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4420 Michael Point Dr,l ? . 4 t?? e?l.-cfrcate of ccc"ancv witij of Cfagan wepatill ext s( 13*0* anoection This Certifreate issreed pursuant to the reqreirements of the llniform Building Cade certifying that at the time of issuance this structure was in compliance with the various ardinances af the City regulatiRg building coRStruction or use. For the following: UseQassificaGion: 8-PM B1dg. Permii No. 76405 Oowpncr 7ype R 1/U I zaoL,g nisaNx Pn/R!? Type ca,et. tnJ ownerofeuaamg PCM IiCS R]G nddrm 11515 192unrrra MS Rn; 122Mrme M Building Address 4420 DR.- _ [.ocaliry 14- R2?.!'?.Ti?R7 'TYId11IMG ?IZI) D.. Bm? AL.90 : 4422,-' 24,' 26 MI4IAF??F CtTOUj?t'25,' 27 SLFF.PY IUI11W POST IN A SITE ADDRESS4420 M"a?e ldi T ?r Unit # L 1 wQ?cw541 Perrnit # acP'?"n? B ?ect./Sub. cI if7 ?,?tke. 1o '10me5 l0/1 1/1 j fl _?....?,Dm ..i i- . urx.ox, w. - ., v . INSPECTION INSPECTOR DATE COMMENTS ? h??•• Z• . ? ?? SITE ADDRESS f ?I"e I ?Mhf 'br Unit # Permit # cfG4OJr' L 'T B Sect./Sub.??-'-Uf h+akC WnYlomes pyp? 4`a3o-s4 o 0, ?°.4 ?On _ 477'° y/?/9s INSPECTION INSPECTOR DATE COMMENTS - -s.- f 57 o-? ? .? ?Yt?. ( ? ?- 4G a l ?? SITE ADDRESS??_ a4 MiU'lAe I -;?i r1 11?7 Unit # ap Permit # a&14011 J nr I INSPECTION I INSPECTON I DATE I COMMENTS I INSPECTION INSPECTOR DATE COMMENTS . .:?G L' ? ,?•??L l?-? 09 ? >> ? SITE ADDRESS 440 r' UC?ae ( TOi n4 1Jr. Unit # Permit #o2& 40-50 SITE ADDRESS44/a?I SlfEA$l lqbljOVY INSPECTION I INSPECTOR I DATE Unit # ?Ake /l ow ,:t77?°_ COMMENTS Permit # 11295 ?? SITE ADDRESS 3'0?W S/eCDt/ ?O?D u/ Sect./Sub. Unit # Permit # volf ' 4 Lake. l?r,?or?nes ? .. t'&.... A I INSPECTION I INSPECTOR I DATE I COMMENTS I iI SITE ADDRESS 4104125 cIeenJ 41(f2w Unit # Permit # L B Sect./Sub..1 C} Lake w.,i'1O?'wS y° ? r 1 ii l? 95 ? ? INSPECTION INSPECTOR DATE COMMENTS ,,p .5,- y? 30 . . /E-G v $1 a ? 6 ? . ?< <r ?ir SITE ADDRESSdAaL! eti7 ?1D W Unit # Permit # G40 5 B I INSPECTION I IHSPECTOR I DATE I COMMENTS ? NIZ ,?....?. INSPECTION RECURD CITY QF EAGAN ?PERMIT TYPE: 3830 Pilot Knob Road Permit Number. Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITE ADDRESS: , • , . „ , ;, PERMIT SUBTYPE: APPLICANT: TYPE OF WORK: INSPECTION D. . .. i?? ??1 ; I???i• i i t I I r?? ? .. .i) I ,J Ri"Mnfrt:, I141 I.lltiiF '. 4 r# AA,'1 44 ? ? 114: 4 ?,;dM I(?HA1? ( F'?1 I IV't (1i; ?. ? ti fIt f+14 ?;nt 1 r ti' ??E fi??; 44:"? ?4.1 T ;,1F.11'Y ltti! 1 r,N ?•;?? ti?, b??.b,?????.s,? , - • ? J . PermM No. ParmR Holdar Date Telephone • ELECTRIC PLUMBING 9 ? •if 9a-o?•?I HVAC • 0) vl Inspection Date Ins Commenta FOOTiNGS FOUND FRAMING ROOFING ROUGH PLUMBINQ PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL CiYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDCi FINAL ??7 ? j BSMT R.I. BSMT FINAL DECK FfG DECK FINAL Address 4420,122,124 '26 m[nraFr. rornrr RD & 4421 '23 '25 '27 St.EEFY HOI.LUA Zip 5512 2 Lot 4 Blk 2 Sub CIIFF LAKE IT14MxMES 2rID THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECfION. Date: '/ wo Yes No Inspector: Final grade (6" from siding) 4 z Permanent steps (garage) Permanent steps (main entry) Permanentdriveway V/ Permanent gas Sod/Seeded grass ? TraiUcurb damage ? Porch ? Basement finish Deck Please verify with the builder the removal of roof test caps from the plumbing system and ihe shut-off of water supply to the outside lawn faucet before freeze potential exists. Contact engineering division at 6814645 before working in rightof-way or installing underground sprinkier system. ? White - City Copy Yellow - Resident Copy Pink - Contractor Copy Serial # U 9 3 7)?7 L) /.5 Chip #_Q 5a / 3 5/ 3 Permit Address:_kef ?0 - .3 ( ').yi ; 1 AGREE TO COMPLY WITH CI'IY OF EAGqN ORDINANCES , f?