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2087 Opal Dr' cIrY oF EAGAN ? 3795 Pilef Knob Roed Eogan, MN 55122 PH4NE: 454-8100 BUILDING PERMiT $1"000 Site Address Lot 8lock Sec/Sub. Pqrcel .# ?a Nome _ ?a z Address Ci Nome _ 00 Address ei u? W W Nome _ W F ?? Addreas NZ I hereby ucknowledge that I have reod this opplication end sta the iniormation is correct and ogree to comply with oll app Stote of Minnesoto Stotutea and City of Eogan Ordinonces. Siynoture of Permittea ? A Building Permit Is issued to: ' oll vrork sholl be done in oaardonce with oll opplicable State Bultdinq Officinl Drive Receipf # Date , 19 Erect ? Occupancy Alter Q Zoning Repoir ? Fire Zone Enlarpe p Type of Const. Move ? # Stories Demolish p Length Grade ? Depth Sq. Ft. Aporovals Faes Assessment Water & Sew. Police Fire Enp. Plonner Councf I Bldg. Off. APC Permit SurcFwrge " Plan check SAC Wcter Conn. Water Meter Road Unit Totol on the express Conditlon thni ond City of Eoqan Ordinances. Permit No. Permit HoltMr Misc• Permit No. Holder Plum6ing H.V.A.C. atsr Wsll W Disp. Sswer Electric InsRection Dste Insp. Other Footings Foundation Freminp Rouyh Plbp, Rouph HVAC lnwlation ? Final Plbq. Final HVAC Final y & Q?j Water Destxibe Location: VYe41 Sewer Pr. Disp. CITY OF EAGAN Remarks * Cedar Grove Acguisition Addition CEDAR GROVE #1 l.ot 19 Blk 6 Parcel 10 16704 190 06 Owner Ll' i ?- ??A 5treet 2087 0pa1 Drive State Eag?, MN 55122 2 ( l p-cr Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. p c 1985 1266.95 84.46 15 STREET RESTOR. GRADING SAN SEW TRUNK * SEWER LATERAL 1972 1r304.00 52.16 25 PaiCY WATERMAIN * WATER LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTEA SIDEWALK STREET LIGHT WATER CONN. 9UILDING PER. SAC PARK , BUILDING PERMIT re be a..a se. DECK CITY OF EAGAN N? 6879 9793 Pllet Rno6 0.oad Eagan, MN 54122 _ PHOH[i 454-8700 Receipt e? v.i„P $1. 000 D?„ September 15 ,9 81 Site Address eUtf'/ Up81 U2'1V8 Lot _1.9 Block 6 seciso, Cedar Grone 1St P„cei # 10 16700190 06 a Nome Robert H. Keller W 2087 Opal Drive ; Addreu - - "- ^^ ' b ____.. ..... p Name _ f OU Addreu Name _ Addreu Erect M Occuponcy R-3 Alter ? Zoning R,1 Repair ? Fire Zone Enlarge ? Type of Const. Vn Move ? # Stories Demolish ? Leng[h 20 Grade ? Depth 25-Sq. Ft.- Apvrovab Faes Assessment - Water & Sew. Police - Fire Enp. Plonner - Councfl _ 1 hereby acknowledge thot I hove read this opplication and stote that Bldg. Off. the inlormution is correct ond agree to wmply wlth oll opplicable APC Stote of Minnewto $tatutes on ogan r" n Signoture of Pertnittee Permit v?'• Surcharge Plon check _ SAC Water Conn. _ Woter Meter - Rood Unit Torai $18.00 A Building Permit Is issued to: on the express condition thn, oll'rrork sholl be done in awordance wit op:._?p . c'cr? Ch 7lfo ble Stah?of inneao Statutes and Ciry ot Eagan Ordinances. Bulldin9 OfHciol ,,,,-,.r ? CITY OF EACd1N BUILDING PERNIIT APPLICATION Include 2 sets of plans, 1 site plan w/elevations & 1 set of enexgy calculations. 7b Be Ilsed For Valuation /C--z,-v Date n7 S ?__ Site Pddress: ;?-G,i'7-6, ,odL- _l??--- I,ot I sloc]c ? sec /subl C'49e Erect ? / Parcel #: /v ??P`z0 U ( QD G ?----?pa,r aaner: 0 6z f',? ??e - Nbve Address: Zo X 7- L Damelish City/ZiP Code: li4G.9_111 ?- 2, Grade OFFICE USE ODII, OccupancY - 3 Zoning Fire Zone Type of Const. ? # Stories Front ft. Depth ft. Phone #: APPR(7VALS FEES Contractor: G I.?nlr /Z Assessmnts Permit ? Pddress: Water/Se,ver Surchaxge Police P1an Check City/Zip Cocle: Phone #: Arch./Eng.: Pddress: City/Zip Code: Phone #: Fire E1'i4 • Planner Council Bldg. Off. APC SAC Water Conn. Watex Meter Road Uni.t TCIPAL ? . ?_:. Address (psesea!) Builder ------- Address ..... EAGAN TOWNSHIP No 512 ? BU?IL?DING PERMlT .. . ?-......"IN_'-"" ' ---- - !?? ? Eagan Township f --- ? Town Hall Dale /?. -'v ' ---...