1075 Northview Park RdCITY OF EAGAN
3830 Pilat Knob Road, P.O. Box 21 •199, Eagan
PHON E: 454-8100
BUILDING PERMIT
To be used for ' i-
Sit2AddfeSS 4v1'' M+aai:Var.r rrucs% saai
Lot ? Block 1 Sec/Sub. LEXINCTQlO SQliAR$
AtJ
Parcel No.
Est. Value M^0 Date
cc Name KARVLN GEQ[tCZ 8LDR8 IliC
W
3
Addres$ P.O. DOX
428
3 3 2
° City Phone
-
o Name SAr?k, 389-320l
.
? ? Address
? City Phone
Name
City '
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply with all applicable State of
Mir.nesota Statutes and Cityof Eagan Ordinances.
Signature of Permittee
A Building Permit is issued to: b'A???JI', G40GE ALDRS INC
on the express condition that allwork shall be done in accordancewith all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
BuildingOfficial
Receipt
M N 55121
i 1' :w -%`.
t
IIOVSNi6a 19
OFFICE USE ONLY
On Site Sewage Occupancy
MWCC System ^ Zoning
On Site Well (Actuaf) Const
City Water X (qllowable)
PRV Required # of Stories
Boaster Pump Length
Depth
S.F. Total
Footprint S.F.
APPROVALS FEES
Engr.JAssess. Permit
Planner Surcharge
Council Pian Review
Bldg. Off. SAC, City
Variance SAC, MWCC
Water Conn.
Water Meter
Road Unit
Treatment P1
Parks
TQTAL
BLDG. PERMIT N0.
?' ?"r,c4 ?-jl t? ,? ?
01-3210 Bldg. Permii
01-3422 Plan Check
01-3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3h0 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 kater Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 5ewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
' CASH RECEIPT ?
CITY OF EAGAN
3830 P?LOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
RCC61VfiD Jl??t j
FROM
AMOUNT
& DOLLARS
+ae
E]CASH [ICHECK
.•C.
% v ?l?? / ?/?.?"C/?/JLWLC?LS/ / ?.?'c.,y? • , j ?. . \Y?
FUND COOE AMDUNT
Thank You
B y t_?vl ?-
White-Payers CApY
Yellow-Postinp CopY
Pink-File CoPY ,
• , . „
? (gtr#i#ir?tit uf (Orrupttnry
Citp of (Eagarr
loPpa1'fmPttt Of llitIbtltg jwP1'twf[
This Certifrcate rssued pursuant to the requiremenu of Seclion 306 of tJre Unifonn Buildirrg
Code certifying that at the time vjissuance rhis saucture was in compfiance wilh the various
ordinances of the Crty regulating building construction or use. For the following.•
Uae Claasi6ation ?t M/C"; Bldg. Rrmit No. 14435
CoCUpx7' 7Ype R3 7aniog District Tyya CoAt, `Jn
Owoer.fBui?ding "•?'."" ?: ' i ; ' Address ?'•C5. i:-'? ;?'?L':?"if'?',
eudaine nddras .'s? l..axliry X`:
DI. 'ti. !9?°
Budding Offidil
POST IN A CONSPICUOUS PLACE
.. . .. .. . _ . _ . . . . . . .?1 ' . .
SEDGWICK HEATING & AIR CONDITIONING CO. ? J
HOUSE HEATI ? TEST RECORD C??SL• C.?' ?
;rl+4) -C W 4L-? _7 CITY
f n ? -C •a nw N E R
HEAT LOSS DATE HTG. INST.
SOLD BY A
Electrical Work By -? " Gas Line By )?'
TVPE OF HEAT GA_ FA,_ HW- STEAM SPACE HTR. UNIT
GAS DESIGN
MAKE ?MAKE OF BURNER
Model 0 37 -'5- Modei
Serial ? S 7A -' 2 2 ? Max. BTU Rating
INPUT ?2-9.,,,261a /=' 1 4, MAKE OF FURNACE
CONTROLS
THERMOSTAT ?> • '' ? Heat Plug
Valve
Limit • ? C L%
Limit Setting
Fan Setting
Pilot Type
Pilot Make
Pilot Model
Pilot Timing ?j
L.W. Cut O,ff
Z
Pressure Percent CO
CFH P
I
O
nput
ercent
Z
Stack Temp. Percent CO j?
Vent Size
KIND OF LINER SIZE NONE
Draft Hood Regulator
Filters Size ?N} mber !
Chimney Location Inside?L.- Outside
Chimney Construction ' '= -
Smoke Bomb
Wiring _
Test Tag
Door Pressure Lighting Inst.
Date Tested
Company Testing / ?'-
Name of Tester
CONVERSION
Form 235
? . CITY OF EAGAN
: '
1 4v? ,
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454•8100
I
BU
LDING PERMIT Receipt 4k
To be used for Est. Value ' Date " ,19
Site Adtlr.ess OFFICE USE ONLY
T; •6 ':_.,l .'h .
Lot ? Block
SeC
S
b
" 0n SIIB S@WBQA DOCURB(1Cy 3
-?
?
.
/
u
? .r , ' .. MWCC System Zoning `
Parcel No. S
W
l l
On
ite
el (Actua
) Const
'Name '` • , .':+??; ? ,,;.
Ciry Water !
(Allowable)
?
' ? AddrBSS PRV Required * of Stories _
.
° ; , ? .. , ; w
City Phone Booster Pump Length
50
Depth
, a
Name ,
S.F.Total
? Q Address Footprint S.F.
I' City Phone APPROVALS FEES
~ ¢ Engr./Assess. Permit 4 t t, • Uv
Name
?
3 ?
?
Planner Surcharge •
_ = Address ?
