1512 Oakbrooke Lane. RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KIVOB RD, EAGAN MN 55122
651-681-4675
6L sasN-'?3 4 5369.99
K,C-- Sv s, 3 -7o .sc
P?- 5-vS14 a J. Sp
5'o Sysls
NewConatructionReouiremenb RemodallRanairReauirements ?l
. 3 registered site surveys showiig sq fl. of lot, sq. k. of hause; and all rooted areas • 2 copies of plan
(20%maximum lot coverage allowed) • 1 set of Energy Calculations kr heated additions
. 2 copies of plan showing 6eam & window s¢es; poured fouM design, etc.) • 1 site survey for exterior additions 8 decks
. 1 set of Energy Calculations ? • IiMicate if home served by septic system for additions
. 3 copies of Tree Presenafion Plan B lot platled afler 7/1/93
• Rim Joist Delail Options selectian sheet (bldgs with 3 or less uni4s) ?
/
if 5`nQ q9
,?-
%, \`?1?
DATE C? \ ?\ O? VALUATION ?a? flOu
SITE ADDRESS
LTI-FAMILY BLDG _Y I/N
TYPE OF WORK FIREPLACE(S)
c? .
Phone #?\??-
`ctc?n
APPLICANT Cu\Ne-
STREET ADDRESS U-E?(43_STATE?N?`k ZIP 5\?-?
TELEPHONE CELL PHONE # \A-??- \?l\ FAX #
PROPERTYOWNER'S?v? NX Orti? TELEPHONE#
------------°--------------------------°------------------°----------------
COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATI:GORY 1 MINNFSOTA RU1.LS 7672
(J submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelopa Calculations Submitted
'
Plumbing Contractor Phonc # zk
Plumbing syslcm includes:? Watcr S __ Lawn Spnn N&())'())0()
Water Heater 1 No. of R.I. No. of'Ba4is Mechanical Contractor ?\Ph Mcchanical system includes: Air Conditioning Heat Recovery Syslem
Sewer/Water Contractor:
----°--°--------°-----------°----°---------°--------°----°---°-°-
I hereby acknowiedge that I have read this application, state that the
with all applicable State of Minnesota Statutes and City of Eagan?c
Stgnature of Applicant
0 ?1 2
and agree to comply
OPFICI: USE ONLY
Certificates of Survey Received y,b.g Tree Preservation Plan Received _ Not Required
/\ Updated 4102
OFFICE USE ONLY
'? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
,)I( 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
x 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (81dg)' ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement 'Demolition (Entire B ldg anly) - Give PCA handout to applicant
Valuation /76660 Occupancy Rr 3 MC/ES System l-
Census Code /G/ Zoning /0-0 City Water /WS
SAC Units G/ Stories .°.? Booster Pump ?-
Nbr of Units ? Sq. Ft. PRV 7 &S
Nbr. of Bldgs 0/_ Length Fire Sprinklered ?
Type of Const ? Width
REQUIRED IN SPECTIONS
at? Footings (new bldg) ? FinaUC.O.
_ Footings(deck) ' FinaVNo C.O.
Footings (addition) _ Plumbing
a? Foundation HVAC
te Drain Tile Other
Roof ?E Ice & Water ? Fi nal _ Pool _ Ftgs _ AidGas Tests _ Final
Framing _ Siding Stucco Stone
? Fireplace ? R.I. -gAir Test )?, Final _ Windows (new/replacement)
Insulation _ Retainine Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S8W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
I .3 tl?ed, VV-414-"
//70
?
G9?,.?fa ??z ? /G
Building Inspector
G 3r go =
/?5// Y
i i
MNr.her.k COMPI IANCE REPnRT I
MinnPSnta Fnarnv rnde I Pprmit #
MNr.her.k SnftwarP Version 3.0
I ?
I ChPr.ked hvlDatP I" I
?
