4061 Pumice LaneCITY OF EAGAN Remarks
Addition CEDAR GROVE #7 Lot 3 Blk 3 Parcel 10 16706 03n 03
Owner I1'• ? street 4061 Pumice Lane State Eagan, MN 55122
Improvement Date A ount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK sf 1970 58.18
* SEWER LATERAL f Z 97
WATERMAIN
? WATER LATERAL (q7/
WATER AREA
* STORM SEW TRK 1971 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 260.00 -1957 2-29-71
BUILDING PER.
sa,c 200.0 3257 2-22-7
PARK
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly Tot
.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
L e. ?,._ t
r
4. Owner ?'K h
- - -
5. Contractor Phone
6. Address
7. City i ri 1,a-« State •'-? ^- Zip ?.-
8. Buiiding Type: Residential Q Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair O
10. Describe
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other lfX
Laundry Tray .
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: ' ' for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
?EAGAN TOWNSHIP
BUILDING PERMtT
Owner --• '6??'"`'' (& -
-••-•••-••-•-•....---• ...............•••..._... ••-----........_...-•••-------•-•••--•--.._.
Address (Preseni) •:-••-----?/? `
-••--•• ............ ....•-••••----._.....•--•-•--••-••--
Builder .......-••••••-•••••--••••--•...••------•-......._..•••-• .................••-•••-•••••-•--•-..
Addreas .....................•-••••••••-..__.....-••••••••._....._..........._...-•••••••••••-•••••••-
DESCAIPTION
N° 2388
Eagan Township
Town Hall
Date ._ °Z1 ?' ??,? ..............••-....
Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks
LOCATION
Slreel, Road or olher Description of Location I Lo! Block Addition or Trac!
This permii does noi aulhorise the use of sfreets, roads, alleys or sidewalks nor does it give the owner or his agent
the right io create any siiuation which is a nuisaace or which presenls a hazard to the healih, safety, convenience and
general welfare !o anyone in the community.
THIS PERMIT MUST BE KEPT ON THE PRE?MISE WHILE THE WORK IS IN PROGRESS.
This is to certify, thai---Ce -..:-4!??---•'c?_`^':-"t-•?--has permission to erect a..-.... ..... `-•... ?"'? ..•-••••••-••••._upon
--?-
!he above described premise subject to the provis.ions of the Building Ordinance for Eagan.Township a od" pted April 11,
• ............
1855.
•°-,•°...__.._....-/•--•••-••••.._...?..........-•-•••-•••- '
?-• ...
Chair an of Tnwn B?oard •..?. Per .....................'?:?:._....:CI__.......... ...................... ....... •.......
? ? Building Inspeclor
?
EAGAN TOWNSHIP
BUILDING PERMIT
._..---• •-....--•--. ...........•
•----• --•°---••-•-----
Ownei •----- ez " ..__. ...... .....•---
Address (Presea!) ........... ?• .................................... .. ...................
Builder ......... ........ !?a`............................... ••--•-•.....
Address ........................•-••----•---••-•---•----•--•--._....._...---••..........•-•..._......_
DESCRIPTION
N? 2604
Eagan Township
Town Hall
C. ? /................
Da3e ..? ???.? ?
.....
5tozies To Be Used Foz Fron! Depth Heigh! Esi. Cost ' Permi! Fee Remarks
?,v?-
? 0-0 Xc.
LOCATION
Street, Road or other Description of Location I Lo! Block Additioni or Trac!
This permit does no2 authorise the use of streets, zoads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard !o the health, safeYy, corivenience and
general welfare !o anyone in !he communiiy.
THIS PERMIT MUST BE EPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.
This is to certify, lhat...tf?.---•--?...................... has permission to erect a....... `?. -••-•- ....... .... upoa
,- ..............
the above described premise subject to !he provisions of the Building Ordinance for Eagan Tow' ship adopted April 11,
1955.
....... Per
................... .... ................. of.?:.?.. T?..- ------.. Board......... ....... Suildinwn . ................................................ •- ,-....g . Insp ............................
