4745 Narvik Dr, -
.
BUILDING PERMIT
(?'2 11994
To b e??d'?or :: r' J'?iEst Vatue o:?, U? U Date :'•AY ? 1 , 19
Site Aotiress ?t f' ?? `• Y ' -'ti' ? ? _ ? ?'? Erect EY. Occupancy A3
Lot Block ' Sec/Sub. Fiemodel ? Zoning
Parcel No Repair ? Type oi Const. V rt
. Addition ? No. Stories
a Name Move ? Length 41
=
;
Address i. r 1. 2 I.VS CROSS Demolish ?
Int Impr. ? Depth 4-+-
Sq. Ft
.0 City Phone 5 y 4- 7 3 3 3 Install ?
a Approvals Fees
o Name • -
0 i Address Z
'" City Phone
a
?Q
F W
? Name_
??-y Address
z
i W Citv -
CITY OF EAGAN 3830 Pilot Knob Rcad, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
agree
NofE
Receipt #
Police
Fire _
Planner
Bld Off.
with all applicable State of 9'
?a"s. / ? APC
( /„ , , 1 .?, Var. Date
8 Sew.
Permit $ 337 .00
Surcharge 34.00
Pian Review 168.50
SAC 575.00
Water Conn. 5 U U. U 0
Water Meter t)3. jU
Road Unit t? ti. U U
Tr. Pi. 15 i) . ': U
Copies
Total
1J:?1111v -..lvt?
A Building Permit is iss ed to: 111v.'lc ?xv. 1a_?.1 on the express condition that
all work shall be done' accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official " ,
I _. I POrmlt No. I Permlt Ho1dN I Dde I TMephorM M I
Plby.
Hty.
m9-
Olsp.
1 N,)PEc.Ti(N1 OF Filx.e SQUEAje5 '56T Up F'oCZ l I/ S/b'7 . FbM
C,l-WM460 To 3' 30 1 t Ib 190 AND ?St31W- SNOwEO c.cP. ((,,neY
• PERMIT #
PLUMBING PERMIT RECEIPT #
3a30 PILOT KNOB OAD, EAGAN, MN 55121 DATE:
'T PRICE: pHONE: 454-8100
Site Address ti 1yD
Lot 81 ck,
m Name
?o Addre A17'y-
c City c
? Name ?
; Address
O CitY
COMM/IND FEE - 1%
MINIMi1M - RESIDEIN
MINIMUM - COMM/I
STATE SURCHARGE I
(ADD $.50 S/C IF PER
BEYONO $1,000.00)
Sec/Sub
Res.
Mult
Comm.
Other
WORK DESCi?IPTION
I ?
New
Add-on
Repair
FOR CITY OF EAGAN
Phone
FEES
CONTRACT FEE
L FEE - $10.00
FEE - 20.00
PERMIT - .50
PRICE GOES
TOTAL
s
9 P? 9 •
FEE _2 y- 00
N FIXTURES
Water Closet - $3.00
?Bath Tubs - $3.00
? Lavatory - $3.00
Shower - $3.00
=Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Tray - $3.00
Laundry
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - $3.00
=Gas Piping Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $1 Q.DO
? ou h O in s-$1 50
STATE S/C: '6-0
GRAND TOTAL: ?? `sO
CITY OF EAGAN Remarks , 1.
Addition PARK RIDGE 1SP ADDN Lot 17 Bik 5 Parcel 10-56750-170-05
Owner street 4745 NARVIK DRIVE state EAcAN KN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. ,
STREET RESTOR.
GRADING
SAN SEW TRUNK 1982 147.21 9.81 is
*SEWER LATERAL 626 . 16 1 . 7
WATERMAIN
*WATER LATERAL
WATERAREA 1982 147.21 9.81 1
STORM 5EW TRK 1985 370-93 24-73 15
*STORM SEW LAT 1985
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN
3830 Hat Knob Road
P, O. Box 21199
Eagan, MN 55121
Zonlnfl:
Owner.
Acldress:
WATER SERVICE PERMR
PERMIT NO.:
DATE:
. No. of Units:
762r;
? ?-7
SfM /lddress: - "- Lr i vg L17 195 P:-,j- k 1 , i rT o e
Plumber.
