50 SIC IF PERMIT PRICE GaES
Gas Piping OuUets # $ 6EYOND $1,000)
Other $
FEE:
S/C: SIGN URE OF PERMITTEE
:S
TOTAL - -, .? ,-
" ?? =J'
FOR: CITY OF EAGAN
EAGAN TOWNSHIP
BUILDING PERMIT
? • ,
...
Ownex ----. '---- .....---`!'.-'s?4?..-------.._--'--
°----...--
Address (Pre/se"ni) ...J1,6../....... _.'22?....?:---....---
Builder :.--'-•-?"''r---------- 5%d.e.-----------------
Address ------- ?.v2.44Q.....
DESCAIPTION
N° 1585
Eagan Township
Town Iiall
Dafe _.°?.-...5'R...-?..7' .............
Siories To Se Used For Fron1 Depih Heighi Est. Cos! Permit Fee Remazks
LOCATION
Slreei, Road or oYher Deseripiion of Loealion I Lo! I Slock i Addifion or Traci
iS 1 c I (-r -g' -'Y s'
This permit does not aulhorise the use of streels, zoads, alleps or sidewalks nor does il give the ownez or his ageni
the righ!!o creafa any siiuation which is a nuisanaa or whieh presenis a heaard !o the healih, safefy, convenience and
geaexal welfare io anyone in the eommunify.
THIS PERMIT MUST BE??'g{?E-?PT ONI THE PREMISE WHILE TH£ WORK IS IN PAOGRESS.
This is fo oexlify. -"........has permission to erea2 a........ ??.1 ......................... upoa
the above described premise subjee! !o the provisions of the Building Ordinance for E an To nship adopled April 11.
1955. (2? /"??Q??
_"'..........'_._......_._?..._.^_^-.:.'_..../......_."`..""]......... Per .................................
1.^...?.1.'?f.
Chairman o"nwn Baard Building Inapecfr
EAGAN TOWNSHIP
BUILDING PERMIT
Owner ..._- --------- 4_'...---------'
Addrese (Presen!) :..... ..
Builder
Address .....
DESCAIPTION
N° 1532
Eagan TowasLip
Town Hall
Dale .A/,I.-L/d?f........° ..................
Siories To Be Used For Froni Deplh Heighf Esi. CosY Permi! Fee Remarks
/"' iT
LOCATION
Adtlilion or 7
*t
This permif does aot authorise the use of slreeffi, roads, alleys or sidewalks nor does it give the owner or his agenS
the righ!!o ereale any situation which is a nuisanea or whieh presenis a haxaxd !o the healih, sefeSy, conveaience and
general welfare fo anyone in the communily.
THIS PERMIT MUST BE KE T OqN THE PR?MISE WHILE THE WOAK IS IN PAOGRESS. ,? .
Thia is !o eerlify. !ha!-4 '--y ?..,...1?.:_...."-'-':-_---......_..haspermission !o ereei a.1..tr.-.... _....?......"--?_.. ....upoa!he above described psemise subjeef fo the provisions of the Building Ordinance for Eeg?wnship adopfe pril 11,
1955.
... ........"_._
....................... .G.?......?.....?.....?.....--...... ............... -----.._..... per ._..""..'__._.... ._.Q..?.?.?,.u---:..:::.r.......-??- ----------
Chairman of Tqwn Soe?d Suildin9 InsPectoz `A
4 -?C3
GG?
CITY OF Er?GAN
3795'Pilot Knob Road
Engan,, Ntinnesota 55122
PERMIT N0. : 754
ihe City of Eagan hereby grants to P=oject Plumbinq Co.
af 9743 Humboldt Ave. So.
a PLUMBING . permit for: (Owner) T Nichols Inc. alteration
at 3961 Mica Trail - ? pursuant to application dated 12/11/7f
Fee Paid: $5•00 dateci-this 16 day of NovemY,er ? 19 76
s c
.50 Building Inspeetor
Mechanical Permits:
Eid Totale ---
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55727 N9 13113
PHONE: 454-8100
BUILDING PERMIT Receiptx
7o be used lor FIRE REPAIR Est. Value $15,000 Date JANUARY 14 1987
SiteAddress 3961 MICA TR Erect ? Occupancy
Loc 15 eiock 6 Secisub. CEDAi2 GROVE 5 aemodei ? Zoning
Parcel No. Repair 09 Type of Const.
