4093 Pennsylvania Ave
Use BLUE or BLACK Ink
r-------------------
For Office Use
~j
Permit I C1
City of Eayn OUL.3 6
Permit Fee: I
3830 Pilot Knob Road I I
Eagan MN 55122 I Date Received: 1
I I
Phone: (651) 675-5675 i Staff: 1
Fax: (651) 675-5694 1 I
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: q l3 oaLz~ ~K~
Tenant: Suite
RESIDENT / OWNER Name: Phone:1i~-l :lpj
Address/ City /Zip: ~(U jD
Applicant is: Owner _X_ Contractor
TYPE OF WORK Description of work: 1 J SConstruction Cost: ( Multi-Family Building: (Yes / No
CONTRACTOR Name: Mlcm License
Address: G City:C f2_Y~C~ T
State: I G iA Zip: ~0 Phone: (,Psl " ~ OVy7(D
Contact: & / V Email:
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 the 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.aopherstateonecall.orp
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
x 4rx Glyn /4 x ~L, 6~,.~
Applicant's Printed Name Applicant's Signature
Page 1 of 2
?r? . . . ?
Q) I
CASH RECEIPT CITY OF EAGAN
a
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
OATE
NECErvEO ! ' , . f. / .1, .
C
AMOUNT
.'
8 DOLLARS
'm
Q CASH f? CHECK .
• . . .- . • . • . i . ! ` ? . 1 . .
Thank You
± ;..
BY
C 12?91 Y??„
_ ft*-Fi.C4m
DATE: APR 8, 1991
4093 P9NWY:6VAHIA AVE (AL HERRMANH CONSTRUCTION INC)
RE: ---
x Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
CALL PUBLIC WORKS (454-5220) FOR YDUR PERMANENT WATER TURN ON.
Your Sewer & Water Permit for the above property cannot be completed for the following
reasons:
Your Sewer & Water Permit for the above property has been completed, but the meter cannat
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
r. ar? i:, izia:v r? • M v°rl u/ 7G
BRENDA BYtNE 687-9048 CITY OF EAGAN
y 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
P HON E: 454-91 UO
BUIIDING PERMIT
To be used tor s? ?/QAR Est. Value s78+000
Site AdTiss ""~ . --.- a ".
Lot Block Sec/Sub.
Parcel No.
W Name AL HERSAW1lf CONS'ttlfCtlOti
? Address 53 STQM 1tD
° City 'MENDOTA M Phone 891-1100
18856
Receipt #
19 9s
nra s
OFFICE USE ONLY
,a Name DiLrArA
Address
? City Phone
?
yVj'W
Name
e
Address
<W Citv Phone
I hereby acknowlege Ihat I have read this appliCation and state that Ihe
infortnation is correct and agree to comply with all applicaWe State of
Minnesota Statutes and CitK, of, Eagan Ordinances.
1
Signature ot Permitee
A Building Permit is issued to: AL liEBRMAIiN CONST
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official ?
Occupancy R-3 ? FEES
3
Zoning s?i??
(Actual) Const ? Bldg. Permit
(Allowable) 39.00
- Surcharge
# of s,«ieS *-. 351.00
Le??
? Ptan Review
1???
Depfh SAC, City
S.F.Total - 650.00
SAC,MCWCC
S.F. Footprints - 660.00
On Si1e Sewage _ Water Conn
?5??
On Sile Well ? Water Meter
MWCC System
?
Acct. Deposit ,?Q. Qd
Ciry Water 30.OU
PRV Required - S/W Permd
Booster Pump - g/W Surcharge 150
276.00
Treatment PI
APPROVALS 370.00
Road Unit
Planner - Park Ded.
CounCil -
BIdg.Off. _ Copies
3,142.50
Varience - TOTAL
. Permk No. Pennit Holder Date Tekphom #
WATER Q y
SEWEIP
PLUMBINC'a 9
H.VA.C. v? -10 SA/
ELECTRIC
Q ?
?
I3 9/ ? pp •
Inspection Date InsQ. Comments
Footings I
Foundation
Fram„ng
Roofing
Rough Plbg. ? -Q
Rough Ht9• ?1;4,111
?U
/• 1 J?
wi. Ds
Fireplace
Fnal Htg.
30 ?
Fnal Plbg.
Const. Meter Plbg. Inspeclor - Notify Plumber
ErgrJPlan
BWg. Final p
oeck Ft9. 9
Detlc Rnal
Well
Pr. Disp.
? _.?:_?--.;.: ...r,..•.?.*?• ?? .---?-
d--: 1 .
` • `, ? 1 (
e • ?? ? " ' ,
f
tl .
