1626 Oakbrooke DrAddreSS 1E25 OAKBROOKE DRIVE
L.ot 6 Blk 4 Sub
Zip 5512?
OAKSROOKE 4th
THESE ITEMS WERE / WERE NOT COMPLETE AT TAE TIME OF THE FINAL INSPECI'ION.
Date; I Yes No Inspector:
Final grade (6" From siding)
Permanent steps (garage) ?jLOG? Se:Y[C?'s Acodia-
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage
Porch
Basement finish
Deck
Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply W
the oufside lawn faucet before freeze potential exists.
Contact engineering division at 681-4645 before working in righPOf-way or installing underground sprinkler system. `
?W
White - City Copy Yellow - Resident Copy Pink - Contractor Copy tTJ
p
Site address: /GRba?1`)M?l?P _?? ??e-Lot _14' Block 4t Subd
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air
tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the foliowing information be
submitted prior to issuance of a Certificate of Occupancy.
_ This sUucture: is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670
OR
?iThis structure: will be constructed to meet more restricGve requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTINGTYPE
Water Heater
? I?47a?sr?
Furnace ? rI? , ? c? . .7CJ & nreC?'
Dryer
EXHAUST SYSTEM
LOCATION
TYPE
MODEL
CFM'S VENTED
YES No
Kitchen kitchen
Bathroom 1 liki
Bathroom 2
Bathroom 3
Bathroom 4
Other
i
FIREPLACE S
LOCATION
GAS
WOOD
MANUFACTURER
MODEL
BTU'S VENTING
DiaECT ATMOS
.+?MP?? ? G,L?s Cc?o ? oo? ?
MAKE-UP AIR MODEL TYPE CFM's
I hereby acknowledge that the above informaGon is correct and agree to comply with the Minnesota Energy Code and City of Eagan
requvements.
Signature -
PU i
CompanyName
5)`a4i C)?
Date
* This form is the responsibility of the General Contractor.
LOT: ? BLOCK: L-4 °" `SUBD./P.I D # ' U A V1X0-1&-L
? 2000 BUILDING PERMIT APPLICATION (RESIDElNTIALI" 'i I
CITY OF EACAN ?
3830 PILOT KNOB RD - 55122
651-681-4675
?a???.}
New Constructlon Reauirements "f"" --,4 yl aL? -1
Remodel/Repair Reauirements
? 3 registered sRe suneys showing sq. If. of lot, sq. ff. of house 2 copies of plan
and all roofed areas (20%, maximum lot coveraae allowedl 1 sef of energy caltulatlons for heated additions
D 2 copies ot plans (show beam 8 window sizes; poured fnd. design; etc.) 7 stte survey for exTerior additions 8 decks
D 7 set of energy calculations
? 3 coptes of hee preservation plan N lot plaNed affer 7/7/93
? Rlm Jolsf Detail Options selecHon sheet (6uildinas wNh 3 or less unffs) DATE: 1O?I ?S?/ 0? CONSTRUCTION COST: "? b?' ?
DESCRIPTION Of WORK: !l e5 il&n}1 rq If muNi-tamily bldg., how many units?
?
STREETADDRESS: 1[v 64 0AIC6IQoai« )D?lll?e
Name: Phone #:
PROPERTY Last First
OWNER
Street Address:
City
State:
Zip:
Company: A/ r/ G/le,M 4 sPhone #:
(area code)
CONTRACTOR SheetAddress: 13$5-mt,40kh?S Ucense# /3Ex0.
City 11t4dd-4 State: MW Zip:
NGINEER / Company:JAM 1f 7TS ?e[ Oo?-e- Name:
Telephone #: (
Sheet
Clly
Registratton #:
State:
Zip:
Sewedwaterlicensedplumber(ifinstallingsewer/water):YO)LL-Cv/ L-UA(129?G Phone#: ?( `Q ) t"a-zlzl
I hereby acknowiedge that I have read this application, state that the information is correct, and agree fo
comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant: vu? ?-t.0'
Certificates of Survey Received y
Tree Preservation Plan Received _
OFFICE USE ONLY
Yes _ No
Yes _ No k Not Required
? DEC 18
Zp00 ?
