704 Oxford RdRESIDENT / OWNER
Name: I& GtA 1 a, P,hon"e:� 651 63 3 - Z
Address / City / Zip: 7O CSC ((.0 // 1 � E C A CAAn 5513
I Yeti)
CONTRACTOR
��,.
Name: ttC44(.�,7✓15,�!! A O MA) License #: 513 en
Cit P' C ;or - hw�.
`t 105 (�5 & /U (
�cC.�
,� I V
State: MA/ Zip: S S "5 95-Z Phone: 5 1
Contact: Plf/t k- McY IV Email:
TYPE OF WORK
New x Replacement Repair Rebuild Modify Space Work in R.O.W.
_ _ _
_�
Description of work: I� �1ALL � 1/J 4 �
PERMIT TYPE
RESIDENTIAL rr
1 Water Softener
Water Heater
Add Plumbing Fixtures ( Main 1 Lower Level)
_
Lawn Irrigation ( RPZ / PVB)
^
Water Turnaround
Septic System
New
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
*Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) 55 ' 0 ° TOTAL FEES $
City of EaQan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
6
FOR OFFICE USE
Required Inspections: Under Ground Rough -In Air Te
d By:
ctfe/Glip
Applicant's gnature
Staff:
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: Site Address: 7 I O rc ` o(, S r ct.A.,, • 55 2 3
Tenant: I66 01.A. (
Use BLUE or BLACK Ink
For Office 7
Permit #:
Permit Fee: $55' CO
Date Received: J '6 / /
Suite #:
CALL BEFORE YOU DIG. Call Gopher State One CaII at (651) 454 - 0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.00pherstateonecall.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 app al .f plans.
Are 7Are niu --kA
Applicant' rinted Name
Review
Da
Gas Test - Final
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
___-.EaRpn, Minnesota 55 1 22-1 897 Date Issued:
(612) 681-4675
SITE ADDRESS:
PERMIT SUBTYPE:
' APPLICANT:
7 fi I ;tcV, .
• . ? ? . . , .
TYPE 4F WORK:
.. . ..
Permit No. Pgrmit Holder Date Telephone N
ELECTRIC
PLUMBING
HVAC
Inspectfon Dete Insp. Comments
FOOTINGS
FOUND
FRAMING
HOOFtlVG
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYPBOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
?p I
?? S
G-L5
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE: V3880' Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITEADDRESS: I-N ` 10"""1 A!N•-*h
10t: r HIUClKs
-++?t ?ixFI)Rf? Rp
?ilit'; I'lt "r 0aIERH r.iaGF 31411
APPLICANT:
t..i ? k . f l F
tA a. o
PERMIT SUBTYPE: TYPE OF WORK: ?
,?t ., ;- ,; ? ? ?r? •., lir t N P,lr.1.14 I.I; iII I
k
Ptrmit No. Permit Holdar Dab Telephone p
ELECTRIC
PLUMBINQ •
HVAC
Inspsctlon Date Insp. Commente
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUM8ING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
.,
. . INSPECTION RECORD I COntrol No. 4 U
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
/J PERMIT TYPE:
Permit Number.
Date Issued: Hil 3 I!? 1101104
(612) 681-4675 ,?w'?7
SITE ADDRESS: t n 1: i APPLICANT:
l04 OXEORb ith CEN7£'X HUMPs
NIt 1.% fli' !•:T0N1'BFi1 0tiE 3Nq (612) 936-7033
PERMI? ,?V,PTYPE:
TYPE OF WORK: NtW
INSPECTION
1"+i 1 1 N#, D, .
F?rAM t Nt} .
IN`?11! 4i! {?r1y FINAI
fii MAk)t 1. :$ & Ld G0NTRAC fOR • p l YMOU f 14 P! HQ
Parmit r+o. Permn Hokfer ow Tekpnon. a
S/W
PLUMBING
HVAC
ELECrRic
ELECTRIC 'I 3 ,Z
InapQCUon Dme Inep. Commsnb
Footings , 73e
Foundatlon J/ ?
Framing ? Z!?'`92 ? 2 • ?
Rooting '
Aoug, Pbg.
Rough Htp.
Isul.
Frepiwe
-P?
12
Rnw Mg. o zY- 9Z ? /o ?3 - ? ' .
orw resc oZZ gz
Final Pibg. ?-? Pbg. IrtspeCEpr-No1lY Plum6er
Consi. Meter
EngrJPlen
Bldg.Fim, ?. ?Z z a
Dedc Ftg. .
Dedc Fnal
wen
Pr. Disp.
` .ficate nf cccupanc?
WHV of Cfa??
?? ? sm" anb"dion
This Cenificate issued pursuant to the requinements of the Uniform Building Code
certifying tlwt at the time of issuance this siructure was in co?npliance with tiee various
ondinances of the City regulating building construction or use. For the following:
Use ClasdficNiML SF DWG BW Paudt No 1039
O-Wancy Type R- ZoMaBDistFia PD R-1 Tyw Com V-N
Owner of BuddioE CENTEX HOMES Address 5929 BAKER RD ti 170
Buikting Addma 0 ORFO RD LocalityL
Dft. OCT 21, 1992
su:kft officW
POST IN A CONSPICUOUS PIACE
•
?a
? ? ?
07AI-632 ?
?
