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4936 Pine LaneqoI? 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construdion Reauiremenls 3 regislered sfle surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas (20%maximum lot coverage allowed) 2 copies of plan showmg beam & window sizes; poured (aund design, etc. t sel of Energy Calculations 3 copies of Tree Preservation PWn if lot platled atter 711/93 Rim Joist Detafl Oplions selectbn sheet (buildings with 3 or less unHs) RemodeVReoair Reauirements 2 copies of plan 1 set of Eneyy Calculations for heated addNons 1 sHe survey for additions & decks Addftion - indicefelf on-site sepfk sysfem 7-D t-2 5, ,.K y? ro y. ,s+J Pd ? cas? - Of(?ce Use OnN ?- Cert ofSurveyRecd _Y _N Tree Pres Plen Recd _ Y_ N. Tree Pres Required _ Y_ N OnsiteSeptkSystem _Y _N Date 9 /Z 2 / a3 Site Address Construction Cost J$00 -? UoiUSte # Description of Work Multi-Family Bldg _ YXN Fireplace(s) _ 0 _ 1 _ 2 PropertyOwner Z)Qa{-\ Telephone#(G5j)?a3_-I?BO Contractor ? Address l? State '?. ?a? Zip ?Ss_ ?L City \NN Telephone #n") Sy x -ny%?, COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet (Jsubmissionrype) Submitted Submitted . Energy Envelope Calculations Submitted In ihe last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone # ( 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 MN 5tatutes; 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 wh&T, reqerre a?r approval of plans. ?? I ????I I c ? )Fa ? 3 2005 C,QO ?. Q ?\-?sk? JI Applicant's rinted Name Applicant's Si ttue ?%- - ---- OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? OB 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) 0 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plez ? 10 OS-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 LowerLevel ? 24 Storm Damage ? 06 04plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous Work Types ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building• 0 43 Reroof 46 Windows/Doors ? 34 Replacement 'Demolition (Endre Bldg) - Give PCA handout to applicant 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 Width REQUIREDINSPECTIONS _ Footings (new bldg) FinaUC.O. _ Footings (deck) X FinaUNo C.O. _ Footings (addition) _ Plumbing Foundation HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final ? Framing Siding _ Stucco _ Stone _ Br ick _ Fireplace RI. Air Test Final X Windows Insulation Retaining Wall Approved By: , Building Inspector ' ----- ---------- ------------------------- --------- Base Fee Surcharge U v Plan Review MC/ES SAC City SAC ? Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies .2.5 Other Total -4-0 .LS CITY U3E ONLY L ? nBL RECEIPT#: I a -??o5s sueo. REceiar oare: PERMIT.# Z 7?2000 PLUNBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3630 PILOT ISNOB RD EAGAN, MA7 55122 651-681-4675 Please compfete for: D single famiiy dwellings D tawnhomes and condos when permits are required far each unit ? backflow preventer for underground sprinkler system FIXTURES EACH i1 TOTAL Alterations to existin dwelling - mini um fee Describe: ?/? ....v-,?, .F? ?rvca? $, 30:00 Bath tub $ 3.00 x = $ Floor drain 3.00 x = $ Gas piping outlet ' minimum -1 3.00 x = $ Hot tub/spa 3.00 x = $' Kitchen sink 3.00 x = $ Laundry tra 3.00 x = $ Lavato 3.00 x = $ Septic S stem newlrefurbished • reymres mac ue. 75.00 x = $ Septic System abandonment 30.00 x = $ RPZ new instellationlrepairlrebuild 30.00 x = $ Rou h o enin 7.50 x = $ Shower 3.00 x = $ Underground sprinkler ff dwelling is under conswction 100 x = $ Unde round sprinkler rf existing dwelling 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x = $ Water softener IT dwelling under construction 5.00 x = $ Water softener if existlng dwelling 30.00 x = $ Waterturnaround 30.00 x $ State Surcharge 50 -> -> -> $ .50 TOtal _n -> _-> -a S \30. Reminder: Call for inspectfons of alterations, i.e. water heaters, water softeners, etc. --------------- ---------------------------.....-----•--...