Ttr#t#tra#e of (Orrupanr"H
Citp of Cagan
]grpwftnd uf %ildittg iwrrtiatt
71tis Cer[iftcate itsued pursuanl to the reqrdrernena ojSc+ction 306 of 1he Unijorm Building
Code cerlifJ`in8 da1 a11he ume of ksuartce thitstructurr wrrs irt compliance wilh the mrrous
ardinanaes oJOe Ci[Y reSulatiR% buWnB ovn.uruction or use For the foUowfng.
tse asmTkafioe $6ac?1'-sR etei. %i tao. 18856
o,a,, R-4 /M 1 z,ic Mw;a R 1 Tra c- VN
o- ar a.wivs Aee= 535 SlUW iTD , tF1+IDOtLa t-?rLM
4i .. _.. .-.s
POST IN A CONSPICVOUS PUCE
SEYVER 84WATER PERMIT
CITY OF EAGAN q
3830 Pilot Knob Rd. " -
Eagan, MN 55122-1897
METER #
CHIP #
PERMIT DATE "`+/ 08 /91
WATER PERMIT # 11907
B.P. RECEIPT # V 12791
B.P. RECEIPTDATE ''4IU5/9]
OSTER PUMP
MEfER SIZE
ISSUE DATE
_ PRV _
SITE ADDRESS
LOT -
?" BLOCK 3 SEC/SUB S.
APPLICANT: al Herrniann Cnnstmrtinn _ i-c__
ADDRESS: 35 Stone Roac:
CITY, STATE "lendote fle19ZIP b1- -?
PHONE:
PLUMBER: -`.^.?•`--?r•N!^ Pll1nhirtc,
ADDRESS: ??? ?u ADRIAN C?h
CITY, STATE ZIP ? •`?-'
PHON E:
OWNER:
ADDRESS:-
CITY, STATE
PHONE: _
SEWER & WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 551 22-1 897
PERMIT REGIUESTED
X SEWER ?_ WATER -
- COMM/IND
__ NEW
x
- EXISTING
I AGREE TO COMPLY WfTH CfTY OF -
EAGAN ORDINANCES:
SIGNATURE WHEN METER ISSUED
OFFICE USE ONLY
METER #??? a? c? 9 O? PERMIT DATE 04 i O8;' 9,
CHIP #0/3 WATER PERMIT # 1190 ;
METER SIZE eA)A S B.P. RECEIPT # C 127y;
ISSUE DATE 112 - fQ '? B.P. RECEfPT DATE 04 05 R 1
- PRV - BOOSTER PUMP
SITEADDRESS ?pE,j??r,yl±yaHria AyeRu
LOT LOCK 4?_SEC/SUB ';.tjaf fg rd 12}A^ -,
APPUCANT: ?A
ADDRESS: )L' Stone ROda
CIIY, STATE ,,`>r;:`uta L-'3 i??11:5 ZIP _ 55 120
PHONE: 7- .. 71;-?`i
PLUMBER: -1!'6?= P1lltnt,i r.
ADDRESS: ';k00 ADRIAN C1' R
CITY, STATE '' f' 1or Lal;e Zip 5 53 72
PHONE:
OWNER: _
ADDRESS:
PERIWIT REQUESTED
X- SEWER x WATER _ TAPS
- COMAA/IND 'K RESIDENTIAL>
? NEW _ EXISTING
1 AGREE TO COIYIPLY WITH CITY OF
EACAI? ODINANCES:
i ?? ,
? Y 1 _u? v ? _ +
?
. ?
ISSUED
CITY, STATE ZIP
PHONE: Up-,
PLEASE ALLOW `I'WO WORKING DAYS FOR PROCESSiNG. FOR STO SEW PERMITS, CONTACT
ENGINEERING DEPT. APPLICANT AND PLUMBER WILL BE NOTIFIED WHEN PERMIT IS PROCESSED.
CITY OF EAGAN Np . 1
$$56
3830 Pilot Knob Road, P.O. Boz 21-799, Eagan, MN 55121
PHONE: 454-8100 -14
BUILDING PERMIT
Tobeusedtor SF DWG/GAR Est.Value $78,000
Receipt # ?_- [a L7?/----
Site Address 4093 PENNSYLVANIA AVE
Lot 24 Block 3 Sec/Sub. STAFFORD PLACE
Parcel No.
w Name AL HERRMANN CONSTRUCTION
3 Address 535 STONE RD
° City MENDOTA HTS Phone 891-1100
o Name SAMF'
ga Address
? City Phone
r
ww
Name
?'a Address
gW City Phone
1 hareby acknowlege ihat I have read this application and state that Ihe
information is correct and a ree o co i '[h all applicable State ol
Minnesota Statutes and f Ea n O dinanc .
Signature ot Permi[ee ?+ -
A Building Permit is issued ro: AL H RRMANN CONST
on the ezpress condition thal all work 5p I be done in accordance wilh all
applicable Stale of Minnesota Statutes and City of Eagan Ordinances.
Building Olficial
OFFICE USE ONLY
Occupancy R-3 M=1 FEES
Zoning R_ i
(ACtuaq Consl y-N Bldg. Permit 541.00
(Allowatle) V-N
Surtharge 39.00
# of SlOries
41'
PlanReview
351.00
Lenglh
Depih 48 ? SAC, City 100.00
S.F.7otal - SAQMCWCC 650.00
S.F. Footprinis -
On Sita Sewage _ Wa1er Conn 660.00
On Site Well - Water Meter 95.00
MWCCSyslem X
30
00
City Waler Accl. Deposil .