?
y
Pea esi D ta Fire No. Ro gn-In Inepectio equiretl ction Olher Than Roogh-In
I e
' (YOUmCaN ioW or when reatly)
Reatly Now Wil tity Inspecior
Y65 ? No pale Reatl
I uv,licensed contractor ? owner hereby request inspection of above electrical work at:
Jab AOtlress (Slreat, Box or Raule No.) Gity
?6 d t
Section No. Township Nflme or No. Range No. County
C
Occupan[ RINT) Pho e No.
?
`
d
6- ?fo
Pawer Supp ier Adtlress
Cn r `
ElecMal Conlrador (Compeny Name) Con[rdclof5 License No.
? ?t-G-b ? C 55
Mailing Adtlress (Conlracbr or Ovmer Making InsUllation)
? r? . ?{?{?l w ' ? i ? /
ANffionzetl Signature (ConVadotl er Making Installadon) Phone Number
135
MINNESDTA STATE BOApO OF ELECTIiICRY THIS INSPECTION REQUEST WILL NOT
Griggs-MlEway 91dg. - Foom 5-128 I II ) I I? I I II I I I 111 111 1111 BE ACCEPTED eY THE STATE eOARD
1821 Univerelry Ave., SY. Paul, MN 55104 UNLESS PflOPEF INSPECTION FEE IS
Phone (612) 842-080p . . ENCLOSED.
o/ Q_/( k3J ?REQUEST FOR ELECTRICAL INSPECTION ????? es.ooooi-os
See instmdions for mmpleting tliis form on b.ick ol yellow ropy. ?N?i?2 ?
? "X" Below Work Covered by This Request
Ne Add Rep. Type of Building Appliznc€s Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Heating
Apt. Building Dryer Load Management
Comm./Industrial Furnace Other (S ecify)
Farm Air Conditioner
Other (s ed(y) ConVador's Pemaeke.
;? M
Compute lnspection Fee Below: Jij " \
# Other Fee # Service Entra ce Size Fee N Circuit Feeders Fee
Swimming Pool 0 to 200 Amps 0 ta 100 Amps
Transformers Above 200 Amps e 100 -Amps
Sigfls Inspemor's Use Only: TOTA
L??
trrigation 8ooms Q
Speciallnspection
Alarm/Communication THIS INSTALLATION MAY BE O RED DISCONNECTED IF NOT
Ofher Fee COMPLETED WITNIN 18 M THS.
I, the Electrical Inspector, hereby
lif
ih
t th
C
i Rough-in oace
cer
y
a
e a
nspection has
ove
been made. Finw . oa
-Z.-
OFFlCE USE ONLY
This request vaid 18 months Iwm
.Addreas: 704 OXFORD RD Lot7 Blk 5 Sec/Suh HILLS OF STONEABRIDGE 3
These 3tems were/were not complete at the time of the fi 1 inspection.
Date: OCT 21 1992 Yes No Tnspector,
Final grade (6" from siding) LI/
Permanent steps - gerage
Permanent steps - main entry tll/
Permanent driveway
Permanent gas
Sod/seeded grass ?
Trai1/curb damaga
Porch
Basement finish ?
Deck
Please verify with the builder the removal of roof test caps from the plumhing
system and the shut-off of water supply to the outside laom £aucet before
freeze potential exists. ?
mcmEOwren
White - City copy Yellow - Resident copy Pink - Contractor copy
RESIDENTIAL B[1ILDING /70
?
Permit Application
City Of Eagan ?L
3830 Pilot Knob Road, Eagan Mn 55122 1 fl
TeleP6one # 651-675-5675 FAX # 651-675-5694
New Construc6on Reauirements RemodelAteoair Reavirements OHice Use Onlv
3 registered site surveys showing sq. ft of bt sq. ft of house; and all roofed areas 2 copies af plan CeA of Survay Recd
(20h, mazimum bt covarage allowed) 1 set of Energy CalalaGons for heatad additions _ Tree Pres Plan Reod
2 mpies of plan shaxing beam 8 window sizes; poured found design, etc. 1 site survey for addNOns 8 decks Tree Pres Not Reqd
1 set of Energy CalculaGons Addition -irMkafe i(afsde sep6c system _ Onsde Seplic System
3 copies ot Tree Praservalion Plan if lot platted aRer 7/1193
Rim Joist Defail Optlons seletUon sheel (bldgs wiN 3 or less units
Date Q? (?2 nstruction Co
t ?
C
o
s
Site Address ?'Q? -0x,T'j r
,
?
?
,
t?G{Xl , 'V^ ' UniUSte #
;.escript:onofWork ??^?'8? ????52.v(e-n,"f? ?, lvdi? i'ICw Zc--r4i, ?
M
lti
F
il
Bld ? Y V N
u
-
am
y
g Fireplace(s) _ 0 V 1 _ 2
Property Owner ri(" Telephone #W) 6? -2-2 r/ 1"
Contractor
5-C 44C I
?
Address ? City
(
State Zip Telephone # ( ) I
?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calculations Submitted
Licensed Plumber
Telephone #(
Mechanical Coniractor
Sewer/Water Contractor
Telephone # (
Telephone #( )
I 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 IvIN
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.
3?'J'c.v. J /Zc- +'1e
Applicant's Printed Name
Ap ican S-si" ' ure
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory 81dg
? 02 SF Dwelling ? 08 06-plex ;K 16 Fireplace ? 21 Porch (3-sea.) ? 31 6ct. Alt - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex O 18 Deck ? 23 Porch (screeNgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Pibg_Y or_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demalish (Interior) ? 44 . Siding
? 32 Addition ?.36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 AlteraGon ? 37 Demolish (Bldg)' CI 43 Reroof ? 46 Windows/Doors
? 34 P.2placem-nt •Demolition (Entire Bidg) - Give PCA handout to appliwnt
Valuation Occupancy 2 -3 MClES System
Census Code Zoning ? t City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
,I
Type of Const V ?1 W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinallC.O.