OFFICE USE ONLY
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool
>?02 SF Dwelling ? OS 06-plex ? 76 Fireplace ? 21 Porch (3-sea.)
? 03 Ot of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened)
? 05 03-piex ? 11 10-plex O 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
)(31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
VALUATION
Census Code
SAC Units
Nbr. of Units
Nbr. ot Bldgs
Type of Const
-l--o-l-
--??
v Pi
? 30 Accessory BYdg
? 31 Ext. Alt - Multi
? 33 Eut. Alt - SF
? 36 Multi
? 35 Int Improvement ? 42 Demolish (Foundation) ?
? 36 Move Bldg. ? 43 Reroof ?
? 37 Demolish (Bldg)' ? 44 Siding
? 38 Demolish (Interior)
• Demolition (Entire Bldg only) permit - Give PCA handout to applicant
_ Occupancy e"3 MC/ESSystem
Zoning City Water
Stories Booster Pump
Sq. Ft
Length ?-6?/
Width -,57A2'
INSPECTIONS REQUIRED
x Footings: New Bldg
_ Footings: Deck
Footings: Addition
? Foundarion
? Frammg
APPROVALS
Planning
K Insulation
FinaUC.O.
FinallNo C.O.
x Fireplace: )( r.i.
Pool _ frgs
Building
?C air tesf ? fmal
_ air/gas tests _ fmal
Engineering
PRV
Fire Sprinklered
45 Fire Repair
46 Windows/Doors
_ Wmdows - new/replacement
_ Siding
_ Stucco/Stone
Root ice & water final
Variance
s
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Park Dedication
Trails Dedication
License Search
Copies
Other
Total:
d?r4s?i 1,2s? X 1 ? =
1h wa .) /Y 5`1 =
?'Vviio 4 4?
IV
?-
3 Z.jqn (,i"' #?--K,rb?
lq 710.>,L
NOU-29-2099 03:13 PULTE HOMES
MNcheck COMPLIANCE REPORT
Minneeota Energy Code
MNcheck Software Version 3.0
651 45G =>/Lf r.uc, r,c
Permit #
Checked by Date
COUNTY: Dakota
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 11-20-2000
DATE OF PLANS: 8/14/00
TITLE; TYLER ELEVATION #4
PROJECT INFORMATION:
OAKBROOKE SINGLE FAMILY
COMPLIANCE: PASSES
Required UA = 520
Your Home = 442
15.0-% Better Than Code
Area or Cavity Cont. Glazing/DOOr
Perimeter
- R-Value R-Value U-Value
-------------------------------------
CEILINGS 1656 ---------
44.0 --------
0.0 --------------
WALLS: Wood FYame, 161, O.C. 2049 19.0 2.0 1
WALLS: Wood Frame, 16" O.C. 243 9.0 2.0
BSMT: Conc. 8.0' ht/7.3' bg/7.3' insul 640 11.0 0.0
BSMT: Conc. 7.0' ht/7.01 bg/7.0' insul 224 11.0 0.0
GLAZING: windowa or poors, Above Grade 378 0.350 1
DOORS 38 0.350
FLOORS: Over Unconditioned Space 352 38.0 0.0
SLAS FLOORS: Unheated, 42.0" insul. 72 5.0
HVAC EQUIPMENT: Furnace, 92.0 AFUE
----------- - -------------------------------
COMPLIANCE STATEMENT: The proposed building -----------------
design deacribed -------------
here is
consistent with the building plans, specific ationa, a nd other calculations
submitted with the permit application. The propoeed building hae been
deeigned to meet the requirements of the Minnesota En ergy Code. -
Builder/Designer
Date / "' D/vo
TOTAL P.02
JOB INITIATION ORDER
DATE: 7/31/00
JOB NO: 0320-206-04 ,J
COMMUNITY: Oakbrooke SF
BUILDING ADORE 1626 Oakbrooke Drive
MODEL NAME: Tyler MODEL#
1R2R1
LOT: 6 LOCK: 4 UNIT:
ADDITION: 2nd Phase
CITY: Eagan STAT MN ZIP: ?