Addition ? No. Stories
? Name GLEN LIMSTRO:I Move ? Length
3 Address S?E Demolish ? Depth
p Int Impr. ? Sq. Ft.
Ciy Phone Install ?
o N LI:V?STROM' S CLEANING & CONST APProvals Faes
ame
$Q ndaress 9621 lOTA AVE NO
Assessment
? city PLYMOUTPAone 544-8761 Water85ew.
Q Police
? i Name Fire
? a Address Eng.
w
a City phone
Planner
Council
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe
' gldg.Off.
information is correct a agree to comply
h all applicable State of
Minnesota Statutes an Ciry of Ea Or i ? ce5 APC
Var. Date
Signature of Permittee
Permit ?'1L8.7U
Surcharge 7.50
Plan Review
SAC
Water Conn.
Water Meter
Road Unit
Tr. PI.
Parks
Copies
r,,,e, 136.00
A euilding Permit is issued to: L INDgTROM' S CLEANING & CONST an the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and Ciry of Eagan Ordinances.
Building Official
C
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8?
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,
i
5 ,i
Requ st Daf Fire o. RougRin Inapection
Requiretl7
•
? Reatly Nowll Notily Inspactor
. ??y
? W?enReaCy9
XIcensed coniractor ? owner hereby request inspection of above elecVical work at:
Job Atlaress (SveeL Boe or Rome No.)
L Ciry
4
Sngl M ' "rRICU * n
Saction No. TownsM1ip Nama or No. Range No. . Cowl^y/
Occu/p} 1 JP?RIN?T) j
'
l Phone No.
.i
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C.
Pow Sup lierl r
?L
? qCtlress ?e?
ti
1990
`
l? • "IF?Jr`I
1
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EleclfnuI ConVactor (Company Namel ??'+?
l
? ConV?adork? QLiC?ense No./
(3L
eC_
J? • ' 1
Mailing Adtlress (CONrector or Owner Mak ng Instg lation)
9
, n2..c.rsa iJn
1
AuthorizeC SlgnaWre iCO?lr o,/Own M ing Inslellationl PVAe Number
- ()- -?..1(
MINNESOTA STAT ! OARD OF ELECTRICITY THIS INSPECTION FEOUEST WILL NOT
GrIpgs-Mltlwey Bltlg. - Hoom S-173 BE ACCEPTEO BY THE STATE BOARD
1841 Univentty Ava., $1. Paul. MN 55104 UNLES$ PROPER INSPECTION FEE IS
G"ne(B1T)bd2-O800 ENCLOSEE).
d 39891.
REQUEST FOR ELECTRICAL INSPECTION
? See inslrudions ror completing this form on back o1 yellow copy.
r "X" Below Work Covered by This Request
km??Al, E8-00001-08
G??s/
'ar.,?.• .
ew Adtl Rep. TypeofBUilding AppliancesWiretl EquipmentWired
Home Range Temporary Service
Duplez Water Healer Eledric Heating
Apt. Building Dryar Other-(Specity)
Comm./Industrial Fumace
Farm Air Conditioner
Olherlspecityl ConlractorS Remarks
Compute Inspection Fee Be/ow: ?? 1? p?t?
# Other Fee # ServiceEniranceSize• Fee # Circuits/Feeders Fea
Swimming Pooi 0 to 200 Amps 0 to too Amps
Trenstormers Above200_Amps Above700-Amps
Signs Inspector§ Use Only: TOT L 5'0
'
Irrigation Booms 6
Speciallnspection
Alarm/Communication THIS INSTALLATION MAY 8E ORD NNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTNS.