Council Plan Review •0K
? W City Phone Bldg. Off. SAC, City •'?'
I hereby acknowledge that I have read this application and state that the
Variance
SAC, MWCC ' ' •'u
,`?
information is correct and agree to comply with all applicable State of Water Conn. • "
Minnesola Statutes and City of Eagan Ordinances. Water Meter ''?
Signature of Permittee
Road Unit
A Building Permit is issued to: Treatment P1 ' • E?
on the express condition that all work shall be done in accordance with all Parks
applicable State of Minnesota Statutbs and City of Eagan Ordinances.
'`
Building Official ? TOTAL
Permit No. Permft Holder Dat* Telephone #
Plumbing •
% ' ?? ,l.??x,? ??i y/v?i
, -
H.V.AC.
Electric ?• , ; ,, :?? ? ?.???`
Softener
Inspection Date Insp. Comments
Footings I
Footing
s II
Foundation
Framing F -
Roofing
Rough Plbg.
Rough Htg_ ,,,/,
fC?? er1 <' RS I.?L L?/?
13UI. -7
Fireplace
Final Htg
h" ?y
Final Plbg. ?_?8
?
Bldg. Final
Cert Occ. ? _ ?
Temp. LP
Deck Ftg.
Deck Final
Well
Pr. Disp.
PLUM8ING PERMIT
CITY OF EAGAN
PILOT KN08 ROAD, EAGAN, MN 55122
Site Address 14?
Lot _ .? Block
? Name _
?o Address
c City
Name _
3 Address
O CitY -?
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINtMUM - RESIDENTIAL FEE - $12.00
MINIMUM - COMM/IND FEE - $20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
FOR: CITY OF EAGAN
.. , _ r ..,
PERMIT #
RECEIPT # 7`1.? ?
DATE: f/-/?- ? I
BLDG. TYPE WORK OESCRIPTION
Res. )< New x
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE F OLLOWING:
NO FIXTURES TOTpL
t ?'
=Water Closet - $3.00 $ %
--/-_Bath Tubs - $3.00 ??. c ?
--;4-Lavatory - $3.00
Shower - $3.00
-/-Ki!chen Sink - $3.00
Urinal/ Bidet - $3.00
_/-Laundry Tray - $3.00
_/--Floor Drains - $1.50
-,Z-Water Heater - 51.50
Whiripool - $3.00
-i7_Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
,7--Rough Openings - $1.50 `f ?C
FEE:
}. 7, e- c
STATE S/C: L)
GRAND TOTAL: ? J• S L,
, '. . ,;.?, . .. . " , ;....1,r .:_. . . . .. _: ; .:? ti,,...
PERMIT ?# % -'
MECHANICJIL QRMIT *
CITY OF EAGAN RECEIPT #
,v 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ?8 7
ITRACT PRICE: PHONE: 454-8100
Site Address •?? •%a I1lrL_¢y,c, ` BLDG. TYPE WORK DESCRIPTION
r - ot BIOck, ? Sec/Sub
y . Res. ? New ?
Mult Add-on
? Name
Comm. Repair
m Address WISI'r.-AROI IS t?Ar 420-
Other
c Ciry Rg7 A%ne
FEES
Name RES
HVAC 0-100 M BTU -$24
00
c Address .
ADDITIONAL 50 M BTU .
- 6.00
p City Phone (RES. HVAC INCLUDES A/C ON NEW
CONSTRUCTION)
GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1
50 EA
.
.
TYPE OF WORK .. COMM/IND FEE - 1a/a OF CONTRACT FEE
Forced Air .,
M BTU J`? APT. BLDGS. - COMM. RATE APPUES
TOWNHOUSE & CONDOS - RES. RATE APPLIES
Boiler M BTU $ MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU $ M1NIMUM COMMERCIAL FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
Vent. CFM (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # BEYOND $1,000)
Other
FEE:
5/C:
SIGNATURE OF PERMITTEE
70TAL•
FOR: CITY OF EAGAN
CITY OF EAGAN Permit No:
t Xn
383
Ptl
b R
d Dete. ?'- -1 °-'`-' 7
5ixe: ?I
o
aa
9
o
Meter Na:
P.O. Bcx 21199 Reader No: Date: 1a 3! S? 7
Eagan, MN 55121 03 PqllY?.
Owner. ''•-i rv Ceu r;: e??
SiteAddress: 10;5 'rJortliview rari; 1:5
Plumber Val 1ey i luribin-
Conn. Chg: "')` _ 00 j ofivAing:
- -
Acct. Dep: ?L 1?14113 No. o
ca{I local ?
Permit Fee: g
?
T?
? coni
gr
Surcharge: piy with the City oi Eagan
n W
Tr. Plant ' grl
C`
Meter.
Misc.: By
WATER SERVICE PERM
,
CITY OF EAGAN Permit No: Date:
` 3830 Pilot Krfbb Road g/P No: Date: P.O. So`k 21199
Eagan, MN 55121
Ownec Marvin George Bldrs. '
Site Address: 1075 *Iorthv:i.ew Par:. ?'oa, T,-•
Plumber:
MWCC: Zoning•
City Chg: No. of Units:
Acct. Qep:
I agree to comply with the City of Eagan
Permit Fee: Ordlnances.
Surcharge:
CITY OF EAGAN
3830 .Pilot iCnob Road
, P.O. Box 21199
Eagan, MN 55121
Owner.
5ite Ad,
SEWER SERVICE PERMIT
.
Permit No: ' Date: ' - I :'-- ".7
Meter No: _
Reader No:
Size;
Date:
Plumber._ Valley
?.
Conn. Chg: s ^ 5_+'f[ n.q Zoning:
Acct Dep:_ 15 _t1()pd No. of Units: Y.