-- -..... SYOries To Be Used For Fronf Depih Heigh! Esf. Cosf Permi! Fee Remarks ? TION Sireel, Roador oiher DescripSion of Locafion I Lo! I Elock I Addifian os Traci ? '.'iY This permii does no! ¢ oriae the use of slseels, soads, alleys os sidewalks nor daes iY give the owner ox his agent ffie righ! !o creafe any s5 uation whieh is a nuisance or which presenis a hasard !o the healih, safety, convenience and general welfare fo anyoae in the commuaily. TFIIS PERMIT MUST ?K PT N T PRE ISF WHILE THE WORK IS IN PROG 'SJ This is !o cerYifq, iha! ?'??has permission !o erect a--- ............................_.___.upon the above described premise subjec! !o the provisions of ihe Building rdinance fo an T?i ship adopied April 11, 1955. i _.___..__..._.._...'......____.. ........_..__.......____ ............ .------ """.'..........._...... Chairman af Town Soaxd ? ilding Iaspector EAGAN TOWNSHIP BUILDING PERMIT Ownex ...f:.lr.4.'.u-[tic!..._-Lt.:---.................. .-------' Address (preseni) --?...?..a.--?--...'?"./{--"--'-----...?i...?..'•t'?'-`-^-u...--- ? v ? Builder ....... XF----------- ......----- ----------------- .------------------------- ..---- Address ..----------------------------------------- -_.... -------------------- ----------°"--' DESCAIPTION N° 836 Eagan Township Town Hall 6/y?/d L Date .................. .............°-°-----_.. ories To Se Used For Froni DepYh eigh! Est. Cosi Permi! Fee Remaxks 7 ? LOCATION Sireef, Road or oiher Descriplion of Locaiion Lo! Block - Addiiion os Traei / < (? 0'4-K-"-? 'Zt-S - 9S= / This permii does aof au3horise the use of slreels, roads, alleps or sidewalks noz does it give the ownez or his agent the righi !o crea2e any siiuafion which is a avisanee or whiah presenfc a haaard fo the healYh, safely, convenienee and geeeral welfare !o anyone in the eammuuilp. THIS PERMIT MUST BE EP?T/D P'AEMI5E WHILE THE WORK IS IN PAOGRESS. .. . . ... Thia is !o ceriify, ihaf.. ........ ........... az permission !o ezect a----- _"'---- -.. '----.......__....____upon .. p adopled April 11. the above described premise subjeei to the provisions of the Building Ordinance for Ea Towns. .'- 1955 ". Per ---. ..__..... ..."-.......... ------------------ -`-?--- -- ..... ..-----k?? Chairman of Tnn ?oard ' / Suildin Ins ecfos '/,S 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN ` ' 3830 PILOT KNOB ROAD, EAGAN MN 55122 0'1" 0(0s- 651-675-5675 Please complete for modifications to existing residential dwellings. Date _? I 2- `l I O? Site Street Address 2-O 8 7 U'.,4 L 7iQ/i'6' Unit# Property Owner e0&72T?C y014 ??L.Ee Telephone #( 6S6 Contractor Address City Telephone # ( State ) Zip The Applicant is: Nzowner _ Contractor _Other Alterations to existing dwelling _Add fixtures to rooms, excluding water softener and water heater _Septic System Abandonment _Water Turnaround (add $121.00 if a 5/8" meter is required) Other: $ 50.00 ' Water Softener _ replacement _ Water Heater additional $ 15.00 XLawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00 State Surcharge $ .50 Total D PR 2 2004 1 1 $?? 11 I hereby apply for a Residential Plumbing Permit and ackn u dge that the infor ation is complete and accurate; that the work will be in conformance with t s an codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and approved. _ XC,,??2T 7-//- ?}FL LE/1 ZZ6!!%? ApplicanYs Printed Name App icanYs Signature ? von ? 2007 RESIDENTIAI. BUILDING PERMIT APPLICATION City df Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Catstructim Reauiremenls 3 regctered site surveys sharing sq. R N bt sq. ft ol house; end all roded areas (20%maximum bt mverage allowed) 7 Shcs Repaf A proposetl buihfing "s to 6e pleced m disWrbed saii 2 copies of plan showing beam & wmdvr s¢es: poured faund design, e[c. 1 set W Energy Calalahons 3 capies N Tree Resercation Plan if lot plaUed afler 711l93 Rim Jdst Detail Opfions selection aheei (buildiigs with 3 or less uniGS) Minnagasco mechanical ventila4on form Omsite Seytic S/stem _ Y_ N Plans are considered