1371 Michelle Dr. . . . . . - . ... . ,. . ? , .. .. . . -?air? _ .
d _ ?; '.i+'--` •. +` .
t
d • ?! - , "!.?
Wertificate vf Cccupanc?
??t4 of c???
ze0ath"ext n? ????g 3*60ted"
This Certifrcate issued pursuant to the requirements of the Uniform Building Code
certifying that at the iime of issuarace ihis structure was ire campliance with the various
ordinances of the City regulating building construction or use. For the fol[owing
SF I7WG
1458
use classification: /? eMg. Pecmic No.
??Y 1?'Pe ??11I Zoning District R' T? (???+_
Owoer of Building ' 'Y {? Address ltl ". ,
, ,
sildi Aadr. 1371 MIal.IE 1E[VE L-Wity
oare_ 12/ 10/92 ,
Baiwing Official
POST IN A CONSPICUOUS PLACE
?_____.....-.. . .. T _?•Y?Y:'?
• CIT1F OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
Control No. iJ ;;
o 7t t b ilfA
•*t 46"
119 j22/JZ
SITE ADDRESS: t 01'i t t
1371 M!('Htt 1.f qR
{{1p[?FN Vt1L) E.Y
PERM4T §?yPTYPE:
APPLICANT:
IlJF`,1 EY CONQT
(iilr ) 452-6687
TYPE OF WORK: N LE W
?
I
r?? r+nn??? • Pau S & w r?My-knc i'uR
?
PermR No. PermR Ho{dar Dete Telephone 1f
S/w
PLUMBING
HVAC
ELECTRIC
ELECTRIC
InspscUon DaRS Insp. Comments
FooCngsl
Foundation
Framing
Roofing
Rough Plbg. "? ^p
?
Rough Fitg'
Isu1.
Fireplace
Final titg.
Orsat Tast ft
Fnal Plbg. Plbg. Inspector - Noiity Plumber
Const. Meter
EngrJPian
Bldg. Fnal
DeGk Ftg.
Deck Final
weu
Pr. Disp.
a-N 4
CITY OF EAGAN
3830 Pilot Knab Road
Eagan, Minnesota 55123
. (612) 681-4675
SITE ADDRESS:
INSPECTION RECORD
PERMIT TYPE:
? Permit Number:
Date Issued:
I.ul :
r+ ! 4:NE t 1. t. flF
PERMIT SUBTYPE:
,lt ; i
i t 1:1i 01f , APPLICANT:
IJALME.tx`>PIt. tM AttM LI
(ti1.d) 4?..:'-bn,,?•
TYPE OF WORK:
t4t 114
FtU f 1. f? i N??
416 if;?J %??q
Permit No. Permlt Holder Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTAIC
inspection Date Insp. Comments
Footings I
Foundation
Framing
Rooflng
Rough Pibg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Ftg.
C
Deck Final q 1
? V Ab/
fr
Well
Pr. Disp.
K 2 5 4
?m ?? ?- ? /
Reduest Date
O^ ? '^^ ie No. Rough-in Inspection
uire0?
eatly Now ?l Will Notily Inspettw
WhenFe"4
Vas ?NO
I?,ficensed wntractor D owner hereby request inspection of above electrical work at:
JoD Atltlress (SireeL Box or Poute No.)
1 1 1 MicSn¢k\Q Dr Cily
E a ri.
Se[tion No. Township Name or No. Fange No. CounyV?
? J.J
Occupant(PRINT)
WLtS? onSi-n., C-H 15 Y1 Phoire No.
(I-S2-b
P up06 r
t'iKK O'?R ??cS?t'iC Address
rMI
?`?l
ElecMCal Coniracbr ICompany Name
(tinc (:?' onVeclor's Licenee No.