_ . ? !??T af EaPH 3830 Piiof Kno6 Road Gaczan MN 55122 Phone: (651) 675-5875 Fax:(a"51; 675-5694 ------------------ I Ear A?ce E?s"e ? I C77? I ? Pertnit#. ?l? 90` ? I Permit Fee: ? ? pate Received: ? I i starr: ? L -------- Ir- rIFt? 2008 RESIDENTiAL PLUMBING PERMIT APPLICATIO Ae; la? SiteAddress: =nant: :.SIDcNT/OWNER I Name: CONTRACTOR Address / City / Name: ?15 1J m OCT 15 2008 Phone: ba -599 7?? License #: l11_4 I T 7 V=?? - Address: ??0 65-13401 City: Eaqan MtJ 55123-1339 State: ZiP: .. Phone: TYPE OF WORYC _ New -,Repfacement Dscrinofwork: PERM:T TYPE I RESIDEN7lAL ! _X `eVater I-teater Lawn Irrigation ? RPZ! _ PV6) Septic System New ? Abandonment Contact Person: ? Repair _ Re6uiid W ater Softener Modity Space _N1ork in R.O.W. Add Plumbing Rutures ? Main J Lower Level) W afer Turnaround =SIbcNTiAL FEES: iG.50 Minimum !Nater Neater, Water Scftener, orWaier Heater and Softener (inciudes $.50 State Surcharge) ;0.50 Lzwn Ir.lc2iion (incVudes w.50 State Surcharge) t0,50 Acd FlumUing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharye) .- TurnF?round (add $136.00 it a 518" meter i; required) 00.50 Septic System New ($10.00 per as built) (indudes County fee and $.50 State Surcharge) ?tl. M rir:; r:epair (replace burn2d out appiiances, ducfwork, etc.) (includes $.50 5tate Surcha? TAL FEES $ . -- „o..,.., ....- ---- -. . r?by aci?no`??eGae rha[ tiiis informaiion is completa and accurate; ihat the work will e in co orm - ;? ;hat ?r^e t??d this is not a permit, but only an appllcaGon ior a permit, and work is not tu staR without a peTmik that the work wi(I be in „?p;oved plan i? the case of work mhicb requires a review and approval oF plans. ? L . ?,." X cer.Y`s r rirYed em ApplicanYs Si re - ;R OFFICE LJSE? ? .auiresl:Inspec:ie?ns: . ' _Under Suite #: ???? ?? ????Ju 'T' Clty of Evan 3830 Pilot Knob Road ? Eagan MN 55122 Phone: (651) 6755675 Fax:(651)675-5694 Address ! City / Zip: 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site it RESIDENT f OWNER I Name: Applicant is: _ Owner _ Contractor 1? Rwl< /? -----------, ; ?.n;sa ; ? Pertnit #: 'I I Perrttit Fee: I ? ? Date Received: ? Staff: I ------------ Phone: 1'YPE OF WORK I Description c Construction CONTRACTOR I Name: Multi-Family Building: (Yes X / No License #: ??1 ?3511 Address: City: L ? Slate:kiN_Zip: ?n2y Phone: (051- u? ? W I v? Contact Person: M," E 1 Y 1 CCZ( COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheel CatBgOry SubmiNed Submitted (4 submission type) • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes _No If yes, date and address of master plan: Licensed Plum6er: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: ify fo. : I hereby acknowledge that this information is complele antl accurate; that the work will be in conformance with the ordinances and codes of the Cily of Eagan; that I understand this is nol a permit, but only an application tor a permit, and work is not to start without a pe hat the w011c wlll be 10 accordance with the approved plan in the case of work which requires a review and appmval f p ns. T- X ?O?1f?T(?fG? . MI?N X ?- AppiicanYs Printed Name Appli nY ature Page 1 0!) L? f +V l ?_? ? COIVLMERCIAL BUILDING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 ?O ri 1-+ 9 Telephone # 651-675-5675 FAX # 651-675-5694 Foundation Onl New Buildin Interior Im rovement • Structural Plans (2) sets • Architectural Plans (2) sets • Architectural Plans (2) sefs • Civil Plans (2) • Structural Plans (2) • Code Malysis (1) . Certifirate of Survey (1) • Civil Plans (2) • Prqect Specs (1) • Code Analysis (1) • Landscaping Plans (2) • Key Plan (1) • ProjectSpecs (1) • CodeAnalysis (1) • Master Exit Plan (1) . Spec. Insp. & Testing Schedule ° • Certificate of Survey (1) • Energy Calculations (1) not alway • Soils Report (1) • Spec. Insp. & Tesdng Schedule (1) " • Elec. Power & Lighting Form (1) not alvrays" . Meter size must be eshablished • Meter size must be established • Meter size must be esta6lished-if applirable l • ProjectSpecs (1) 1 • EnergyCalcula6ons (1) " L 1 • Electric Power & Lighting Form (1) " J 1 • Master Exit Plan (1) l 1 • Emergency Response Site Plan (t) y • SoilsReport (1) L • SAC detertnination - call 651-602-1000 • SAC determination - rall 651-602-1000 SAC detertnination - call 651-602-1000 Call MN Dept of Health at 651-215-0700 for de[ails regartling footl sc beverage or ioagmg iaciucies. ** Contact Building Inspections for sample and if required when it s[ates "not always". '•• Permit for new building or addition will not be processed without Emergency Response Site Plan. y j ?dO Date 03 Construcrion Cost ze;z Site Address a 7 e5,0L???GI/ Unit/Ste # Tenant Name Former Tenant Name y ao- a-2 1 Description of Work QN/e5l? Property Owner Telephone #( ) Contractor ?re?s ? /7? Address 2? 