Permit Fee: 7 fl _'ln3 d
Surcharge: _ _ 50n:i 1 agree to comply w{th the City of Eagan
Tr. Plant Ordinances.
Meter.
RA:.... .
CITY OF EAGAN N°_ 1 4 4 j,.
3830 Pilot Knob Road, P.O. Box 21 •199, Eagan, MN 55121
s?9 a. r?
BUI PHONE: 454-8100 Receipt # /
LDING PERMIT
Tobeusedfor SF DWG/GAR Est.Value $75,000 Date NOVEMBER 19 19 87
SiteAddress 1075 NORTHVIEW PARK RD
Lot ' 5 Block 1 Sec/Sub. LEXINGTON SQUARE
Parcel No. 6TH ADD
W Name MARVIN GEORGE BLDRS INC I
z Address P.O. BOX 428
o City PRINCETON phone 332-3034
o Name SAME 389-3201
?a AddresS
P City phone
ww Name
l
i? Address
?a W= City Phone
I hereby acknowledge that I have read this application and sFate tha[ the
information is correct aad agree to comply with all app icable State of
Minnesota Statutes and City ag n ORlinan s ? -
Signature of Permiqee ? __-
A Buiming Permit is issue to:_MABYSN_f?E ??LIlFS-7PLC
on the express condition thal all work shall be done in accordance with all
applicable State of Minne ta Statutes andof Eagan Ordinances.
BuildingONicial._''?_'?___
?
OFFICE USE ONLY
R3
On Site Sewage _ Occupancy R
MWCCSystem X Zoning
On Site Well _ (ACtual)Const Vn
Ciry Water X (qllowable) Vn
PRV Required # of Stories
8ooster Pump _ Length 43
Depth 50
S.F. Total
Footprint S.F.
APPROVAIS FEES
Engc/ASSess.___ _ Permit $ 416.00
Planner Surcharge __ 37.50
Council _ Plan Review 208.00
Bldg. OB. SAC, City _ I00 00
Variance SnC,nnWCC 525.00
WaferConn. 525.00
water Meter 67.00
Road Unit _30$.00
Treatment Pi 180.00
Parks
TOTAL $2,363.50
This request void
1ft months f'om
.
D 6 9 3 2 51.?
APnuest Uate rne NP: [tqvAn-in irisVec??on
1,pqw1etl? (?? ?Ready Now MWt II Nmily Inspec-
i/. 1 kL -F7 ?Yes nNO tor When Feady
?licensed ElecVical ConVactor 1 herebY 00puest insvection ot above
? Owner electrical work installeC at:
Sueet Address, Box o, Route No. C itv
!0 7s Noa JA R"%o 4I&APIL/
ection o. TownshiD Neme or No. TnBe No. County
L o7' S 11,4069 ?,r GJrN S ? P'OsKe
OrcuVant (PRINT) Phone No.
ML!/inJ 6-?o iL s 3? a-
Power SupVlier ?+ddress
?n c. rx
Elecerical CoNractor iCompany Namel Conhactor's License No.
/y/A-srF.e- Ezec r? , ? D?/o y?-3
Mailinq Address IConVdc[or or Owner Making Instailalion)
.?F
aZ 6 51
?
Authorizetl S? ?amre IConvacmr?Owner Making In siallationl Phme Numbe?
Y90 -3 S 's`-_
iH15 INSPEGTION REQUEST WILL NOT
MINNESOTA STATE BOARD F ELECTHICITV gE ACCEPTE? BY THE STATE BOApO
°"^as•MidweV Bltlg. - Boom Nd91 UNLESS PROPEN INSPECTION FEE IS
--:tv Ave.. SL Peul, MN 55104 ENCLOSED.
% REQUEST FOR ELECTRICAL MVSPECTION . es-ooooi-os
? See insVUClions ior comDletii,ii this iwm on back of vellow copy.
D" 69 32 v' X" Below Wark Covered by This Reques!
ada aeo. Tvae o+ e.0a'.e AoCliancna Wiretl eq.iu.,a.t wi.ea
Home Range Temporary Service
Duplex Water Healer Liyhtiny Fixtures
Apt. Building Dryer Electric Heaun
Commercial Bidg. Fumace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Ne, oec70 ,ine, Ispnn?yl
t ?_r Succify ther pih?;r
omnute lns0ection Fee Be/ow
p Fee Serviro Enhence5iza B Fee FanJers/Subieeders N Frte Circuits
i- 0 to 200 Am s 0 ro 30 qm s z- 0 m 30 An >s
A6ove 200 qn»>y 31 to 100 qmps ?- 31 to lU0 Am s
Swimming Pool Above 700_Amps Above 100_Amps
TransPormers Irriqation Boorc?s . V Partial'Other Fee
Signs Speciallnspection ?
Hamarks $ TOTAI ?E?
/ i7 r/ ?
1-1"7 i, ?na elacYy?,r(
InSpec[oq he?Bby
certify thet the abov
! G? inspection has been
U m9de.
• RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OP EAGAN
3830 PILOT KNOB RD, EAGAN MN 55122
651-681-4675
New Construction Reaufrements
. 3 registereA sHe surveys shmving sq. R. of lot, sq. ft. of twuse; and all roafeA areas
(20% macimum lat coverege allowed)
• 2 copies of plan showirg beam 8 window sizes; poured found design, etc.)