I, the Electrical Inspector, hereby Rough-in
?
certity that the above inspection has
been made. Final ? C
+ 7
OFFICE USE ONLV
This repuest voiE t8 monihs Irom
//?'VS'% REQUEST FOR ELECTRICAL INSPECTION AV% ee-ooooi-os
k See ins4ueliona lor completi'q this tnrm on Ceck of Vellow coov.
c; ? 17 Q "X" Below Work Covered by This Request
?Iew?AAdl Reo.? Type ol BuilEing ? Applionces WiroO ? Equipment Wired ?
n Home Range Temporarv Service
Bulk Milk
M iee ServlcaEntrenceSlxe Ir Fee ieeders/SUbfeeders k Fee Circuits
0 to 200 qm 5 0 to 30 Am s () tn 30 Am s
Above 200 qm S 31 to 100 Amps 31 to 100 A
Swimming Pool Above 100-Am s Above 100_Am s
Transiormers Irngation Booms Partia6' er e
I Inspection JS ,
Final
1. thAE 9I
Inspector, haraby
certiiy thet the above
fnspection hea bean
tlqUQ9f VOId
(I15IfOT
`6 50 2 9
HeQuesi O
I ta Fire No. qequlied7 nsPection 1 l Notilv. InsPec-
OReady Nuw W1
?,Q 7 ?Yes ?Na i When ReatlY
1
Licensed Elecirical ConVacmr 1 hereby repuesf inspecHon of eEOVe
Ownar elaccricel work installed at:
Sireet Address, Box or Route No. C?tY
?V?' .+
ection o. Township Name or Na. ange o• Coun
Occupant (Pfll 1 p
'
l Phone No.
? ( YYV ?'1 V\? I??...=
Z il ?
Power Sup0lief AtldrCSs
?
1
ra tor ICony Na
iqe
Elac)s.i<al Co Cnn« mr's License No.
?
`
?
l/A-(.l 36 /
Mailin0 ?r??Contractor oS. ? aking Insta' Ationl
?
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`
Or
4AP
L/1
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L..I.P
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.
Authorized kwffaVla IComractor Ow Maki I tallationl Phone umber
? ?7-
MINNESOTq STqTE 80AR0 OF ELECTqICITY/ tHIS INSPECTION flEQUEST WILL NOT
Orippe-Mitlwey Bldp. - Room N-791 " BE ACCEPTED BV TNE STATE BOARD
1841 Univareitv Ave., St. Paul. MN 65104 V . UNLESS PROPER INSPECTION FEE IS
Phonel6721642-0800 ENCLOSEO.
S'eG-? a b
SEVERSON,SHELDON,
DOUGHERTY & MOLENDA, P.A.
suiTe 600
7300 WEST 147TH STREET
APPLE VALLEY, M(NNESGTA 55124-7580
(952) 432-3136
TELEFAX NUMBER (952) 432-3780
E-MAIL baueu@seversonsheldon.com
TO: Jolm Gorder, Assistant City Engineer
FROM: Rober[ B. Bauer, City Attorney /Y
DATE: July 8, 2004
RE: Lot 15, Block 6, Cedar Grove 5
Keith S. Limstrom and Michelle L. Limstrom
Easement No. 946
Our File No. 206-19117
7ohn,
Enclosed for the City's records, please find the original Drainage and Utility Easement dated
June 25, 2001 and recorded with the Dakota County Recorder's Offlce on December 9, 2003, as
Document No. 0523758.
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0523758
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DA1E EiRIGW
C?97Y3 cC;L! Y -
DRAINAGE AND UTILITY EASEMENT ,, ??,???E?U??? ;0y Ce
.f.:
THIS EASEMENT, made this 'Zs day of 2001, between
KEITH S. LIMSTROM and MICHELLE L. LIMSTROM 8Pf? r6&red to as
"Landowner"), and the CITY OF EAGAN, a municipal corporation, organized under the laws of
the State of Minnesota, (hereinafter referred to as the "City").
WITNESSETH:
That the Landowner, in consideration of the sum of One Dollaz ($1.00) and other good
and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, does
hereby grant and convey unto the City, its successors and assigns, a permanent drainage and
utility easement, over, across and under the following described premises, situated within Dakota
County, Miimesota, to-wit:
A permanent drainage and utility easement lying west of a line described as follows:
Beginning at the southwest comer of Lot 15, Block 6, Cedar Grove 5, thence 20'
east on the south property line to the point of beginning; thence north on a line
10' east and parallel to the existing utility easement line recorded on the plat.
and the further right to remove trees, brush, undergrowth and other obstructions. After
The grant of the foregoing permanent easement for drainage and utility purposes includes
the right of the City, its contractors, agents and servants to enter upon the premises at all
reasonable times to constntct, reconstruct, inspect, repair and maintain pipes, conduits and mains;
completion of such construction, maintenance, repair or removal, the City shall restore the
premises to the condition in which it was found prior to the commencement of such actions, save
only for the necessary removal of trees, brush, undergrowth and other obstructions.