Meter No.: a t ? nedion Char9e: ' ` ! ' } ? ?'•
Siu: 1ltooy DeposJt:
Reader No.:?NQ??? di?gEr?gcatl lo?l?ioa
I •p•• b mmoy wI&T+iifj*ftR•WCTRI£,?ALWc.
^ r/t ?
sY '? Date Poid:
Date of Insp.: Irop.:
GITY OF EAGAN SEWER SERVlCE PERMR
3830 Pilot Kno6 Road
P. O. Box 21199 PERMIT NO.: '
Eagan, MN 55121 pATE;
Zonirg: Na of Unita: -
OriMr: - •::1?3.^•Fi ?ClaRE.'8
AddlCSS:
S7te Address• 4 745_`3eruik Dr ive-L1%°, -:sz k
Plumber:
1 Mm te eew* wt16 Nr CRp of apw Conrnctton Cha*e: 7 5.0 0-? - z ;?
0?+iMeeM. Aopcunt p,eposit;
Permlt Fee:
5urchorpo:
By
Dota of Inap,:
Misc. Chorges:
Totol:
Doh Poid:
C -1?; 1;1"%.7G't^ „ . ? . y
??a
PERMIT #
MECHANICAL PEIiMR ? ` ! / •- ?
RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE
CONTRACT PRICE: PHONE: 454-8100 Site Address BLDG. TYPE WORK DESCAIPTION
Lot ? ?? ?I clt ?ec/Sub
Res. New v
m NameCt L? ? Mult Add-on
Addr o ?T- rc. ?.
c City. ?phone ?'S"? ?em. Re ir
Name 2 -c 4 &
L
c f
Address *
'
p Ciiy Phone
TYPE OF WORK ?
7
Forced Air t, v0U M BTU •?
Boiler M BTU
Unit Heater T M BTU
` Air Cond. M BTU
Vent CFM
--
Gas Piping Oudets # Other
FEE
S/C:
TOTAL•
FEES
RES. HVAC 0-100 M BTU -$24.00
ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
COMM/IND FEE - 196 OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - 10.00
MINIMUM - COMM/IND FEE - 20.00
FSTATE SURCHARGE PER PERMIT • - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
BEYONO $1,000.00)
SIGNATURE OF PERMITTEE
FOR: CITY OF EAGAN
RESIDENTIAL
' BUILDING PERMIT APPLICATION
CITY OF EACAN
73 3830 PILOT KNOB RD - 55122
651-681•4675
Naw ConsWctlon ReauiremeMS RemodeVReoalrReauirements
. 3 registered ske suneys showing sq. ft of bt sq. R W hause; enCH roofed areas • 2 apies M plan
(ZO% mazimum bt coverage abwed) . 1 set of Energy Calculatlons for healed additions
• 2 copies af plan shaxing beam 8 window sfas; pouied fomM design, e1c.J . 1 sile survey tor exterar addiUons 8 decks
. 1 set of Energy Cakuletions . IrMicafe if home served by septic system Por additions
• 3 oopies of Tree Preservation Plan if bt platted aRer 711193
. Rim Joist Defail Options selection sheet (bldgs with 3 or less unNs)
DATE T Z` "Q 1 VAW/[ION ?S q(4O • 00
JOB SITE ADDRESS y9 4 S 0. 2.%11 I C p? ?
IF MULTI•fAMILY BUILDING, HOW MANY UNITS?
PROPERTY OWNER _?Wtr ?j?? V?JS6V?
TYPE OF WORK FIREPLACE(S) _ 0_ 1_ 2
APPLICANT PHONE# 6fS7 gq<6L0
ADDRESS 910-0 ?6U $?? ZIP CODE S. 3
PAGER # CELL PHONE #CDKa-k 3 6 3' 13a-I FAX #q,?Z I , ?ffl?? Z
NEW RESIDENTIAL BUILDING ONLY- FILL OUT COMPLETELY
Energy Code Category MINNESOTA RULES 7670 CATEGORY 1
(check one) - Residential Ventilation Category 1 Worksheet Submitted
- Energy Envelope Calculations Submitted
MINNESOTA RULES 7672
- New Energy Code Worksheet Submitted
Plumbing Contractor: Phone #:
Plutnbing System Includes: _ Water Softener _ Iawn Spruilcler Fee: $90.00
_ Water Heater No. of R.I. Baths
_ No. of Baths
Mechanfcal Conhactor. _
Mechanical System Includes:
Sewer/Water Contractor.