• 1 set of Eneryy Calculatians
• 3 capies of Tree Preservatan Plan if lol platted after 7/1/93
• Run JaislOeiail OpGons selection sheel (bldgs with 3 or less unds)
DATE
_ Water Softener
_ Wa[er Heater
_ No. of 13alhs
SITE ADDRESS /B 75 AIDaA , f//Cw Y',aiy 10h MULTI-FAMILY BLDG _ Y _ N
TYPE OF WORK Z' C?`Z `? FIREPLACE(S) _ 0_ 1 _ 2
APPLICANT Gol4
STREET ADDRESS /0
A 4 /L STATE?IP -?5
RemodaVRamir Reauirements ( ?- a-`- U?-'
• 2copiesolplan
• 1 set af Energy Calculations for heated additions
• 15itesurveyforexlenoradditions8decks
• Indicate if hame served by septic system for addNons
TELEPHONE # 651- `/S y-4ff'eEll PHONE # (&-/2' 339-CY-I RFZ FAX #
Og7,/
PROPERTYOWNER TELEPHONE# 6-Si- VSy-as>y
COMPLETE FOR °NEW" RESIDENTIAL BUILDINGS ONIY
Energy Code Category _ MIA'NISOTA RULES 7670 CATEGORY l MINNESOT!1 RULES 7672
(J submission lype) . Residentlal Ventilalion Category 1 Worksheet Submitted • New Energy Code Worksheet Su6mitted
• Energy Envelope Calculations Su6mitted
Plumbing Contractor:
Plumbing system includcs:
Mechanical Confractor:
Mechviical system includcs:
Sewer/Water Contractor.
Air Conditioning
HcaC Recovery Sys[etn
I hereby acknowiedge that I have read ihis application, state that the
with all applicable State of Minnesota Statutes and City of Eagan On
Sfgnature of AppOcanf
? v_0
'-„?'F'.? Ylu.?-?
Fee: $90.00
Phone #
17F i?00
Phone ? mation is cbrrect, and agree to comply
OFFICE USE ONLY
VALUATION 400
_ Phone #
L,awn Sprinkler
No. oF R.I. Baths
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
- Updated 4/02
OFFICE USE ONLY
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 31 New
? 32 Addition
)Sl- 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
0
?
?
35 Int Improvement ? 38 Demoiish (Interior) ? 44 Siding
36 Move Bldg. .? 42 Demolish (Foundation) ? 45 ' Fire Repair
37 Demolish (Bidg)' ? 43 Reroof ? 46• Windows/Doors
'Demolition (Entire Bldg only) - Give PCA handout to appiicant
?
---I---
_V-P-
Occupancy ?_W MC/ES System
Zoning
Stories
Sq. Ft.
Length
W idth
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
Footings (new bldg) FinaUC.O.
ZC Footings (deck) _X FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tesu _ Final
? Framing _ Siding SNCCO Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insularion _ Retaining Wall
Approved By Tz , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
.,
? 07 OS-plex ? 13 16-plex O 20 Pool ? 30 Accessory Bldg
? OS 06-plex ? 16 Fireplace , O 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 EM. Alt - Sf
? 10 08-plex X 18 Deck jg? 23 Porch (screened) /0 36 Multi
? 11 10-plex ? 19 lower Level ? 24 Storm Damage (
?
12
12-plex
Plbg_Y or _ N
?
25
Miscellaneous ,?,pI,
Ow,?'?t,
h :) S
?g-! ?"?G ?,?'?0
I6y 'y 30
;?-0 4-P o
19 ?a
----?_
.?? 9??
. .?
2422 Encerpnse Orwe
,?ONEER Mendota He,qhis, MN 55120
IINOSUAVEYOASI CIWL [Yfi1HCCA{
MgIn`PrrInL,•• L4NOIlANNEAS•LANp3G11K.NCM1TCCiS 'V G 1 L ?1 1 C0 VO 1', D 11 14
? I! I I
J Ja
, 4L ,f
Certiticate of Survey for: MARYIN <1tOR4fE gVIL-UPERS ?KfJG .
/
?
NoRrN
ZV s s, 8?5. o3o3??E ?,?M (e 0 ?o
N
?i- - - - - ----?5
I ?
i q' ? ?.Icw ?t?k
? • bo.+?z ? / (. Z ?
IFiG'-> L X y
h • ,
1125: ??, ^
vZ oM M? ^
j1,4 M? ?.?
./_
? ? nl g%?a38i4 ?
Zi
? 8?a?M ??hs
?
?
N
--?Jn -
rJ 99 10.0? ? a ?qy ?
oe, Rob I D?A LL
NoRTRviF-W PaRk RoAp io-?s 'K)0e+06u Pr<?,p
ToTAt A(ZEn oc LoT• l03-2 32 y1.C1. G 1EgAU, ll SSIV
r 900.0 Denofes exrsfrn? Elevatioo
. soo?o Denotes Proposed ElQVafron
------- Dfnotes Droinoge r Ufilr y Eosemenf
-?--DenolesDroino?F/ow Arrow
PROAOSED NDUSE EL fVAT/QNS
(owesf Floor flevafion _
Top of Block Elevafion =
o Deno{es rnorrument Garase Slab Elevation = a`J9.z
Beargiock shown o?re assumed
ar 5, 1, LFxlNCroN SQUQaF 6ry A0017-10N
QqKOTA COUNTy, MINNESOTA SUBJFCT TO EASFMENT,$ OF RfCOL7p
1 hHehy cemly inal tn, it a nu• a^'1 correct r.prps!ntnbon of a w.1ry OI •^• hn?1011,11 ril ?^e ?bo•f tl^t6J??? hM ?a^d an.1 ?,1 rhr 1ncaTron n?l ay':
?,Idingt. thereon, and all v?oGle encrwcnm•ntt.•l any, from or nn ta,d 4,•ff Pt sv•.+?M hv ^•?'" ? 7? ?r' a?Y OI _?Q?W«:nA
/ ,D. 13L1L.
?nch_ n 1. / /'
.?C?y1./ J Clp : ] - - .J lJ ? e1_ ' - -- J`? ` "°` ? = ? -•'? '?'' _-?-
.. ... .. . n . .. .. . .. . . .
t
SINGLE FAMILY DWELLINGS
r
t
J ?