------------ ----------------------------•-------------- I he2by adcnowledge that 1 have read this appliption, state that the iMomiatlon is corred, and agree to compty with all epplicableDity of Eagan ordinances. k is Me applicanPs responsibility to notify the property owner that the Cily of Eagan assumas no liability for any damages caused by the City dunng ks. nortnal operational and maintenance activities to the facilities wnstruded under this pertnit withinCity pmperty/rightaf-wayleasement. SITE ADDRESS: OWNERNAME:: 7Hi?r??iL Y_3Y?t.o. ('w?cnt??A TELEPHONE#: ol-'L SaS^ 19aAll (AREA CODE) fNSTALLER NAME: L TELEPHONE #: /oS ys?3 - 'j-A30 ?p?.., (nRea, coDe) STREETADDRESS: /5'? n?t.k1??.?2r?. yl"?_ CIN: STATE: A.) 21P: -83-04Y SIGNAT R£OF PERMI EE city oF eagan 4 1 PATRICIA E. AWADA Mcyor Octo6er 26, 1999 PAULBAKKEN BEA BLOM4WST PEGGV A. CARLSON RO al Oaks Rea( TIIC ? ? SANDRA A. MASIN . } r Council Members 4196 LCXlflg'[OR AYO. THpMAS HEDGES 5horeview MN, 55126 citv Adminisrrotor E.J. VAN OVERBEKE City Clerk RE: 'Pinetree Forest - Erosion Control Concerns 4929, 4936 Pi ? Lane & 4938, 4882 Sycamore Da The attached letter was written and mailed out to generat cantractors on April 15, 1999, and has been distributed with building permit applications since that time. The aforementioned permit was issued in your name. A Ciry staff person has observed the site where the pernutted work is taking place and has found deficiencies in the erosion control efforts. The City Code ciearly states the authority of City staff in enforcing the removai of siltation, dirt, clay, or soil (SIL1) upon any street within the City (Section 7.05, Su6division 5.1 of the Eagan City Code). The following erosion conuol efforts should be taken immediately: 1. Removal oPall SILT upon the street and walkways adjacent to said property. 2. Installation and maintenance of approved silt Tence at curb & property lines. You have 48 hours to bring this site into compliance with this section of the City Code. Upon your failure to bring this site into compGance in said time, the City's enforcement actions will be as follows: 1. Order street sweeping/deaning activity 48 hours aRer initial faaed/mailed request 2. Charge/mail sweeping/cleaning invoice to development contract obligee or permit 6older. 3. No further Letter of Escrow Credit reductions will be granted. 4. Place hold on Certificate of Occupancy until compliance and paymeirt of invoice(s? We appreciate your cooperation with our erosion control efforts. Please call us with any questions. Sincerely, Cc: Russ Matthys, City Engineer Doug Reid, Chief Building Official Engineering Section Dale Schceppner, Assistant Building Official Department ofPubGc Works Stan Lexvold, ConsWction Supervisor City of Eagan MUNICIPAL CENTER 3830 PILOi KNOB ROAD EAGAN. MINNESOTA 551221897 PHONE. (651) 68I -4600 FA%: (651) 681-46I2 10D: (651) 454-8535 THE IONE OAK TREE THE SYMBOI OF STRENGTH AND GRGWTH IN OUR COMMUNIN Equal Opportunity Employer MAINiENANCE FACILITV 7501 COACHMAN POINi EAGAN. MtNNESOiA 55122 PHONE: (651)681-4700 FAX (651) 681-4360 iDG (651)454d535 . ....?.?.i,e:,?.. ,.;, 2; i -„? r,??:,?: ?'°;•'? ,-_?,.?,.,.nIAi ... . _ il?? •,,c,?i'.::a i.; nt.31..E", ,;;czn-; ;ii?1;?, .r.:?li?:3ri;U!:T:[[]P.i ..,,?,., ?-•:,.,- .... ,:.-?:.,;. ?: .,?,:- , ;n?n0 • 221117 !,i(.ii..!;. k`:).:li:'? NF. ? OL 21? I'T Mi' ? (Ni:: .r ...'i i . ?)I"=. L.N . 0 "50 37 -i2 .4.`33F:, . ., ? ..... SKit:i1. r.i.? . 36 %F5 ,.(lU , z .. ti c; ?.:,: I' i:.n•.C°.,, .. ? f;O??T:I:;?L??. !.:?.Cl?y (irr ,...? T .?r.?r.;,. ?Ei (.'h. .F'?"]?.\.A1.. ?!(]b 't..-?„ r.:?i T ?...._.. .., c:.'r, ..i?i?iEi:, n7^F", TI.I9 ",,?4.-.,, r•;;;,rJi...f:?:`,' I'l3 CON";l"I'::l!l:Ti.)N! 371 i:, .9c'i't) ?..'1.4.(3, 0 ?.. ?.3'.f.!lii: '...i3 ..?i..?..