PRV Required _ S/W Permit 30.00
Baoster Pump - SIW Surcharge - Sn
Trealmenl PI 276.00
APPROVALS RoadUnit 370.00
Planner - park Ded.
Council
BIdg.ON. _ Copies
Varience - TOTAL 3,142.50
'VII590
° Y or_hu?1'U6
*iEQUEST FOR ELECTRICAL INSPECTION
P. See inslrudlons br completing this form on back of yellow copy.
X" Be/ow Work Covered 6y This Request
EB-00001-08
/007E'?p
ew Atltl Pep" TypeolBuilding AppliancesWired EquipmentWired
Home Range Temporary Service
Duplez Water Heater Electric Heating
Apt. Building Dryer O[her (Speciry)
Gomm.llndustrial ' Furnace
Farm Air Conditioner
Other (specity) Conbac[or§ Remarks
Compute Inspection Fee Below:
# Other Fee p ServiceEntranceSize Fee # Circuits/Feeders Fee
Swimming Pool 0 ta 200 Amps J 0 to 100
Amps
Transtormers Above 200 _ Amps Above 1-Amps
SignS 6
Inspecror§ Use Only: TOTAL
Irrigation Booms '
Special Inspection
AlarmlCommunication THIS INSTALLAT70N MAY BE OR DISCONNECTED IF NOT
Other Fee COMPLETEO WRHIN 18 MONT
I, the Electrical Inspector, hereby
certity that the above inspection has
been made. Rough-in
Illlkff,
F;nai
? oaie J
?
OFFICE OSE ONLY
This request voitl 18 monihs Irom
.: _.,.
Fequest Date
7
I Fire N Fough-in Inspection
Required?
es ? No
? Reatly Now ill Notity Inspectar
When Ready?
I? licensed contractor
owner hereby request inspection of above electrical work at
b? Atltlr ss ( treg? or Rouie No.)
3 Ciry
Section No. Township Name or No. Range No. Coun
Occu n.(PRI Yl
I ?
O
?C?Y? PhorW?J?
O
o Suppli ? Atldress
EI Co vaa r ?Com ame ntraaor5 Lic ns
M tlress nVactor r Owner W ki 1 I n)
Au rizetl SignaWre C hactotl r Ma ing inslal ion) Plhon ?er ^j
`
?
MINNESOTA STATE 80AflD Of GTPICITY THIS INSPECTION REOUEST WILL NOT
Gtlgga-MMway Bidg. - Roo 1)3 BE ACCEPTED BY THE STATE BOARD
1821 Unlverelry Ave., St. Poul. MN 55104 UNLESS PFOPER INSPECTION PEE IS
Phoae (BiY) 642-0800 ENCLOSED.
Address: 4093 PE[a7SYLVANIA AVENUE LOt 24 Blk 3 Sec/SubSF??qrtp prA!'F.
t
.These items wera/were not complete at the time of the final inspection.
5/30/91
Date: Yes Na
Tngpprtnr-
F
Final grade (6" from siding) ? o-
Permanent steps - garage ?
Permanent steps - main entry v 'r
Permanent driveway ?i
Permanent gas t '
Sod/seeded grass y
Trail/curb damage
Porch 1/7 1
Basement finish `t
Deck q
Pleasa verify with the buildar the removal o£ roof test caps from the plumbing
system and the shut-off of water supply to the outside lavn faucet be£ore
freeze potential exists. ?
;L1tlFOMRR
White - City copy Yellow - Resident copy Pink - Contractor copy
RESIDENTIAL BUII.DING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
J- `-t y-- a5
New ConsWCffon Reauirements RemodeUReoairReauiremenis O(fice Use Onlv
3 registered site suneys showing sq. ft. of bt, sq. R of house; and all roofed areas 2 mpies of plan CeR of Survey Reoi
(20% mazimum bt coverage allowed) 1 set of Energy Calcula6ons for heated additions Tree Pres Plan Recd
2 copies of plan showing beam 8 windaw sizes; poufed found desgn, etc. 1 site survey for addNOns & decks Tree Pres Not Reqd
lselofEnergyCalculatbns Add'dion-indicatei(on-s8esepficsystem _On-siteSepGcSystem
3 copies of Tree Preserva0on Plan if lot platted afler 7l1193
Rim Joist Detail Options selecdon sheet (61dgs wIM 3 or less unik
p
Date 6 /,s
I? n
Construcflon Cost L[[, /
7
Site Address 401 QU?t?
T ?4 14?7 UnitlSte #
Description of Work 6910r- `4ri.C_ /e V , Ivo G%PK ¢_Liti?K
Multi-Family Bldg _ Y( N Ftireplace(s) _ 0 _ 1 _ 2
Property Owner Q MAJ9, Telephone #( )
Contractor Wq
Address
.3151 , ; City NLIh
State [I[l/1/ ZipCh,2 Telephone # (763) 417-1100
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ven6lation Category 1 Worksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Submitted
• Energy Envelope Calcula6ons Submitted
Licensed Plumber
Telephone #(
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
I hereby apply for a Residential Building Permit and acknowl ?e that the informatio' is complete and accurate;
that the work will be in conformance with the ordinances anodes?aP'The CFy of?agan and the State of MN
Statutes; I understand this is not a pernvt, 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.