VV3 aS
/
BQILDING PERMIT APPLICATIOH _ C7TY OF SAGAN
INCLIIDE 2 SETS OF PLANSY 3 CERTIFICATES OF StJROEY, t 58T OF EIQERGY C9LCOLATIONS
HOTE: ADDRESSES FOR CORNER LOTS - CONTR9CTOR/HOMEOiiNER MIIST DESIGIYATE WHICH ADDRfiSS
IS DESIRED. NO CHANGfiS WILL BE ALLOWED ONCE BQILDING PEAMIT IS ISSQED.
MULTIPLE DWELLINGS - RFSIDENTIAL RENTAL UPITS FOR SALE i7NISS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SQRVEY - CHSCK iiITH HLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
C0IMkIERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
ftV 13 MT
To Be Used For: ,5/-164?E 6?114?1 Valuation: 5;Larl?? Date:
Site Address
Lot S Block i
Parcel/Sub ,(Czj/.16ja-Z ? . PoT{ /"
Owner Q'fi9•L'li.?/ ?'3Er126? sb [02t r4e
?
Address ip, Q, soUX ?` ?
City/Zip Code RLtt,Fi?,/ln,,•:
Phone 3u°f?.?¢/?...?..?•? :3c?3s/
Contractor
Address ?sQewe!5,
City/Zip Code 1-540v-
Phone
Arch./Engr. p„S r94&,3e?
Address
City/Zip Code 54,071z-
Phone
'l S, OOO- ?-
On Site Sewage
MWCC System ?
On Site Well
City Water
@PPROVALS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Couneil
Bldg Off l I 17
APC
Variance
Oecupancy
Zoning j2,- I
Type of Const
(Actual) V- N
(Allowable) V_N
Ik of Stories
Length
Depth SoT
S.F. Total
Footprint S.F.
FEFS
Permit
Surcharge
Plan Review
SAC, City
sac, rTyrcc
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
416,00
97,50
td8. ArJ
( oo.na
525. OD
sz5, au
b'7,oD
3 ,00
1 SO,oa
?
?
,
?/AG AT:?oN . .
GA12A6F
zzxz6 =.:s-7 2
?d x Z - ?16?
SSb X1z = 6677„
?JACSEIV?EU?-
a4x?s = 9/2
r2x r?i R rbs
8 x9%2= ?6
?
ti-IOXSE
1?6 w?T
cnr.z ?Z
114sa?cyy= S1?1zo
,-?y rn
?
* Pion
* engin
* * **
ER
g..
LAYD 5UA V E YOR+' C1 V IL E!IGIH[C n5
lArvO VLANNCFS ' lANO5C4GC AACMITECTS
2422 Enterpnse Dnve
Mendota He+ghts, MN 55120
(612) sst-tsta
Certiticate of Survey for: MAKVIN 6f,04ZUE gVILVERS .ENC .
.???
5 64°43'o3"r ?°'
85. GO
i
i
i
i
w?p
IZ?+ im
25?
0
p?
(P '^L
\?R
.0?
109'0
? 09'4
NottTttVIEW
TOTAL A(tEA oF LOT? f0323.Z yt. F?.
' K 9ao.o Denofes exrsfrn?j ElPVarioo
. soo.o Denofes Proposed ElevafioR
------- Dcnotes Drainale ,r' Ufi(i ? E-asemeR f
? Denofes Droina?¢ie F(ow Arrow
PRpP05E0 NouSF ELEVAT/ONS
(awest FloorEleva'flon °
aP of Block Elevafion =
G Slab Elevation =
ara?re ?99.z
a Denofes monumenf
E3ear%nJ¢s shown pre assumed
Lor 5,?LOCk 1, LEXINGTON SQUAI7E C TNADDITIaN
pquorA COUN7y7 MINNESOTA SuBJfCT TO EASFMENTS OF RECORp
I hereby ceniiv zhat thn is a i'u+ "% conect renre5?nlnbon of a surveY of e^• boa^danet 01 trie abovr tl^;ylGw1 land antl of i?ie IocaUOn 01 a''
p?7
bvildin9s, thereon, and ali v'uble enuwcnmenn, d any, trom or on saiA IJnn pt su•+vy, ? py r. , ;'+ ? •- ?Wy o1 A.D. 19L1.L.
incfl, J7 e ?/j??l
r. . ? .?. t ? --
ScalP : l- o
; .
So.3Z
ProposeJ ?
o?S/s
m
„
/aa
4
NORrN
i
?
+
I ,y
Ira
I
-22.IZ4
15.11
tol9!
d`5°s4'49
PARk RoqD
' 2') ?
R I? oR Lµ h&ROAa a
MINNESOTA STATE BUILDING CODE DIVISION
, EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION
OWNER Mm?vitJ COPpF-C'e vO?IC?PKS
SITE ADDRESS y,bT` 5 , :BLOGK LuxrN&Tow G4u,qRE GTOADD
CONTRACTORMAQ'la-?U 6P6aC??- iRll {4.0e-S DATE PHONE
Determine working aquare footafte of each:
1. Total exposed wall area..... ?-7 Sq sq. ft, x, 11 = l9 3. yC?
2. Total roof/ceiling area..... j0 92 sq. ft. x.Od(a ___;? J-5:5
Total exposed wall area above floor = /(0(O d '
a. Total wall window area . . . . . . . . . . . . . .
b. Total door area . . . . . . . . . . . . . . . . . .
?
. . ?
c. Total sliding glass door area. .... . . . . .
d. Total fireplace wall area. ......
e. Total wall framing area (average lOX).
f. Total ne2 wall area above floor. . . . . . . . . . : /J(o a'?
g. Total rim joist area . . . . . . . . . . . . . . . --9-9-?