(:?4J ..,^r?:•`'? `,.?i:''.::''.I,.1 ?:`'???rf?':. i-'A.;;!;`_ LH .? i"?;, O"afii..:37 ??..., ` 1999 BUILDINC PERMIT APPLICATION (RESIDENTIAL) ` CITY OF EAGAN 3830 PILOT 10N06 RD - 55122 ? r,-'U cs 851-681-4875 ? L?Ac? S-?V-- New Conslructbn Reau&emenfs Remodel/Reoatr ReaukemeMs D 3 registaed aHe aurveys showing sq. H. of lot, fq. fl. of house and po roofed areas (20% maximum lot eweraae albwed) D 2 coples of plans (show beam 3 wlndow sizes; poured fnd. design; efc.) D 1 set ol energy calculatlons D 1 coples of hee presenaHon plan 91ot platted alfer 7/1/93 DATE: S • 5 • 99 2 copies of plan 1set W energy calculatbro for heated addMlons 1 fMe suney for exferior addlNOns S. decks CONSTRUCTION COST: ? I a9 , oL)O• m DESCRIPTION OF WORK: STREETADDRESS: L42-'?NE- LOT: I C? BLOCK: 3 SUBD./P.I.D.#: PlNZ--T-T? Name: MP??L-E^I ??TN F--r---S Caas-r. ?x-Phone #: 3$ ?• 3$15 PROPERTY « FM OWNER Sheet Address: 3338 Wv.-*-r.--%c? P-:4t- S2-104 City M, t'l NState: M" . Zip: '-5-,!:SL-4o$ Company: Phone M: 3%(. • 38 15 (area code) CONTRACTOR SheetAddress: License#aExp. --? clc?'=) Cify State: m?-l . Zip; ?S?L-IcJ3 ARCHITECT/ ENGINEER Company: ?V-.4c-- Nome: Telephone orea code ( f?'j?. ) L-1 S? • ofl SheetAddress:3LA 3-'7) LJas+-i,-Ac?xt=*4 1-??Jf- RegislraHon#: CI}y State: m.a. Zip; ?S la? Sewer 6 waler Ifcensed plumber lreauired tor new conslrucHon onlv): ':!5R-Jv" PenolFy applies when addre:s change and lot change Is requested once pertnlF Is issued. c' I? i hereby acknowledge thaf 1 have read thls applleaHon, state Ihat the IMortnaFion Is conecf, and agree fo comply wRh ali appilcabl State of Minnesota Sfatufes and CMy of Eagan Ordinances. , Signature of Appllcant: ' --? OFFICE USE ONLY Certificates of Survey Received ? Yes _ No iiA?i ? 3• .? Tree Preservation Plan Received _ Yes ?No _ Not Required ?% , OFFICE USE ONLY BUILDING PERMIT TYPE '0 01 Foundation ? 06 4-plex ? 11 10-plex ? 16 Fireplace 0 21 Porch (3-sea.) X 02 SF Dwelling O 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea. ? 03 1 of _ plex O 08 6-plex ? 13 16-plex ? 18 Deck 0 23 Porch (screened) 0 04 2-plex ? 09 7-plex 0 14 Apartments 0 19 Lower Level ? 24 Storm Damage ? 05 3-plex ? 10 8-plex ? 15 Lodging O 20 Pooi 0 25 Misceilaneous WORK TYPE 3 1 New ? 35 Tenant Impr ? 39 Gas Line On ly ? 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) ? 42 Reroof ' Give PCA hando ut to applicant for demoiition ermit GENERAL INFORMATI ON p Const. (Actual) ? Basement sq. ft . I aya67 Census Code !O/ (Allowable) i/ v Main level sq. ft . ? aS7,i7 SAC Code oP UBC Occupancy Il U1 a?P5A sq. ft. l 01V9 No. of Units , 6,1 Zoning 6,#K sq. ft. 9HN/ 9,3' No. of Bldgs o/ # of Stories 13-. sq. ft. MC/ES System ? Length 73 sq. ft. City Water ? Width 319 Footprint sq. ft . g O3/,y5 Booster Pump PRV Fire Sprinklered APPROVALS Planning Buiiding vv ?Engineering Variance Permit Fee , 38.ti.7S Valuation: $ -7QD? 5urcharge gsad ?? „Ie4 PlanReview q40,7y /35r; /qi,33 License AN u ;yg : 67A,00 MGES $AC PO.SQ,06 1l•"g N= N5.33 City SAC 10c,00 16 x ao = 3a000 WaterConn. ssas,00 1 Y "y ' "y ^ WaterMeter Ily,pO laHa, 67xa6=31,0664 7 Acct. Deposit ioo,tb Ilp%A a h = yz,6? SNV Permit 36.00 u c - , S/W Surcharge ,so t'o )e /6 = 15 Treatment PI. N6R. oro 11 " ? - 1; ,o,s Park Ded. ?y g Trails Ded. 17 x6H? 69j 607,60 10187 Other , Copies 36 x a'i = S 6H ;k j08= 1;?G TotaL• Sp,?.yy ? I x lo k S = ?d SAC Units ? >` `? ?? ? J5y .,r6j6y6.46 ? % SAC 639 "x ayy= - ?a. r a = aH - Syx ?6= S ?bx 7 ? lo,? I!? qo?r, Ny . 2? sENERGY CODE WORKSHEET FOR 1& 2 FAMILY DWELLINGS SITS ADDRSSS S V CITY 1- I? 90ILDING CLASSIFICATION: ? catagory 1(etandard) or 4L category 2(muat includa ventilation) i HINIMUM CRITERIA Foundation Insulation-R10 Walla F Wlndown Roof Attic Zneulation: (See table on reverse side Slab on Grade Insulation-R10 Eor allowable percentages) R44-With Attic No Heel Floor over unheated spaces-R24 R38-With Attic Raised ifeel Foundation Windowa 1/2" R38 & RS-Solid Rafteis ineulated Glass. -Wood or Vinyl Frame . STSP 1 Windaw & Door Area A. Total Window & Door Area in Sq. Feet WINOOWS (Including Foundation Windows): YIINDOW MANIIFACTURE NAMH: WINDOW MADTUgACT[TRE TYP6: WZNDOW MANUFACTUR6 ? FACTOR: R. O. Quantity sq.EC.Area Dimensions ? u x 4,o " // AV x `T to X SN kv ? M X ?K 1.0" X z?L-cw ? I-au x Z5 '-e ? y Z'cm" X 4'!sk lI Z?i x DOORS: 11 zg "?oe I / I 1a III 'f'otal Area of Windows k Doors B. Total Wall Area in Sq. Ft. A'4r.J14.ft. 11 Wall Total Height Area Perimeter rJ' ? 