COUNTY: Daknta
STATE: Minnesota
70NE 2
CoNSTRUCTtoN TYPE: Single Family
DATF_: 1-11-2002
DATE OF PLANS: 7125I00
TITLE: Oakbrooke Sterling with Lookout
COMPLIANCE: PASSES
RPnuirPti UA = 532
Your Home = 403
7420% BPtter Than CndP
ArPa or Cavitv Cnnt. G127ina/Donr
Perimeter R-ValuP R-ValuP U-Value UA
---- -----------------------------------
CEII..INGS 1218 380 0.0 37
WALL
R.SMTSConrn9 (Y ht/R.3' bn 9.O' insul 1047 ? 1110 ? 0.0 ? ??50
GLA7_ING- Windnws nr nnnrc. ?? hnvP GrariP 402 0.350 141
DOORS 0.350 13 ?
H AC EC) IIPMENT ? Fumar.e. 99.0 AFUF_38.0 0-0- -----
-
------ -----
-------------------- ----------------
COMPLIANCF STATFMENT? ThP nronnsed huiidina dPSinn rfPSCrihed ere is
ronsistent with the huildina nlans. sner.ifir.ations. and nther r.alr.ulations
suhmitted with the nermit annlir,atinn. The mmnosed huildinn has heen
designed to meet the?J e ire nts o/f ?the eso Energy Code.
? , , -^--°---- / ? ? // ???3? Date
ow
' PULTE HOMES OF MINNESOTA ? ?
JOB INITIATION ORDER
DATE: 4128/2002
JOB NO:
COMMUNITY:
ADDRESS:
MODEL NAME:
BUYER:
ADDRESS:
HOME PHONE:
SALES REP:
n19n_ali_ni
Oak6rooke Single Family
1512 Oakbrooke Lane
STERLING MODEL#: 18232
3-May
LOT: 13 BLOCK: 3 UNIT:
ADDITION: PHASE 4
CITY: Eagan STATE: MN ZIP: 55122
ELEVATION: 4 GARAGE: RIGHT
3497 Coachman Road CITY: Eagan STATE: MN ZIP: 55122
651-456-9311 BUSINESS PHONE: 651-405-3016 BUSINESS PHONE:
Jolayne Moberg PHONE: 651-686-2862
1
?
18232 '• ?ayg,
P .. 'S.'„a3c".fr
STERLING-'
R» Mw '
??6
S286,990
1 00000 Lot Premium $4,000
1 11012 FULL BASEMENT- WALK_Ol1Ti $4,095
1 18039 ECEVATION #4-1 $10,995
1 22004 3RD C,4R GAR=EL#47 $7,995
1 19025 GARAGE SERVICE DOOR $760
1 14000 BASE CARPET ADJUSTMENT $0
1 14004 1 ST CARPET PAD UPGRADE $1,675
1 14001 i 5T CARPET UPGRADE $370
15000 BASE VINYL ADJUSTMENT $0
5 17024 CEILING ELECTRIC OPENING $500
23007 3 TON AIR CONDITIONER $2,800
4 32001 CAT 5 PHONE OUTLET ali beds, living room, kit $400
1 32004 SATELLITE R.I. $165
1 10091 GAS RANGE/OMIT 220V $450
1 21021 GAS FIREPLACE -.CERAMIC WNVOOD 7 $4,395
1 13077 WHIRLPOOLTUB $1,175
1 26043 WOOD RAILING - 2ND FLOOR $620
1 31011 LAUNDRY TUB SNGL COMPRTMNT laundry room $300
1 35066 4TH BDRM-FL OAK DRS $1,240
$0
$0
TOTAL $328,925
THIS CONSTITUTES A CONTRACT BETWEEN THE SELLER AND THE PUCHASER (S) FOR THE ABOVE ITEMS.
APPROVED BY BUYER (S):
APPROVED BY BUYER (S):
APPROVED BY SUPERINTENDENT:
APPROVED BY SALES:
? ??
??
Builders License # 0001371
r
' • LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING PERMIT APPLICATION
PROPERTY LEGAL• L o? I? 13 --i? LQ ?'