oublic information unless vou state thev are trade secret and the reason. Date 7 / I U / 0 ? Construction Cost 3(a - o-, Site Address Z9091' Q aA'- ?7 fz - -? Unit/Ste # Description of Work Rla.sid/rIePL ? /) 7l 4 L? L12' ? Multi-Family Bldg _ Y_ N Fireplace(s) _ U _ 1 _ 2 Property Owncr 6 0}3-LY l?? / Le,9 Telephone ti (?"JI )4'17q Bud9QL Exk@rIOK Cootracrot 8017 Nicollet Ave S. Addrei Bloomingtoo, MN 55420 City rx: 1-877-310-1742 State _ FAX: 1-952-887-1659 Z+P "1'etephone k( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residerrlial Ventilation Category 1 Worksheet • New Energy Code Wo(ksheel (J submission type) gubmitted Submitted • Energy Envelope Calculations Submiried In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan2 _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Conhactor Sewer/Water ConTractor ?4go ? RemadeUReoair Reauiremails Oice Use OnN 2 oopees of plan shanmg kiatings, beams, pists Ced of Survey Recd _ V_ N 1 set ot Eneyy Calculatlais for heated addNOns Sods Report _ Y_ N 1 sile wrvey Tor addilions & dedcs Tree Pres Plan Recd _ Y_ N, Addition - indicaleifon-s"rlesepG'csysiem TreePresRequired _Y _N Telephone # ( Telephone #( Telephone # ( 1 hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; 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 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. SAW-p-N- To-F/L ci`n LT ApplicanYs Printed Name DO NOT WRTTE BELOW THIS LINE Sub Tvoes ? 01 FoundaGOn 13 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Aooessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Pireplace ? 21 Porch (3-sea.) ? 31 Ext Alt - Multi L7 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Pach/Addn. (4sQa:) O 33 Fxi. Alt - SF ? 04 02-plex O 10 08-plex_ O 18 D9dc _ ? 23 Porch (saeenlgazebolpergola)-13 36 MuMf Misc. ? OS 03-plex O 11 10-piex ? 19 Lower Level ? 24 Storm Damage_. . _. _.,, . ? 06 04-plex ? 12 12-plex ? 25 Mlscellaneous Work Tvoes ? 31 New 0 35 Irrt ImprovemeM ? 38 Demolish Interior ? 44 Siding ? 32 Addi6on p 36 Move Building 0 42 Demolish•Foundation ? 45 FreRepair ? 33 Alteration O 37 Oemolish Building' O 43 Reroof O 48 Vlfindox5lDoors ? 34 Replacement 'Demolltlon (Entlre 81dg) - Give PCA hertdout to apptleant D9SCfipt1011: WaOer Damaip _ Yes Valuation Occupancy MCES System Plan Review _ 100% or _ 25% Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Wdth REQUIRED INSPECTIONS _ Footings (new bld8) Sheetrock _ Footings (deck) FinaVC.O. _ Footings (addition) FinaUNo C.O. ! Foundation F{ypC Drain Tile ? Other Roof _ ice& Water _ Final _ Pool Ftgs AidGas Tests Final _ Framing _ _ _ Siding Stucco Lath Stone Lath Brick _ Fireplace _ RI. _ Air Test _ Final _ _ Windows _ Insulation _ Retaining Wall Approved By: , Building lnspector Base Fee ? Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit 8 Surcharge Treatment Plant License Search Copies Other Total t? gYj ?,S 2007 COMMERCIAL PLUMBING rExMrr nrrLicnTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Do not combine inside and outside plumbing on the same application; separate applications and permits are required. Date-IK! [T7 Slte Address /-, tn Unit # TcnantName Former Tenant Name Property Owner -7'?in/? Telephonc#(4;r`/ ) ?7X /-61-t''iy Contractor -^uAtii'A AdiIsecv A.i- City ? i t1JC?t_ State /t9 ; v Z+p S S?t l 7 Telephone #(6J`! I a E/ License# .A)R"101Mf? Expires: /2 I31167 The Applicant is _ OHVer ?C Coniractor _ Other Wqr4.T.7'FP tJ4 _3Gcv3ifi;R.R"- _4:^r?ii?tn.F{t?le.m."' ?'ex XNa. ?bGvk.?m*p?1?,?-w/easemen!? -X RPZ. PVE3: New _ Repair/Rebuild _ Replace _ Kemove Rain senson are reuired on irri ation s stems Description of Work 1'D/L 'Vr-+? DALA 25Z!