_ Footings (deck) Z([ FinaUNo C.O.
_ Footings(addirion) _ Plwnbing
Foundarion HVAC
Drain Tile Other
Roof _ Ice & Water _ Fi nal _ Pool _ Ftgs _ Air/Gas Tests _ Final
Framing _ Siding _ Srucco _ Stone
?Gl Fireplace ?C-, R.I. LCAir Test ? Final _ Windows (new/replacement)
?p Insulation _ Retaining Wall
4nnrnvad By
Building Inspector
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
G o,?,?. ?PU?1
PLUMBING (RESIDENTIAL)
Permit Application
City OfEagan
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 nnit
Date 05 /0:?
Sitc Address 'v' J Unit #
Property Owner oriao PGZ.VI aVl Wja j0e1fk Telephone # 4'6-I ) Lp`p -
Contractor
Address City
State Zip Telephone # ( ) _
I
The Applicant is d Owner _ Conffactor _ Other ?
Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 ?
Includes County fee. Additional consultant fees may apply.
-
Altera ' ns To Existing Dwelling Unit, Including
Adding fiMures to lower levels or room additions, exGuding water softener and water heater
$ _
?
50.00 ?
_ 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 T '?
G 7
f? $ 15.00
replacement additional 3 D
DEC
2
?
State Surcharge BY $ 50
Total $ so..sv?
I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the wa'k will
be in conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is noi n
permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance wiih ihc
approved plan in the cas of work which requires a review and approval of plans.
r?C? ?j
Applicant's Printed Name A licant's 'gnat re
Cities
? Control
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ACITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(672) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDIN6
001039
07/21/92
SITE ADDRESS:
PERMIT ?
704 OXFORD RD
LOT: 7 BLOCK: 5
HILLS OF STONEBRIDGE 3R0
DESCRIPTION:
-6uiliiing Permit Type SF DWG
Building `Work Type NEW
- UBG Occupancy R-3
Construction'iype V-N
2oning _ .? PD R-1
Building Length ? 56
euilding Width ' 39
l
r7
REMARKS: b QZou ?,(//
S& W CONTRACTOR - PLYMOUTH PLBG
FEE SUMMARY:
8ase Fee
Plan Review
3urcharge
SAC
SAC 8
SAC Units
Subtotal
VALUATION
$755.00
$49@.75
$66.50
$700.00
100
$2,012.25
$133,000
MI3CELLANEOUS ,$1.610.50
Total Fee ;3,622.75
CONTRACTOR:
CEN7EX HOMES
5929 BAKER RD
MINNETONKA MN
(612) 936-7633
- Appl3cant - ST. L
19367833 00013
55345
CENTEX HOp1ES
5929 BAKER RD
MINNETONKA MN
(612)936-7833
55345
170
I I
I hereby acknowledge that I have read this application and state that the
information is correct and agres to comply with all applioable State of Mn.
Statutes and City of Eagan Ordinances.
L Ald? ?GLx?P ea c ?
/
APPLICANT/PERMITEE SIGNP7URE ISSUED BY: S G ATU
control No. 0848
PERMIT t 103 .
• CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
$j, L 22. '?..?
/\j /pt 70 s
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural.& structural plans, 1 set of
specifications, 1 copy of.energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date -7 9z Yaluation of rork
Site Address: -7041- Ox-fazd nGtrP
STREET STE I
Tenant Name: (commercial only)
LOT -I BLOCK ? SUBD. P.[.D. Y
Descri tion of work:
The applicant is: ? Owner Contractor ? Other (Desoribe)
Name Phone
Property «5T FIRST
Owner
qddress a?
TE #
STREET S
City State
ZiP
c
- 7
tAi
Company 4...*er Ph.one 931, -7R33
Cantractor Address 5 929 no License # rmrB33 Exp.
City 44innvA?y,,(-a State M Nl Zip _ 5534K-
Company Phone 93?- -7 ws-:? _
Architect/ t,
Engineer Name _ Ilay; d ne UAQa4le? Registration M_ niz6s9
Address
City State Zip
Sewer & water licensed plumber Q)?amov-1?1. p)um6;?, Processing time for
sewer & water permits is two days once area has been ap oved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable State af Minne ta Statutes and City of
Eagan Ordinances.
Signature of Applicant:
/
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 05 Apt. Bldg ? 09 Basement finish
12 02 SF Dwg. ? 06 Garage/Accessory ? 10 Swim Pool
0 03 Two family ? 07 Fireplace ? 11 Res. Add.
O 04 Multi-fam. T.H. 0 08 Deck O 12 Res. Porch
WORK TYPE
pr 31 New ? 33 Alterations O 35 Move
0 32 Addition E3 34 Tenant Finish O 36 Demolish
GENERAL INFORMATION
Const. (Actual;
(A1Towable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
Engineering
_, . • • ., ,
? 13 Comm/InP New
O 14 Comm/Ind Add
O 15 Comm/Ind Rem
? 16 Public Fac.