DATE OF SURVEY:
LATEST REVISION:
?
rn
c
W
L) OOCUMENTSTANDARDS
Y a v
O Z Q
?_? - • Registered Land Surveyor signature and company
??C ? • Building Permit Appiicant
7? G G • Legal description
? E _ . Address
?"
- • North arrow and scale
t
lit
t
l
k
t
)
li
/
. en
ry,
ou
, e
c.
t w
o, sp
oo
House type (rambler, walkout, sp
?C C • Directional drainage arrows with slopelgradient °/a
C C • Proposedlexisting sewer and water services & invert elevation
? C C • Street name
? • Driveway
/ n
c • Lot Square Footage
d C - • Lot Coverage
ELEVATIONS
Existin
• Sewer service (or Proposed)
• Property corners
?/^ • Top of curb at the driveway and property line extensions
?/ - • Elevations of any existing adjacent homes
• Adequate footlng depth of structures due to adjacent utility trenches
. Waterways (pond, stream, etc.)
Prooosed
• Garagefloor
? - - • Basement floor
• Lowest exposed elevation (walkouUwindow)
6_/'/- - . Property corners
. Front and rear of home at the foundation
PONDING AREA (if aoolicable)
? ? _ • Easement line
? • NWL
? ? C: • HWL
• Pond # designation
• Emergency Overflow Efevation
e?/ ' -_ .
U" ' _ •
?/ - - .
?/ _ - •
DIMENSIONS
Lot Iines/Bearings & dimensions
Right-of-way and street width (to back of curb)
Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all structures requiring permanent footings)
Show all easements of record and any City utilities within those easements
Setbacks of proposed structure and sideyard setback of adjacent existing structures
Retaining walt requirements, i
Reviewed:
Surveyor's Certificate
SURVEY FOR :auLTE HoMes
DESCRIBED AS :Lot 13, Block 3, OAKBROOKE 6TH ADDITION, City of Eagon, Minnesota and reserving
easements of record.
ar ? ???
Be
r
?
?
,
Q 5no.i =?,'?
O ?
N
?
r
i?
# ,szs,
PROPOSED ELEVATIONS
Top of Foundation = 944.0
Garage Floor =943.7
Basement Floor =935.0
Aprox. Sewer Service =932 o±
Proposed Elev. _ (Z:::)
Existing Elev.
Drainage Directions =-
Denotes Offset Stake = .
SCALE: 1 inch = 30 feet
HEDL UND I HEREBV CERTIFY THAT THIS IS
OF THE BOl1NDARIES OF TFiE AB
BY ME OR UNDER MY OIRECT ^?F
PLANNING BNGJN6l1RlNC SURVltYlNG SHOw IMPROVEMEN75 OR ENCR
2005 Pin Oak Drive
Eagan, MN 55122 DnTE AL/--/02
Phone: (651) 405-6600 ?
fax: (651) 405-6606
4?
EA(3A`?
RIEV EWED
BY -G?
?:. LUILDING IEMSPEbTIOd`9a? ?EPT.
' ?r?,% ` 931.7
F)?nn?f ?U
L 0 T SQ. F00 TA GE
HSE SQ. F00 TA GE
L 0 T CO l/ERA GE _
-vncnuT-
= 11, 664
_ 7, 852
16%
BENCHMARK,
MIN. SETBACK REQUIREMENTS
Front - House Side -
Rear - Garage Side-
suRVerEo
PORT TO
AS
R_
N0:
02R-500
CAD FILE:
SURVEYOR
t 14376 Oakbrooke 5
I'iC if1
5- 9 (":2f c)
PLUMBING (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
$3 o_s--a
Date o6 / A6> ! D 'J
Site Address Unit #
Properry Owner t;p ?1 /y U x/1 A Telephone # (45'"/ ) YS6- r3//
Contractor GA-,`d, d- Sb n S `1 y M. b in o
Address 315- ?9-Unt?Q.u Zarn e- City_ P/}riK OV?