C.s?c'DI192
Mailing AEtlr SlGOmmctor or Owner tallahon)
Autho' ignawre ICOnVa nar Making Installatio P?one Number
?as.?,, 9 0 Ss
MINNES A TATE BOARD OF ELECTJCITV v THIS INSPECTION REOUEST WILL NOT
Grlggs- 1 ey Bltlg. - Room S-i]J BE ACCEPTED BV THE STATE BOARD
1821 Un venity Ave.. St. Paul. Mf155104 l1NLE55 PFOPER INSPECTION FEE IS
Phane(812)B<Y-0800 ENCLOSED.
S,? ee.ooooi oa
REOUEST FOR ELECTRICAL INSPECTION ?°°'x.
? See instmdions lor completing this form on back of yellow copy.
K r2 9 514,? Q 129
/j?s.gejow Work Covered by This Request rsAZk i,?
Add Rep. TypeofBUilding AppliencesWired EquipmentWired
Home Range Temporary Service
Duplex Watar Heater Electric Heating
Apl Builtling Dryer Other-.(Specity)
Comm./Industrial Furnace
Farm Air Conditioner
Other IWaphY) Conirector's Remarks:
Compute Inspection Fee Below:
# Other Fee # ServiceEntranceSize Fee # CircuitslFeeders Fee
Swimming Pool 0 to 200 Amps 0 to 100 Amps
Transformers Above 200 _ Amps Above 100 _ Amps
$1905 Inspeclor5 Use Only: p? TOTAI
?
0
Irrigation Booms ? y,G
l/ i6 s
?
Special Inspection
Alarm/COmmunication THIS INSTALLATION MAY BE ORD D DISCONNECTED IF NOT
Other Fee . COMPLETED WITHIN 18 MO (
I, the Electrical Inspector, hereby Ro?gn-in
i oa ?
certify thai the above inspection has
been made. Final oate
OFFICE USE BNLY . /?`R
Thls mquest voitl 1B monihs Imm ? ?d??
Address: 1371 I+?M E?RIVE L*t I I Blk 1 Sec/SubHIpDEN p i.T.FV ZIp: 55123
These items were/were not complete at tha time of the flnal inspection.
Date: P'lb 2 Yas No
Final grade (6" from siding)
Permanent steps - garage V",
Permanent ateps - maln antry ?
Permanent diiveway
Permanent gas
Sod/seeded grass ?
Txail/curb damage ?
Parch ?
Basement £iniah ?
Deck
Please verify vith tha buildar tha removal of roof test capa from the plumbing
systam and tha shut-off of vater supply to the outside lawn faucet bafore
freeae potential exiats. ?
.enuuwn
White - CSty copy Yellow • Reaident copy PSnk.- Contractor copy
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 687-4675
PE*MIT ??
PERMIT TYPE:
Permit Number:
Date Issued:
.
? s 73
6la?/fz-.
BUILpING
023979
06/27/94
SITE ADDRESS:
P.I.N.: 10-32900-110-01
1371 MICWELLE DR
LOT: 11 BLOCK: 1
HIODEN VALLEY
DESCRIPTION:
Building'Permit Type DECK
•Building Work Type NEW
'r
, ..?? ??p. \ . ?. ?..•- ? _ _
ti
/ .?
L n? ?
C_JL...V\\?
REMARKS:
FEE SUMMARY:
Base Fee $30.00
Surcharge $.50
Total Fee $30.50
CONTRACTOR: OWNER: - Applicant -
PALMERSHEIM ARDELL
1371 MICHELLE DR
EA6AN MN 55123
(612)452-6622
I hereby acknawled hat I have read this application and state that the
infiormat3on is co rect and agree to comply with all applicable State of Mn.
S utes and City of E gan Ordinances. J
?
?oan ?,e.?.l m?t1
LeA APPLICANT/PEFMITE SIGNATURE SSUED : SI NATIJ
,
13919
C1TY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
(A ytd L -24
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site su rgy
calcs.
? u iv 2 2 1994
I
COMMERCIAL 2 sets of architectural & structural
lans, 1 set of
specifications, 1 copy of energy calc ________
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date.SN-a. Valuation of work iSdcs ?
Site Address: /3 1/ Ynr'CAi_-L1? iD.e. e????