Applicant's Printed Name Appls Signature
OFFICE USE ONLY
Sub Types
? Ot Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. 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 ? 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Yor_ N ? 25 Miscellaneous
Work Types
? 31 New ? 35, Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 AddiSon ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof O 46 Windows/Doors
? 34 Replacement •Oemolition (Entire Bldg) -.Give PCA handoutto applicant
Valuation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
- REQUIRED INSPECTIONS
_ Footings(new bldg) FinaUC.O.
_ Footings(deck) FinaUNo C.O.
_ Footings(addirion) _ Plumbing
Foundation HVAC
_ Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ F[gs _ Air/Gas Tests _ Final
_ Framing Siding SNCCO Stone
_ Fireplace _ RI. _ Au Test _
_ Final _ Windows (new/replacement)
_ Insulaaon _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
Building Inspector
RESIDENTIAL aS
BUILDING PERMIT APPLICATION , ? -
CITY OF EAGAH ?
? 3830 PILOT KNOB RD, EAGAN MN 55122
651•681-4675
New Construction Reouiremeab RemadellReoair Raouirements
• 7:e,istarea site surveys showing sq. k. of IaC ;q. R. of housc and all mofed areas • 2 co0ies of plan
t20% maximum bt coverage allowedl • 1 set of'cneqy Calcula6ons for heated additions
• 2 ropizs of plan ;hcwing heam & window sizes; pcured found tlesiyn, ztc.) • 1 sde survey `or az[enor addi(ions 8 decks
• t,zt of'cnergy Cakulations . Iridicare f .^,eme served oy septic sys[em fer adtlitions
• J copies of Tree Preservation Plan if lot :latted after 711193
• 3im Joist Cetad Options selecdon sheet (bldgs with 3 or less units)
DATE 16 ? VALUATION
SITE ADDRESS Y6 ?.3 PPNN Uf- 4TMEMI MULTI-FAMILY BLDG Y N
TYPE OP WORK_ 'Ne "(kOa4- FIREPLACE(S) _ 0_ 1_ 2
APPLICANT A LCvuQ '?Zlcrdri? et- SA,I^`s
STREET ADDRESS (05_S S` /2?IPti' 011 1gIvd CITy
TELEPHONE # 015? 1'7Y-P3f CELL PHONE #
FAX #
PROPERTY OWNER ?8k GY& ve TELEPHONE #
COMPLETE THIS SECTION FOR KNEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ M[A\E:tiOT.1 A1.1ES 7670 C.A"CEGORY 1 _MINVESO"!':A RCI,t:S 7673
(v submission type) . Residential VenfilaUOn Category 1'NOrksheet Suhmitted • New Energy Code Worksheet Submittzc
• Energy Envelope Calculations Submitted
?,('?n1? T C
Plumbing Contractor: _ ___
Pfumbing s}s[ein includes:
Mechanicai Contractor.
Mcchanic:il scstcni includc,:
Sewer/Water Confractor:
_ Water SoRener
_ Water Hcater
Vo. of Baths
P?io«t =
LawTi Spnnkler
No. oF R.I. Baths
Air CoudiLioiting
HcaLRccoccr? 5vstccn
Phone #
Phone #
Pcc: y70.00
-----------------------------------------------------------------------°--------°--.._-----•-°------------•--------°--
I hereby acknowledge ihat I have read this appiication, state that the information is correct, and agree to compiy
with all applicabte State of Minnesota Statutes and City of Ecgan Ordinon? ?
Signature af Applicanf ?
?
----------- --------------------- - ---------- --------------- °----- ----------- __---------------------------- °---------------------- -------------------------
OFFICE USE ON'LY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
Updated 3%02
AE •P . STATFWrtir-ZIP SS3Y.?
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory 81dg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Mulli
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 peck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 S[orm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N 0 25 Miscellaneous
? 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 (Bldg)' ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation Occupancy MC(ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Foo[ings (new bldg) _ FinaL'C.O.
_ Foorings (deck) FinaUNo C.O.
_ Footings (addiuon) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & W'acer _ Final _ Pool , Ftgs _ Air/Gas Tests _ Fina]
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.L _ Air Test _ Final _ Windows (new:!replacement)
_ Insufation _ Retaining Wall
Approved By , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
1991 BIIILDING'PERMIT APPLICATION
CZTY OF EAGAN
SINGLE FAMILY DWELLINGS M[JLTIPLE DWELLINGS COMMERCIAL
2 SETS DF PIANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
_# OF RENTAL UNITS
_# OF FOR SALE UNITS
PENALTY APPLIES WEiEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. l0 CHANGES WILL BE ALIAWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: RS.S Valuation: --(p-?.?"0ate:
?
? .
Site Address
Lot 7t Block
Parcel/Sub
Owner
Addres
City/2
Phone
Contractor At L?trrNle?,?,rr?\ f?s?aS
Address ,S1-c- S-{-?.d (LO
City/Zip Code S 5?1?
Phone Aql -1100
Arch. /Engr. ?? Jy, ,p 1 ? ? ` ?u.,,
Address Z?{Z+?" ??, ?,r.pT ,Se_ D?