O 17 Agricultural
`y.-N Basement sq. ft. MWCC System ts
V-N lst Fl. sq* ft. City water E! ..S
? 2nd F1. sq. ft. PRV Required
?? Sq. Ft. total Booster Pump
Footprint Sq. ft. 'fire Sprinkler
_36'- On-site well • Census Code /o/
391 On-site sewage SRC Code
Building Assessments
- Varlance
REQUIRED INSPECTIONS
? Site
? Mallboard
El Footing
? Final
? Framing
? Draintile
? Insulation
? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
, City SAC
, Water Conn.
' Water Meter
Acct. Deposit
5/W Permit
5/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
sac % roo
SAC Units -T
v.tuec;a,: s I 3 3`?b?
GARa?
?1 )c2.7_= 146Z x /6= 7392
'l35MT"
----
aa'/ x33's-96d'
yx I:%3 ? 10
ljx5?(3% (oq
? b`17 x Is ?
? ST #'?,?vn
r/oG3tb?c93 =
,
x
16 7aS
576 e 339
loo5x53- s32G?
A
E:tTE?ICR ENYELOPE AYERAGE "U" COMfuTAT[ON
OWNER: HILLg nnir: /,P=? !IZ
l?? '7 ?? S, SrbHE6?e??E 3? @?ao.
SI7E ADDRESS: A1i SFD @ DF,EF,HE,HR,HU,ST PHONE: CON7RACTOR:C:94-([Ci4 PLqN $ ?/?
?'
Determine working square footage of each
1. Total exposed wall area..... 247Z sq. -ft. x .12 = ZGJ3. liZ
2. Tota] roof/ceiling area..... lp(p3 sq. ft. x .026 = 4.4
Total exposed wall area above.floor=_ 7316
a. Total wall window area ........................................... I/p 3
b. Total door area..................................................
?-3
c. Total sliding glass door area .................................... 31
d. Total fireplace wall area........................................ -
e. Total wall framing area (average lOS) ............................
f. Total rim joist area............................................. ald
g. net wall area a6ove floor ..................................... gE,
h. wall area above floor .......
:.............................
i. wail area a6ove floor ....................................
j. frame wall area at founda-tion ...................................
Total exposed foundation area=?
k. Total foundation windo++ area ....... ............. F
1. Total net foundation area above grade ..............
Determine "u" value of each wall segment
(e.g. window, door, each separate wail section)
X -U..
b. x •u°
c. 31 x •u°
d. ? x "V"
e. z(j:? X 'U" .10 . 26.7
f. X "U" .042 ? 11.51
?--
9. X 'U" .045 = 85.41
h. X nVn a
' ;• x MuN
' j. X 'U"
k. ? X "U" -?
If item /3 is the same
less than m
1. X"U" -133 --
_.7.85 - 91. youhaveoet the
intent of SBC 6006 (c)
3 . .................................TOtdl = 242.99 • .
4.,, TOTAL EXPOSED RAOF/CEIL111G CALCULATIOt15:
To[al exDOSed
roof/ceiling area....:... sq ft
--?'---
J) Tota) skylioht area....... ? sq fe x"U" ? ? -
k) Total roof/cei)Inq framing
area (Averaae 10z)...... JGCp sq ft x"u" , DZ
1) Total net insulated
roof/cetlinq area....... q 5? sq ft x"U" pZ
4• TOTAL j) thru 1) ?i
If total of A Ts the same as, or less than N2, you have met the intent of
2?lG.Z 1.16008 A sLd O.
ALTERNATE BUILDlHG ElIVELOPE DESIGN
To utilize the totat envelope system method, the values established by the sum
of items R3 and 94 shall no[ be nreater than the sum of items PI and 92.
1. ?q?/ l1i + 2. ?i • °. Ti ?
3• 242.99 } 4. _ L?.(p? = 264.67 '
LINEA[. FEET ERPOSED WALL
e[.ocK: 33 ? ?. . s 4??r0v.+-?-% 1
L`1 • 33 t?.i ?. 33 ?. 33 -- ? f
KNEE: ,
WALKOUT: ?
!k?l3? ?38
y
FULL 1: ?33+ Iz- i•?? 8.33+`?•?'' ?Z.v'1 ?-f? ?5+ -4•1u-25+
FULI. z: Z4.33• IZ- I•33.r? 3?ir?•33+-Ia,r.'li 35t? =13f'
FIREPLACE: -
RIM: L74
* SQUAgE FEEr ERPOSED WALL AREA
BLOCK: I -5te
KNEE: _.
WALKOUT: ^
FULL 1: k=jp
FULL 2: [3(P
FIREPLACE: ^
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SQUARE FEET ERPOSED CEILING 3?
WINDOWS: DOOdS: Zo?
, yg _ 1111 ?'3 3
• Zo = ( ? PATIO DOORS:
, zA = 1 13
„ 3Z = UU BASEMENT UN TS: ?
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CITY OF EAGAN
3830 Piiot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-32992-070-05
PERMIT
PERMITTYPE:
BuzLozNc
Permit Number: 0 2 9 5 5 7
Date Issued: 0 4/ 14 / 9 7
704 OXFORD RD
LOT: 7 BLOCK: 5
HILLS OF STONEBRIDGE 3RD
DESCRIPTION:
??'? .? SCREEN PORCH W/DECK
k??i3ldi;n??">g,ermit Type SF PORCH
;Buifding l1'`br,k Type NEW
?l Census Cfoc{e ''430. ALT. RESIDENTIAL
,..? . . ., , e .. .'3......,?
`
,
?
\
?b (: x? •
C f? 7 y' ?