Chaisman ? ector'13
? - . ?3-3---7
TOWN 0F EAGAiV
3795 Pi1ot Knob Faad
St. Pau1, Minn. 55111
PERMI T N0. 86
The Board of Stipexvisors hereby grants toCedar 8roye Construction Co.
of 7343 Cdncord Blvd. E. So. SC. Paul 55075 a PLUMBING
Permit for: (Owner) Cedar Grove Construction $t 2866 Jade Lane 6. 4061 Pumice Lane
, pursuant to applicaCion dated February 17, 1971 ?
Fee Paid: $40.00 Dated this 2?? d day of February , 1971
Bu;.lding Inspector
-*ryE SUSSEL CO.
1850 COMO AVE. ST. PAUI
CALL: 645-0331
SALESMAN
CONTRACT DATE f-'t't 2??
CONCRETE WORK ORDER
NAME M.R • 3'FE?c=S 04 • Dfl_K1iq PHONE#'/:.;V -&6YV'
JOBADDRESS
BLDG. CODE AREA 17 eA0&4, r""
FOR OFFICE USE ONLY
CONTRACTOR TCI, V i-1 ?-- JOB #.
SUSSEL JOB # '7 ?-s 4- ; CONTRACT # 300- jS
I INDICATE THE ITEMS BELOW ON LAYOUT I
)?Permit by
' Legal Description
r'' Lot
? 21k
i.? Add'n
? Value
1-'iType Const_
"-?<'Square With 14 i 4 ?`=
i-J Rods
V.Mesh
? Sod Rem. - By
? 5 Bag Mix
?o 33 ag 1? A ix
? Tamping
;d; No Tamping
XA.B.U. CdEt??f`? -
2 Startings Points Only
S.P.L.
_ S.S.P.L.
R.P. L.
- AI{ey, ,
, n E z;,,i T
v7 ?.5 ?AC K 4-l r' ?41 ouse(; f- ..
F. Street?`'.
Xt'QLIIeY
-L-1 CONDUIT
N,'O.H. Dr. Offset
X S.D. Location
74-$fesk s
XWindows
?
22
S 'f--
_-
ncR ...?_? ' . I
? ly??'?'s ?
?-
?
( ^j /.5G
>
?. \ , .
? ... ?
n
?
?
1
ic C-.??0Q- A spc,RC.r-
u
-/??D
?
,.
DIRECTION ?
_ ?``;. ? . . . ? . .
. . . _ ? ??-?., . _ . ? . . . . . ? . . ? ? ?
MASTER CARD
• LOCATION
OWNER
STRUCTURE AND
LAND USED AS
•
Permit
No.
Issued Issued To
ConTractor Owner
BUIIDING
PLUMBING eL4e
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAL
HEATING
GAS INSTALLING
SANITARY SEWER
OTHER
OTHER
• - Approved
Items (Initial)
FOOTI NG
FOUNDATION
FRAMING ?
FINAL
ELECTRICAL
HEATING ?
?
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANITARY SEWER
?
COMMENTS:
Date Remarks Distance From Well
/? . '/ SEPTIC
CESSPOOL
Z,- TILE FIELD FT.
?.z-?--
DEPTH
OF WELL
Violations Noted
on Back
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
9
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF COfVSTRUCTION AT TNIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVlA710NS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS fOLLOWS:
? NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
Wltl BE DELAYED 8Y CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
DATE OF REINSPECTION
?
REINSPECTION REVEALED
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions ot;served to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
a ALL IMPROVEMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
CONIMENTS:
DATE
•
? 23
. LOCATION
OWNER
STRUCTURE AND
LAND USED AS
MASTER CARD
I
ss
Permit No. Issued Contractor
BUILDING 3 fir , /_ L4. G.
PLUMBING ?
CESSPOOL - SEPTfC TANK
WELL
ELECTRICAL
HEATING
7 Q?
GAS INSTALLING
SANITARY SEWER D
OTHER ?