_ Air Condirioning
_ Heat Recovery System
Phone #
Fee: $70.00
Phone #
All above information must be submitted prior to processing of application.
I hereby acknowledge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan Orc
Signature of Applfeanf
is correct, and agree to comply
Certiricates of Survey Received _ Tree Preservation Plan ReceivQ'd/_ Not Required _
/ Updated 7I01
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 11994
'
BUILDING PERMIT PHONE: 454-8100 Receipt # 6d- -7,?-r ?
_ ?
86
TobeusedPor SF DWG/GAR Est.Velue 568,000 Date MAY 21 79_
,
i
'
SiteAdaress 4745 NARVIK DR Erect C? Occupancy R3
4ot 17 elock 5 Sec/Sub. PARK RIDGE Remodel ? Zoning R1
Parcel No. Repair IJ Type of Const. V14
Atldition ? No. Stories
w Name ORRIN THOMPSON HOMES Move ? Length 42
? 1712 HOPKINS CROSSROAD Demolish O Depth 46
o Address Int. Impr. ? Sq. Ft
city MTKA phone 544-7333 Install ?
F Name SAME
=
oa Address
s
?
Ciry
Phone
hQ
w w
Name
tz
Address
z
a W Ciry P ne
I hereby acknowl et tlhaverea thisapplicationandstatethatthe
' information is corre d agree t om y with all appli le State of
Minnesota Statutes a Ciry of E n ina es.
C
Signature of Permitte
?
.,
A euilding Permit is iss etl to: ORR IN THOMP SON HOMES
all work shall be done n accordance with alt applicabl tate Minnesota
Building OHicial o fJ&
Assessment
Water & Sew.
Police
Fire
Eng.
Planner
Council 5 21/8i
Bldg. Off.
APC
Var. Date
Permit $ 337.00
Surcharge 34.00
Plan Review 168.50
SAC 575.00
Water Conn. 500.00
WaterMeter 63.50
RoadUnit 290•00
Tr. PI. 156.00
Copies? 0Q
Tnlnl ?
- on the express condition that
Eagan Ortlinances.
This raquest void ? - 1 ? ?j ?` ? (/ 2
10 rrqn[hs trom Cr I ( T?
C 212 7 g L 1-? [? ?Qajr 2rnV cvf'/
NeQUest Dats , Fire No. Rouph-in InsVection
R rred?
?Peatly NowW?ll Nolity Inspec-
'
Ves ?No or When Heady
&l.icansetl Elechical Convactor I hereby reQUest inspection of above
? Owner electrical work installed ei:
Street AAdress B a or Poute No.
- Cit
' . /
?
'f- s ?n
i?i
ecumi o. Township Name or No. anBe No. Co ?ly
OccuOantIPPINTI Phone No.
/'rN , ? 7333
ow r Sup lier Address
JD"G
E tncal ConVact
or 1 ompany
m
el Conher,tor's License o.
/
/
?
/.?/ .Y??(? ?IL?? ? ?' O_"
Mailinp J ss ICoMra or or Owne Makmg Instellation
?J?
ut orize Sq^ature IConrtactor Owner Making lnstnllatiqjn Phone N
um
ber
/
,
Y- ?
MINNESOTA STpTE BOARD OF ELEC711,190?- THIS INSPECTION NEQUEST WILL NOT
Grie9s-Mitlwey Blde. - poom N-191 . BE ACCEPTED BV THE STqTE 90ARD
1827 Unive.sify Ave., Sc Paul. MN 65104 UNI.ESS PROPEH INSPECTION FEE IS
PMnn 16141 797J111 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
, See inatrucliona lor complalin0 thia form on back oi yellow copv. ?7?