?? L 1 i ?a :? 1` ?1 '? i? t. ? ? Lj ? : ? ? ? i 9iJ °'i. ?f"`i•,.
l
REMARKS:
FEE SUMMARY:
VflLUATIOM
Base Fee
Surcharge
Total Fee
$124.75
$3.50
$128.25
$7,000
COPITRACTOR: _ Applicant - 5T. LIC OWNER:
DECKS ETC 13337757 0007180 ERTCKSON BRIAN
4AW11655 RIDGEMOUNT AVE W 704 OXFORD RD ,
MINNETONKA MN 55305 EAGHN MN 55123
1(612) 333-7757 (612)688-2264
I hereby acknowledge that T have read. thi,s application a?nd stete thaC the
informatiorr,i5 correct axtd agrQe tq comply with aI1 appSicable 5tateof Mn.
L Statutes and City of Eagdn Ordinances.
APPLICANT/PERMITEE SIGNATURE SSUED BV: SIGN RE
#!,???? ? 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL)
? CITY OF EAGAN
3830 PILOT KNOB RD - 55122 ?,??yt?.c.?•??
881-4675
New Conatnidian Reauirements $gmodeVRecair ReauiremeMs
? 3 registered site eurveys ? 2 copiey of plan
• 2 capies of plans (indude beam & wintlow saes; poured fid. design; eto.) ? 2 site surveys (exterior additions 8 tleeks)
• t energy calculations ? 1 energy calwlations tor heated addRions
? 3 eopies of tree preaervetion pian H lot platted after 7H /93
repuired: _ Yes _ No -
DATE: 1"UV (;LV CONSTRUCTION COST:
DESCRIPTION OF WORK: WcUvl,,
STREET ADDRESS:
LOT l BLOCK ? SUBD./P.I.D. t??, ?
PROPERTY Name: 6JV1 I\ U 1f\y I L n?,?tS o? Phone #: G"K °?44
OWNER
Street Address: u
City: State: Zip:
CONTRACTOR Company: lriGiCGmv 4aVC0i> Phone#?-?757
Street Address: ?SS I6 > w?? License #: 7 v
ciry: 4+?1 U state: .m lU zip:
ARCHITECT/ Company: Phone
ENGINEER
Name: Registration #:
Street Address:
City: 5tate: Zip:
Sewer & water licensed plumber (new construction only):
and lot change are requested once permit is issued.
Penalty applies when address change
I he2by acknowledge that I have read this application and state that the information is cortect4nd a9ree to comply with all applicable
State of Minnesota Statutes and City of Eagan OMinances. r?
Signature of Applicant: ?---------
OFFICE USE ONLY RECEIVED
Certificates of Survey Raceived _ Yes _ No FEB 2 6 1997
Tree Preservation Plan Received - Yes _ No _ Not Re ':??
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation o 06 Duplex o 11 Apt./Lodging ?
? 02 SF Dwelling ? 07 4-piex ? 12 Multi Repair/Rem. o
? 03 SF Addition ? 08 8-plex o 13 Garege/Accessory
?
z'04 SF Porch ? 09 12-plex o 14 Fireplace ?
? 05 SF Misc. ? 10 = plex ? 15 Deck
WORKTYPE 5-? vce.,a? x, c1? w/ D-rcfe-
,
r A, -.? r? , •v .
,.. ;
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
.a'?31 New o 33 Afterations o 36 Move
? 32 Addition ? 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actual) Basement sq. ft. MC/WS System ?
(Allowable) Main level sq. ft. City Water ?
UBC Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code. ?i3y
Depth Footprint sq. ft. SAC Code ? t
Census Bldg ?
Census Unit ?
APPROVALS
Planning Building MS Engineering Variance
Permit Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Raad Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $ -7. 000• ?
De c?
Sc?ee..oJ ?o.e?n
?2 X i?l ?r-StQ ?30 = ??0?10
?-'?-
?? 2ko
% SAC
SAC Units
1999 BUILDING PERMIT APPLICATtON (RESIDENTIAL) ??-?
CITY OF EAGAN
3830 PILOT KNOB RD - 55122
651-681-4675
New Conshucflon Reculremenfs
Remodel/Renair ReauIremenfs
> 3 regfstered sNe suneys showing sq. fl. of lof, sq. N. of house 2 copfes of plan
and atl roofed areas (20% maximum lof coveraae allowed) 1 sef of energy calculatlons for heated addNlons
: 2 copies of plans (show beam 8 window sizes; poured tnd. design; etc.) 7 sNe suney for exferlor addflions 8 decks
' 1 sef of energy calculaflons
> 3 copies of tree preservaflon plan fl lot plafled affer 7/1/93
DATE: 0 "' - -
G/22 S
CONSTRUCTION COST: S_ ?d • ?
DESCRIPTION OF WORK:
STREETADDRESS: /Uy kfrf
LOT: -;?- BLOCK: SUBD./P.I.D. #:
Name: ?e dJ/? Phone #:
PROPERTY last Fint
OWNER
Street Address:
City
Sfate:
Zip:
Company:&'Ji'e,a_s -ZOC Phone#: &12 / ]p-
CONTRACTOR (area code)
Street Address: /y9'D &/? r?:! License # 34Z2- . Exp.,4 2-2o?
Cify 6'/?.J04Ss t,) State: ^It? Zip:
ARCHITECT/
ENGINEER
Telephone #: area code (
Street
City
Name:
)
Regisfration #: _
State: Zip:
Sewer 8 water Iicensed plumber (reauired for new consiruction onlv):
PenalFy applies when address change and lot change is requested once permR Is Issued.