OTHER
• Items
rOOTING
FOUNDATION
- FRAMING
FINAL
ELECTRICAL
HEATING
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING
WELL
SANI7ARY SEWER,
t
0
COMMENTS:
Approved
(Initial)
D
Date
_?? I !1
? '?7• ?i
3-,) ` 7l
• ur -
.
Remarks Distance From Well
SEPTIC
CESSPOOL
TILE FIELD FT.
_ 4- ? DEPTH
OF WELL
d To
00
/
?
Violations Noted
on Back
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
?
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
a ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
? REIPtSPECTION REQUIRED
REINSPECTION REVEALED
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
DATE OF REINSPECTION
CERTI FICATION - I certify that I have carefully inspected the above in which I have no interest present or prospective, and that I have reported herein
all significant conditions observed to be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? AL! lMPROVFMENTS ACCEPTABLY COMPLETED
BUILDING INSPECTOR
CONUAENTS:
DATE
.
0
23
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMtT FOR WATER SERVICE CONNECTION
Date: February 17 1971 Number: 543
?
3-3-7
Billing Name: Cedar Grove Const. Co,. Site Address: 4067 p„mi,rp T.ane
Owner: Same Billiag AddressZ343 co s,ord Rlvd_ F_
South St. Paul, Minn.
Plumber: Stein, Inc. 55075
Location of Connection
Meter Siz er +Connection Chg.
2/22/71
Meter No.i Permit Fee 10.00 pd 2/22/71
Meter ReadingiMeter Dep.
Meter Sealed: Yes lAdd'1 Chg.
NO ( Total Chg.
Building is a:
Residence xxxx
tlultiple A*o. Units
Commercial
Industrial
Other
Inspected by
Date
Bemarks;
A'._If'r.? ..'i i t.. .. . .,.... . .. .
.,-?,- ,^ ?s i-, A. ;? •,
By:
Chief insgector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulatioas of Eagan Township, Dakota County, Minnesota.
By: CED AR GROVE CONSTR.UCTION COMPANY
Please notify the above office when ready for inspection and connection.
EAGAN TOtiJNSHTP
3795 Pilot Kttob Road
St. Paul, Minnesota 55111
Telephone 454•5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE: Februarv 17. 197:1
OWNER: Cedar Grove Const. Co.
PLUNlBER Stein, Inc.
NUMBER 702
(Lot 3, Block 3, Cedar Grove #7)
Address 4061 Pumice Lane
TYPE OF PIPE a t T on
D ESCRIPTION OF BUILDING
Industrial` Commerciall Residential Multiple Dwelling No, of units
Location of Connections:
Connection Charge 200.00 pd 2/22/71.
Permit Fee _ 10.00 nd 2/22/71
SCreet Repairs
Tota l
Inspected by:
DaCe
Remarks•
By
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree Co do the proposed work in accardance with the ruies and
regulations of Eagan Tox-mship, Dakota CounCy, Minnesota
By- CEDAR GROVE CONSTRUC^TON f'(3MPANY
Please aoCi.fy when ready for inspection and connection and before any p rtion
of the work is covered.
PERMIT # L? I
RECEIPT DATE:
8002 RESIDENfIAL PLUM$INC PERMTf APPLICATION
crrY og EAsM
3$30 PILOT KROH iiD
EA6lkN, MN 55188
651-681-4695
Please complete for: single family dwellings, townhomes and condos when permits are required for each
backflow preventer for irrigation system
? L
1? ?
p?2 Uf?C??,
MAR 0 6 ZDOZ ? I
u
?
BY ?.?.?