STREET SUITE #
Tenant Name: (commercial only)
LOT BLOCK ? SUSD. NI?PC,?J U?,)ay P.I.D. #
Descxi tion of work: ' ['t?c
The applicant is: Owner ? Contractor ? Other fDescribe)
Name Po l n.., Ar,YSrYEi sv',? 19 R?DELC, Phone -,KSa -d G.2z
Property tiAST FIRST
Owner qddress /.? 7 !? ?'h A •
EA-GAN
STREET STE #
City _ G?C79-J State Yh? - Zip S/a ?
Company Phone
Co ntractor Address License # Exp.
City State Zip
Company Phone
Architect/
Engineer Name Registration #
Address
i City State Zip
Sewer & water licensed plumber Processing time for
sewer & water permits is two days once area has been approved.
d state that t
he information is
I hereby acknowledge tha I have read t'
correct and agree to o p with all ap Minnesota Statutes and City of
Eagan Ordinances.
tff
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 5F Dwg.
O 03 Sf Addition
[1 04 Sf Porch
? 05 SF Misc.
WORK TYPE
0 31 New
? 32 Addition
? 06 Duplex
? 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
? 34 Repair
? 11 Apt./Lodging
0 12 Multi. Misc.
? 13 Garage/Accessary
? 14 Fireplace
J2 15 Deck
? 35 Tenant Finish
? 36 Move
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
REQUIRED INSPECTIONS
? Site
? Wallboard
Basement sq. ft.
lst F7. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
Eq"Footing
Eg Final
? Framing
? Draintile
? 3y
?v
0
? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
veiuat;a,:
.
,
? ?; "? ?? ?,? ?
? 16 8asement Finish
? 17 Swim Pool
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire 5prinkler
Census Code
SAC Code
Census Bidg
Census Unit
Assessments
SAC %
SAC Units
r
. • ..
* pl???p^ U ?liRVLrbR! ? dN CNbIN,?,??, I
* enp neer ing °N MN ? HOlC P ROh y
**??
Certl#Icate of Survpy for: ,W.C- IeY H om eSA Ih m
NoUge Addtbgh: AAlct,elle hrlv?dn?
rp.1be br??e
ielqnle, MN 65120
-191d&1Tdk 891-9468
029 Hlphwtly 10 NorlhAat!
Blalnl, MN 36434
erz> M-Mo•rdx 783-,ed3
10 . ? '-
? ij
? ? 90?,?A r
I 3 / ?
y ? ?y?/b' dl, b R I
CV
l y ? I
84.k l ? >. ? . . .
? Jo SE'?9??
. w ?? ? ? ? • 1 1 ? ? / ?d , ? /
I
?1 ?a; oa
.._ ?
MICN?LLt
b ?
p
-
t
1 ?.
`
? aoe.e bAno4dg ?xldting ?I?vattoh {?f20pdSEU H_ UQ SE ELF-YAtION
?cla?tienotea p"epeeed Elevnlion ?webt Flro? ElevcUonr „°+'?-""`
--a ddNetog Clydintlg? dt U41tlty Edo6Yn9Ylt t6p ef 0I66k tIbvnlion:_ _
--4-b9nbF69 Drnlnnqe PItiw birdattan cnrnoo Slab Eldvatlbn:
-?-. panatee MonuMant ----
bino49ll b?Fse! Hub HeerfHgli 9MtlWH drt nNSUMAd
L.Ofi i1 , BLOCK I `HIbpLN VALLEY
bAoTf? CbuNfrl I?lNN?stitA
I 6lilby llrtlly 1611 !tiN i??? v, p iN tlt robtlt wH prtblHd bV " di Uhdlr MV dlr8el 1uqlrr416n !nd th8t I Am duly Nlpllikfd l6ad 9urviver
ukdoF IhI Iw3,1 el Itil lUo el IAIhri1ia11. tlN1d 01- A1v bl A,tl: id-:
? ? 1,?,?L. ?i+y,..` ROOGqi s.61KtCN l.l. pCO. N0. I?IOt
1[lSeII l 1 ?ev? . .