ELEVATIO •-GARAGE: RIGHT
BUYERS NAME: Donald & Mary Lockwood
CURRENT ADDRE 13820 Echo Park Ct. CITY: Burnsville STAT MN
HOME PHONE: 612-432-1598 BUSINESS PHONE: 651-646-8969 BUSINESS PHONE:
SALES REPRESENTATNE: John P. Van Beynen HONE:
1 18281 Tyler ?k
1 0 Lot premium $2,000
1 19021 FUtL VIEW ALUM CQMB DOOR $150
1 14160 3RD CARPET UPGRADE $2,775
1 15087 CERAMIC TILE FOYER $750 .
1 40026 LAMINATE KITCHEN/DINETTE $7,625
2 17000 ADD'L ELECTRIC.OUTLET Garage $100
5 17024 CEILING ELECTRIC OPENING BR1,2,3 Den, FR $500
1 32012 T.V. JACK-CABLE READY Loft $50
2 32020 ADD'L PHONE JACK Loft, Den $100
1 36019 WATER LINE FUTURE ICEMAKER $125
1 36039 WATER SOFTENER LOOP $240
1 21021 . GAS FIREPLACE - CERAMIC W/WOOD $4,250 -
1 22001 - 3RD CAR GARAGE-ELEV#1 $6,795
1 22016 INSULATE - 3 CAR GARAGE $1,010
1 29006 CAST IRON'KITCHEN SINK $425
1 14007 1 ST CARPET PAD UPGRADE $245
$0
.
. $0
?
P
M $0
- $0
$0
TOTAL $241,130
THIS CONSTITUTES A CONTRACT B TWEEN TH SELC D THE PUCHASER (S) FOR THE ABOVEITEMS.
APPR OVED BY BUYER (S): :
APPR OVED BY BUYER (S):
APPR OVED BY SUPERENTIDENT: ?
APPR OVED BY SALES: 1
ZIP: ####
Builders License # 0001371
• LOT SURVEY CHECKLIST FOR RESIDENTIAL
? BUILDING PERMIT APPLICATION
L PROPERNLEGAL: 1?7- / &ffZ/' y ?A??Q?k? 4'TN /?vLnTLG,I?
h DATE OF SURVEY:
H
iL LATEST REVISION: Ic? ' c? I? d
?
C OOCUMENTSTANDARDS
0
O
?? Registered Land Surveyor signature and company
?p ? • Building PermitAppiicant
W?a ? : Legal description
d/o ? . Address
df ?4 ? • North artow and scale
p? p? • House type (rambler, walkout, split w1o, split entry, lookout, etc.)
? • Directional dreinage arrows with slape/9redient %
o'?b ? • Proposed/ebstng sewer and water services 8 invert elevation
ra??a ? Street name
?j? ? : Driveway
m'/? ? Lot Square Footage
? ? ? • Lot Coverage
ELEVATIONS
? Existina
d ? ? • Sewer service (or Proposed)
? ? • Property corners
q? ?? • Top af curh at the driveway
e ?? • Elevations of any ebsting adjacent homes
aR'?' ? Adequate footing depth of structures due to adjacent utifity Venches
Prooosed
/
e'/ a o • Garage floor
r? ?
? o • Firstfloor
i
d
w)
lk
U
d
l
tl
? ? w
n
o
on (wa
ou
e
eva
• Lowest expose
q/ ? ? • Property corners
q/ ? ? • Front and rear af hame at the founda4on
PONDING AREA (if aodicable)
/
a ef ? • Easement line
o ?/ ? • NWL
? co" ? • HWL
? p? ? • Pond # designa0on
? q? ? • Emergency Ovefiow ElevaUon
? DIMENSIONS
r' o? • Lot lines/Bearings & dimensions
o ? • Right-of-way and sUeet width (to back of curb)
(9/o ? • Proposed home dimensions induding any proposed decks, overhangs greater than 2', porches, etc.
/ (i.e. all structures requiring permanent footings)
rd o? • Show aA easements of record and any City utiGdes within those easements
? o ? • Setbacks of proposed structure and sideyard setback of adjacent existing strudures
?o ? • Retaining wall require ments, if
Reviewed:
March 1G89
cnAoaeLocvnMr.cM
, .. Surveyor's Certificate
SURVEY FOR :PULrE
DESCRIBED AS : Loc s, Block 4, OAKBROOKE 4TH ADDITION, City of Eagan, Dakota County, Minnsoto ond
reserwng easements of record.