1 IL. LP7 i e-l'li STBP 2 Calculata area ae a percent of wall C. From step 1 divide box A(4findow & poor Area) by Gox B(total wall a1'ea) Limen l0o equals the window and door area as a percent oE wall area (box C). P.OX A X 100 = 7 bo'` 13 5-7 / l G.? sree a A.SSEtqBLY PRAMING TYP6: S'!'ALIDARD FRAMING AOVATICED FRFtMING Cx,VITY INSULRTION Denign Featureo ?studs 16" o.c. e,tude 24" o.c. RL7- SHBATHItIG TYPB: LESS Tf{AN < R-5 X R-5 , OR FIORE U-FACTOR U From the tahle, (reverce side) determine the maximum percent window & door area for thedesign op[ions sel.ected and enter the b value in Box D below baeed on the window mfg. U- factor: [(C4D n The :? value from the cable in Box D shall be equal to or greater than the } in Dox C 7'otal Area of Walls ? U=??77q,ft ? 0 OPIE- & TWO-FAIvIILY RESiDF.NTfAL DU]LDING PRESCItfp7'NE (COOK-BOOK) nPrROncH MAXIMUM WiNAOW AND DOOR AREA AS A PERCENT OF OVERALL WALL AREA From Mlnn Rulen yart 7??2 item F Cavit Sxterfor Window U-Factor Framin Inaulation 5heathin 0.49 0.36 0,31 0.27 S7"ANDARD ft-13 2-1-7 13.4% ]7.8% 21.3% 24.3% STANDARD ' R•13 R- 5 12.4% 16.446 19.7qo 22 5% ST ANDARD R-I5 > ft- 5 1T.9°h 17.1% 20.1% . 23 4% STANDARD R-18-19 < R- 5 12.19'0 16.0% 18,89', . 22 0% STANDARD R-18_19 R- 5 14.096 38.69', 21.8% , 25 3% ADVANCED R•18-19 < R- 5 12.9% 17.195 20.19'0 . 23 4% ApVANCED R-18-19 > R- 5 14.5% 19.296 22_59'a . 26 1% STANDARD jR21 < R- 5 ]2.8°e 17.0% 19.9°0 . 23 1% STANDARD 21 > R- 5 14.5% 14.3% 22.5% . 26 ]% ADVANCEp R-21 < R- 5 13.fi°? t8.1°a 21.2?, . Za 6% Ai?VANCED R-21 R- 5 15.0% 19.9% T3.29'0 . 26.9% d[t(onal eakulated values, STANDARD R-17 < R. 5 11.9% 15.70/9 18.4°k 21 5% STANDq1tD R-17 z R• 5 13.8% 18.4'/0 21.59/a . 25 0Yo ADVANCGD R-I7 < IZ • 5 12.6% 16.8% 19.6'Yo . 9% 21 ADVANCED R-17 >R- 5 14.3% to nq »-iw . le ,. Notee: Window area equals rough opening minus inatailation clearances. Window U-factor must bt determined by eitfier the National Fenestration Rating Council elandard 100-91, or ASHRAE 1993 Handbook of Fundamenlals, Chapler 27, Table S. PoN-Mr Fax Note 7871 ' Dft w n rra„ G.Dµ Co. - ?Me Pnar • YI c?-F ccZ ce? I (SEE ATTACHMENTS) Development -T.-<R Irc,v?ed {- Lot Number 16 Block Number 3 Address ti.936 Tln t C6iL Builder Tree Protection Reauirements: ? Tree Fencing Oak Tree Pruning (Seal wounds during Aprfl 15 to July 1) Therapeutic Pruning Retaintng Wall Other: Not Requlred As Follows: Attachmants: Yes No Additional Notes: ?GAN FORESM DIVISION 6128234689 ?5/19/1999 12:22 6128234689 MANLEY BROS CONSTRUC ?.s ? . [? a? . ti ?4f? ??e? ?..io..w? ;=-Awoe- :.n u a% ?` '? a? ??jj' f-?nep: ? ur w+s. ura's .A.?en a ? * ?a +F * _ "?? ? Certificate of Survey for: MAREA 12,01Y aq. ft. SE AREA - 2,115 sp. /t. 15 W ' W ? a I d ? . , ? BEN ?Mv pEK ` ELEV.?978-BO II 19 I 39 G ? ? 976. 974 o 4rq7W 13 EXISTNG GAR. ti?t?lta ?u ?..?v • -?• ec 1-?aas? Tc? C3? 1 o.?a l.._-sr Y 978.0 (r"i 78 A) ? O 7Q O ? k., 5 $o ? ? 4 P 'pTC' ^ROP011110 GRACEy ? IWR aADING n.w+ or [-0. wo LOWEST FLOOR ELEVATON: NOl[r BWDV10 Ow[MOOMf 1MOM? ww[ F0' wO1bZOMTAI ?InD vE1tTIC4L l?wuC?u?aa wtr LOC?np, ?? d , fq ?rg?µ wywy FpR ftryyMp Ayp TpP OF BLOCK ELEVATON: GARAGE SLA9 ELEVA7fON: rroi[' rM ni[wiiiMl? a Tisdtf TOSM?CW E? t???c riai?r rH[ TOB O LOOKOUT ELEVATON: PRvoxo o nor na R[xwaieUn v n¢ aumKrort. NDT[: MS QIITIW'wl[ pQ(s N07 ?WPpRT TO IINpM GE[M[NTf O1N[R nH.w x ooaao o[ram cwaruw tuvAnd. 1MOg 910W W MK AD00110[O /LAT. ( 00600 ) OCMORS AOrOAD 4LVAl1ON MOR: CpM1RAC10R YIIfT ? ObK?Y 0c71PL ??- DpOT[f OANMA6[ AMG UT,NTY LA%Vdp7 04qi[3 ORNMAM ILOW OMCCIIW nom swa.os wo+w Mc swIpEo aw M Atwuco ownr --- oawrrs ?[Mr -? ea+oTcs arxr Mw WE HEREBY CERTIPY TO MANLEY BROS. CON57. TiAT THIS IS A TRUE ANO CORRECT REPRESEN7Ai1pN OF A 41RVEY Or THE BOVNOARIES OF: LOT lfi, BLOCK 3. PINETREE FOREST pAKOTA COUNTY. MINNESOTA 17 DOES NOT PuRPOhT TO SFfOw IMPROVENEN75 OR ENCMROACMUENTS. E7fCEPT wg SHOwN. w9 4klRVEVED HY ME OR UNDER MY OIRECT SUPERVISMN THIS 28 OAY pF APR1L, 1999. ?.. exisnNc 977.9 aAR. 978.1 ? N& PAGE 02 CAYE ,1 3e.50 ? 