C 21278 "X" Below Work Covered by This Request &qlu
ev4 Addl flep. ' TVPe of BuileinB Appliontes WireA Equiument WireA
Itiofie flange Temporary $ervice
Duplex Water Heater Lightiny Fixtures
Apl. 8uilding Dryer Electric HeaLn
CommerCial Bldg. Furnace Silo Unloader
Industrial BIAg. Air Conditioner Bidk Milk Tank
Falm Other peu y Othnr(5nerify)
! er Suc6 y Other Other
ompute Inspection Fee Below
N Fee SauviceEntrenceSixe M Fee Fextlers?$ubfaede?s b Fee Circuils
U to 200 qm s .etJ 0 to 30 qm s a tn 30 tlm s
Above 200 qm ps D 31 to 100 Amps 31 to 700 A s
Swinvning Pool Above 100_Am s Above 100_AmPs
Transformers Irrigation Booms Partial-'Other F
Signs Suecial Inspection 5
TOTA
emarks
i' 1
•
? . ro EE
?
?
?
l?c??.
flouoh-in
Final Dnte
?f?
?.3 ?, ?he ecVica
Insoecto , eby
certily tha? the abova
inspectian has been
mea.
tltlsrequasivoi0lBmonthshom
C%
y, RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122 ? `]
651-681-4675 ?a 1b
New Canstmction Reuuiremenh
• J registeretl >ite surveys showing sq. fl. of ;oC sq. %. of housc an0 all roo(ed areas
(20% maximum lot coverage allowed)
• 2 copies of plan showing beam 3 window vzes; poured (ound desgn, etc.)
. t set o( Energy Calculations
• 3 copies of Tree Preserva0on Plan if lot platted after 7l1;93
. Rim Joisl Detail Options selection sheet iOIEqs wiM 3 or less unds)
DATE
RamodeUReoair Reouirements
. 2 coDies of plan
• I sel of Energy Calculations for heated adaitions
• 1 site survey for extenor additions & decks
• Indicate il home served 6y sepfic system for additions
c? ?. li
VALUATIONi' (TI? - l
SITE ADDRESS 'f 7- yS /'l v: MULTI-FAMILY BLDG _ Y $!.N
TYPE OF WORKRaSt.? cJ Oycc1 FIREPLACE(5) _ 0_ 1_ 2
APPUCANT A45 -?--
STREET ADDRE55 L9 2 '-f 7 A Il2Y'?'c k D i^. CITY ESTATE IIIAZIP .S I a a
TELEPHONE # C '1?90CELL PHONE # fAX # - 3 FS `-I4
PROPERTY OWNER S?'? -t( Jo ? kl3 b n. TELEPHONE # C651/qO5 -pa 2 Q-
-----------------------------------------------------------------------------------------------
COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ ?dlNuF.50'1:?1 RULE:S 7670 C:A"CEGORY ( V[IY\
(V submission rype) . Residential Venolation Category 1 Worksheet Su6mitted • New
• Energy Envelope Calculations Submitted
Plumbing Contractor: ____
P1umUing system includes:
Mechanical Contractor:
Mcch,uiiril scstcm include,:
Sewer/Water Conhactor.
_ Water SoFtener
Warer Hcater
No. of Balhs
.air condiuo„i„n
HeaL Rccovci}• Systcixi
_ Phone #
Iawn Sprinkler
No. of R.I. Balhs
Phone #
Phone #
OCT 0 4 2002
rcr. :$ i 0.00
----------------------------•--•---------------------°----...-°---------.....------------------°°--°--°•-----°-----
I hereby acknowledge that I have read this appiication, state that ihe information is correct, and agree to compty
with all applicable State of Minnesota Statutes and City of Eagan Ordinanc?s.
??j/y??',?
Signature of Appllcanf `?"'"
----------------- ---------------- ----------- ------- ----------- --------- -------------- ---------------- _---------
OFFICE USE ONLY
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
UpAated 4102
* ??.., . .
npPLcrAT:c:a
* ArrxovAL or t=:r>.•uT. 1 *
?