And the Landowner, its successors and assigns, does covenant with the City, its
successors and assigns, that it is the Landowner of the premises aforesaid and has good right to
grant and convey the easement herein to the City.
/2ECEIVED - MAIL
fioV 05 2003
DAICOi7t COUNTy
?-AWITOR
IN TESTIMONY WHEREOF, the Landowner has caused this easement to be executed
as of the day and yeaz first above written.
??--???--
ITH S. LIMSTROM
,
???o y ?-?,- -
IvItCHELL STROM ?
STATE OF MINNESOTA)
)ss.
COUNTY OF ?-?-t ,
The foregoing instnunent was acknowledged before me this Z? day of
?,,,.,?, , 2001, by KEITH S
husband and wife.
APPROVED AS TO FORM:
?-?/v ' , ? ?
City Attorney's Office
Dated: ? J/o ? u ?
LIMSTROM and MICHELLE L. LIMSTROM,
Notary ublic
APPROVED AS TO CONTENT:
??
P lic or es Department
Dated: /?- ??i ???
THIS INSTRUMENT WAS DRAFTED BY:
SEVERSON,SHELDON,DOUGHERTY &
MOLENDA, P.A.
? 7300 West 147th Street, Suite 600
Apple Valley MN 55124
(952) 432-3136
(ryaisement #946)
. (206 - 19117)
2
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??_?Y j? J???? h
/3//,3
1987 BIIILDING PERMIT
SINGLE FAMILY DWELLINGS
- yfz/-?10U
ILYCLDDE 2 SEfS OF PLANS, 3 CERTIFICATES OF SOBVSY, 1 SET OF ENERGY CAI.COLATI06S
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOHEOWNSR MQST DESIGA9Y8 AHICH ADDBESS
IS DFSIRED. NO CEiANGfiS WILL BS ALLOWSD ONCS BDILDING PERMIT IS ISSDSD.
M04TIPLE DAELi.IHGS - RFSIDENTIAL RENTAL OAITS FOR SALE IIAITS
INCLUDE 2 SETS OF PLANS, CEBTIFICATE OF SQIiVEY - CHECg HITH BLDG. DEPT.,
7 SET OF ENERGY CALCULATIONS
INCLUDE 2 SETS OF ARCHITECTURAL & STRIICTURAL PLANS,
t SET OF SPECIFICATIDNS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
To Be Used For: r/,ee C?ar9tO?e Valuation:Date:
Site Address 3961 m1C.4fr?i2
Lot L-S Block 40
Parcel/Sub ?-? hln/ ?;-
Owner GLeu L/mS?r-om
Address 396/ 1)?Ic,9
City/Zip Code LeN.
,
Phone
Contractor z it'dStYaM "J
Address Wo2/ - /d/7ur' ,f/o
City/Zip Code
Phone 7 6 1
Arch./Engr.
Address
City/Zip Code
On Site Sewage_ Oecupancy
MWCC System _ Zoning
On S3te Well _ Type of Const
City Water (Actual)
(Allowable)
# of Stories
Length
Depth
S.F. Total
Footprint S.F.
APPROQALS FEFS
r
Assessments Permit ?? ?•so
Water/Sewer Surcharge ), SD
Police Plan Review
Fire SAC, City
Engr SAC, MWCC
Planner Water Conn
Council Water Meter
Bldg Off Road Unit
APC Treatment P1
Variance Parks
Copies
ToTaL I .31„ • aa
Phone #
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41:
MEMO
- city of eagan
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECHNICIAN
DATE: AUGUST 23, 1993
SUBJECT: STREETLIGHT ENERGY COSTS-CEDAR GROVE NO. 5(208 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 5 Addition.