3?o?' C.CUe_ .? .. ? Cityl§vff77ihc s?'rJ State Telephone # (aL?/) y60 - EZ Arch/Engr Registration # Address CitY ' r' I? ? II' I? State Zip I Telephone #( I AUG 1 1 Z003 J T l i Licensed plumber installing new sewerlwater service: Phone #: I hereby apply for a Commercial 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 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. Applicant's Printed Name Applican s Signature Sub Types C 01 Foundation C 14 Aparhnents C 15 Lodging ? 25 Miscellaneous Work Types ? 31 New ? 32 Addition ? 33 Altera6on ? 34 Replacement Valuation Census Code SAC Units Nbr. of Units Nbr. of Bldgs Type of Const OFFICE USE ONLY C 26 Public Facility C 27 Commercial/Industrial C 28 Greenhouse C 29 Antennae r "1 30 Accessory Bldg. 7 32 Ext Alt - Apts. 7 34 Ext Alt - Comm. J 35 Ext Alt - PF ? 37 Nail Salon - -? _, ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors ' 'Demolition (Entire Bldg only) - Give PCA handout to applicant _ Occupancy MClES System _ Zoning Ciry Water _ Stories Booster Pump _ Sq. Ft. PRV _ Length Fire Sprinklered Width REQUIREDINSPECTIONS _ Footuigs (new bldg) _ Footings (deck) _ Footings(addition) Foundarion Drain TIle Roof _ Ice & Water Final _ Framing _ Fireplace _ R.I. _ Air Test Final Insulation Fina]/C.O. FinaWi o C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tesu Final _ Siding Stucco Stone _ Windows (new/replacement) _ Retaining Wall Approved By Base Fee Surcharge Plan Review MC/ES SAC City SAC Water Supply & Storage S/1N Permit S/W Surcharge Treatment Plant Park Dedication Trails Dedication Water Quality Copies Other Total Building Inspector , CLIFF LAKE TOWNHOMES 2ND 17791 PAGE 2 OF 2 PERMIT DATE & USE LOT BL ADDRESS P.I.D. #'S 9/95 12-PLFX 020 02 1861/ CA.SEY TRAli. 127 02 1863/ 128 02 1865/ 129 02 1867 130 02 1869 131 02 1871 132 02 1860/ BUCKLEY BAY 126 02 1862/ 125 02 1864/ 124 02 1866/ 123 02 1868/ 122 02 1870 121 02 9195 s-rLFx 030 02 1856/ MICHAEL POINT DR 141 02 1854/ 142 02 1852/ 143 02 1850 144 02 1855/ SLEEPY HOLLOW 148 02 1853/ 147 02 1851/ 146 02 1849 145 02 9/95 s-rLex 040 02 4421/ SLEEPY HOLLOW 133 02 l 4423/ 134 02 i 4425/ 135 02 4427 136 02 4420/ MICHAEL POINT DR 140 02 4422/ 139 02 4424/ 138 02 4426 137 02 15 ,? - ?YEY FV11?? Pu1tLOHo?esBlock 2, CLIFF LARE TOWNHOMES 2ND ADDITION, City of Eagan, CI f ? QL? Dakota County,,Minnesota and reserviny easements of record. PROPOSED ELEVATIONS Top of Foundatfon Garage Floor Basement Floor Aprax. Sewer Servlce Elev. Proposed Elev. Existfng Elev. Orainage Directlons Denotes offset 5take = 4+5.5 =9is.i = v«" ?'? _ 909.3 _ = 0 = o SCALE : i Inch • 30 Feet BENCNMARK, MiN. SETBACK REQUTAEMENTS Front - Hause Side - Aear - Garage S(de - SIM Planning En9lneerln9 Surveytng ^"' Eaet BI^^rlnOten Prsealy BIOO?lneten, Nlnnegote 55@0 I HEREBY CERTIFY TO PULTE MASTER BUILDERS THAi THIS IS A TRUE ANO COARECT AEPAESENTAiION OF THE BOUNDAAIES OF THE A80VE OESCRIBED PROPEATY AS SUAVEYED BY ME OR UNDEA MY DIAECT 5UPERVISION AND OOES NOT PUAPOAT TO SHOW IMPAOVEMENiS OR ENCROACHMENTS, EXCEPT AS SNOWPI. DATE 8 /30 /94 _?? N0: 45R• 2oq : PAGE: F i I F' IOWG. ( ? . W 4 . '? W W r N m t ? ? ' ^ W Q d W ? K m W ? V h 6 ,Z Z ?.., . LOT SURVEY CHECKLIST FOR RESIDENTWL BUILpIpIGPERMITAPPLICATION .n PROPERTYLEGAL; DATE OF SURVEY: ?? LATEST REVISION: DOCUMENT S't'oyDARDS ?? ' ? • Registered Land Survayor sipnature and company R- C3 *-'Cl 0 • Building PermitApplicant C) • Legaldescriptlon ?? I] • Address • North arrow and scale 13-'C3 e-'C3 0 • House type (ramblar, waikout, splft w/o, split antry, lookout, etc.) El"C3 0 o • Directional drainape artows wilh slope/gradlent % • Proposed/existing sewer and watar services 3 invert elevatlon ? ? • . Street name ? o • ' Drivaway ELEVATIONS .gt " 2-'E3 9?'13 o • Sewerservice 2?'? 0 • Properry comers ? • Tap of curb at the dr(vewey ? • Elevadons of any epstlng adjacent homes QJ---O ? . Lq'(3 O . ff'O O • e?'? o . 9? ? O . C3 M,-' O • C3 o% e O 6/Q v ? ft"O -/ • ? B? O • O,-'O 0 • 0` /? O ' • G O o . 