APPLtGATION FOR PERMIT *
. * INSPF)CPZON (3F SE??v'h?t At?ID/G2 FG'?TF1t
rmTArrATrONS W1IZ, ixJP BE 5(Hm-- +
SEWER AND/OR WATER CONNECTION ?ULED UMn PERMIT HAS $EEN *
APPAWID. *
* r
* •
_.... '?:?*???,r*****x*****te*+e**k******sx?**
.1) PROPERTY ADDRESS:
LEGAL DESCRIPTION:
Please Pririt 1
JiF
kLOL/niocx/bubaivision or Tax Parcel"ID ?j
IF EXISTING STRL'CI[.7RE, DATE OF ORIGINAL BLILDING PERMIT ISSC'ANCE: '
--
PRFSIIIP ZONING/PROPOSF,D USE: {Nbn ear
F-I MMx'ff'ItCIAL/RE,TAIL/OFFICE
Q IML'STRIAI,
0 INSTITL"fIONAL/GOVII2NR7E,TTP
? R-1 SZNGLE FAMILY
? R-2 DL'PLEX (Two C?nits)
? R-3 76WN[IOrISE (Three + Units)
? R-4 APARTMENT'/CONDUNLiNlUM
2)
ADDRFSS:L71?...__f.r`_???
, CITY. STATE, ZIP:?,f
?
PfiGNE:-?(?,/"
3) tvAME;
,ADDRESS:
CITY. STATE, ZIP:
PxorE: MASTFI2 LICENSE#
¢j asa ? • ?
tu,rE:
ADDRESS:
CITY, SI'ATE, ZIP:
PHONE:
( L?nits)
( Units)
Plimibers License:
Active
LJ Exnired
Not recorded
sta?'Initia].
5) f' 0 m ??: t ? m• •?- • a •?? u-'vro? .
0 CONNECPION 1n CITY SEWE2 ? CpNNECTION TO CITY WATEEt
6) PLEr'1SF HOI,D APPROVID PEE2MIT FOP PICK-U? BY O\E GF AB0VE
? PIF-^SE MAIL APPROVED PERMIT TO 1, ¢. ABOVE :
'?
7) ,!V ?
A (Ci.rcle one)
L ? r
r 6 s? ? d '- ??4 ??
? ??!J-l?
?-?_e??'1
•r 1?. r 1 e??f tir: 4 1?.:_ p 7.?.." 6..???F-??.Sir_ ??ci~ i tl f-::T.' .
?f'?e'?..i
?B ?
.
_
..
.
ri?_.,F Y 1 f i ry.
? C/I"m.
?OR Gi i"Y USE- Or??-Y
?'Ei:%fIT # ISSi'F.J
I'e w/Bldg. Permit FEES:
.?
/6 , 5 D
$
$ $ $ ????'? $
$ $
$ $
S s /? ? a
` t; e, $
$ $
S $
$ ' $
$ $
$ ,. $
42-? ? S O s -.? ? o'7J
CP
RB EIPT RECEIPT
SEWER PERMIT (INCLL'DE SCRCHARGE)
WATER PERMIT (INCLUDE SCRCHARGE)
WATER METER/COPPERHORN/UCT'S"1CIE
WATER TAP (INCLL'DE CORFURl7'iON Siuz )
SEWER TAP
ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRCNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
I
LATERAL BENEFIT/TRONK SEWER
LATF.RAL BENEFIT/TRUNK WATER
WATER TREATMENT PLANT SURCHARGE
OTHER:
'S'OTAL
1I.0'r;5 OTILITY CONNECTION REQLIRE EXCAVATION IN PC'BLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMZT FOR WORK WITHIN PUBLIC
Q ROADWAY" MC?ST BE ISSfIECl, BY THE ENGINEERING
NO DIVISIO[V. LIST AS A CONDITION.
SOBJECT TO THE FOLLOWING CpNDITIONS:
APPROVF.D BY:
TITLF.:
?a?'?
. ._ /
1986 BQILDI PE T APPLICdTZON -
NOTE: ALL CONTRACTORS MOST BE LICENSED iiITH THE CITY OE EAG.'!N
SINGLE F9MIILY DWELLZNGS
PL?q - 6-G3 -/A
INCLUDE 2 SETS OF PLANS, 3 CERTIrICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
2+1QLTIPLE DSiELLINGS - RESIDENTI9L RENT9L IItiITS FOR SALE IINITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SIIRYEY - CHECK `d2TH BLDG. DEPT.,
1 SET OF cNERGY CALCULATIONS
CQP4iERCI9L
IvCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIrICATIONS AND 1 SET OF
r.NERGi CALCULATIONS,
$2,000 LaNDSCAPE BOND
T_o Be Used For: J\kf?j1Q11J,lli..? Valuation
Site Address ??iS? N(yz i;i
Lot ? Bloek
S Er=et
Remodel
Parcel/Sub
Owne^ Move
Address Int.Impr.