? g4314,0!
........... ... .
INSPECTION RECORD Control No. 10M
H 4
CITY OF EAGAN PERMITTYPE: suxLozNe
3830 Pilot Knob Road Permit Number: 001458
Eagan, Minnesota 55123 Date Issued: 0 9/ Z Z/ 9 2
(612) 681-4675
SITEADDRESS: LpT: 11 BLOCK: 1 APPLICANT:
1371 MICHELLE pR WESI,EY CONST
HIDpEN VALLEY (612) 452-05$7
PERMIT SUBTYPE:
SF DWG
TYPE OF WORK:
NEW
INSPECTION
FOOTING D. .
FRAMING .A
TNSULATION FINAL
FIREPLACE
REMARKS: PRV S& W CONTRACTOR -
?
?
•--- PERMIT Control No. 1084
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
001458
04J22J92
SITE ADDRESS:
DESCRIPTION:
1371 MTCHELLE DR
LOT: 11 BLOCK: 1
HIDIIEN VHLLEY
"duild''in_g Permit Type SF C1WG
!' 8uilding'-Work Type NEW
U6C Qccuparrey R-3 M-1
Gonstructidn °T-ype
/
V-N
Zonirlg
ry ft-1
Bu%iding Lenqth
euilding :Width '
: ; ,..
60
52
c] t (
t?? Fr'li(9 .'i o- I;-..'}
( ly ?
a? ... ''f?y 2',L' ??y tJ
REMARKS: C
PRV S & W CON7RACTOR -
FEE SUPJiMARY:
Base Fee
Plan Review
5urcharge
SflC
SAC 96
SAC Units
Subtotel
VALUATION
$762.00
$495.30
$67.56
$700.00
160
$2,624.80
$135,000
MISCELLANEOUS $1,610.50
Total Fee $3,635.30
CONTRACTOR: - Appiicant - 57. LI OWNER:
WESLEY CONST 14520587 00013813 WESLEY CON5T
6966 KENMARE DR 3861 1447H 57 W
MINNEAPpLIS MN 55438 ROSEMOUNT MN 55068
(612) 452-0587 (612)452-0587
I hereby acknowledg2 tMat Z haue read this applicatiorr and state that tHe
information is carrecti and agree to cwmply with al,l appkicahle state of Mn.
c Statutes and City afi tiagan Ordirranoes.
,
? , -
APPLICANT%PERMITEE SIGNATURE ISSUED BY: SI URE
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t her@by.Ackh&N1@d @ that f hiv@ 'rbad tM"s ap' llciti6ti tiid stato that the iiiformation is
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Eqgan OrdiRAncpt:
Signature of Applicant: ..._ . .: . . ........ __? ...._._ . ._.
gUIL-dlNG POfNlfi t1fPt
. ? O'MCt U§F. C?NLY
,.;
CJ 01 FaUfidatidh LI_ 65 bupjoit.;
tX02 3F dv?g: : d 01 4=P1 @k
a o3 sF Adaition .?:. d oe 844x
O 04 SF Pertli C] 69 12=p1@it
? 05 St Mist? ` ? 1o Nuitl:/Add'1
WOFIIC T?PP. '
O'31 New ? Cl 13 A1teratioiit
? 32 Additioti C1 $4 Iteotir
GENEgAL INP6h1NATION
const:.?Actual)
(A1 6wib1e)
UBC occupaney
Zon1n
0 bf Itoeies
Length
Uepth
?-I
. R-1,'
_bo'-
aaPRbvaLs
d 11 Apt,/Ltldging
d 13 MUI;i: Flitc:
b i? aaFay?jA?cps?ary
d 14 hr@Olaco
" b 15 b€ck
[j 35 tonah! Finish
L`j ?6 Mov?