10 ?1 -f2------ r ^ e6 -I 10 i 77.6 ¦ 97e.3 ENVi =a 16 isv.}vs+.e ? ? ? ? t ' 4.00 ? o ?. Y 077 ,o ?--- ?ao - 977.1 ? ?WJ ?a 976.7 SCALE : 1 INCH - 30 FEET an ` /i? ! 6128234689 95/1t/1999 12:22 6128234689 MANLEY BR05 CONSTRUC PAGE 01 MAN ?Lff CROTNERE CON8TRUCTIOM,INC. .4w4rd W"snning BuikJer Kuri Marrley Phone (612) 431-6042 • Pax(612) 431-9943 f YlL . H.}vE- r T?1F- "rx.?t? ??? -?-1? +-v"\ I 4oLc.. c.F' -r?? L.=O-r ?_ --o&? -,.-. , "Ta 13i c..e?.?.r?-?cr? ?wa 'T?-1?'t?t?t.. F?.?-?E?v??T? d-?,?? .?..? o+?.awe?.. _ d L?o GL. ??1 L`aC?6 t"i'1 C.? ? TFl e: r .? s s ?yd CSTLi ?L 'C'?? S O?.J "ru ?S T?.1L. p.?aL. OG 1""f--- L?csT- ?TZ? ?.?'Gt? '"f?-IEr ?sCb?..3 Lc7.r ?• rv-JL. DCT.- 38b-38\5 lC.n.x M??-W ** * * PION¦¦R * eng nesr * ?* * [?, ??`?::::r.:i??_'.."?•c'±?:!`:?M.[?i Certificate of Survey for: MANLEY BROS. 4936 PINE LANE LOT AREA =12,012 sq. ft. HOUSE AREA =2,115 sq. ft. cci V.0 V4v -e 17.610 15 ? W I Z ? J W ? Z I a r 3 JTELE. ? N N89041'52'E ? BENCH MARK TOP OF PIPE-, EXISTING ELEV.=976.60 ? ? GAR. I `. 977.9 978.1 ? . ,s N \ m to 975.5 -"" "30.00 974.5 (47?l.8 r? ^ 10 o ? 0? :c 974.4 2 to I 11 vlH 2422 Enterprise Orive Mentloto Heighta, MN 55720 (851) 881-1914 FAX:881-9488 uMQ y,n?ran . ax? noacae [E-moll: PIONEERQPRESSENTER.COM ? 976.7i 3 s?RV. ELEV.t964.5 -? co i C) ? Z L io --?i 976. o ? i 625 Highway 10 N.E. Blcine, MN 55434 812) 783-1880 FIUL•783-1883 -mcil: PIONEER24PRESSENTER.COM CONST. , I 136.50 --?--?------ 977.6 x 978.3 - -- a N w r?j ? a.R0i°n lTr 976.7 ? io ?I ? i ii JJ 16 .~aa ' I DW I ,ba a? ? Z I Ofa _ _oW J ? (Y't 78 A> 97e.0 0 0 _a sSt-T Fenret` W 5 O 00 O (0 ?zoT£CT ? C3 w/sr (q 7q,G? fENC 974.4 ,`977:0 _-1 '-- m 974.0 CqT00.00 38.33 9 6.90 ? 976.9 ? 3 i?77'3 r EXISTING m 13 ' CAR. o.?,... i ? . ? BENCH MARK ' TOP OF PIPE' EIEV.=977.22 17 H? , ... Q NDTE.a PROPOSED GRADES SMOwN PER GRADING PLAN BY: E G. RUU NO7E: BUILDING DIMENSIONS SHOWN ARE FOR MORIZONTAL ANO VERIICAL LJnON OF STRUCTURES ONLY. SEE ARCNI7EC7UAL PLANS FOR BUILOING AND FWNDAIION DIMENSIONS. NOTE: NO SPECIFIC SOILS INVESIIGATION HA$ BEEN COAIPLETED ON MI$ LOT 8Y 1HE SURVEYOt. iME SUITABIUT' OF SpLS TO Sl1PPOflT THE SPECIFlC HWSE PROPOSED IS NOT T1iE RESPON98IUTY OF 7ME 5UROEYOR. '52wW 1 ? 4 ? PROPOSED HOUSE ELEVATION LOWEST FLOOR ELEVATION: ? 7G- '5 TOP OF BLOCK ELEVATION: ?' 7 GARAGE SLAB ELEVATION: TOB 0 LOOKOUT ELEVATION: NOIE: 1NI5 CERTIflCATE DOES NOT PURPORT TO SMOw EASEMEN75 O7NER iHAN x 00(k00 DENO7E5 EXIS7ING ELEVATION TMOSE SNOriN ON iHE REWRDED PIAT. ( 000.00 ) OENOlES PROPOSED ELEVATION NOTE: CON7kACTOR NUST VERIFY ORIYEWAY DESICN. ?-- ?MTE5 ORAINAOf AND UTIU7Y EASEY(Ni - DENOTES ORRINAGE FLOW DIRECitON NOTE: BEARING$ SNOWN ARE BASED ON AN ASSUMEO DANM f- DENO7E5 MpNUMENT $ DENOTES OFFSE7 NUB WE HEREBY CERTIFY TO MANLEY BROS. CONST. THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES Of: LOT 16. BLOCK 3, PINETREE FOREST DAKOTA COUNTY, MINNESOTA IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN, AS 91JRVEYEO BY ME OR UNDER MY DIRECT SUPERVISION THIS 28 DAY OF APRIL, 1999. c 12,A Vt s-e a SIGNEV?P!.QIIEER ENGINEERIpG--P)A. SCALE : 1 INCH = 30 FEET 979.61 BY: el 98275.22 JJS ? ? LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPUCATION PROPERTYLEGAL: LaY l& ?t ? nir :s -PrNET?EE Foi2EST DATE OF SURVEY: Lf-7g--3R LATEST REVISION: S- 'o Is -qq DOCUMENTSTANDARDS cbl ? ? • Registered Land Surveyor signature and company a/ ? a • Building Pertnit Applicant s? ? a • Legaldescriplion ? ? • Address m/ ? ? • North arrow and scale m/ ? o • House type (ramWer, walkout, split w/o, split entry, lookout, etcJ OR,' ? ? • Directional drainage artows with slopeJgredieM % &1/" ? ? • Proposed/existlng sewer and water services & invert elevation M/ ? ? • Street name a/ ? ? • Driveway V/ ? ? • lot Square Footage 4/ ? ? • Lot Coverage ELEVATIONS ExlsUnn 1/ ? o • Sewer service (or Proposed) ? / ? ? • Property corners d'/ o? • Top of curb at the driveway ?? • Elevations of any ebstng adjacent homes ru? or ? Adequate footing depM of structures due W adjaceM uUliry trenches rosed m/ ? ? • Garage floor q/? o - Firstfloor m/? ? • Lowest exposed elevation (walkouUwindow) ? ? ? • Property comers ?? ? • Front and rear of home at the foundation PONDING AREA (if apolicable) ? M/ ? • Easement line a tr/o . NWL o da/ ? • HWL ? V ? • Pond # designation ? v? • Emergency Ovefiow Elevation ?? ? V? ? e/ a ? 