City/2ip Code
Phone
Address ?7+? ?T,q,y6 (/I hSS/i,-si'
City/Zip Code??if-q?, p( `yl ??1/
Phone
Arcn./Engr.
Address
City/Zip Code
?hone v?
?
OFFIC? ASE ONLY
Repair _
Addition _
Denolish _
Install
APPROVALS E'EFS
Assessments Permit ?7 I.(.(J
Water/Sewer Surcharge
Police Plan Review
r ire SAC ?? . Op
Engr Water Conn
Planner Water Keter • ?
Council Road Unit 2 O
Bldg Off,T - Treatment Pl
APC ' Parks
Variance Copies
SOT9I. 2/$
Data:
Occupancy 93
Zoning R 7
Type of Const
ii of S
tories
Length
Depth
?
Sq Ft
YOTE: ADDRESSES FOR CORNER LOTS - CGNTRACTOR/HOMEOfiNER MIIST DESZGNATE HHICH ADDRESS
IS DESIRED. 90 CHANGES SIILL BE ALLOHED ONCE BIIILDING PERMZT IS ISSIIED.
Lu7rANY • 2815 WAYZATA BOULEVARD • MSNNEAPOLIS
• PHONE: 374-4740
CER1'IFICATE OF SURVEY FOR:
ORRIN THOMPSON HOMES
A Division of U.S. Home Corporation Scale: 1" = 30'
PROPOSED ELEVATIONS: • Iron monument found . l
BASEMENT SLAB: o Spike or wood stake set ? t
el. = 942.43 ft. .500.0 Existing spot elevation,
FRONT GARAGE SLAB: oo.o Proposed spot elevation
el. = 945.30 ft. ?- Drainage direction
BENGNINABK.:
Top NUT qY0RPN7
EIEVATiON= 940.77 FT
9 \ S
°' F3e
K ?
?G v? Y? 4933S?c 9'!?
?30
? ` `vy y?3,
X
lr g ?. ? . %? / \a?\ a ?
4 1 b % ' C
oe ' ? .g ?.i. ?. P
/ ?:o ?•s '6
^ ? i So4 ?S, ?o k?
? ?qa4.2 , .. . ..
32.89
S?gp ?2 0? W ,
Lot 17, Block 5,
PARK RIDGE
Dakota County, Minnesota
I hereby certify [ha[ thia is a true and correct cepresen[a[ion of a survey of the
boundaries of the land above described and of the loca[ion of all buildings, if any,
[hereon, and all visible encroachments, if any, fc«n or on said land. I further
cer[ify [ha[ (his survey vas prepared by me or under my direc[ supervieion and [hat I
am a duly 12) tered Land Surveyor under the lava of the SCate of Minnenota. s LLL. M Reg. No.1577,4 Da[e ?'I q'9(1
Proposed Housex As-Built House_ Drawn by PE Project no. 8510 d
I-
For Office Use/S136
•
••, ::::;ee:
os, , E AG N
'' /di)
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694
Staff:
buildinginspectionsacityofeagan.com
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
t _
Name: 5c 4A tAS d` 1 Phone:(r, STA/ 0
Resident/
Owner Address/City/Zip: V\ 5 o.v u s.Vt i?V
Applicant is: Owner Contractor
Type of Work
Description of work: 142._-- OOV'
Construction Cost: % o00 ° `7 Multi-Family Building: (Yes /No )
Company: \--=--- 0_•-1•\ \�rvLec3A Contact:
Contractor Address: 1-V3\1‘ S�crMs 1/4V0..k\ City:
State: OJ Zip: �J\2.� Phone: L 'L 1(S �,2 Email:
License#: )CAZ-1 O Lead Certificate it
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 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.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaaan.com/subscribe.
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.
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.00pherstateonecall.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 n. a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordan - ' th- -•• • -. •ir1rthe case of work which requires a review and approval of p gns J_
7-11011°7''-
441111/111
Applicant'- Prin : • 'ame Applicant's ignature
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