6401nent sq: ftc
1St Fl, tq: 1'tY
2tid Fl: sq: ft,
5q, Ft: tota1
Footpriht Sq: #t-
On-tito will'
On=31t@ seWSg@'. '
P1 anit i Ftg Bu i 1 d i iig
EngineerlHg ;.?„ _. Variance
RLiQUIAMfNSPECfilONS ,
.. F
O SitE` t] Fotitirig teifiifl§
t] Nailbwd.: tl Fiha1 ?I ???intlie
YES
W
YE'S
T
0 Insulation
O Firoplace
4;? ? ,
; vBluctltw: ° 9
._
„ ??5G? o, "';
rchaf3, e
an
32 x ZZ. ?r7a1-1 .
Cefif@ , 2% 1.2 = C24} ?
CC SAC.. ._ 6SMT; G 8d X Ib =/08
ty 5AC 3 0
?
t6e Cti?itit N? x30 ? ISSo
tEf . MI?pF
ct oepo§it
1? (?prlelt r?20
I Z4 g%) !7: J 3
M Surchir ? ?
Treatinpnt Vl: - - Is7-?=??02 ;
Road Unit
PaPk.Opd?. C38M? ? 1.2Wg. .
Trails Ued. .- ' ,. .._._....??. , zK?o=
Copi!s "•"'-
Other 67,2ay
Tot51.
Zr?D FC,a u)?.; .
d 16 Ba"sement Finish
0 1t Swinl Pool
? 18 Comm:/Ind.
? 19 Comm./Ind: Misc.
? 20 Pub11c Facility
O 21 Miscellaneous
? 37 demolish
Mwcc system
City.Water
PRV Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
SAC 96 100..` o..7 loxs3r3?7('o
SAC lftifit§ 43y, 96 N
P.02
* PION6EA ,,,,,p SVR,E,.ORg •
* dng?n??r?nB ?+o W+Na, . LO
* * ,?. *
$422 Enterprisa Oriva
Mendoto Hetghts, MN 88120
812) 681-1814-Fax 881-9488
625 Hfghway 10 Northeaet
Bloine, MN 55434
612) 783-1880•Fox 783-7883
Certificate of Survey for: WeSI e Y H OI'1'1 eS, In C.
, • Hquse Address: 1371 Mlchelie Drive. Eaqan. MN
1- ,.?
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- -- --- -• -- -- ? _, R ` 28s" S ? j
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x 900.0 Denotes
•? Denotes
- Denotes
Denotes
-o-- Denotes
$ Denotes
Existing Elevotton
Proposed Elevation
Drainage & Utility Eosemlnt
Droinaqe Flow Direction '
Monument
Offset Hub Bearings shown
nc"
PROPOSED JH.QU-$E-LEy_T14!
Lowest Floor Elavation:828.85
Top of Block Elevatton: e3?7?.6?6
Garage 51ob Elevation: 8,?.7!53 ??5 `
are assumed
LOT 11 , BLOCK 1 HIDDEN VALLEY
DANOTA COUN7Y, MINNESOTA
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..?
LBL ? CITY OF EAGAN
/ ? •? ? V??t?? PLUMBING PERMIT
SUBD. J?•oCfl(¢x. Ua.E? (612) 681-4675
PLEASE COMPLETE UPPER PORTION ONLY FOR SINGLE FAMILY DWELLINGS
WHEN PERMITS ARE.REQUIRED FOR EACH UNIT.
CITY USE ONLY
RECEIPT # 7 .2 I Y 7
DATE 1(- Co - 02
ALSO, FOR TOWNHOMES AND CONDOS
WORK DESCRIPTION
NEW CONST i'ADD ON _
REPAIR _
OWNER NAME:
SITE ADDRESS:_ 13 7 / l/ ?//c //f «F /?-'?P
,
INSTALLER: [ X'IU' O-/97'creS brv / ti,BG
ADDRESS:Ao?7CJG G
CITSC: GJBS?•ER ZIp: S5-0 Vr
NO
i
?
?
?
L
L
/
?
STATE SURCHARGE .50
TOTAL
lc °-iO
3 °p
?
?
4ICT7e-2
TOTAL: ?•?v /
PLEASE COMPLETE THIS PORTION FOR ALL COHMERCIAL/INDUSTRIAL BUILDINGS. AISO FOR MULTI-FAMILY
BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT.