Block 1, Lots 1-22 22
Block 2, Lots 1-19 19
Block 3, Lots 1-11 11
Block 4, Lots 1-16 16
Block 5, Lots 1-25 25
Block 6, Lots 1-22 22
BloCk 7, Lots 1-25 25
Block 8, Lots 1-5 5
Block 9, Lots 1-2 2
BloCk 10, Lots 1-23 23
BloCk 11, LOts 1-14 14
BloCk 12, Lots 1-9 9
Block 13, Lots 1-15 15
208
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Edward J. rsc t
Sr. Engineering Technician
cc: Mike Foertsch
EJK/je
CITY USE ONLY
PERMIT #: 4 T?-? RECEIPT DATE: )^ a T- 0 MEGHAHIGjkL PI ?_AN?_V?V-?ESIDEN'fI.?R PERIbI?APPLICATdON
- CITY OP E1kfiAN
SSSO PILOT KNO$ iiD
f.Afli41V b1A 55122
651-6$1-4675
Please complete for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: J
SITE ADDRESS: 6 /
./
i
OWNER NAME: K2t7 ? ?,-J?4lU,+,. TELEPHONE #: SL 60?
(AREA CODE)
INSTALLER NAME:
STREET ADDRESS:
CITY:
STATE:
Di??e ? ?0.n?4 ...?.4 ..e..t t.. fMn .. rn.ie v..r4 Fvnu
ZIP:
New residential dwelling unit under constructionand not owner/occupied $ 70.00
Add-on, modification or alteration to existin dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
. other ?1 /" ???
Nature of work: ! tti??? oxi?,
.. . .
, . , .. ?• ,
State Surcharge $ 50
rotal , $ ..?C'O • ?
Reminder: Call for inspections.
Nt'c Rcoter TELEPHONE#
2FG7 CJTIYIpmn DT., SYe, # 40 (AREA CODE)
rjy.?.--::1:, MN 5544
LJAN2 3 7001 _
SIGNATURE OF PERdvIITTEE
Updated 1/01
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
COl4MERCIAL bl£CHANICAI? ?ERMIT APPLiCATIO1V
C1TY OF EAfiAP
S$SO PILOT KNO$ RD
EAflA1V, MN 55128
65 Y-66Y-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS: -
OWNERNAME: PHONE#: -
(AREA CODE)
TENANT NAME (IMPRO V EMENTS ONLY):
WAS THERE A PREV [OUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS: PHONE#: -
(AREA WDE)
CI1'Y: STA1'E: ZIP:
.-
WORK TYPE: New construction Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
Specify Nature of Work:
When installing/remnving underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbtng Iinspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstallation = minimum fee
Contractprice: $ xl%=$ (BaseFee)
State surchazge calculate at $.50 for each $1,000 Base Fee
TOTAL . $
SIGNATURE OF PERMITTEE
Updated 1/Ol
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Use BLUE or BLACK Ink
r
For Office Use I
Permit#: 13yS
Ron -A
City of Ea ;
Permit Fee. 1
3830 Pilot Knob Road
Eagan MN 55122 ; Date Received: 13 ;
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ,'1 Zdl 3 Site Address: _ 3 f q L) ,~n
I r J 1 G a A aA ~ Unit
Name: Ms. S. A yy\y A g n S GN Phone:
Resident/ r~ Owner Address / City / Zip: 3`161 n^ 1'r 1 t O TRa1 t ea-azyl 55-12,-7
Applicant is: Owner Contractor
Description of work: u O F ~y~l(, 3` S Z D~iy
Type of Work
Construction Cost: S b C) , o Multi-Family Building: (Yes / No _m
Company: l1, ' 14V}lelgon ~ soh &nrr, . ,Contact: _CDArkV ~P-n «-L & is I^
Contractor Address: 55 F `f LA-,.Q, City: _,A P YA' [A
State: M M zip: SS-31A Phone: 'V,3-Y13 -O 3 I R
License M k Z13)22_70° Lead Certificate N A r - 31990 1
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.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.
x6ASy T)PdAt °VLSon x r
Applicant Printed Name Applica s ignature
Page 1 of 3