6-?a o . D-? ? . ro s Garege 8oot Fust noor Lawest axposed elevatlon (walkoWwindow) Property comers Front and rear of home at the toundatlon PONDING ARFA RI anntlMtilo) Easement lina . NWL HWL . Pond # designatlon Emergency Overflow Eievatlon DIMENSInNc Lot IineslBeartngs S dimenstons Right-of-way and streat width (to baclc of curb) Proposad home dimensions (ncludinp any proposed decks, ovefiangs preater than Z. porches, etc. (I.e. all shuetures requ(rinp pertnanent footlnps) Show all easements o/ record and any Cily utilitles wiWn those easements Samacks,of proposed structure and sideyarcJ semack of adJaeant e)dstlng structures Retaining wall requirementsiLanv Reviewed: . iwy is9s INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 auz?oxNr 026405 09f26/95 SITE ADDRESS: LOTe 4 BI.OI:K: 4420 MICHAEL PdINT DR CLIFF IflKE 70WNHOMES 2Np PERMIT SUBTYPE: a-P?Ex APPLICANT: Z pULTE HQMES OF MN CO (S12) U52-5200 TYPE OF WORK: NEW . F00T7NGS ?. • FOUN?ATION .• FRAMING i?qqFINC? SNSULATIpN FSREPLWCE ROUGH IN PLBG ROUGM TN WTG FINflL PLB6 FINAL REMARKS: INCLUDES 4422 A92q 4q26 MICHAEL POINT DR S& W PLRR - VRLLEY PLBG 4427, A423 4425 4q2? SLEEPY HOLLOW ? . ._.?_ _... . .,,.. __ ._. . , . . . ., .: - ? . . . ? , .. ' ` ?, °;? ? -°' ? .f ?? ? ? ? : . . ...... . _. .. .,.......? ...?...,.? PERMIT ?OA?9*811 J ?-CfTY OF EAG AN 9a? .? ? 3830 Pilot Knob Road PERMITTYPE: BU I Eagan, Minnesota 55122-1897 Permit Number: 0 2 6 4 0 5 (612) 681-4675 Date Issued: 0 9/ 2 6/ 9 5 SITE ADDRESS: 4420 MICHAEI POINT DR LOT: A BLOCK: 2 CLIFF LAKE TOWNHOMES 2ND DESCRIPTION: Buildiing?-Plermit Type 8-PLEX Buildiny Work Type NEW , 'C1BC Oa!cupancyl,-, " R-1 U-1 ' Constructican Tylt.q U--N Zoning - PD R-4 ? r` Oiii.lditlg LBflgY`h x 112 BuildinQ Width 68 Building sCOries 2 i= '.. ? ? .• ? ? . J . ?b f . r ?? ?s ".. - ... ... REMARKS: INCLUDES 4422 4424 4426 MICHAEI POINT pR S& W PLB R - VHLLEY PLBG 4421 4423 4425 4427 SLEEPY HOLLOW FEE SUMMARY: VALUA7ION $524,000 Base Fee $2,989.25 CITY 5AC $800.00 Plan Review $1,046.24 WATER CONNECTION $6,000.00 Surcharge $262.00 S & W PERMIT $100.00 SAC $6,800.00 S & W SURCHARGE $.50 SAC ? 100 TREATMENT PLANT $2,976.00 SAC Units 8 ROAD UNTT $3,400.00 Subtotal $11,097.49 Total Fee $ 24,373.99 CONTRACTOR: - Flpplicant - sT. l.IC. OWNER: PULTE NOMES OF MN CO 14525200 0001371 PULTE HOMES INC 1355 MENDOTA HEIGHTS RD 300 1355 MENDOT A HEIGHTS RD 300 MENDDTA HEIGHTS MN 55112-1112 MENDQ7A HEIGHTS MN 55120 (612) 462-5200 (612)452-5200 I hereby aekno wledge that I hdve read this appLication and 5tate that tHe information is correct and agree to cdmply with all appliceble State of Mn. Statutes and C 3ty of Eagan Ordinances. Jhuw APPIICANT/PERMITEE SIGNATURE ISSU D e ?U E ??? SI CITY OF EAGAN rk3 q q 3830 PILOT KNOB RD - 55122 j64 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 ? 3 registered aite surveys ? 2 wpies of plan ? 2 copiea of plans (Indude beam 8 window sizes; poured fnd. deaign; ett.) ? 2 sde suneys (exterlor edditions 8 dedcs) ? 1 energy calwlations ? 1 energy calwlations ior heated additions ? 3 coDies of Uee preservation plan H lot platted after 711l93 required: _ Yes No oATE: q-14--as CONSTRUCTION COST:???? •0 v DESCRIPTION OF WORK: STREET ADDRESS: ' LOT 4_ BLOCK PROPERTY Name: ?)ov'tPy tlrarnrs ? n1 c. Phone #: 457,- SZao OWNER '"°' Street Address I355 d"aoV 91S 10 *30v City: I"Oa r.t fli?.H-rs State: Zip: '5?'/2U CONTRACTOR Company: 12Ai+1r- Phone #: Street Address: License #- City: State: Zip• ARCHITECT! Company: Phone #- 3l1- Sz3d ENGINEER Name: Ff:enak Registration #* Street Address, 212, S-E? ??? ? ?4-0 0 City: jwd5'RO0t,+S State: A p? Zip: 55?i-IN' Sewer 8 water licensed plumber: VkU.L? ?L.a»+b?nf& . Penalry applies when address change and lot change are requested once permit is issued. 1 hereby acknowledge that I have read this appiiqtion and state that the infortnation is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: ? OFFICE USE ONLY ESEP ??Certifiqtes of Survey Received Yes No 1 4 igg5 Tree Preservation Plan Received Yes No BUILDING PERMIT TYPE ? 01 Foundation o 06 Duplex ? 02 SF Dwelling o 07 4-plex ? 03 SF Addition -e-08 S-plex 0 04 SF Porch o 09 12-plex 0 05 SF Misc. ? 10 _-plex WORK TYPE ,M? 31 New o 33 Alterations 0 32 Addition ? 34 Repair GENERAL INFORMATION Const. (Actuat) rI -N (Allowable) H UBC Occupancy -/ - 2 Zoning 7 -?/e-y # of Stories ? Length «z Depth ? OFFICE USE ONLY ? 11 Apt./Lodging ? 0 12 Multi RepaidRem. ? ? 13 Garage/Accessory o 0 14 Fireplace o 0 15 Deck 0 36 Move ? 