I hereby acknowledge that I have read this appllcaHon, state thaf the Informa}ion is conect, and agree to comply with all applicable
Stafe of Minnesota Statutes and City of Eagan Ordinances. ?
Signoture of Applicant:
OFPICE USE ONLY
Certificates of Survey Received _ Yes _ No .-
Tree Preservation Plan Received _ Yes _ No _ Not Required .-
' --
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bidg.' ? 41 Wood Stove ? 45 , Fire Repair ?
? 34 Repair ? 38 . Demolish (Interior) O 42 Reroof
' Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire 5prinklered
Variance
Permit Fee
Surcharge
Pian Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
SAC Units
Valuation:
% SAC
C:_rv Fa,;.>..-.,N
/
*?,..
' ? r?n.?. ?t'i':' n?ni ??•_.n .•t,?_,
I,.i- ?u+Ty i.? ? y
aX:-?e??.. .•..l.i ':.?..
_ ... J
...^&?7.?mt
R
. ?c-
. ?.. ) . 11. 5? .:i :. i.:.,.,
? CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
030807
09J16f97
SITE ADDRESS:
P.I.N.: 10-32992-070-05
709 OXFORD RD
L07: 7 BLOCK: 5
HILLS OF STONEBRIDGE 3RD
DESCRIPTION:
d3no-rptermiti Type
di:n:g; T y p e
Ls CotlB ?.,
?,..
. >?
? n..,
? -,
?
SWIM POOL
NEW
329 NONBLpG STRUCT.
f? ?Z?" ??? ??dF ??%T??
".? sS '?? ,? 3 k ?.r w?4?'tl..? ?...t3 JLt D iJ
K5 - C??:../
REMARKS:
FEE SUMMARY:
VALUATION
Base Fee
5urcharge
Total Fee
r
$187.25
$6.90
$193.25
$12.000
CONTRACTOR: - Applicant - OWNER:
PERFORMANCE POOt & SPA 17313440 ERZCKSON LZ2
1890 WOODDALE DR 704 OXFORD RD
WOOpBURY MN 55125 EAGAN MN 55123
(612) 731-3440 (612)688-2264
I hereay acknowled'ge that,Iqhave.read this app,,iicet3on aaad stete th.at'the
infarmation is correct ansi agrOe tts "c'vmply a`rt?h -a11.' applieabie Statz af Mn. •
' I
Statutes and Gity af Eagatt OrrJirtanses ? . . . . . , ;.
?L-_ _
ARIaRmYLM9
LICANTIPEfiMITEE SIGNATURE ISSUED B: SI CNATUF
?997 BUILDING
Mew Construelion Reautremerrts
RemodeUReoair Reauirements
? 3 regislered ske surveys • 2 copies of plan
• 2 coples of plena (indude beam 8 wlndow alxes; poured fid. design; ete.) ? 2 sRe surveys (exterior adOttions 8 decks)
? t energy calculations ? 7 energy calculetlona tor heated additions
? 3 copies of tree prexrvalion plen H lot platted eRer 7!1/93
required: _Yes _ No -
DATE: ?-1 ?- 9? CONSTRUCTIONCOST:
DESCRIPTION OF WORK: I N`?T 14 LL ?w ? fU ?? ?V (,- 7-L70L
STREET ADDRESS: `lb ?I DX-FDe.O 46AP
LOT ? BLOCK T SUBD./P.I.D. #: '?IVDPL fifd,_ 19ft
PROPERTY Nam@: _ h) C-k- S 0 N iic i A N?j IZ phone #: Gg ?-ZZ ?O?I
OWNER
Street Address: '76 y OxOQ p 10
City: _LA G6 (u State: M +li Zip: 'SS I Z-3
CONTRACTOR Company: M_L? E-`kk?Nu-76-o" phone#:
StreetAddress: 19'7U WmD1,?4r.t DL, License#: A_9'?&'j4L°-`7
City: 1/)uv 0 15 uState: IV_ Zip: 67511_s
Company:
Name:
Phone #:
Registration #:
Street Address:
City:
eh 8 water licensed plumber (new construction only):
lot change are requested once permit is isaued.
State:
Zip:
Penalty applies when address change
1 hereby acknoHAedge that I have read this application and state that the iniortnation is correct and agree comply with all applicable
Stateof Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
CertifiCates of Survey Received
_ Yes
PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
5830 PILOT KNOB RD - 55122
661-4675
_ No
Tree Preservation Plan Received - Yes _ No _ Not Required
ARCHRECT!
ENGINEER
OFFICE USE ONLY
BUILDING PERMIT TYPE
d . ah .
?Y •?o-..t? ., L.•. ; «. ?
•w.' pr .??4[.
0 01 Foundation ? 06 Duplex o 11 Apt./Lodging o 16 Basement Finish
n 02 SF Dwelling a 07 4-plex ? 12 Multi RepaidRem. ? 17 Swim Pool
0 03 SF Addition ? 08 8-plex ? 13 Garage/Acxessory 20 Public Facility
0 04 SF Porch o 09 12-plex ? 14 Fireplace n 21' Miscellaneous
? 05 SF Misc. ? 10 = plex o 15 Deck
WORK TYPE
? ? 31 New
32 Addition
0 33 Alterations o 36 Move
0 34 Repair o 37 Demolition
GENERAL INFORMATION
Const. (Actuai)
(Allowable)
UBC Occupancy
2oning
# of Stories
Length
Depth
APPROVALS
Basement sq. ft. MC/WS System
Main levef sq. ft. City Water
sq. ft. Fire Sprinklered
sq. ft. PRV
sq. ft. Booster Pump
sq. ft. Census Code.