City/Zip Code
r7B,OOJ' OFFICE USE ONLY
FEES
Occupancy R M-I Bldg. Permit 54/1,0 O
Zoning 'R-1 Surcharge .S?T.UO
Actual Const V-N Plan Review 351•0D
Allowable ?/-/4 SAC, City /00.00
# of stories SAC, MWCC 4,50,00
Length yi' Water Conn. 660l00
Depth 41$, Water Meter 100
S.F. Total Acct. Deposit _SL),L)C)
Footprint S.F. S/w Permit C),C))
S/W Surcharge ,SO
On site sewage_ Treatment P1. 296,4)
O
On site well Road Unit 3?D1 aO
MWCC System Park Ded.
City water ? Trail Ded.
PRV _ Copies
Booster Pump _
SUSTOTAL
APPROVALS Penalty
Planner _ Lot Change
Council TOTAL 3 1 y a.,
Bldg. Off.
Variance
agrees that all work shall be done in accordance with
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
G?Te, A (-, -e-
20 r 22 = L{ y -o
Vs X r.S°= ?-
y 35 x IS= 6?25
f3S MT,
26p x 40 = foyo
?; x?t =
Y, /?I ? lL) 1?? o
?ST
RSMT= iu5-v
x6': =1= lo ?: ? _
ID71 X S'J % 5?763
?-
1179w%
?
u A. i IOh!
orZ -l$I t30o ?
?
+. .
Y? * * . ' • • 2422 Enlcrpitse DrlvE
MendotaNeights,MN55120
? pIC]NEEq ?AHeeunvcrwea•CIVII[NpINEEl13
„
?M „??h „??.. ? UNDI?IINN[11l?L11NpSLpPC11NtHRECTS
?F ?* Ist21691 1914
? ?
*
Certi(icete of Survey (or. AL- PepPMA ON (oNS -
??. c.
-- ?
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o ? ? pRpPosev r ?
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0
9Oy '°?--- _ J
?
_
?
• 900.o Deno%s Exislin EleVa&ln PGoP03ED HouSE WEV4VION
r oo•o Uerbfes propvgEd IlevoJion Lowes -7oor Elevo ion 905, 9s
---- DiernotesUrriraerU1ilYy Evsement Topot"Block£/PVOfion 9e .93
-?---?- Denoles Drr;W't-160"Direclion GaaleSlabElevafion 08,6
° Cknoks Monuffienf Bear7?7g5 Shown are assun?d dUP?x? es q e/,fib
LOT24,gLocu 3 SrAFf-ORD PLACE
DakorR CbtlNryt MINNESOrA
1 herebY eerllfy Ihel Ihif furrEy, plan or roporf wes preppreA by m,e? orI unde,r?my dirnct supmvisim, nnA thnt I?m dnly flegistercA Lend Surveyor
under tMe lewf ol tha Stne of Minne?ols. beted thleAay nf .?K!/ A p
? _7jG/ •
Scale :limh `4V j! hel 9/083, e/ J -R sne r n cna ,ii t s, nrr.. rio. tanot
90
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i.,, ; •
CITY OF BUILDINQ DEPARTI4ENT
XT
R =
N
E
IOR ENVII,OPE AVERAGE I'll li 0014PUTATION
(To be submitted tvith building permit application) . q,.?
Ona or Two Family Dwelling Owner
All Other Site Addresa
STAiyo,Qt} PLA4 e -
Contractor U ?.oNaT Data
Phone
?
, LINEAL FEET OF 11\''
EXPOSED VfALL
'/J
I
j?
YWOP
, %6 7
ft, above grade a Gl::;l
,
TOTAL EXPOSED WALL AREA SQ.,,FT•
OPAQUE WALL COHSTRUCTIONs "U" Value x Area
' Detail ?1ZfNS9? npn
reference "U"
Prom npn
attached "U"
;<. _.. .. .._..._. __...._....__......__. r
6h66t6 -.- "ll"
, . uUti
WINDOWS: "U"
Make & Type
n n
n o
n u
.O •' x SQ.
.07 x SQ.
x SQ.
X sq.
x SQ.
x SQ,
FT._?(op$.ZO. (v9•?S .
FT. 93•53GL . Z
FT. . o? .
rvr. -
FT• a
FT. =
'? .
Value x Area
?1UZ?1G?4?171?T, u0n_ -?- X SQ. FT. .3 D 3 JC?-?j C)?
UA) ir;
upu x S . FT.-L._
npn Q - (11)(A).
nUn x SQ. FT. _ (U)(A)
x sQ. Fr. _ (u)(n)
DOORSs "Ult Value x Area
tdalca & Type ?• J??sv(., uUn •11 x SQ.
n ° Yr?"nn npn
n n x 5?,.
n ??Un x S .
a - nuu x SQ.
ToTar,s Z03r? sn_
AvExA4E "UII
TOTAL (II)(A) VALUES l?zto$
DIVIDED BY TOTAL NALL AREA Zp? p, 0 ??SD
AVERA(iE "U .115 r less Yor 1&2 fami inga
s
ROOF/CEILIN(i--?