;-6..
?60 ,??,? ?
oaz. i
= 9,164
= 11 788
207o P
\\?? 2ea
?
. ?
?o ytiy `.?9,
+e'' ' ?' `?O' ?'?•?
, ?57
?
LOT SQ. FOOTAGE
HSE. SQ. FOOTAGE
LOT COVERAGE _
Plan # 18281
PROPOSED ELEVATIONS
Top of Foundation = 999.8
Garoge Floor = 944•9
Basement Floor = qql,g
Aprox. Sewer Service =
Proposed Elev. = 0
Existing Elev.
Drainage Directions =-
Denotes Offset Stake = .
SCALE: i inch - 30 feei
Front -25 House Side -
Rear -15 Garage Side-
JOB NO:
L?/ND ' HEREBY CERTIFV THAT THIS IS A 7FiUE AND CORRECT REPRESENTATION OOR-557
OF THE BOUNDARIES OF THE ABOVE DESCRIBEO PROPERTY AS SURVEYED
IfEDBY ME OR UNDER MY DIRECT SUPERVISION AND DOES NOT PURPORt TO BOOK: PAGE:
PLdNN1NC BNGINB6RlNG SURVEY/NC SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN.
2005 Pin Ook Drive '
Eagan, MN 55122 DATE 11 i 16 I oD CAD FILE:
Phone: (651) 405-6600 (7 JMIF D. LIND EN, L D SURVEYOR
Fax: (651) 405-6606 f?(?1V. IZ ZI ?' NN OTA LICENSE N BER 14378 OAKBROOKE
?
?
:
?J 495.9
?A?y
'o \
?oae
G?
RB
,.
?e
i.l ?[ -^?? ?a
? , ew.i '• -•p".Y'rr???il.T .'i" i. ?
,/ r-' ss?l? ..
2F S(APESxruTMt$ AtEEA
E"'-FM 3?1 A 1?er?rrise
WALC. MAY '[3 Er
?aF? ti
5
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1
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V
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• ?'?
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i ?
i ?
.
L mA2?Dl'A?1 Z"/e ?
Guoe AcROss Ler.
14
1212)
BENCHMARK,
TNF/@ 13
£ltu= 495.03
A
MIN. SETBACK REQUIREMENTS
? ma 'oo ?
s
Jce+ ,?0 999k
O ?-
?4,, d
/ -Q,?
\
iqZECE1VP-C a.f:.. . ..::[
CITY USE ONLY
PERMIT #: , RECEIPT DATE.
MIDENTilkL M£CiMICAL PEfiM1T !lPPLICATION
ctrYoF EwsaP
3830 Pnor sxos Ru
£AHlkA MlY 551 YE 651-681-4675
Please complete for: D singie family dweltings
townhomes and condos when permits are required for each unit
Date: I07
SITE P.QQRESS: 4
OW NER
TELEPHONE #:
DE)
INSTALLERNA`I}Ec????G TELEPHONE#: (A /J
STREET AD RESS: ? W'f
? CITY: 1 STATE: 0174__? ZIP: S S 32'4
6
r?aco a wc?n wa.n ncwi av w.c
? New residential dwelling unit under constructionand not ownerloccupied $ 70.00
Add-on, modification or alteration to existin dwelling unit $ 50.00
• furnace replacement
• air exchanger
• air conditioner
• other
Nature of yyork:
State Surchar e $ 50
Total s
Reminder: Call for inspections.
.
? ?
ATURE O ERMI EE
Lipdated 1101
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
COMMEEtCIi41. MECEA1VICAL PEPMiT AppLICmiON
C1Y'YoF ERSAlv
3$30 ?lLOT KROB itD
EA6AN,IHN 5518E
651-6$1-4675
Please complete for: all commercial/industrial buildings I
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNER NAME:
TENANT NAME (IIvIpROVEMENTS ONLY):
PHONE #: -
(AREA CODE) WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDR.ESS:
PHONE#: -
(AREA CODE)
CITY: STATE: ZIP
WORK TYPE: _ New construcrion Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
Specify Nature of Work:
When insta!ling/removing underground tank, ca!! 651-68I-4675 for inspection by Fire Marskal axd
Plumbing linspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is greater.