Footprint sq. ft. SAC Code nI
Census Bidg
Census Unit
Planning Buiiding VOL Engineering Variance Pertnk Fee
Surcharge
Plan Review
License
MCNVS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pi.
Road Unit
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $ IF- O OJ
,. . _....? ?.: ...-.=l
°k SAC
SAC Units
SWIMMING POOL
INSTALLATION
?
?Xw?.o Rn
?
HOUSE
NAME OF HOMEOWNER:
AnnxESS:
•
C)+?,aN, ?5- i z 3
PHONE: &8g- ZZ(p?I
LNaP- ?
? ?'?' f'3 '
l.Or.s1-ZPLTct 70
? w.
, I
56' VL- % CuS-?o lu?t ta 6aecc-r- X1
/g,xy3,
tA Z? L IDi
P +-
i ' M,rL?
?j o? ` I
I ?
I
I- - - 3b? PL 1
CONTRACTOR:
PERFORMANCE POOL & SPA
1890 WOODDALE DRIVE
WOODBURY, MN 55125
(612) 731-3440 (JERRY T.)
EG°QGl?°- N
???wl?
BY r
DATE _
BU
DEPT.
* ? * .
PIONEEF! LAND SUNVEV01
* engineeri-ng _ LAND PLANNERS •
* * * *
2422 Er'.erprise Drive
Mendoto Heights, MN 55120
612) 681-7914•Fax 681-9488
625 Highway 10 Northeast
Blaine, MN 55434
612) 783-1880•Fax 783-1883
Certificate of Survey for: CenteX. Incorporated
House Address:
Model Name:
/ N
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903 ?.0 pR ?
2 -
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0'•°o
?i 95.58
S 89'50'54° E
S-UM
807.4
DEPx
. 900.0 Denotes Existing Elevation pROPOSED HOUSE ELEVATION
•?o Denotes Proposed Elevatian Lowest Floor Elevotion:902.45
-- Denotes Drainage & Utility Easement Top of Block Elevation:910.56
- Denotes Drainage Flow Direction
-o-- Denotes Monument Garage 51ab Elevation:910.23
--e-- Denotes Offset Hub Bearings shown ore assumed
LOT 7, BLOCK 5 HILLS OF STONEBRIDGE
DAKOTA COUNTY, MINNESOTA 3 R D A D D I TI 0 N
1 hereby certify thal this survey, plan or reporl wpe?s ?p?repered by e or under my direct sup rvrsion aad that I em duly Registered Land Surveyor
under tAe laws o/ the State o/ Minnesota. Dated thisX!_ dey ol uit, A,D, 19 ,
Scale: 1!^°h=30'eet ?-`, 2
ROBERT . I FI .5. EG. NO. 19891
704 Oxford Road, Eagan, MN
764 s \
. ? 0
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/?
eoa.s ? C? ? 0
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aR\ ?
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Rsf H / ?i
9yS Q?? C
J4 SJJ ?FNT? / ?'?Qn
/EA?2--A?
2422 Er!erprise Drive
•' Mendoto Heights, MN 55120
?NEEA
LAND SURYEYqtS • CINL ENGWEERS (siz) sai-isia.Fox 681-948e
-_""____'___ ._'_'__'___._____'-'
dA ?neerin uND PUNNERS • UN?SCAPE ARCNITECiS
g 9 625 Highway 10 Norlheast
? - Bloine, MN 55434
* * *. (812) 783-1880•Foz 783-1883
Certificate of Survey for: C@ntEX Incorporated
(#§Ji.-o-)
2 1
voxi,-A
ip
s_ op
?
House Address: 704 Oxford Road Eagan MN
Model Name: 764
\ Fo. ? O
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. 903.6 •6? (n ? I%?
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7
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95.58
5 89'S0'54" E
. aoo.o Denotes Existing Elevation
. sWo Denotes Proposed Elevation
-- Denotes Drainage & Utility Easement
---Denotes Drainage Flow Direction
--0- Denotes • Monument
-e-- Denates Offset Hub Bearings shown
?