TOTAL AREAz
FT. 100 = S.SQ (U)(A) .
FT. r D _ ' r' M(A)
(U)(A)..?
FT. _ (U)CA) ...
k'T._ _ 1(07.(09 ?(U) (A)
Detail reference
from liUi i .p ?
x Sq. FT,- 1rr??,
22•47 (U)(A) ;
1-!.?
"
attached sheeta.
nUu x S
Q• FT
• _`
.
(U)(A).;*"..,.:.
Describe openings „U„_ x SQ. FT, e (U)(A)
in roof. ?IUI? x Sq. FT. _ (U)(A)
x SQ. FT. _ (U)(A)
TOTAL (U)(A) VALUES DIVIDED BY 2Z-7 _ To7' I. Iv7O v??2 47 CVya?
? i?
TOTAL ROOF/C I (3 AREA
? 1070 • OL
AVERAQE
025 or ventilated roofa.
=
il Mopar- ??de:E7- 'J
-irv' ?xt'a..ej>
?38 + 38 -i- 3z-r?? =
•l?7 ? 3S t3o-? 3z+3Z.? =
,sr
• 8 ?C C3,8 t38 t,Z+-?2,, _
z,o3o, oo?
93-So4,
Pb, zo4
ZoX - 5.o x jz = ?oo
71?X = (v o X 8= 4?-oa
Zo x ^ (p, y X 4_ Zl?.Bv
-?-
?o-
sr z1.oo
2!0-ST Z/, oa
.
ole-7
wfaLL ??v??s
69' W?e?L Z, 030-00
L?SS (70NC.1 93.80
9114A Illv.zo
?, kibyv?s r3?.go - 4?/.Sv
Ae)r->?Ll s 7100 ll?og.2o?
;_..
,._,.
??? IJO7D ?
DN--
11, Rim. and Conc. Block
i ROOF/CrILIN4 R VIIT;U
1.) Interior llir P'ilm •'0.61
2.) 5/8 1f ayp. Bd. .56 ;
3.) Inaulation
AZ.
v
4.)
%o
5.) Exterior Air Film
(STILL)
°Uo = 1/R= .OZI TOTAL (R)n 17•1$
NlALL
6.) Interior Air Film
7.) P aYp. sa.
8.) Insulation
9. ) gvrc?"T'?'7E
10.) Masonite Sidirig
11.) Exterior Air Film
R VALU
Os68??` ?
f045
,
Z 6?
.17
'lUll _ 1/R= rO?'3 ToTar. (R)a Z?.Ot
r--
RIM
12.) Interior Air Film
13.) Ineulation
14.) 2" Fir Rim Joiat
15.) &VuT g1'z-F
16.) Manonite Siding
170 Exterior Air Film
R VALU
0.68
fQ.00 .
1:88 -
Z.6
.17
uUn = 1/R= TOTAL (R)e
?-.
FOUi7DA'PION
18.) Interior Air Film
19.
Zo.,
21.) 12" Conorete Block
22.)
23.) Exterior Air Film
li„ll = 1/a= 07lo
?
a var,u
0.68
11.oa .
1.28
.1Z
TOTAL (R)a ?Zl-13,
PERMIT V '
( 1fffit)
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681 -4675
APR 2 0 RECD
SINGLE 8 MULTI-FAMILY 2 sets of plans, 3 registered site surveys, i 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 r lot chan e is re uested once ermit is issued.
Date _Ll / '10 / 9a Valuation of work
Site Address: yC'?G3 v-\ nUqv,,G
STREET STE t
Tenant Name:_ bRE?`1i'm
LOT ?y BLOCK ? SUBD. P.I.D. / .
Descri tion of work: u?1 L
The applicant is: Owner ? Contractor ? Other (nes«rx)
Name 2 L itE)\s-o Phone
Property LA:T FIRST
Owner qddress Z/0 93 1-?Ie' -sy l„µ..,'0. ,4t ,
STREET ' STE N _
City L0.tian State /nN Z;p 6-sia3
Company Phone
C011t1'8Ct01' Address License # Exp.
City State Zip
Company Phone
Architec U
Engtneer Name Registration #
Address
City State 2ip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has een approved.
I hereby acknowledge that I have read this application and state that the information is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
5ignature of Applicant:
vrrw? ua? vr??r
BUILDING PERMIT TYPE
? 01 Foundation ? 05 Apt. Bldg O 09 Basement Finish
? 02 SF Dwg. ? 06 6arage/Accessory ? 10 Swim Pool
13 03 Two family ? 07 Fireplace ? 11 Res. Add./Porch
? 04 Multi-fam. T.H. ? 08 Deck O 12 Comn./Ind.
WOR K TYPE
P 31 New ? 34 Repair ? 37 Demalish
? 32 Addition ? 35 Tenant Finish O 99 Undefined
? 33 Alterations 0 36 Move -
GENERAL INFORMATION
Const. (Actual) Basement sq. ft.
(Allowable) lst fl. sq. ft.
UBC Occupancy 2-3 2nd F1. sq. ft.