Total exposed foundation area = 9 /
h. Total foundation window area . . . . . . . . . . . ---
i. To[aZ ne[ foundation area above grade. .......?
Determine "U" value of each wall segment:
a. g .-U.- 3y 50. (0(115;1 ?
b. ya x„U„
c. ya X„U„
d. - X ",,"
e. )(OCO_ R "up, I 5L
f. ? ) (0?k X?.u,,?? _.?(,y g
.. • ,
. g, ? ? ? I
x °ull . 0 Q ? O .
h. " g liUil
i. q C-1 X „U„?? e (o, ?3
3. TOTAL . . . . . . . . . . . . . . . ( ?• 2 /
If item 113 is the,same as, or less than item #1, yeu have met the intent of SBC 6006(c)2.
Total exposed roof/ceiling area =/ Q'? a
j. Total skylight area . . . . . . . . . . . . . . . . "!
k. Total roofJceiling framing area (Average 10%) ...:?
1. Total net insulated roof/ceiling area .......
Determine "U" value for each roof/ceiling segment:
j. y x„U„ , 33 m i. 3`a
k. 99 X „U"
1. ?'19 J X ,,,,,, , o u'
4. TOTAL . . . . . . . . . . . . . . = as ? ?
If total of item !l4 is the same as, or less than item 42, you have met the intent of
SSC 6006(c)1.
Alternate Building Envelope Design
To u[ilize the to[al envelope system method, the values established by the sum of items
ti3 and U4 shall not be greater than the sum of items fll and Q2.
?. l9 3.yg +Z. a?,Ss s ?,oy
3. 1 4. ?C5•7O ? l??b?
RESIDENTIAL
BUILDINC PERMIT APPLICATION
? CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681•4675
New Construction Reauirements
• 3 registered site surveys showing sq. R, o( iat, sq. R. of house; and all roofeU areas
(20%maximum lot coverage allowed)
. 2 copies of alan showing beam S window sizes; poured lound design, etc.)
. t set ul Energy Calculations
. 3 copies of Tree PreServation Plan if lot platted aRer 711193
. Rim Jaist OeWil Optians selection sheet (blags wiN 3 or tess units)
pATE 9 ' o?_ 9 " a a--
SITE ADDRESS 075 A/Ok--T L}? ( t u) PK R
TYPE OF WO
APPLICANT LD FZ I ko & + D E L1
MULTI-FAMILYBIDG _Y N
FIREPLACE(5) `!0 _ 1 - 2
STREETADDRESS 10-75 !SoKTq Ji'Etn) Pr-- P- J) CITY ?-A Gf1A/ STATE 'JZIPSSl13
TELEPHONE # G Sl- L/5;-Lj-o97VCEll PHONE # I-SD3- % 4 7 $ FAX # '-
PROPERTYOWNER d? G? cQ4 a-c-( TELEPHONE#
COMPLETE FOR °NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ N[I.VN kSO"t'.1 RtiLl:S 7670 CA"C1:GORY I tiIIVNESO"171 RULL'S 7674
(+? su6mission [ype) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Sutmitted
• Energy Envelope Calculations Submitted
Plumbing Contractor: ___
Plumbing sys[em includcs:
Mechanical Confractor:
Mccli.uiic.il sVstcnl includr,:
Sewer/Water Contractor:
rlir Coudiuoning
- Hcat Rccovcy S}•slcm
_ PtIORC # _
L,awn Spnnkler
No. oF R.I. Baths
_ Phone # _
tJ,l_
Phonel#i R
I hereby acknowledge that I have read this application, state ihat the informati
with a1l applicable State ot Minnesota Statutes and City of Eogon Ordinances.
comply
SignatureofApplicanf oZ?? 't • GK+-? `L
OFFICE USE ONLY
_ Water SoFtcncr
_ Water Heater
No, oF I3aths
RamodeVReoair Reuuiremente
. 2 copies of plan
• 1 set of Eneryy Calwlations for heatea adCitions
. 1 site survey fcr extenor adAiOons 8 decks
. Indicate if Ywme served by sepfic system ,`or adaifians
a?
VALUATION ?3.,;?' ao• 06
Fee: $90.00
F, ?T m
Certificates of Survey Received ^ Tree Preservation Plan Received _ Not Required _
Upda[etl 4l02
OFFICE USE ONLY
? 01 Foundation O 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Acceasory 81dg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi
? 03 Ot of _ plex 0 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
O 06 04-plex ? 12 12-plex P16g_Y or_ N ? 25 Miscallaneous
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Additiort 0 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• q 43 Reroof ? 46 Windowslpoors
? 34 Replacement •Demolition (Entlre Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC/ES System
Census Code 2oning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bidgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) Fina]/ido C.O.
_ Footings (addition) _ Plumbing
_ Foundation HVAC
_ Drain Tile Other
Roof - Ice & Water _ Final _ Pool _ Ftgs _ A'u/Gas Tests _ Final
_ Framiag _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final Windows (new/replacement)
_ Insulation _
_ Recaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
Building Inspector
CITY OF EAGAiV
APPLICATION FOR PERMIT
5EWER AND/OR WATER CONNECTION
1) PROPERTY ADDRESS:
LEGAI, DESCRIPTION:
*XYP?': PAYMFNT' QF FBE AT TIME OF
APPLICATION DOFS NOT CDNSTIILTIE
APPROVAL OF PERNIIT.
irrsrrx-riorr oF sBM Arm/Oz MOM
IP]S1FLLaTIONS WIId. NOT BE SCHED-
OLF]] UNTII, PII2PSLT AAS BEEPI
APPftOVID.