- ? To inyuve d'Pressure Reducing Valve is reyuved on ncw service. ca11 65 1-67 5-56J6 Meters - Call 651fi75-5646 to verify that hydrostatic, conductiviry, and 6ncteria les[s passed orior to oicldne uo meter. Irrigation Size & Type Avg GPM 2" turbo req'd unless smaller size allmwed by Public Works Fire Size & Yrice 3;4" mcter 174.00 Domestic Size & Type Avg GPM Indudes hig6 demand dev-ices? _ Yes _RVo Flus6ometers Y Yes _ No PRV Required _ Yes ? No Permit Fee $50 50 mrnimum (includes State Surcharge) ',. ContractValuc $ 1;2S ;2, 6<'l? x 1"/0 = $ Pe[mit&"ne ? $ % f)L Me4er(sN Requ'vedonallnewbuilding+&boulevardimea[ionsvstems 31 1,5"S Itmdtobk:terRead $ / State 5rcchargc IIpmitfe is less than 31,000, surcharge is 5.50 If vgnaitice ismorethanS1,0U0,aurchargew5.51Nftw'eaanV1,'fMmn'eU. Following (ees apply whcn installing new lawn irrigxNon system ? $ Waler Parntit Call ihe Cin's Engineering DepanmrnL 651-675-5646. Sor requircd fee amwn[s 1 [eaIIDCRI rlafll Water 3upply & Storage Slate Stccharge $ „2 `= Total Fce C 6r,mbY aqqlv, fnc a Cnwmercinl Plumhing Permit md actvnwled%p t6at the mfnsmat'via ia rnmQlete md acsu*ate; thal ihe wrnk will he iu caofocmaaoe wnh ihe ordinancee and wdes of the City of Eagan md wiN fLe Plumbing Codee; ihat i uvdersfand thia ia not a pertni[, bul only an applieation fort a prnni[, md wor4: in not to sGA without a prnnit, Utat the wodc will be in mcordance with the approveA plan in Ihe ease of work which roquires aruview and approval ofplans. Applicanl's Printad Nnme ApplicanPs Signaturc CITY USE ONLY y REQUIRED INSPECTIONS: ? U.G. -Z Air Test _ Gas Test ? Rough In o Final PLANS SUBMITTED APPROVED BY: 3 U '0 ?7 . BUILDING INSPECTOR General Information • Radio Meter Read (required on all new buildings. Boulevazd 'urigation systems may require a radio read -$153.00 • RPZ's must be tested every yeaz and rebuilt every five years. Test resulu should be mailed to Paul Heuer at the City of Eagan. • A minimum fee peimit per address is required for the following RPZ's: new, rebuild, renair, remove. • Water meters include copper horn/strainer, remote wire, and touch-pad meter. METERS REOUIRING 4-HOUR ADVANCE NOTICE PRIOR TO PICK UP GPM METERS USE PRICE GPM METERS USE PRICE 1-20 5/8" residential $136.00 4-120 1-1/2" imgation syst $ 855.00 displacement or turbine*" Public Warks maximum small commercial must approve continuous meter size 10 2-30 3/4" lawn irrigation $174.00 4-160 2" turbine large irrigation $ 1,063.00 maximum displacement residential system & continuous or productionlines 15 small commercial 3-50 1" displacement lazge residential $219.00 1/4 to 160 2" compound bldgs over $ 2,018.00 bldg to 24 units 65 units maximum stnall commercial & conrinuous & large comm bldgs 25 irri arion s stems 5-100 1-1/2" 25-64 unit bldgs $532.00 maacimum displacement & conrinuous most comm bldgs 50 METERS REOUIItING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP GPM METERS USE PRICE GPM METERS USE PRICE 5-350 3" hubine very large irrigation $1,411.00 6-500 4" compound +300 unit bldgs $3,956.00 system & production & very lazge lines comm. bidgs 1/2-320 3" compound +200 unit bldgs $2,577.00 10-1000 6" wmpound +400 unit bldgs $6,623.00 very lazge verylarge comm bldgs comm bldgs 15-1000 4"turbine very large $2,533.00 6" turbo $4,090.00 irrigation systems & producrion lines Comments • To schedule inspection of the inside water line and backflow preventer, call 651-675-5675. • To arrange for water turn-on, call 651-675-5200. cc: Utility Division Systems Analys[ December 2006 ' 2007COMMERCIAL PLUMBING rERNuT nrriacnTioN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Do not combine inside and outside plumbing on the same application; separate applications and permits are required. Date Site Address Unit # Tenant Name Former Tenant Name Property Owner Telephone # ( ) Contractor Address City State Zip Telephone # ( ) License # Expires: The Applicant is _ Owner _ Conhactor _ Other Work Type New Bldg _ Modify Space _ Irrigation System** Yes No Work in public r-o-w / easement? _ RPZ _ PVB: New _ Repair/Rebuild _ Replace _ Remove Rain sensors are re uired on irri ation s stems Description