Zoning -iw Sq. Ft. total
# of Stories Footprin t Sq. ft.
Length On-site well
Depth zL On-site sewage
APPROVALS
Planning Building jjs
Engineering _ Yariance
REGIUIRED INSPECTIONS
? Site
? Mallbaard
lp Footing
IR Final
? Framing
? Draintile
0 Insulation
? Fireplace
Permit Fee 5,00 v.iuat;on:
Surcharge . So
Plan Review
License
MWCC SAC
City 5AC
Water Conn.
Water Meter
Acct. Deposit
S/N Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
s
r - w
?
? 13 PUbrl i ? FaC. -
CJ„14 Agrtculturxl
O 15 Miscellaneous
MWCC System
City Water
PRY Required
Booster Pump
Fire Sprinkler
Census Code
SAC Code
Assessments
SAC %
SAC Units
` .
???? •-,
rIYNCEM U1NOfUlIV[T011!•CIVILENWNE[M
`*?ng * eer ng ?. 1AN0?IANN[pg• IANDlC1119 11wpnT[Cil
*?*
Ceriiftcate ot SurvEy ior:
4422 Entcrpiise bOve
Mendota Ileigiris, MN 55120
1612! 691 -1914
,dL 1-IERKMA?JM CoNS-
pjFNNSYL-VQN1A /-\V E .
8% o'O N 3°30' w
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0
a
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6
?
?
e
0
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° 3.
:
r-- ?
Ze.
i s.:gw?as v1
I A /B.e .
° $ pKaPosev
I HoNSE
2;.7 4a v
;4;r
T `
I
?
? I o 90''9
I
2o,-e
?
I ? N
N a O
I
?
% Ia - - - -
85 /6 itJo,eT}/
V'I
Zp?
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0
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0
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??. . . .. ..._..
_;,: -
i ....•: __?': ?° x;?--:
* 9vO.o Denoks E*xislin? Elevalion PlaevosEO NousE.E[£M • oo.o Utrdes f?ivpc? fd flev+a/ion Lowes IovrEleva ion 905.9 $
-------- Deno%sdrornrr eiUli/i?1y fasement Topor''B/ocl?f/FVa/ion 90 .93
-?--}-- Denvlrs Drni?,e Flot?V'DirPCfion Ga??aot Slab £lEVafiorJ 9oe,6
? Uena?s Monuli3enf Bevrils shown ar-e assumfd n Ue,ves q e Ab
LOT24,BLOCk' 3 SrAFFORD PLACE
OAKOTA Ct)t1Nt yj MlNIVESOTA
1 herebY cer111y thet 1hN wrveY. Plen o. r.ryorl wef Prepnred AY me or nndpr mV dirqr.l spmvisinn nnd Ih?t 1 nm dnly firgis?eicd lead Survey0r
under the Iwm 01 Ihe 51ue ol IAlnnnote, Ds1eA Ihle_jh V-lday ol A.D. 194k . `
/.
oCcale : lhc6 = 40hel Wog 3. o, n 1i n F , ?. ?„<, ,, ,<. Pfl:. NO. 141191
?b¢ ?
` CITY OF EAGAN FOR CITY USE ONLY
3830 PIIAT KNOB ROP.D
EAGAN, MN 55122 PERMIT # AI %SO
PHONE: (612) 454-8100 RECEIPT # D$ y
t"IX?DATE:
PLEASE COMPLETE UFPEAPORTION ONLY FOR SINGLE FAMILY
?.. . .
TOWNNOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
-------------------''°-- -------^--------------------------------°
WORK DESCRIPTION FEES
NEW CONST _x
ADD ON
REPAIR
OWNER NAME: C.P.E LLuc.i-?
SITE ADDRESS:?? T
LOT: °r T BLOCK ? ;UBD. J :
TNSTALLER: METRO AIR INC.
ADDRESS: 16980 WELCOME AVE. S.E.
CITY: PRIOR LAKE, MN. ZIp; 55372
PHONE #: 447-81 24
ADD-ON MINIMUM
HVAC 0-100 M $TU
ADDITIONAL 50 M BTU
GAS OUTLETS - MINIMUM
OF 1 PER PERMIT
SUBTOTAL:
STATE SURCHARGE:
TOTAL:
DWELLINGS &
$15.00
24.00
6.00
3.00
$ 27.00
.50
$ 27.50
SIGNATURE OF PERMITTEE
PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS,
APARTMENT BUILDINGS, AND MULTI-FAMILY BUILDZNGS WHEN SEPARATE PERMITS ARE
NOT REQUIRED FOR EACH DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BIACK _ SUBD.
INSTALLER:
ADDRESS:
CITY: ZIP:
PHONE
FOR:
CITY OF EAGAN
FEES
16 QF CONTRACT FEE.
STATE SllRCHARGE - $.50 FOR
EACH $1,000 OF PERMIT FSE.
PkGI",E3S¢,D P1YIi?IG = $25.00
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE
T71 AL'-"ujl^nz??
(SIGNATURE)
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MN 55122
PHONE: (612) 454-8100
toommm
FOR CITY IISE ONLY
PERMIT # I 2 6
RECEIPT # (
DATE: a
PLEASE COMPLETE UPPER PORTZON ONLY FOR SINGLE FAMILY DWELLINGS &
TOWNHOMES/CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
------------------------
WORK DESCRIPTION
NEW CONST ?