WORK DESCRIPTION:
OWNER NAME:
SITE ADDRESS: _
TENANT NAME: _
SIIITE #:
INSTALLER: ADDRESS:
CITY:
PHONE
FOR:
ZIP:
CONTRACT PRICE:
1% OF CONTRACT FEE. .
STATE SURCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 1% $
STATE SURCHARGE
TOTAL:
( S IGNAT[TRE )
COMPLETE THE FOLLOWING:
FIXTURES EA.
REPAIR/ADD ON 15.00
SHOWER 3.00
WATER CIASET 3.00
BATH TUB 3.00
IAVATORY 3.00
KITCHEN SINK 3.00
IAUNDRY TRAY 3.00
HOT TUB/SPA 3.00
WATER HEATER 3.00
FLOOR DRAIN 3.00
6AS PIPING OUT.
(MINIMUM - 1) 3.00
ROUGH OPENINGS 1.50
OTHER
WATER SOFfENER 5.00
PRIVATE DISP. 15.00
U.G. SPRINKLER 3.00
W. TURNAROUND 15.00
CITY OF EAGAN
PHONE #:_ 1?9/- °?7'?/ ?
CITY OF EAGAN
3830 PILOT RNOS ROAD
EnGnN, !Qr 55122
PHONE (612) 454 8100
?lE,Gi?NICAL; `PERMIT
PLEASE CO?IPLETE IIPYER PORTZON ONLY FOR SINGLE FAMILY
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. -----°-----------------?--------°---°-----------------°----------__
WORK DESCRIPTION
NEW CONST _
ADD ON
REPAIR _
OWNER NAME: UV li? -' L_M) N?i i
SITE ADDREJS: / 3 7, /kflsf-fL-'LLu DoP/6/2-7-
IAT:BIACK ? SUBD
INSTALLER:
ADDRESS: ZO ?7^Ji???L E /4/?/E ??)
CITY: ??CtF-?'/tZb ?N ZIP:
PHONE 3 /D
FOR CITY IISE ONLY
PERMIT #
RECEIPT #
DATE:
ADD-ON MINIMUM
HVAC 0-100 M BTU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCkL4RGE:
DSIELLINGS &
$15.00
24.00 -
6.00
3•00
$ y2r
.50
TOT $?SU *) I,-)
SIGNATURE OF PERMITTE
PLEASE COMPLETE THIS PORTION FOR ALL COT4fERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND HULTI-FAMILY BUILDINCS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING IINIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
IAT: BIACK _ SUBD.
INSTALLER:
ADDRESS:_
CITY:
2IP:
PHONE #:
TOTAL:
(SIGNATURE)
FOR.
FEES
1$ OF CONTRACT FEE.
STATE SURCHARGE - $.50 FOR
EACii ;tii,v','U Or Yr'.FtifIT FEn.
PROCESSED PIPING - $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
FEES
CITY OF EAGAN
Use BLUE or BLACK Ink
r
For Office Use
City ofEaall Permit#:tbPermit Fee.
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone:(651)675-5675
Fax: (651)675-5694 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name: -(� C. I i.,-Qi r)",\ Qt^.S'A t' i Phone: C{t,5/ sZ 3 - N. 0 f:7
Resident/ .--7
Owner Address/City/Zip: / 0 T' ) Yyl ,ch.e ' ) e t-)i s
Applicant is: Owner Contractor
Type of work: , >��
o#Work // ��
Construction Cost: (�- �O i) ----- Multi-Family Building:(Yes (/ /No )
Company: Contact:
Contractor Address: City:
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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:Plans and supporting documents that you submit are considered tobe public information. Portions of
the information maybe 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.orq
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 ermit; that the work will be in
accordance with the approved plan in the case of work which requires a review and ap ov pf plans.
1 ,
,
Exterior work authorized by a bung permit issued in accordance with the Minnesota State Building(ode must be completed within 180
days permit issuance. / `..,.
b
Applicant's Printed Name Applicant's Signature
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