IF EXISTING STRC'MRE, DATE OF ORIGINAL BLILDING PERMIT ZSSCANCE:
Mn ear
PRFSErIr ZONING/PROPOSID LSE:
0 CONP7ERCIAL/RETAIL/0FFICE
0 IAIDL?S2RIAL
C] INSTITLTIONALJGOVOUZEpr
? R-1 SINGLE FAMILY
a R-?. ? DLPLEX (Two Units)
..
? R-3 7UWMOC?SE (Three + Units) ( Units)
q R-4 APARIIKaNT/CAAIDOMINIOM ( Units)
2) Q?
ADDRESS• C ? -
CZTY, STATE. ZIP: Orcl.?rt??t?'.5-_
PHONE:_?..?
3) • u ?: ?• N?_ For City Use ..
Ww ef- Plumbers License:
ADDRFSS: ActiVe
Ecpired
CITY. STATE, ZIP: Not recorded
PFIONE: MASTER LICENSE# Staff Intial
4) ?• • i?.
NAP'ES < - . . ' . . . . .
ADDRESS: `
CITY? STATE. ZIP: . ARM R=mm
PHONE: .
•5) ?? ? r• • ?• : ? • a? - ??
corNFcriorv TO ciTY sEMM ? cnNrmcrioN Tv ciTr wATm d arfmR 6) '? • •?' [:3 PI.EASE HOLD APPRpVFD PERMiT FY)R PI. -LP BY ONE OF ABDVE - --
2ZE
MAIL APPROVID PERMZT TC???:q,)3f 4, ABOVE
(ifcle one)
7)
r ?• ?
:'FOR -CITY USE ONLY
PERMIT # ISSUED
-?
Pd w/Bldg. Permit
$
$
$ ?7. irv
c
FEES:
$ lO `? SEWER PERMIT (INCLUDE SURCHARGE)
WATER PERMIT (INCLUDE SURCHARGE)
$ WATER METER/COPPERAORN/OC'TSIDE READER
$ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
S ? 2 $ wAc
$ ?z' Sr' U U $ SAC
$ $ TRDNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMEtVT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRDNK WATER
$ WATER TREATMENT PLANT SLRCHARGE ;
$ $ OTHER:
$ 3,9 7' ep-D $ TOTAL
RECEIPT #? RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
a YES 'IF YES, THEN A"PERMIT FOR WORK SQITHIN PLBLIC
Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY: 4
TITLE: ,
DATE : II ! I ? ??_ .
?/4? 341 4/ :
,?/?2 d.4,2?? ?oE? flea• d??a?;u?lck ,Q ?5 ???:,r?L::?- ?'.?. ???
HEAilOSSCAICULATI0N5 HEATING&AIH CONDITIOfIl9NG t:O. MINNEAPOLIS.MINN.
WeathmstI ipe A.S.H.V.E. . ' Cvnstructlon No. .. . Insulatlon
WWows Doors Guide
Relerance Out. Wall Inl. Well Cefllnp Rool
I IW Kird Now Applled
Yes-No
Yes-No
19_,_
'
• g .
? FI. p Poam Lenpth /Q Wldth Halpbt FI. qoom lenpth Width Neighl
Ylind ws end Dows-Crackape end Area Windows end Doors- Crackago and Are a
A
. Ho• ?y?tl?n
ol n? Me?p01
of ?n? No, ol
li hU Lmul II.
ol . 1 Ar??
•. 11. .
'.
NO' y/Id?n
el ?n Hmyhl
ol an? Nn. ol
II hu
_ l?nenl IL
of r? .en
?a. 1?.
. '.
a' _ EE E- F_
, , g 2D .
coei ew coo+ a,o
Inliltration 7 79(, InllitmUon
Glsas ? Gleaa
Exp. well Exp. well
Net ekp, wall D '
y?Q Nel ewp. wal)
tnt. wall Inl. well
Celllnp Celllnp . . . .
FlooF . Floor ' .
totel Biu.
Aequired sp. it. E.D.R. or eq. Ina. W.A. Leedar erea to Total Blu.
Pequired cq. It. E.D.R. or ea. Ina. W.A. leoder arae
Roont lenpth ? Width / HaipNt FL Aoom 11 Lengih Witlth Heiyhl
Windows and Ooora-Crackage and Area t/o Windows and Doors-Crackage and Ar ea
• No. W'tllh
l Ilnipht
of ?ne Na. ol
L hu Unaet II.
ol r 4r4 n
o. 11.
'
No• y? rbh
01 ? e Illa?phl
a nntl No. ol
b M1U L.nsnl 11.
ol G Y Aren
aq. 11.
/ sne
o .
1 L- G, /5
d / /L o? (o
Coaf g lu Cool 0 tu
Inl{Itrel{on L/ . / a2 InlNtration
Gless GieeB -
Exp. welI EmP, well
Net exD• wall Net e.p. well
Int. well Int. wnll .
canina 5 c0liina '
Floor Klow ?
Totel Blu. Tota1 Otu.
Requued sq. IL E.D.N. or s0• ins. W.A. Leader erea
fl. 1?)IdIJ4 Roan lenplh ?Jp Widlh HefgHt ?.
Wiadows and Ooors-Crackage end Area ,
NO. ?',drn Ha?pht No. ul L n6nl d. Aren
.
o •n . ol nn? II M1U ol cre s. 11.
.
Coei 9 W Required oq. f6 E.D.R. or sq. in5. W.A. Lcader eroe
il. Roan Lenqth Width Naighl
Windows and Doors-Creckage and Area
11 Nn. Uneel 11. 4rm
???p? n?pbt nl
No? u? ?n ul nnx b h?? ol cre M t. 11.
?