37 Demolition Basement sq. ft. Main level sq. ft. Z N? sq. ft. sq. ft. sq. ft. sq. ft. Footprint sq. ft. APPROVALS Pianning Building . ? . ? • ? ? :' 16 Basement Finish 17 Swim Pool 20 Public Faciliry 21 Miscellaneous MCNVS System yo 3 L City Water -G ys4y Fire Sprinklered PRV Booster Pump Census Code. /os SAC Code 03 Census Bldg i Census Unit 8 Engineering Variance Permit Fee Surcharge Plan Review License MCNVS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Road Unit Park Ded. Treils Ded. Other Copies Total: Valuation: $ SZ y? s, aV Car_ ?? ?GaG?-/ % SAC SAC Units ExTEnIOh ENVELUrE hVEhhCt "U'll Col11'UtATIUN EdEf 6-Y oFM ? 121 siT? nnnnFSS? 4?kzt ?E? ???? • . ' •bAtt I r,onrnncTOn! ? , . : . . i??7?hMlri? 4ronNllir s?Unn? kootAa? ur Enclli ll ? 1, rornl Exroseu UnLL n10,46,,,,, iq fi x''U" (o7L tq rt x iCID? « 17.T8 2, 7ornL noor/cElu Hc nntn,,,,,,,, ` 7. To1nL txrostU unLl nntn cnLCUl.nrlnNst Total exposed weli area above f1ooY„,,,, --k ? a) Total wal) wlildoW 6rea! q8 ?5 DOlJf3LG glaz?d,.,... 9?2(!_9q f! k nUn ,?'R Rq ft k z?d l g a .?.?.? b) Total door AYba .,,,+t&.i ?? . . c) Tofa) slldinn n??ss door aheal gfezoJ„ ?, ? ? !q Ft k liull ----- (l) . .Total flrepiace wa11 srea . L-- --- g?v aq? y +oq2. 7,78 e) 7oto1 wail FruMing areu 8? y eq (AveYnpe 10").46itl„?,°M^?V F? k „Ull . Iro e Z ?? 5 f) 7otol net wall arae ebove ,Og.c'. ?b'G•7 ? ,5%IV rioor (InsulAfpJ1,/'??Q^? 1w+5 sq rE .O6? , oq.4! -b yo.9? 2, a y 9) 2 Total 1'Im fnlst tlYea?f"`.'s'=•?) 0y -- ?oto) foundaklon l.^ 1. ?q ?t area h) Toto1 founJatlon - ----- - - ? . I) ? .. .. , , ??, .. . Total net foundatlon "lo 9q ?t rede b . k itull ?C -. --- -. ? '.. nve g ereg a TQtAI N) lhru 1) IF Itr.m 03 Is the samc aso nr less than IE@m'h1? you 116Vti me t !h#A Intent of 2 I ICAR 1.160U8 A aud 0. ? , . ?r.r' _ , 'i?l) f r'?•:1.?, 1i. '? • ' •. , w : dj:: :'; ": . • otnL rxrosea nnor/cE1L111n CALCItIAtjnll5i Total r.xposed rooF/celllnh aren???i1??i? ? ??y ,?q ?! . , • ?. , .?) Total skyllaht '-41 ?E k ?? - k) Total roor/cei f Inq ?ramin? ` .'•1 ",y?'', ,''' ?'` ?.}? erea (nveren6 4 1 il,V&? ? 1 ? I? , 4q ?'t St ???11 '• Z? b,?LJ L.? . :;r"i . . . . . 1) Total net Insuleked ' '2' • ' ? 13 r?' Yoof/aelllni ar8d,si1s1l ?Q ?V bq fti k U?II r? O ,d , 4 , . = tn.t!?L J 1 thru 1) . Ob Ir tocal oF ?4 Is tl,e seme 6e1ur I??s khan X21 you havo mr! th? In?trit oF '). FICAIt 1,1008 A ettd 0+ ' i , .., ' .. ?. ( nLrIEhllnTE nUlLulllr, ENVELoPE nt51rN 7o Util?ze the ta?e) enVe?op? 9y5tt!M Metl?otl? thd Qdiupg atlubtlshed bY tl,e Surtl uf Itehis N3 anJ N4 sl?al) not be clreatmr then khd gUM tfF, IE??d? 11 AA a'. 21?'? 8y 3. . ... , , ,,• , ' . . .. C? li T I r ? f_. A T I d 11 , I hereby certlFy tl,at I heve cnleulukbd Ehm l'U'l tackbrt Mnd values heYnln end thAt tbe hulidlnn herti .deserlhod t+e6t or exc??d3 the S?Ute of Hlnnesota Enerny f.onservation l1ct+ ' / l ' ls?hnak?rgy ? , (D?l?1 • ?: ? :. Pnl',r, 7 ?.. ,.? u;.`.: . .; ! .c'.?„/• . 77.1?. t 1-f tI' G r' f?:J? ? ?xT?n?on Euv??nrE nvennat "Ull cnHrUtntloN PAIJ 1007 ? . ??• ; otnlL• n: ?u?'T? .?+?s ?e?/c_ , 517E Af1hRfSSa ' bATE t a?( 4?-9? hNoN? s?l'SZ -5;-- conrnneTOn: , n?T?nNlai? Nonv.llih sO.Unnt kooTAct oF tAclli i. YoinL ExrosEn unLL nnEn.,,j,,,, xfoUit -- -, 1 -I??- - 10?,16 2. 1o7nL noor/cEILilic nntn„„4.4, y? tq ft x'lUll j. ToTnL txrosEd WnLL nnEn cnLCULnTInNst Totol exposed wall areo above Floor„I ,,,,,, `/ g?_. , (t) o) Total well w11iJow Area! '. DOUDLE cl l azed.:.. .. FjC?, ?l' . 9q tt KliU,i ? 4 --HLtJ.?--- . r Uii e 11 b) 7ota1 Joor hYba -q +, .. . , ' . .,, . ? , . . . . c) total slldlnh glass duor arcaI UC7UELE- g I dzeJ. I I . t 4 t k uUu ?•??+--nloted??, f! A I.Voil "r J) .Totnl flreplace wall erea 9q f! kliU'f yi?? •q$,,?, ,04Z 945 e1 Total wall frnMing er11uCeiMmO4 fk it "U'l . 11c " (Aocroge 1041•?,<<,?,? IUB, y gd f) Totol net wall etea above • 044 lp, 4 ?• 3045_6 floor (1nsuldt6J),KPY'!'CP^? .067 q I? y r?) Total rlm Joist arooiyv ?1l) 77 64 k .00 -' ° 1, 7oto1 foundatIott nrea (?xposed),?.,,?.+•_ h) Total foundatlon wlndoH aYea, ... '46+4416 I) Total net founJatlon area ebove gtade,+,#++il 3• lo .-- tptAL a) ll,ru 1) 1 If ltr.id P3 is the same nsi nt• less lheFt Itbm?hll ydu lidve met the Ihtent oF z ncnn 1.1600e n a»a v, , , • , i'nge 1 .