131 ? ? 2/? ? ? dv ? DIMENSIONS • Lot lineslBearings 8 dimensions • Right-of-way and street width (W back of curb) • Proposed home dimensions induding any proposed decks, overhangs greater than 2', porches, etc. (i.e. all structures requiring permanent footings) • Show all easemenis of record and any City utilitles within those easemenis • SMbacks oi proposed struclure and sideyard setback of adjacent ebsting structures • Retaining wall req Reviewed: March 1998 CpAIGrBLDGPRMf.FM 1 CITY USE ONLY L t BL ? SUeD. Pi..4e-FY - RECEIPT #: I 1 -1 RECEIPT DATE: - - PERMIT A 1999 PLU1fdBIRfi PERbIIT (fL5IDENTIlkl) crrYaFE?swA s83o Pu.o1' xiros su . BABAN, ]NN 551E8 ?-." (s3t)68Y-4a7s Please complete for. D sinple famity dwellings ? townhomes and condos when pertnHS are required for each unit ? beckflow preverrter for underground sprinkler system FIXTURES EACH # TOTAL t?i wu Floor drain n .'...?.7 X x = ,•?_ $ 3.00 Gas i in outlet ' mimmum - 1 3.00 x = $ 3,Q Hot tub/s a 3.00 x - $ Kitchen sink 3,00 X - g 0.p'D Laund tra 3.00 x - $ Lavato 100 x - $ p Minimum fee alterations to existin dwellin 30.00 x = $ Private Dis osa15 stem new/refurbished " requires MPC iia 75.00 x - $ Private Dis osal S stem abandonment 30.00 x = $ RPZ new installation/re air 30.00 x = $ Rou h o nin 1.50 x $ Shower 3.00 x $ .p Under round s rinkler if dwellin is under construction 3.00 x - $ Under round s rinkler if existin dwellin 30.00 x = Water closet ' 3.00 x = $ .db Water heater 3.00 x $ 3_00 Water softener if dwellin under conswcnon 5.00 x = $ Water softener if existin dwellin 30.00 x = $ Water tumaround 30.00 x $ State Surchar e .50 -> -> -> $ .50 Total -> \5"b.0 .-a."JVNV?Oa 4l.??.?- ?,IL 11 /??. 4f?r4s.?E 4.yA.+P w?ORaTC, .. cv?.ii???.er: 4/?,a?i ivP /II?OF/ +n .? ?04? . . . . ? . ? ?. . ? .. ? hereeY adcn?s?vled88 that i have read thFS ?CeBm. atate that tlie infama.. B .m is oorrect, arM agree Lo comply wiTh all applica6Ie Ciry of Eagan ordinanoes. It is Me appGpnCs responsibitiry to nollfy tlie property owner Mat the City of Eagan assumes rw IlaWqh for any damagas pused by the City durinp its narnal operaUonat and malntenance actlvWes to the fadl(tiea conshuc0ed under fhls penmt within Cily qopeRyhight-of-way/easement. SITE ADDRESS: OWNER NAME: :?? TELEPHONE #: &14 Pa.S- 9a5?R (AREa CooE) INSTALLER NAME: T?7i „? ,O? ? i,_da? ,.Av,P? • TELEPHONE #: 651 5`a3 -?3?30 (AREA CADE) STREETApDRESS: CITY: ?-ru?ve.?.tf"? Y STATE: W.J ZIP: ,?a'ob8 ? SIGNA URE OF PE lTTEE )? CITY USE ONLY LOT -& BL J RECEIPT#: I II J 3? SUBD. Q,l`k 1'DYL S? RECEIPT DATE: MECHANICAL PERMIT # 1999 MEcHAxicAL PERMrr (REsIDErrr[Aw crrY of Ens,ax sgso Paor Krros Rn E4fiAN MN 551 EE Date• (651)6$1-4675 Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under construction and not owner /occunied. iIAC. v i An ? i T 1 T T ADL:T:O:JAL sc M BT-u 6.00 • Gas outlets (minimum of one required @ $3.00 ea.) '.?• 00 ? State Surcharge .50 Total $?? (D Complete this section onlv if you are remodeling, adding to, or repairing an existing single family dwelling, townhome, or condo. Please indicate if i[ is a new item, alteration, or repair. _ New Furnace _ Air exchanger Alteration Repair _ Other Reminder: Call 681-4675 for inspections. Air condirioning Other a 'su.0U 5tate Surcharge .50 Minimum Total Due $ 30.50 SITE ADDRESS: ' OwNER NAME: ? INSTALLER NAME: STREET ADDRESS: CIT1' sEa 2 8 2:,9 PHONE #: - (AREA CODE ? PHONE • (AREA CODE) L BL SUBD. CITY USE ONLY RECEIPT #: RECEIPT DATE: APPROVED BY: , INSPECTOR MECHANICAL PERMIT #: 1999 MEcHAvIcAl. PERNIrr (coafME[tcIAW GITY OF EAfiAN 3$30 PILOT KNOB ftD EAsAN, MN 551 ES (651) 681-4675 Please complete for: ail commercial/industrial buildings multi-family buildings when separate permits are not required for each dwelling unit LI ? ! Lr. .