Coe? ???
lliiiluation ?h7 /???'-? Inlillrntipn
Gles4 ?p p Gleas '
Exp, wall E.p, wnll
Nai axo. well Nol ewp. wall _
inl. wall Inl. wnll
Cailin0 • t
f low ? (? T
cy
3
O Cailinp
f Inur
lutal Btu. - . OS 10101 uW. . ,
11m..:.a1 en il F llA. nr en fnn_ W.A. I.undm xib11 }rq. fl. F.U.(:. bl SQ, i,0. Yi.A. Lo?dut LrOJ
,.
HEAT IOSS CAICULATI0N5
MINNEAPOLIS, MINIJ.
0'"•
HEATING&AIR
Std3a`tu? .
CONDITIONING CO.
. WSetbsraulps A.S.H.V.E. . Conatructlon No. Insulatfon
Wirxbws Daors Guide
Fefaroncs OW. Wall Inl. Wall Callinp Roof Floor Kind How Applied
Yes-No Yaa-No 19__ • , '
F1. EA/rRoom lengtM 3? Wldlh Helphl
Roan Lenplh. Wldth ? Haighl
F1. GI1_p r
Ylindows and doors-Creckage and Area Wlndows and Doars-Cracka ge and Area
No. W?ih
ol ? an Nuvhl
o/ ?n? No. ol
li h?• l.neal F.
1 r Ann
?. II.
'
No• WId?h
ol ?n 11niohl
o/ ans IINno ol
ht? Unenl 11.
ot rs Aran
?a. 4.
/!o /L-
Coel B W Coel B W
Infilualfon (n`? 417 Oo In111dmion 471
Glacs .34 50 / 0O • Gleea 50
E.p. wall E.p. well
Net eMp. wall ? 5 Net sKp. wall
?30
6
??O
- IM, wall . ' Int, well
Csllinp Celllnp
Floa . . . / Jr
Totel Bw. S? a
? Floa ' . . 5
Total Bw. -
//D
ReQuired sd. It. E.D.R. or sq. Ina. W.A. Leedar area llequired sq. It. E.D.R. or eq. Ins. W.A. Leadar area
/ FI. 1V/,J Roan Lanplh / Width / Heiphl F/ I. If'J. ? poom Lenplh / Witlfh /a Heidht
Windows end Ooors-Crackage nd Area Wi ndows a nd Doors- Crackage end Area
' N0. ??d?h
p p1?! ?ei •pAt
o ne No. ol
hht, l.nsAl II.
al cr c Alen
o. 1t. .
No• WuUh
ol ene phl
nl nn? No. ol
1i hu l?ne+11 11.
af crs M Atea
sq. I'. .
? ('o '?/ i3 a
/ 1.5
coai e w - cooi o io
- Inllilrellon Inliltretion ' aa 4 /O
, GIE56
G1068 t
JV C
?5 JC
EKp, wall
Net e.p. wall EKp. wall
Nol erp. wall
_
Int, wall Int. wall
Celllnp
Floa
S Cellinp
Floar ? V
S ?
Tolel B1u. . ? Totel Blu. .3
Repulred aq. It. E.D.R. ot eq. ins. W.A. Laeder areo
FI. ' Noom Lenplh Wldth Halght
Windows and Dows-Crackage n Area
No. q?N,n Hap„i Na. ol l1niol II. Alea . '
01 an . 01 en. 11 AO Of tre s. 11,
? Requirad eq. Il. E.O.R, or 64. ins. W.A. Leador aroa
/ FL Roo^ Longlh ,0 Width 7 Noight ?
Windows and Doors-Crackago and Area
No. Win.b Il???p??l no. ol l?nanl It. 4?en
ul nn UI Onnx h hl/ Of tlaCk s. 11.
• • Caet Btu Coe? B?u
Inlipration . t? InliprnllOn I `'?
Glesa
E.p, wall // D 550 Glnas
Evp. wall ?
wall
Nel emp
Nel axp. wall
Inl. WBII .
Inl. wall
c.irne
floo, - S
rotal atu. _cairna 70
Flnw
lotnl uto. 280
2rP
Panufrwl cn. IL E.O R. nr sn_ Ina. W.A. L,,ndei eiuu ' 11',yuii 2d 7.1. ft. EA.r% oi sV. in5. W.A. Lu2dur uiaa
EAGANnECE
I
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 JUL 6 6 2020
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-56
bui Idi noinspectionsecitvofeaoan.com
r For Office Use
Permit #: 1 if122��11l
Permit Fee: 1G1 RQ - C
Date Reserved: .1 1 l0 I
ZO,
I
Staff.
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 7 - '7 - ./142 ® Site Address: / d 7 ar Alogrilvirtv P l . R d Unit #:
Resident/
Owner
Name: Lo zi 'lo Bi2Ei 4_
Address / City / Zip: 16 75 /V e,e7#I V i E lnJ
Applicant is: ✓ Owner Contractor
Type of Work
Phone: L s t' - J`D 3 -9167
Description of work: /:42. ram' o -F
Construction Cost: it / aZ, 0 0 t
oc.vt side. 1, o rh e
Company: A£AS-ti 0;11 c e-
Address: � Mc , °e fA
State: /J��Zip:. i3 Q F Phone:76�' J 1
Multi -Family Building: (Yes / No )
Contact: A IA -Sit; n 1 r ✓lcI ( I
City: LeLt v v Ike,
;V Email: . 11.5. r'IGME'l 40 "KA-' �o
License #: Lead Certificate #:
If the project is exempt from lead certification, please explain why:
-F vitly
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 perm/t 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.citvofeagan.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 D1G. Cali Gopher State One Cali at (851) 454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www.aooherstateonecall.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 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.
x L o re i' i?o g i r t fF vt. x
Applicant's Signature
Applicant's Printed Name