-r" ' '1• i . . , • °TOrnL ExrasEa nnoF/eElll?in enLcULAt?nlisi Totnl r.xposed - roof/celllnh area,+iiiiii ky Ft .1) 7ote) skyllpht arca,?.???? 44 .Ft k IlU', •. , i ?...?; k) Totel roof/cellinq ('rmmlng area (Averena Inq,),,,,,, ?,Ja Sq tt x"U'l +?? tl !r5 . ,. > I) Tote) net Insulated -y[... roof/celllnq k''Ull -+QC h. . totAl J,1 thru 11 If tota) oF b4 Is the same as, or less kl,en N21 yoti have mak thtl Ihkpnt bf 2 fICAtt 1, 16UU8 A and 01 , ? . ? ?,.nLTth11nTE eUlLbltfr, ENVELohE ht51cN A Tn utlllze the total enveiope system inethodi the vuluos agtabilshad bV khe 9Um uf Iteins P3 anJ N4 shall not.be ?reater thdn khn sum bf ?lgIdt p) hNd k2f • i. I?Z, tL +?. '14. 9A b; 117,14 ? d . .... 3 . ., , ; i Ct r,Tlhlcntlbll ' ( hereby certify thet I hade calcUltltmd the "U" tectnt5 Und "h" veluee hernln and that tha bulldlnq ilerm.de9erlhed madte ar bxokidd tha stete of Nlnnesota Enerny f.onservatlon hct4 ' • / I. ` + ' S gneRUl'? f - / . /, J/?. . ? (bnte) • , . P?nrp 2 Pulte Homes of Minnesota Corporation July 26, 1995 Mr. 7oe Voels City of Eagan Plan Review Department Mr. Voels: This letter is to inform you that Puke Homes Inc., will be using the same plans as specifications for the 12 unit buildings located on Lots 2 Block 1, and Lots 1& 2 Block 2, 2nd addition as used on Lou 2 Block 1, 1 st addition. We will also be using the same plans and specifications for the 8 unit buildings located on Lots 3& 4 Block 2, 2nd addition as used on Lot 1 Block I, 2nd addition. None of the shuctural builcring components, H.V.A.C., plumbing or electrical will change from the original building on Lots 2 Block I, lst addition. Regards, ? ? Tom Thell Designer C 1355 Mendota Heights Road., Suite 300, Mendota Heights, MN 55120-1112 ? «......... Phone: (612) 452-5200 • Fax: (612) 452-5727 • License #0001371 44 9& ae?- CITY USE ONLY g ? L BL RECEIPT SUBD. pl r? OATE:? 1995 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Piease complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit _ (Z New construction Add-on furnace Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc. Date: ? -Caq- q5 ? Minimum Fee: Add-on/Remodel (existing residence only) $ 20.00 ? HVAC: 0-100 M BTU 8 X 24.00 = I g 2• ?° Additional 50 M BTU g X 6.00 =?? -0C) ? Gas Outlets (minimum of 1 required @$3.00 each)ZA-Oo ? State Surcharge .50 TOTAL A'•G fi4 20 ? 4422 >QAa4%442Co M ccJnGte-? Po••,? SITE ADDRESS: 64V 14423 44'2`???W''L7 2?'\eeQSi OWNER NAME: ??eS c?' PHONE #: G?? ?CC? INSTALLER ? STREET ADDRESS: CITY: STATE: N?.(1 ZIP: PHONE #: ( U.It?) ?"OCVO- ST cirr use oNLv L BL SUBD. RECEIPT #: DATE: 1995 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: ? all commercialfindustrial buildings. ? mutti-family buildings when separate permits are pgt required for each dwelling unit. DATE: WORK TYPE: NEW CONSTRUCTION CONTRACT PRICE: DESCRIPTION OF WORK: INTERIOR IMPROVEMENT FEES: ?$25.00 minimum fee pj 1% of contract price, whichever is greater. ? Processed piping - $25.00 ? State surcharge of $.50 per $1,000 of permit fee due on all permits. CONTRACT PRICE x 1% PROCESSED PIPING STATE SURCHARGE TOTAL SITE ADDRESS: OWNER NAME: TENANT NAME: (IMPROVEMENTS ONLY) TELEPHONE #: INSTALLER: ADDRESS: CITY: PHONE #: STATE: ZIP: SIGNATURE: SIGNATURE OF PERMITTEE CITY INSPECTOR L // BL CITY USE ONLY RECEIPT #: $51p oZ ^ SUBD. DATE: 9 9 ?15 1995 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681-4675 Please complete for: • single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACE( NJOL Shower 3.00 x = Water Closet 3.00 x I L, _ Bath Tub 3.00 x ?(_ = Lavatory 3.00 x Kitchen Sink 3.00 x Laundry Tray 3.00 x = Hot Tub/Spa 3.00 x = Water Heater 3.00 x Floor Drain 3.00 x Gas Piping Outlet' minimum - t 3.00 x V = Rough Openings 1.50 x = Water Softener 5.00 x = Private Disposal ` Dakota Cty. license 50.00 = (new and refurbished systems) U.G. Sprinklef ' home under const. 3.00 = Afterations ' to existing 20.00 = Water Tum Around 20.00 STATE SURCHARGE TOTAL 4x_ ay a?l .50 SITEADDRESS: H4ai-21 91 1<< . 14, tle.? ," ycl?o•?? r-c OWNER NAME:2,j I 1 e INSTALLER II._, Pis STREETADDRESS: gb U CITY: ?') 191 C_?a? STATE: l'`' - ZIP: SY''' PHONE #: ( ) uI &1?- a I')l ?