SITE ADDRESS: ?Q?? ru'joVL(,. C -P- r 1
OWNER NAME: : T"nc TELEPHONE #:
(AREA CODE)
INSTALLER NAME: NiCGIJ+RE $ SOi',!S TELEPHONE #: _9S a R3\-90 ,?,P
UU5 ih avenue 'outh (AREA CODE)
STREET ADDRESS: HnQkinsMiv 55343
CITY:
STATE: ZIP:
_ SEPTIC SY5TEM, new/refurbished (requires two sets of pians and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATION/ALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
I `
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
Water turnaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener ? water heater $ 15.00
State Surcharge $ .50
T
l $ ?l
ota
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable City of Eagan ordinances. It
is the applicanYs responsibility to notify the property owner that the Cit.y, of Eagan assumes no liab' 'ty for any damages saused by the City during its normal
operational and maintenance activities to the facilities constructed under this permit with City operty/right-of-way/easement.
? AE;S Z, U?
? r? SIGN TU E OF PER ITTEE 1/02
?IA?0-1
2004 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas
(20% maximum lot coverage allowed)
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 711193
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
RemodellRepair Reauirements
2 copies of plan
1 set of Energy Calculations for heated additions
1 site survey for additions & decks
Addition - indicate if on-site septic system
Office Use-;C7nlv
Gert of Suruey,"ketxi _ Y _N
Tree pre,s Planfiectl, =Y ? N!
'Cre6PresRequir?dp ,, _Y
pn-site Septic spstem _Y _N'
Date Construction Cost U Z''o t 00
Site Address ? ? 6 1( t-c ? Unit/Ste #
Description of Work L? ? G,-,
Multi-Family Bldg _ Y? N Fireptace(s) ? 0 _ 1 _ 2
Property Owner ?D ?1 ki C J ?-n ? cs?? ?? P ty rf - ?ssn sP.?, r -I
?` --? GJ q Telephone #( ) L.`r+?"f . Ilvd 6?ikrc?rlP
Contractor G?OO
Address City
-?
State ? Zip ( ff Telephone #(?)
,
/V'
COMPLETE THIS AREA ONLY 1 CONSTRUCTIN4 NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(4 submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y ` N If so, 25% plan review
fee applies.
?
Licensed Plumber
Mechanical Contractor
Sewec/Water Contractor
Telephone # (
Telephone # (
Telephone # (
I hereby apply far a Residential Building Permit and acknowledge that the information is
that the work will be in conformance with the ordinances and codes of the City of Eag,
Statutes; I understand this is not a permit, but only an application for a permit, and w
permit; that the work will be in accordance with the approved ' ie case o wo B
approval of plans. `
pplicant's Printed Name Applicant's Signat ,L,'
Zd plete and accurate;
the State of MN
not to start without a
requires a review and
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06: 04-plex
Work Types
? 31 New
C] 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Occupancy
Zoning
Stories
Sq. Ft.
Length
Width
Roof _ Ice & Water _ Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
Insulation
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Final/C.O.
_ Final/No C.O.
_ Plumbing
HVAC
Other
_ Pool _ Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco , Stone _ Brick
Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total ,
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage O 22 Porch/Addn. (4-sea.)
? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo)
? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 12 12-plex Pibg_Y or _ N ? 25 Misceilaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
*Demolition (Entire Bldg) - Give PCA handout to applicant
12.09.7/8'
46,0-a2
C!ty ef Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use ,�, /C
�.
Permit #:
iu
Permit Fee:
Date Received:
Staff:
2012 MECHANICAL PERMIT APPLICATION
Date: /Z.L.Q /1 2_ Site Address: LIo to I 1 1A1'v /l e . e _
Tenant: Suite #:
'RESIDENT /OWNER;,
crcl
Name, Re,r( �Y Y1r ..At'YlC e1 Phone: 2' asa .-750)
Address / City / Zip: (-ib1. I P(�Ylte _` 'e_ _
CONTRACTOR:
,
•_
Name: f L �, t"fe >f Ct]lflo"'"L!icen e#: MI')�J /2- �/
Address:() -n111)160+1 fve, City: GDAen Vi 4.v
State: VAN*-% Zip:,LI.Z' Phone: -714).1' Jq2 - I/
Contact:&t,6Ct ` j ori<S Email: —NFD e4-F1/SF-E ti kw1 'L0'
TYPE;OF W;OR.K
4444...