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/DAEV
PROP05ED_ HOUSE _EL_E_.VATION
Lowest Floor Elevation:902.45
Top of Block Elevation:910.56
Garage Slab Elevation:910.23
are assumed
LOT 7, 3LOCK 5 HILLS OF STONEBRIDGE
DAKOTA COUNTY, MINNESOTA 3 R D A D D I TI 0 N
1 hereby cerNfy thet this survey, plen or reporl W s prepgred by e or under my direcl sup rvision and Ihet zty.S. Regictered LanA Surveyor
undtr the laws ol Ihe Sta1e ol Minnesop. Dated this dsy ol l7lY
A.D. 19
Scale: 1 Inch. OT IiiEG. NO. 14991
79
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09/2a/2015 11:07 FAX �001/002
Use BLUE or BLACK Ink
�----------------� �
1 For Office Use �
1
�t f�1, � Permft#:��J' �J` � �J p� j �� �
C�by �l L���� I ft Fee• . � i �i
Perm
.�o � �
3630 Pllot Knob Road
Eagan MN 55122 � Date Recei�ad�— ��J—f� i
Phona:(6S4)6y5�i676 � I
Fax:(681)67S-S694 I SteH:� I
�------- --------�
2015 RESIDENTIAL BUILDING PERMIT APP�ICATION ,
Deh: "1'a"C�"~' � � Site Address:�� �x � ��i1 Q✓� ��J 5����Unit�l:
, �(1. • �� J
Name:�r�,(�V1 � L(?, � �L��(� �1 Phone:l0')�" C��� �'�
ResldenU
Owner Address i city i Zip: 1 d`� QX�0 4^ �G�a�'�JlvtGl l'1 ,� �� � �3J
Appllcent Is: Ownar � Cont�actor
T�O'�WO�C Description of wo►fc: ��_�'0� I
Conatnacdon Cost: `b� ��� .�� MuIN-Femily 8uilding:(Yas /No )
,
Company:M L ��V'l �Ir'� Contact: M D 1 S�,S
Conlractor Address:�-��� �['��► I�r a a h��11�rv � City: �v�.1N ��r(�A�n"�QYI
scare�� z�p:55��Z Phone:�+�Z"'�L?�'�����mail:r�,��s�s C�nn�P r►ers�,vt r�v►�
Licenso#: gG�,�{�o�o n�o I.ead Certlflcate#: N�' b� 1 r-7— �
If the project is exempt from lead certiflcatlo�, please explain why:
COMPLETE THIS AREA ON�Y IF CONSTRUCTING A NEW BUILD,NG
In the last 12 montho,ha�the City of Eagan Issued a peRnit for a slmllar plae based on a master plan7
Yes No IFyes,date and address of master pla�: q,�,
Licensed Plumber: Phone:
Machanical Contractor: Phone:
Sewer&Water Conlraetor: Phonec
Flre Suppreaslon Contractor: Phone:
NOTE:Plans and supportl�g doeumontrr thet you aubtn/t a►e cons/dered to be pub/la infonsadon. PorNbns of
tlfa/nfom►atlon mpy ba c/osslRed as non�ub/lc M you prvvlde apvolftc r�easo�s t/,rat wou/d perm/t ihe Cliy ta
cone/ude tha!�h� ar�e trsde aecrets.
CALL BEFORE YOU DIG. Call Gophe►Staca One Call at(6S9)464�0002 ior protectlon agalnst underground utlllly damage. Call 48 hours
befa�e you Inlend to dip lo reCelve IOCfllee of underground uNI1Ges. www.aa�herstateonecall.org
(hereby acknowledge thet this information Is complete and accurale;thdt the worlt wlll be in coefortnance with the ordinances and cqdes of the City of
Eagan; that I understand thls Is not a pennit, but only�n applicaGon for a parmit, and work is not to ataA wlthout a psrmll; thet the work wlll ba in
eccordenee wlth fha approved plen In the cese of work whleh requlres a revlew and approval of plans.
Exterior work au#�orizod by A buildlnp pormlt Issu�d In aecordaneo wkM ehs Minnesota Stet6 B Idl�g C u�t be wmpl�bd wllhln 180
days of psnrdt luuancs.
x iM� i�s�E� s Ca h��,ra.
AppllwnCs Printed Name Applicant's �gn ure
Pege 1 of 9
Nov, 20. 2015 12. 06PM No, 0060 P, 1
use es�UE or�31.ACK Ink
�.._����.�...�—�.�����—
1 For OH9ce U9a �
n:�_ _r n---- ; � �� _/- ��a�( �
.� ��iy ut ���dll .o..,,,.�.
I Permit Fee:���` ���
383o Pllot Knob Road i • I
Eagen MN SS122 � Date Received: j
PhOhe:(851)675-s675 � �
Fax:(651)673-5694 � S�a�': 1
I �
-----------------�
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
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�/1 �v�1V C�j 1�� Unit#:
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�f��,'41�"'�+'��,'�:'� ��''� �,�+�I� ApPlicant is: Owner �Contrector r�^ I'
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: �� . .<�.,.. ,, Description of work: 1 '
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;x, ,``�:;�.�;"",' `'`:;"" :. Co�struction Cost: �
,' : Multi-Family Building:(Yes /No�)
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a t,:. Com Contact:
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' � <,,; State��Zip- Phone: Emeil•�D_j_����4 �(/��1�j G ��
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`;:;;.,,�;:; ,,;,�°:<Y,.,;:. ,',<''°�;', l.icense#: �G�j►k��s 14o Lead CertiScate#:�$�— �o���� ~ 1
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If the p�oject is exempt from lea,d certlflcatlon,please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for e almlle�t plan based on e nta8tar pla��
Yes No If yes,date and address of inester plen:
Licensed Plumber: Phone:
Mechanital Contractor: Phane:
Sewe�B Water Contractor; phon�:
Plre Supp�ession Contractor; I'hone:
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�ALL BEFORE YO�„QIG. Call Gopher Sfate One Call at(651)454-0002 for protection against underground ullliry damage. Cai148 hours
before you Intelld to dig to receive locates of undergrouRd utiliNes. +y�;,�oDherstaleonecall.org
1 hereby acl�nowledge that this Infoimelion is canplete and aC�urate;thet�e Work wlll be in confortnanea wlth the ordinaitces and cflde8 of the City af
Eegan;that 1 underatend this is not a pertnit, but onty an appliceflon fot a permit, and work is not to ataR wlthovt a permit:thak�e w�k will be in
eCCordancs wikh the epproved plan in tha cese of Wo�k whiCh requlres e revlew a�d approvel of plans,
Exterior work auihorized by a buildiae pennit Isaued in aeooialanca wil�the Mln�eaote State euilding Code must e completed withln 180
days oFpermit faauance.
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Appl�wnYs PHnted Name Appticaht's Sig�ature
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