^'?/lA1Tl? ? l1T y Trl?T. VJ3\liVi?l (Ulilr.• WORK TYPE: New construction Install U.G. Tank _ Interior Improvement _ Remove U.G. Tank (Minimum Fee) _ Processed Piping (Minimum Fee) •'NOTE: When installing/removing underground tank, ca11 65 1-68 1-4675 for inspection by fire marshal and plumbing inspector. DESCRIPTION OF WORK: FEES: I% of contract price OR $30.00 minimum fee, whichever is greater. CONTRACT PRICE x 1% PERMIT FEE STATESURCHARGE TOTAL ------------- ----------- SITE ADDRESS: OWNER NAME: TENANT NAME (IlvIPROVEMENTS ONLI): INSTALLER: ADDRESS: CiTY: ZIP: ($.50 per $1,000 of,pemtit fee due on all pertnits.) PHONE #: (AREA CODE) PHONE #: - (AREA CODE) STATE: SIGNATURE OF PERMITTEE ? RESIDE NTIAL BUILDIN Gn City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 9 651-675-5675 FAX # 651-675-5694 New ConsWction Reaui2ments 3 registered site surveys showing sq, fL of bt sQ. fL M house; and all roofed areas (20% rreximum lot coverage allowed) 2 copies of plan showing beam & window sizes; pvured found design, etc. 1 set of Energy Calculations 3 copies ot Tree Preservation Plan 'rf lot platted after 711193 Rim Joisl Detail Op6ons selecUon sheet (buildings with 3 a less units) Minnegasco mechanical ventilafion fortn RemodeUReoair Reouirements 2 copies of plan showing foo4ngs, beams, joisLs 1 set of Energy Cakulalbns for heated additions 1 sde survey ior additions & decks AddAion • indkate Mon-sde septic system "oo Office Use OnN ./ CeR of Survey Recd , r ±Y _ N TtcePresPlanRecd _Y_N. T2ePres Required Y'_N On-site Septic System ..? . .. _Y. _ N 5111-11) -rflQ4DA Date (JJr l? l O?o Coostruction Cost Site Address 7736 /?wc L,¢NG Unit/Ste # /vW , S /2 Description of Work .D c cK - NeLj Multi-Family Bldg _ Y t" N Fireplace(s) _ 0 ? 1 _ 2 Property Owner UAVaES t!' 1Ro54!-E? 712 • Telephone #(6/S/ )Y2 3-Sa 73 o _ 990 w P- 6s'"1 - 6-7s - 57 0 0 Contractor SEZ F 4ow"t-i,Q 1 Address CitY State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 7670 CateQOrv I _ Minnesota Rules 7672 Energy Code Category . Residential Venfilation Category 1 Worksheet • New Energy Code Worksheet submissiontype) Submitted SubmRted . Energy Envelope Calculations Su6mitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a masTer plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone #( Telephone #( ) D LS ?? Telephone # ( ) MAY 2 2 20[ I fiereby 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 accgrdance witti the approved plan in the case of work w'ch requires a review and approval of plans. 91kn--c z 'P ccxiskF? .'l2 : // Applicant s Printed Name (A plicant s Sigiature DO NOT WRITE BELOW THIS LINE ! ? Sub Tvpes ? 01 Foundation ? 07 05-plex ? 13 16plex ? 20 Pool ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 EM. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 EM. Alt - SF ? 04 02-plex ? 10 08-plex )< 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10.plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex ? 25 Miscellaneous Work Tvpes ? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding A 32 Addition ? 36 Move Building ? 42 Oemolish Foundation ? 45 Fire Repair ? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors ? 34 ReplaCement `Demolitian (Entire Bldg) - Give PCp handout to applicant UC5CflptlOn: Water Damage _ Yes aoAllo ? Valuation Occupancy MCESSystem Plan Review F) 1 00% or _ 25% -- / ' ? Census Code '7 3 ( Zoning City Water SAC Units Stories Booster Pump ? # of Units - Sq. Ft. ? PRV ? # of Bldgs ^ Length i /q Fire Sprinklered Type of Const _ZL3 Width 10 REQUIREDINSPECTIONS Footings(new bldg) Sheetrock ? Footings (deck) FinallC.O. _ Footings (addition) A FinaVNo C.O. Foundation HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs Air/Gas Tests Final ? Framing _ Siding _ Stucw Lath _ Stone Lath _Brick _ Fireplace _ RI. _ Air Test _ Final _ Windows _ Insulation _ Retaining Wall Approved By: Base Fee (/ 5urcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total _, Building Inspector ---------- ? . .? f l? * snpin * * * * Certificote of Survey for --- "'uis• 625 Hiqhwoy 10 N.E. Bloine, MN 55434 ?812) 783-t880 FAX:783-1883 -mad: WONEER2EPRESSENTER.COY MANLEY_BROS. CONST. i 4936 PINE LANE LOT AREA =12.412 sq. ft. HOUSE AREA =2,175 sq. fi. i W i W ? Z? i., t 15 . BENCH MARK TOP OF PIPE-, EXISTING ELEV.