- ?? OFFICE USE ONLY L BL sueo. RECEIPT #: DATE• 1995 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 65122 (612) 681-4675 Please complete for. ? ail eommerciaUndusfiat buildings. ? mufti-family buildings when separete pertnits aro II4i required for each dwelling unit. DATE: WORK TYPE: NEW CONSTRUCTION CONTRACT PRICE: ADD ON _ REPAIR DESCRIPTION OF WORK IS WATER METER REQUIRED? _ YES _ NO. IF SO, PLEASE PROVIDE THE FOLLOWING: WATER FLOW: CaPM. ARE FLUSHOMETERS TO BE INSTALLED? YES NO. FAILURE TO PROVIDE THIS INFORMATION WILL RESULT IN A DELAY OP METER ISSUANCE. WILL YOU BE INSTALLING A METER FOR A FUTURE U.G. SPRINKLER SYSTEM? _ YES _ NO. IF SO, YOU MUST APPLY FOR A SEPARATE U.G. SPRINKLER PERMIT. FEE: $25.00 minimum fee or 1% of contrect price, whichever is greater. State surcha?ge of $.50 per $1,000 of permit fee due on ail permits. CONTRACT PRICE x 1°k STATE SURCHARGE TOTAL SITE ADDRESS: TENANT NAME: STE. it OWNER NAME: INSTALLER: ADDRESS: anr: PHONE #: SIGNATURE: OFFICE USE ONLY METER SIZE: " DATE: STATE: 21P: APPLICANT _ INSPECTOR: e • WAIVER OF HEARING #503 Special Assessment Authorization UWe hereby request and authorize the City of Fz.g?n Minnesota (Dakota County) to assess the following described property owned by me/us: Lots 1 through 3, Block 1, and Lots i through 4, Block 2, ;Cliff Lake Townhomes 2nd Addition, for the benefit received from the following improvements: ITEM QUANTTI'Y RA'I'E AMOUNT Lateral Benefit 3anitary Sewer 1,268.95 f.f. $19.20/f.£ $24,363.84 TOTAL $24,363.84 to be spread over five (5) years at an annual interest rate of 70/o against any remaining unpaid balances. The undersigned, for themselves, their heirs, executors, administrators, successors and • assigns, hereby consent to the levy of these assessments, and fiuther, hereby waive notice of any and all hearings necessary, and waive objections to any technical defects in any proceedings related to these assessments, and further waive the right to object to or appeal from these assessments made pursuant to dris agreement. DATED: June 16, 1995 OWNER: PULTE HOMES OF MINNESOTA CORPORATION, a Minnesota corporation By: Andrew C Hi11 jts; Vice President 0 STATE OF MINNESOTA ) • ) ss. COUNTY OF DAKOTA ) On this 15 t May of i u n e , 1995, before me a Notary Public within and for said County, personally appeared andrew c. xiil to me personally lrnown, who being by me duly swom, did say that he is the v i c e P r e s i d e nt of Pulte Homes of Minnesota Corporation, the corporation named in the foregoing inshument, and that said instrument was signed on behalf of said corporation by suthority of its Board of D'uectors and said v i c e P re s i de nt aclmowledged said instrument to be the free act and deed of the corporation. SNLLY JEAN NAAS 4*292i- 0 NOTARY PUBLIC-MINN60TA HENNEPIN COUNIY ? •?MYCommissionExpiresJan.31?2000 _._,,..?„?, ,_.... ._._..?i APPROVED AS TO FORM: IS C4Attomek-s 0 TO CONTENT: ??IQJI Public Works epartment Dated: f u', e 1 R, 19 9S THI3 INSTRUMENT WAS DRAFTED BY: SEVERSON, WII.COX & SHELDON, P.A. 600 Midway National Bank Bldg. 7300 West 147th Street Apple Valley, MN 55124 (612) 432-3136 MGD 0 . 1 f??• •'V" ? CL I FP LAKE T00qN0ilES ZNO ADD1 T I ON . , c9 xErr Arm ` . . ma imimma mimmammmonu mmuam?mmiiai?uwimnmimim umimm punnnum?nnum mmmm ?nuimnnaimuiuwEyy? ?mi?na?pm??ni r- - ? ? Nn?n / • / f ?I FF ??? ? ? ? w • / d a? E \ ¦? ? r ? ? ? t:H+3MES ? a I=g a ? I e ? ' OlSTLOi ? I ?, Z e' j 2i : ? POND s ? . _oMoT? ? . . j +'+tt• ?? ~? ?? ? ? ? ? ? C I F O I ?I ? Cqk ?.,,• ? e ? w "+ ? Lqkx ROAD ?t .? l?w+i? w d?t. ' r R oi?IS? f? oipn i ;I?? U11"M?0iMf11?N ?Inl ¦YI I a[fl/ : uA of ci ? 1?. . ? rs e°mor=• FINANCIAL OBUGATION LEGEND mnmimnmmm teteral 8eneflt Sanitary Sewer {FNMn?Ni,M'1N CJ1M~<N11M IY? OOw?n Ir?n NsMww?1 FNd . ?. e1M:9iMti <.o~ N?the I MniIN ' 11.34r, p~r ,. FMT br ? fIM! H ?M ?IK N 1 Mr.Ir Mrw?? ?..wMI • • • ` . ? v I GITY OF EAGAN CASFI:f.Cfi: MY4 T'EnMINAI_ tylO: 356, DAT'E: 0204/96 1']:ME: 09:14c31 ID : NArf[t VnLI_I:Y 1='LUMRTNG 3716 3220 1' DONES?TC MLT 02•00 / '-?UZo -1?, 11,t.<i?<:?_(' ??(-?j• ?t ?_ ?- ? C • ?/ To? o1 I:cceip+, Amoun+.: 02.00 CR0:;1031. USf_F ID; MARY R ? c? /? Z ??"