Underground tank removaUinstallaHon = m;nim,,.,, Fee
Contact price: $ x 1%= $ (Base Fee)
State surcharge
TOTAL
$
calculate at $.50 for each $1,000 Base Fee
SIGNATURE OF PERMITTEE
i
Updated 1/Ol
CITY USE ONLY
L _ 61 BL ? RECEIPT#:
SUBD. OCI KYI YOO KC''i I-i'ib RECEIPT DATE: ? -U
PERMIT#
2000 PLUNBING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT IQI08 RD
EP,GA2I, MPt 55122
651-681-4675
Please complete for. ? single family dwellings
? townhomes and condos when permRs are required for each unit
? backflow preventer for underground sprinkler system
FIXTURES
EACH #
TOTAL
Alterations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $ ?
Floor drain 3.00 x = $
Gas piping ouUet ' minimum • 1 3.00 x
Hot tub/spa 3.00 x = $
Kitchen sink 3.00 x $ ?
Laund tray 3.00 x
Lavatory 3.00 x = $/ ~
SEpUC $ stem new/refurblshed • requlres MPC Iie. 75.00 X = $
Septic S stem abandonment 30.00 x = $
RPZ new installationlrepaidrebuild 30.00 x = $
Rough opening 1.50 x = $ ..S
Shower 3.00 x
Under round s rinkler Hdwalling is under construction 3.00 x = $
Undergroundsprinkler rfexistingdwelling 30.00 x = $
Water closet 3.00 x = $ -
Water heater 3.00 x = $3 ?
Water softener if dwelling under oormvuction 5.00 x = $
Water softener itexissin9 dweuin9 30.00 x = $
Water tumaround 30.00 x - = S
State Surcharge .50 -> -> -? $ .50
TOtal $
Reminder: Call for inspections of alterations, i.e. water heaters, water softeners, etc.
I Ae?eby ecknowledge thet I hsve read this apphption, state that the intoonation is correc[, end agree to comply wRh ell epplicable City of Eegsn ordinances.
It is the applicanYs respansibility to notify the property owner that the City of Eagan aasumes no liabllity for any damages caused Cy the City during its
nortnal operational and maintenance activities to the facilities consWCted under this ?emift within City propertylright-of-wayleasement.
SITE ADDRESS:
OWNER NAME: :
INSTALLER NAME:
tll'J
STREET ADDRESS:
CITY: ?? !' /'? ,
'/(/'e
TELEPHONE #:
(AREA CODE)
TELEPHONE#:
(AREA CODE)
TE:
c
ZIP: -5&a5/z
OF PERMITTEE
CITY USE ONLY
PERMIT #: RECEIPT DATE
?? Q1
M1DENTIAL M£CHANICAI. PERMiT Ai'PLIC!lTION
crrYoF Ea?snx
3830 Paor xxoa Rn
£AHAft btN 55122
851-6$1-4695
Please complete for: > single family dwellings
townhomes and condos when permits are required for each unit
Date: 51s'Z3f 0 I
SITE ADDRESS: `Ua( 0 OQY.-bYDOy-.tyc•
OWNERNAME: ?C?Y1U?I? LoUCwoo& TELEPHONE#: 6 f 0& zI3a -I5 R?
(AREA CODE)
INSTALLER NAME: '-? Y1Svl I(Q. TELEPHONE #: 7 Sa.
(AREA CODE)
STREET ADDRESS: `94$ I ?CY'Qx ?s LUE\C9-. V?:k ) . S_
CITY: S 0 Ct r4 4- STATE: F-kP ZIP: J"rJ 3
Place a check mark nezt to the oermit work tvoe
New residential dwelling unit under constructionand not owner/occupied $ 70.00
x Add-on, modification or alteration to existin dwelling unit $ 50.00
• furnace replacement
• air exchan er ,
• air condition
• other
Nature of work: A"A44_e., y^-?C
State Surchar e $ 50
I Total $ SO •'o d
Remi»der: Cal! far inspections.