ADD ON
REPAIR
OWNER NAME: //c ?'/ p??c-,"5
SITE ADDRESS: C)C( 3 C V` -4;m44- ve
LOT:ow SIACK I SUBD.
INSTALLER: '?C--hCl e? 0 I W i n
ADDRESS: ,v-
---- ---------------------
COMPLETE THE FOLLDWING: ------
N0. FIXTURES EA. TOTAL
ADD-ON MINIMUM 15.00
_ SHOWER 3.00
/ WATER CLOSET 3.00
/ BATH TUB 3.00
+ LAVATORY 3.00
?? -
i KITCHEN SINK 3.00
-? -
i LAUNDRY TRAY 3.00 _? -
HOT TUB/SPA 3.00
i WATER HEATER 3.00 3.
i FLOOR DRAIN 3.00 3
GAS PIPING OUT. ?
+ (MINIMUM - 1) 3.00
j ROUGH OPENINGS 1.50 ?b
_ OTHER
WATER SOFTENER 5.00
_ PRIVATE DISP. 15.00
_ U.G. SPRINKLER 3.00
SUBTOTAL ?
ST. SURCHARGE .50
&0
TOTAL:
C02?IMEI?GZf?IN$?S7'RTAL:: PLEASE COMPLETE THIS PORTION FOR ALL COMMERCIAL/INDUSTRIAL BUILDINGS AND
MULTI-FAMILY BUILOINGS WNEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UNIT.
CONTRACT PRICE:
OWNER NAME:
SITE ADDRESS:
LOT: BLOCK _ SUBD.
INSTALLER:
ADDRESS:
CITY:
PHONE #:
FOR:
ZIP:
FEES
1% OF CONTRACT FEE.
STATE SURCHARGE _ $.SO FOR
EACH $1,000 OF PERMIT FEE.
$25.00 MINIMUM FEE.
CONTRACT PRICE x 18 $
STATE SURCHARGE $
TOTAL:
$
(SIGNATURE)
CITY OF EAGAN
CITY: P( ?pr L??1-e ZIP: 5? 3`7 v
City of Earn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use tt�
Permit #:
Permit Fee:
(pus)
Date Received: Of (3
Staff:
2013 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
l�
Site Address: / 73 /4/4 -
Date: D' 3
Tenant: g2f/034-
Sy #t)C
Suite #:
J
Name:,5 f'4!J-4 ,67>,72. 4; c Phone: �6�,- 7 (4/6
Address/City/Zip:'/2 3 PeA.i »i 7,)4,0,4113 .4tJ,'+k- /L/
Name: gl.k)A )07f.. 14,4 4 fl 4 -
Address: (.070 c%� .(4) ALM' Al
State: M Zip: 6— 50 P02.
Contact:JO E L LI A 6:E'4.1
License #:
City: „-72 L- (L.4'T C ae-
Phone: 67-113 7
Email:
New j Replacement Additional Alteration
Description of work: iCC!'1.�+t re... .,4e c e A -
NOTE: Roof mounted and ground moue
Code. Please contact the Mechanical lee
/ RESIDENTIAL
VFurnace
1/ Air Conditioner
Air Exchanger
Heat Pump
Other
Demolition
New Construction
Install Piping
Gas
COMMERCIAL
_ Interior Improvement
Processed
Exterior HVAC Unit
Under/Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge) /' , e
$100.00 Residential New (includes $5.00 State Surcharge) = $ L' TOTAL FEE
COMMERCIAL FEES
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
*If contract value is LESS than $10,010, Surcharge = $5.00
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
***If the project valuation is over $1 million, please call for Surcharge
Contract Value $ x .01
=$
=$
=$
Permit Fee
Surcharge*
TOTAL FEE
I hereby acknowledge that this information is complete and accurate; that the work will be in confor ance 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 nott 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.
x46't
Applicant's Printed Name
plicant's Signature
FC
OFFICE U
Required Inspection
Underground Ro
Use BLUE or BLACK Ink
For Office Use---------
j Permit
City of Eap 1 ~ ~
Permit Fee: loc~ 1
3830 Pilot Knob Road
Eagan MN 55122 Date Received: ;
Phone: (651) 675-5675 I 1
Fax: (651) 675-6694 1 Staff: I
I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
Name: Ql.,~ /~6
G I`~G Phone:
Resident/ C
Owner Address / City / Zip: ® PaA)S Y4-VA'V14 A A.`
Applicant is: Owner X Contractor
Type of Work Description of work: -764,%-
Construction Cost: f1 Multi-Family Building: (Yes / No V)
Company: Twl'J CI fib C(Yv 04( fW(- S 6kOCO Contact:
'Address: City: ~ C.UC~tG~GI~
Contractor
State: nw Zip: Phone: 62 U/
License Ac Lead Certificate N A r f'l f 6_<~S7-1
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.aopherstateonecall.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 ota State Building Code must be completed within 180
days of permit issuance.
~
X_ ~
Applicant's Printed Name Applicant's Signature
Page 1 of 3