State M/1f Zip sS V'f 7 Telephone # P63) q-7s =472 r 6
The Applicant is _ Owner ? Contrac[or _ Other
Sep[ic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional consultant fees may apply.
Alterations To Existing Dwelling Unit, Including $ 50.00
_ Adding fiMures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
_ Water turnaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
? Lawn irrigation system
_ Water softener _ Water heater $ 15.00
_ replacement _ additional
$ .50
Stste Surc6arge
Tota? s 3
I hereby apply for a Residential Plumbing Permit and acknowledge that'Ehe information is complete and accurate, tUat the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; 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 ?i???' `?
' % wr !?'?o hr
Applicant's Printed Name Applicant's Signature
/S/2 OAYLb.ceniu` L4 Lot!L13 &ock 0-3 Subd.
3fte address:
On April? 15, 2000 the Minnesoia Energy Code, Category I Building RequiremeMs for insulation protection, air
Ughtness, and verdilation rtCeificate of Occupancy. C? of Eagan is requiring that the following information be
submitted prbr to issuance of a
I hereby acknowledge that the above informatlon is correct ana agree w u+?ly'l •°•• --
requirements.
Date
Slgnature
Comperry Name
• Thia torm is the reapaisibGity of the General Gontractor.
This structure. Jg constructed ta meet minimum requlrements of the Mn Energy Code, ChaPter 7M
OR 7672 or 7874
? Thfs ffiructure: ? ?n???ed to meet more restrictlve requlreroents of Cheprs
_a -7e
2007RESIDENTIAL BUILDING rExMiT nrrLicATiorr
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
/,?9- a) ,
CC"? '
New Construction Reouirements RemodeURepair ReauiremenLS Office Use Onlv
3 registered site surveys showing sq. ft of lot, sq. ft. of house; and all rooted areas 2 copies o( plan showing footings, beams, joists Cert of Survey Recd _Y _ N
(20°/, maximum lot coverage allaved) 1 se ryy Calculations for heated additions Soils RepoA
.. ? -_Y -N
1 Soils Report if proposed building is to be placed on dislurbed soil Y ,- - ?si, for atldiUons & decks Tree Pres Plan ReaJ _Y _ N,
2 copias of plan showing beam 8 window sizes; poured (ound de ron -'cafe if an-site sepfic sysfem Tree Pres Required _ Y_ N
lsetofEnergyCalculahons -' On-sKeSeplicSpstem - ,"_Y,_N
3 copies of Tree Preservation Plan ii lot platted after 7/7l93 2007
Rim Joist Defail Options selec6on sheet (buildings wiGi 3 or less u
Minnegasco mechanicalven6lationform
Plans are considered ublic information unless ou state ttYe WeALde'secre`t a?d he rea?on.?nd" \
Date `;5 /
? / d( Construction Cost
?
?
?
Si[e Address 2 ?
aa" _ Unit/Ste #
?
s
Cr?-? / 4•1 ? - S S? "?-?
Description of Work
Multi-Family Bldg _ Y?N Fireplace(s) _ 0 _ 1 _ 2
- ?I31
Property Owner Telephone # (05 ()
i
Contractor
Address City
State Zip Telephone # ( )
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Venfilafion Category 1 Worksheet • New Energy Code Worksheet
(J submission rype) Su6mitted Submitted
• 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?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Coniractor
Sewer/Water Contractor
I hereby apply for a Residential Building Permit and
e;
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 wark is not to start without a
permit; that the work will be in accardance with the approved plan in the case of work which requires a review and
approval of plans.
Applicant's Printed Name
Telephone #(
Telephone #(
Telephone # (
the information is complete and accurat
ApplicanYs Signature
. s I • DO NOT WRITE BELOW THIS LINE
r
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 AccessoryBldg
? 02 SF Dwelling O 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - MuIG
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 DS-plex A 18 Deck ? 23 Porch (screen/gazebolpergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
7r, 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 WindowslDoors
? 34 Replacement •Demolition (Entire Bldg) - Give PCA handout to applicant
DBSCription: Water0amage_Yes
Valuation Occupancy MCES System
Plan Review _x 100% or _ 25% Code Edition
Census Code \/1 Y V!