:v) `
SIGN.A I URE OF PERMITTEE
Updaied I,01
CITY USE ONLY
PERMIT #:
APPROVED BY:
RECEIPT DATE:
INSPECTOR
COMMEftCIi41. MECHANICAI. PERMIT APPLICATION
CTfYoF gAfiAN
3$30 f'ILOT KNOB gD
Ekfii4BT,MN 55122
651-6$1-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
LATE:
SITE ADDRESS:
OWNER NAME: PHONE #: -
(ARLA COUE)
TENANT NAME (IMPROVEMENTS OVLY):
WAS THERE A PREVIOUS TENAN'T IN TH1S SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
WORK TYPE:
New construction
_ Intenot Impiovement
_ Processed Piping
Specify Iv'ature of Work: ,,
Instal] li. G. 'Canlc
Remove U.G. Tank
When installing/remnving underground fank, cal[ 651-681-4675 for inspection by Fire Marshal ai+d
Plumbixg Iinspector.
Fees: 1% of conuact price OR $50.00 minimum fee, whichever is greater.
Underground tank removallinstallation = mviimum fee
Conhact price: $ x 1%= S (Base Fee)
State surcharge calculate at $.50 for each $1,000 Base Pze
TOTAL g
SIGNATURE OF PERNIII'7 EE
PHONE#: -
(ARFA CODE)
STATE: ZIP:
Updated 1/01
Use BLUE or BLACK Ink
For Office Use
j Permit* L' 1
City of Eaaan I . . ~s
Permit Fee:
3830 Pllot Knob Road
Eagan MN 55122 j Date Received: 3 j
Phone: (661) 675-6675 I
Fax: (681) 675-6694 1 Staff:
,
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9 1,3 Site Address: ) tarter lame- Unit
Name: 011~, Phone: (,gM- ZS~/~ HLBw
~
''t Address / City /Zip: ) 1 Z~,
t i, ht ll!~=~i=if I 1 I'1 3'
1, II. i.j•I ` Irii il`Ifi
Owner Contractor
; Applicant is!
W 1 Lie ~r- oar
l~
Description of work:
,,.Ti. Y, P t 1,;,4 ,'r ~ ~ "T~le' o•~r a' f a1`o air 2~ 1 • s"5~~ I~r
;..:,,';:,•„1 i•IJ'il'r;l Construction Cost: Multi-Family Building' (Yes No )
i i l , Inp lnly t I'I .oli li'I CompanY G toYw~et1 IS Ctrl Je+t/•
Contact: ),M1! c h1
5 ~K
Address: t S . ~rr erg ~e~r. P Q d. City: 10.5 4 r a
state: Zip: Phone: Gzb'1 D~ X757
rc,rl`i
License i:SC G, to ~ Lead Certificate 1V 4J: - J 0 NA 7 J - L
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan Issued a permit for a similar plan based on a master plan?
Yes -No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
..;?li4 Jtf r, ~'})"f~ <l l ;Ih I a'' 1., '1~ : + i I ,.,.G : 'tt', Id, i ~i! :ra 1l.!'se "::yl.li I V~:~','! . rtr g: ' . , J 'W fr *tl ~
{ II'~
,~l'!. 1•'M . 'I'•i . . I
!/~•.rr f,.j.~i• fEj ~t
MIN;,
:..t-.. ,•.u•,e:r,': 1:. t ..-..~u'' . cn i 'i a r @. . !1l ,e 'Ic;1,i. li r,, . l H.. „I:II .'1'.i!i• 6, i -9.
? !tia:,~1,u I(,l iilf•c! ; ri=1,a.I:. il; r) lilt I s; I ~ • ~;;i:(e~l ~ I ~ ; ~ it f
, I a I •~•J f 11, 1I L,,,
ii't I: I a, !a?; I t • cJ ja,~ t... i. d'( ~Iti lY~ ~ .rt . ,n I t
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.ora
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan: that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit: that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of parmlt Issuance-
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Applicants Printed Name Applicant's Signature
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b0/ZO 397d 31X3 WO1S00 S-1-13NN00 THZ8E17ZS9 LZ:TT ETOZ/H/69