of Work i To inquire if Pressure Reducmg Valve is required on new service, call 651fi75-5646 Meters - Ca11651-675-5646 to verify that hydrostatic, conductivity, and bacteria tests passed prior to oickine uo meter. Irrigarion Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works Fire Size & Price 3/4" merer $174.00 Domesric Size & Type Avg GPM Includes high demand devices? _ Yes _ No Flushometers _ Yes _ No PRV Required _ Yes' _ No Permi[ Fee $50.50 mrnimum (includes State Surcharge) ContractValue $ x 1% _ $ PemiltFee $ Meter(s) Required on all new buildings & boulevazd ittieation s, s? $ ' Radio Meter Read $ State Surcharge If permit fee is lessithau $1,000, surcharge is $.50 If nermrt fee is more thao $1,000, surcharge is $SO for each $1,000 owed. Following fees apply when installing new lawn irrigation system ?$ Water Pem'ut Call [he CiTy's Engineenng Department, 651-675-5646, for required fee amounts $ Treatment Plant Water Supply & Storage $ State Surcharge $ Total Fee I hereby apply for a Commeraal Plumbing Permrt and aclmowledge that the information is complete and accura[e; that the work will be m confomtance with [he ordinances and codes of the CiTy of Eagan and with thc Plumbing Codes; that I undersqnd this is not a pertnit, but only an application for a permi[, and work is no[ to start wrthou[ a permiq that the work will be in accordance with the approved plan in the case of work which reqmres a review and approval of plans. ApplicanYs Printed Name ApplicanYs Signature City of Eapn 3830 Pilot Knob Road Eagan MN 55722 Phone: (651) 675-5675 Fax:(657) 675-5694 Date: Tenant: 2008 RESIDENTIAL BUILD Address: Suite #: RESIDENT / OWNER Name: Phone: Address / City / Zip: Applicant is: _ Owner _ Contractor TYPE OF WORK Description of work: Construction Cost: Multi-Family Building: (Yes No ? CONTRACTOR , Name: f) C License #: Address: 7 '- n State: Zip: City: Phone: v? 7L? ? C?a?Person: l ll41 ? ld COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet CBtegOry Submitted Submitted (4 submission type) • Energy Enveiope Calculations Submitted In the last 72 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 suppoRing documents that you submif are considered to be public information. Portions of the information may be classified as non-public if you provide specifc reasons that would permit the City to conclude that the are irade secrets. I hereby acknowledge that this information is complete and accurate; that the work will be incon! Eagan; that I understand this is not a permit, but only an appliwtion for a pertnit, and work is accordance with the approved plan in the case of work which requires a review and appfokal of pl; x b hl tJ ? h S" t\ ApplicanYs Printed Name ------------------ I F,or:bffide Use I ? ? Permit #: ? I Permit Fee: /? - ? ? ? I ? Date Received ? I I ? ? Staff: I i PERMIT APPLICATION ;e with the o,rQinances and codes of lhe City of start wRhoyYa permit; that the work will be in Page 1 of 3 Use BLUE or BLACK Ink r - - - - - - - - - - - - - - - - - I For Office Use tt,¢- Permit non City of EaEd Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: -7 13 Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 3 Site Address: ~1~ U ( Or e ' V ~ Unit - I Name: Phone: 6Sh-Y Y-~0/~ Resident/ e~ / Owner Address / City / Zip: 0`3 Ci l f t V Applicant is: Owner Contractor Type of Work Description of work: ;C9Construction Cost: w Multi-Family Building: (Yes / No Company: 1 C- Contact: YO U C~ (~c- l City: Contractor Address: c~ State: A~ Zip: _Q 0 c Phone: 61L L License #:F- 5 _D~ q0 Lead Certificate If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 4 Q l ( © C ~'L 1r Ile, 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.oopherstateonecall.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 Build' Code must be completed within 180 days of permit issuance. x 4 Applicant's inted Name pplicant's Signature Page 1 of 3