---?-??- Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const W idth
Footings (new bldg)
?C Footings(deck)
Foohngs (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
REQUIRED INSPECTIONS
_ Sheetrock
FinaUC.O.
X FinaUNo C.O.
HVAC
Other
Pool Ftgs Air/Gas Tests Final
_ Siding _ Stucco Lath _ Stone Lath _Brick
W indows
_ Retaining Wall
Approved By: (i , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
5&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total '
ol,co
Surveyor's Certificate
JURVEY FOR :PULTE HOMES
DESCRIBED AS :Lot 13, Block 3, OAKBROOKE 6TH ADDITION, City of Eagon, Minnesota and reserving
easements of record.
r? T?.
4e:,rr,).
.. ?:,.:.:
. ? . `; s. ;???? ???•
C- AuFiN
r ` 1J
tY _
?
„{.,?i:l?_?i??G I??SPECTIO?a,,.? DC?"T,
,
?P`PI `q517
3?•l
MOONW "
Be R qu?red
C,e.
Q 990.1 `;?.1'?'
a \
?x
o ?
0 y
x ?
?
?n.
F`
,
?
# ,926,
PROFOSED ELEVATIONS
r x
a 9qo9" ???.s S89°42'31;;,? 110.33
? ?vn<nur-
FOO RRU D
LOT SQ. FOOTAGE =? 7 9, 664
HSE SQ. F00TAGE = 1,852
LOT C011ERAGE = 16%
Top of Foundation = 944.0
Garage Floor =943.7
Basement Floor =935.0
Aprox. Sewer Service =932.0±
Proposed Elev.
Existing Elev. _
Drainage Directions =
Denotes Offset Stake = •
SCALE: 1 inch = 30 feet
HEDLUND I HEREBY CERTIFY 1HAT THIS IS
OF THE BOUNDARIES OF hIE AE
BY ME OR UNDER MY DIRECT Si
PLANNING ENGINBSRlNC SURVBY/NC SHOW IMPROVEMENTS OR ENC
2005 Pin Oak Drive :
Eagon, MN 55122 DATE
Phone: (651) 405-6600 ?
Fax: (651) 405-6606 e-?
BENCHMARK,
,IIO?
MIN. SETBACK REQUIREMENTS
Front - House Side -
Rear - Garage Side-
JOB N0:
IENTA710N OZR-SOO
SURVEYED
PORT TO BOOK: PAGE
AS
CAD FILE:
SURVEVOR
t 14376 Oakbrooke S
GLG-
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1512 Oakbrooke Lane
Lot: 13 Block: 3 Addition: Oakbrooke 6th
PID:10- 53765- 130 -03
Use:
Description:
Sub Type: e- Reroof
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Delta Construction Inc
547 Woodduck Dr, Unit H
Woodbury MN 55125
(651) 747 -6323
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Construction Type:
Occupancy:
If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
$88.50
$1.50
Total: $90.00
- Applicant -
Owner:
Dung M Dang
1512 Oakbrooke Lane
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
0801
9001
Issued By: Signature
Building
EA089873
06/23/2009
ePermit
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
Use BLUE or BLACK Ink
r
For Office Use Q
Permit 118600 j
City of EaRd Permit Fee 105.057
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received: (1
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: Phone:
Resident/ F ,
Owner Address / City / Zip: o 14 Z
a I Applicant is: Owner ,'L Contractor
Type of Work Description of work:
YIDe
Construction Cost: Multi-Family Building: (Yes / No
Company: Contact:
Contractor Address: City:
State: Zip: Phone:
:
License Lead Certificate
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:
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.
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.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 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 permit issuance. t
x x
Applicant's Printed Name Applicant's Signature
Page 1 of 3