-U? ? ?? ? ?7- ??? l 6 7-Mk 2007 RESIDENTIAL MECHANICAL rERMIT nrrLicnTioN City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 Please complete for. single family dwellings & townhomes/condos when pertniLS are required for each unit 6z>"SU Date ? l 44;-7li ml(hca-'t ?0 ? i/t ?_ i br. Site Address ?'T a r) Nl',GRy "?U ll?? . , W Unit # Property Owner KUp, GoI) D GV Telephone #(v5l? l? 8 f-? 2E l Contractor 1'HOUR ON 8 Street Add? 1904 Vemvllion Street Cily State _ Hastings, MN 55033 Telephone #( Bond #: Expires: The Applicant is _ Owner ? Contractor _ O[her Fire repair (replace burned out appliances, ductwork, etc.) $ 90.00 This fee applies when extensive mechanical repairs are made to a building. Add-on or alteratioo to existing dwelling unit $ 50.00 ? furnace _Additional VReplacement _ New air exchanger air conditioner heat pump other CC?EIiMC? State Surcharge MAY 0 9 2007 $ .so Total I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; that I understand this is not a pertnit, but only an application for a permit, and work is not to start wi[hout a permit; that the y?ork will 6e in accordance with the approved plan in the case of work which requires a review and approval of plan?s.? ?? JoSSv ?-Owvwce/ Q44?e? J-1 Applicant's Printed Name Apacant's ignature 71(l q3 2007 RESIDENTIAL PLUMBlIVG PeRMir aPPUCaTtoN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. ?6-t '6D Date S 1???_ ?/ f-CJ d'VlI t:V1C(,?( 'PDI v7T "^ Site Street Address lP H0 i ? 1 L^J Unit # Property Owner fto ( i11)Dc.y Telephone #( ) /a?t?m?,r, 0 • UR Telephone# (?p51 ) ?'3?-?11? Coni {//? " ?fe?s aotoormrnufa?c Addi 1904 Vermillion Street CitY State Zip Hastings, MN 55033 The Applicant is: _ Owner ?Contractor _Other Refurbished Submit 2 sets of plans and MPC license Septic System _ New Includes County fee _ $ 100.00 Per as-built $ 10.00 Fire Repair (replace burned out fixtures, etc.) $ 90.00 Alteretions to existing dwelling $ 50.00 Add plumbing fixtures. This fee inciudes installation of a water softener and/or water heater at the same time. If you are instafling onlv a water sokener and/or waier heater, do not complete this section; move to the next section and check the appliance(s) you are installing. _ Septic System Abandonment Water Turnaround (add $136.00 if a 5/8" meter is required) n?p Other: ' MAYHe: , Water Heater ft W t S s . $ 15.00 / er ener a o replacement _ new ? Lawn Irrigation _RPZ _PVB _new _repalr _rebuild $ 30.00 State Surcharge $ .50 $ 15 5? Total ..?.. a.. .,...1 .? iro}n• fhnt fha I hereby apply for a Residential Plumbing Permlt and acKnowieage mai cne iniumia????? ?? ?OM -P C.? u,,.. ?......,.-•-, •••-- -- 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 review d and approved. Je.ssd I,4wvWcci - ; Applican 's Printed Name Ap canYs? ignature öðö îøú ÿþ þýý üû ûú ùýýÿÿúöðþ ééúöò ã þýö ýüûúùøíü Þ ÷ ôö íü Þ Ýü ÿ ÿ ø ò îü ò üû þý ø þàãß ý ä æêäêää õù ýü æêãêã ôó öòñ øø éÿ ñÿÞ ÿü ä øø ýü ÿ ôâ øøçù ô àãßðä ûùöÿë øø é ò ÿ òøùöøøûý é ýü ùé ÿì ê øøõ òýÿü üùýÿü For Office. Use I city Of Eapfl I Permit / I a ~ I 3830 Pilot Knob Road I Permit Fee: I i I Eagan IVIN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 1 Staff: 1 I 1 2008 RESIDENTIAL 9UILDING PERMIT AP LI~AT N ~l2 1, ~~z~ 5° r Date: Site Address: L 72- y X1,7 / Tenant: Suite RESIDENT / OWNER Name; Phone: Address / City / Zip: Applicant is; Owner Contractor TYPE OF WORK Description of work: Construction Cost:! G Multi-Family i CONTRACTOR Name: ZZ5 jy,/, License Address: r f~ 292) City: State: hw Zip: JJ%,l~_ r Phone: _4)12-3, _2,y Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted I subi-nission type) Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _Yes No If yes, date and address of master plan: Licensed Plumber: Phone: Wechanical Contractor: Phone: Sewer & Water Contractor: Phone: IUOTE: Plar►s and su ~ ppo►iirr documents thaf you su,~rrrlt are cc~nsidei°r~d to be public ir►~®r~ratior~: Poriioirs o~ i the ir►formation Wray k~e classified as nr~~7~puJ~lic if you provide specific reasons that t~rduld permit the City to .conclude that the are trade secrets: iereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of j 3gan; 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 :cordance with the approved plan in the case o work which requires a review and approval o 1 )plicant's Printed Name Applicant' Signature Page f