New X Replacement Additional Alteration Demolition 1
_
Description of work: �lt-03.\43' r iterict C t -1- lir Cm -16411)111n
....._...,,•:,.....,�.� "�rt ,... ��., .,",;.
. ,: �;�:..: ., . :�: 4444 •.:
NOTht;Rodf rhd"ilntdd ant) u"nid;riioiJ
Codd Plea§e con"f cl the Methanicai
.. ..,. 4444.. .. .. ,. . .� . ..
_ _ �;n�
ted':me't h riit I eq i0°ment'is::rr gU�rdd� 'o' o spoe 10d 4 -Cit
lnspe'Ctor for:;Informat Oi. ot►;;perrl'tr4gd screening methods.
PERMIT TYPE
1 RESIDENTIAL
t Furnace
COMMERCIAL
New Construction Interior Improvement
---1—Air Conditioner
Air Exchanger
Install Piping Processed
�--,
Gas Exterior HVAC Unit
Heat Pump
Under /Above ground Tank (___ Install /_Remove)
Other
_
RESIDENTIAL FEES:
$60.00 Minimum Add-on or
alteration to an existing unit (includes $5,00 State Surcharge)
burned out appliances, ductwork, etc.) (Includes $5.00 State Surcharge) _ $ TOTAL FEE
$100.00 Fire repair (replace
COMMERCIAL FEES;
$75.00 Underground tank installation/removal
$60.00 Minimum (includes
(includes $5.00 State Surcharge)
State Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by 5,50 for each 51,000 Permit
Fee requires a $ 5.50 surcharge)
OR Contract Value $ x 1%
= $ Permit Fee
- If the pramilzea is less than
- If the Permit Fee Is > $10,010,
= $ Surcharge
Fee / 00
$ b • TOTAL FEE J
= CP
(i.e. a $10,010-$11,010 Permit
CALL BEFORE YOU DIG. CaII Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 43 hours before
you Intond to dig to receive locates of underground utilities. www.gopherstateonecall.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 approval of plans
x
A.pllcant's 'r) e. ame
App icant's Signat
FOR OFFICE USE
Required Inspections: RevleWed ay:... ;bath:
Underground Rough In AirTest Gas Seryloe Test ;_ Ir) -floor Heat _-„�;�Final �HVAC Screening
G00 'd I0I OGI;569G .0N Vi ONlsb'HH HHti'IH Nb 9f7:60 fH,L/Z I0Z/GG/dHS
Glenn Roofing 7633899278 p.1
Use BLUE or BLACK Ink
1------s----- ----t
t For Office Use 1
115
o n I Permit I
City Ul I
of EaV n
5
~ Permit Fee: 10 55 I
3830 Pilot Knob Road I 2
Eagan MN 55122 Dale Received ~J t
I 1
Phone: (651) 675-5675 I
Fax: (651) 675-5694 ~ staff: ~ j
IleSI_~c
2013C _ 1 BUILDING PERMIT APPLICATION
Date: 9 -119 -13 Site Address: A Mice
Tenant Name' (Tenant is: New / Existing) Suite
Former Tenann: f
Name: Phone: 1Q 11-
Property Owner ' Address/ City/zip: 1,2A .5 5 1) 1
a
I
i Applicant is: Owner Contractor
t'
Type of Work Description of work:
Construction Cost Z -54 `7.
Name: C.a /P a 4 1~00~/ tit C, License
Address: ~Sfh Of City: f Amt ll~i/7
Contractor Cj
State: Zip _ Phone: '//a 331 -109V
t
1
Email- r r,
1 It
Contact: ::Y0.e!)Ql nPI
s
Name: Registration
L
City:
' Architect/Engineer ' Address: f
State: Zip: P one:.
Contact Person: Email.
Licensed plumber installing new sewer/water service: Phone i
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-orq
t 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 a ication 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 ca o- work hich requires a review and approval of plans.
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Applicant's Print Name Ap s Signat
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