=976.60 1 ' \ 977.9 978.1 . ? 3 13 ITELE; \\`\? N N N89*41'520E ? 975.5 --"'3p.00 974.5 in c 10 n CO o, aS'' 974.4 Go d0 04, F? •r I i VI 974.0 . O oD O 0 2 876. (9711 ? 976Ji ?/ /? 'E? ? IEV.?H64.S .-L 4 :::4,90 ° o /c `?4,00? 1 ? I ? 1 ? ? 3 L 10 - '"}' 14 p 0 976.7 IA ? I 3? t3 I/ ' . BENCH MARN ? TOP OF PIPE• ELEV.?977.22 979.61 Enterprise Drivs to Heighln, MN 55120 ) 681-1914 FAX:881-9488 I ? 1,36.50 ?O 0 Lf 1 , i ? 10 977.6 x 978.3 ? ?, ? +rr'- . 16 .r \ .x `o a# I z ( QN _ 4Po977.1 _oW J 10. ,G M. 1rV_? aIG'/tf 38.33 ' 976.90 976.g?9-4j'?J20W 19?.? ( 3 r exrsnNC ? _ o CAR. p I f 17 ND(E' PROPOSED CRRDES SHOWN PER GRADNIG PLAN 8Y: E.G. RVO : NOFE: dU1LWJG WMENSIONS SMOWN AfiE fOR HMIONTAL AND VERTfCAL LOChiION OF 51M/CNRES Ot0.Y. SEE ARGMtECSUAi PLANS FOA BUILOING AND Fp{INOATION OIMEN9Wi5. nOTE: NO SPEQF1c SIXlS iNMESnGAnIXi NAS BEEN COAIPLETEO ON TNIS t0i 0r THE SUpyETpR. THE SUITAOMITr pf $01L5 i0 SUPVORi 1N[ SPECIfIG HWSE PROPOSED i5 NWl THE RESPOn5WJiY OF THE S1RVEYIXt. 6 e?a.o (?i ??i A? OD co r W 5 Q OD O N r?rt!?'.- 97414 4 PROPOSEO HOUSE EL VATI N LOWEST FLOOR ELEVATION: 0' TOP OF BLOCK ELEVA71014: ?? GARACE SlAB ELEVATION: i ,r,lt--7- T08 O IOOKOUT ELEVATiON: NUK: TH4 GEfl71FICATE OOE$ NOT PUR70RT i0 SNOw EASEMENTS oiHER THAN X 000.00 UENOTES EwSDNC ELEYAIIIX+ RiOSE 5110YM ON THE REGORDEO VLAi. I 000.00 ) p[NOTES PR0705ED ELFVATION - pENOlES dtA1NACE M1p UM1TY EASEYENT NOIt: CprvBpCIUR MuSi vtiRIFY pRIVEWpY OESICN. -- -> OENOIES ORNNAGE flOW DIRERiON NOTf: BEAkiNCS SHOWN ARE BASED ON AN ASSUMED OAiUM -0-•- DENOIES MONUMENT -c- UENOTES OFFSET HUB WE HEREf3Y i:ERTIFY TO MANLEY BROS. CONST. TNAT TN15 l5 A TRl1E AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF LOT 16, BLQCK 3, PINETREE FOREST DAKO7A COUNTY, MINNESOTA 17 OOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS. EXCEPT AS SHOWN, AS 9URVEYED BY ME OR UNDER MY QIRECT SUPERVISION THIS 28 DAY OF APRII_. 1999. 12'e `, i SIGNEPI EER ENGINEER? , P)A. SCALE : 1 INCH = 30 FEET ? --? BY: 5R} 9R775 79 ,LIS J n C. Larson, L.5. Reg- Na. 19828 ü ÿ ÿþþ ýîýü úþþðîè á öîö Þáá ÿþö þýüûúùôöêñöýûúù øöûúùõ öùòýÝ ö ñýñíýùú ð þïýöî êöùöùùööêÿööóýóùö ÷öêüöë þ ýööùüýêùë ñöüóéöööïýöüú êóúóë îçæçååëåëå õú þýöö èýçæçëäëä èýÿë ôó öòñ ùù þôê ôó ûöú öÚ éöìäá þëý ãõä àáßååá öüú ìöùùêöóöö öóùú ùùüþ êãþýñúê íöë ùù÷ ýúþ ýö Use BLUE or BLACK Ink For Office Use City of Eakan I Permit oer p I Permit F • u~ I 3830 Pilot Knob Road ?013 I ee' I Eagan MN 55122 I I Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 Staff: 2013 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: 7c? 3~r_ X ?,w:;, 4,, Tenant: Suite Resident/Owner Name:, W / ~05,I A. ~ Phone: ~ Y2.3 ~E0-2-3 Address / City / Zip: /K Name: MILBERT COMPANY INC dba CULLIGAN WATER License 063031-WC Contractor Address: 1801 50TH STREET EAST City: INVER GROVE HGTS State: MN Zip: 55077 Phone: 651-451-2241 Contact: BILL MILBERT Email: Type of Work - New Replacement - Repair - Rebuild _ Modify Space Work in R.O.W. Description of work: RESIDENTIAL Water Heater Lawn Irrigation RPZ / - PVB) _;PMer Softener Permit Type Septic System Add Plumbing Fixtures Main / Lower Level) - New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation (includes $5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $200.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) TOTAL FEES $ 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 or4 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 out a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval o pl Applicant's, Printed Name x Applicant's Signature w FOR OFFICE USEReviewed 13y, : "Date: Required Inspections: -Under Ground Rough-1h _ Air Test Gas Test Final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