3158 Quarry CtCITY OF EAGAN Remarks
addition Donnywood Addn. Loc 9 etik 3 Parcel Ab 20960 M 031
Owner??`r --.'r?' i'. •:?i. U/?? Street 315$ QU.az'T,y Ct,. State Eagan,rN 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
* STREET RESTOR. 1975
GRADING
SAN SEW TRUNK z 1970 62.80 2.51 2 Paid
* SEWERLATERAL Z 1975 2278.78 455.75 5 Paid
- -
WATERMAIN
3? WATER LATERAL 1975
3? WATER AREA 1975 5
* STORM SEW TRK 1975
* STORM SEW LAT 1975
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 130.00 lQ 6 7-1-74
BUILDING PER.
sac 00.00 1 G969 7-1-74
Receipt '
1. Date
3. Job
4.
PLUMBING PERMIT
CITY OF EAGAN
Fil1 in numbered spaces
Type or Print /egibly
j 2. Installation Cost
C
Y
Pe?mit No.
Fee
S/C
Tot
_Blk. ? Tractz?"flV! 1"rf?dV
5. Contractor ? Phone 'r"
6. Address
7. City State Zip
8. Building Type: Residential fif Commercial ? Institutional O
9. Work Description: New ? Add M/ Alter .? Repair ?
?
10. Describe ?-
11.
No,
?, • Fixtures
Water Ctoset No. Fixtures
Cesspool/Drainfield
Bath tubs $eptic Tank
l.evatory Softner
Shower Wel I
Kitchen Sink
? Urinal/Bidet
Laundry Tray Other
? 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 ancLcodes governing this type of work.
Signed : ? i-' ? ? j -±? • for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454$100
W, i? 1----
CITY of EAGAN N° 3332
BUILDING PERMIT
.
Owner ... . ................... ... .... ....V--- ........... •-• -
Address (Areseni) ..?. . ....... ...........4.?...?-- • .. .?"'-( e
Buildes .................... .................................................
Address ......--•-••-• ............................................•-•-...••,.........._...............
DESCRIPTION
3795 Pilot Knob Road
Eagan, Minnesota 55122
454-8100
na:. ...... .. .... . ?....?:?'
5iories To Be Used For Fron!
- Depth Heigh! Est. Cos! Pqrmi! Fee Remarks
W?w 74 16 .???0? ?I ?=a LOCATION
Slreet, Road or other Description of Location _ 1 Lot I Block I Aaaisioa or -rrac:
C3 /?? 11 1-3
This permit does not suiho#i4e the usq( of sireets, roads, alleys or sidewalks nor does it give the owaer os his agea!
the right fo create anp siYuatibn whieh is(a nuisance or which presents a hasard !o the health, safely, convenieacs and
general welfare !o anyone in the community.
ILE THE WORK IS IN OG E.
THIS PERMIT MUST B K ?,,?ON T PFjEMISEF
has permission to erect .......... .... ........ ... .........................._upoa
This is !o certify: thai__?.... ??`?- ?..??.. ..
the above describe emise subject to the pisions l applicable ces f e Cit E a
-•-•--••••-• ..... -•--•-• • .- ....................•••-•-•-. Per .....• •-• -.....-•--•-....... _......?.. ...... ........ .. ................................
ay0 r Building Iaspector
??? ?isg a-?
/D '5?09(,"o
-?29?ny") cro
('I7'i O^ ??GAN
379? I'ilot I:r;ob i u.zd
EaF;s.?., T?iinnesota 55122
FER1vJT NO e e f-7^
The City of Ea.-an hereby g.rants to K1a:-v, T?eat:inr, ro.
of 55337
a Permit for: ?O?aner) CYE:3C.1tir? :r
1329 & .
aL 3 ; ., ., pursuant to application dated
Fee Pai.do ? " dated this 3.7 day of =1?v , 19 7=1
,
1. Jv .J/C
Building Inspector
Mechanical Permits:
Bid Total:
CIT`z' ?r FACAN
3795 i ilot Rr;ob P.c>a.d
I?aga_., .'Iinnesota 55122
PEIR.M1IT NO e : 557
The City of Eaoan hereby grants to F,-„d Vog,t re
_ of 12fin Vn hmn Ava An_' 3t_ IQni a Pk _ 55d96
a Permit for: (Owner) rrE•ar_iv?, gmwing,_„__ ??` ?-.
1341 5,1329 Jurdy a8d ?` , - . -
?u?, pursuant to application dated -?7/7a
.
Fee Paicie 0U DU datec? this 31st day of Tutv 9 19 7d s^?!
2.50 s/c
Building Inspector
:^echanical Permits:
i'3_?.1
? a T0t-a1:
/-
CITY of EAGAN
BUILDING PERMIT
own.: ......9r.:../..A-,??..........a.!.r.?..c_.?.?.l.C?.....
Address (pr.sens) .?l.,?f?....?.uPjt,
.r ... ............ ".?.v.?.?.
Builder .......... a...?.d11..LJa.f .......... .../2.cO....?....?f..••-•--.._.........
Address .•••• ...............................•-••••-•........._..._.....--•••....................._....
DESCRIPTION
eir
N2 3695
3795 Pilot Knob Road
Eagan, Minnesota 55122
454-8100 ?
Date Z ? ?••..-?r..?:?......1......
-•? ••
5_.ries To^Be Used For Fron! Depth Heigh! Est. Cos! Perm' ea
- Aemasks
r
?'udllvt 1 (2y oo/ f ,feWC /
/
.?YC7 o ?
?t s,?rp or ? a?
?-
-S? ?QPa?'' ?' ,•
/ ? J
LOCATION
Slreet, Fl.+id or other Description of Location I Lo! I Block I Additioa or Trac!
'
0 I , //b
This permii does lp63 sulhor'iae the use of streets, :oads, alleys or sidewalks nor does it give !he owner os his ageat
!he right to create any siluation which is a nuisance or which presents a ha:ard io !he health, safely, aonveniestce and
generai welfare to anyone in !he communiiy.
THIS PERMIT MUST B-ErK PT ON T E PI ? ISE E THE WORK IS IN PROGRESS. ,
This is io certify, ihat..?./.?_._?? .. ...iG, ... ._..has permission to ezect a.?>?/1..?.. .. ... "?!?6p
the above described p is subject to th?e /rovisions all applicab ces for the C' o gan. '
........... .
.--•-..?-•--••-- -- •-•-----"' . .f.t ?.Y...------• ........................ Per ...... . ._ ....... ---•---• .......... .. ....
_... . .-- -••---
yor BuildinQ Iaspectos
YILLAGE OF EAGAN WATER SERVICE PERMIT
3795 Pitol Knob Rood PERMIT NO.: 1529
Eagan, MN 55122 DATE: 7/15/74
Zoning: PUD No. of Units:
Owner:
Address
Site Add
Plumber: Klamm Plumbing & Heating
Meter No.: Connection Charge: 190.00 pd
Size: Account Deposit:
Reader No.: -s?-5--7 ?--?? J?4 permit Fee: 10.00 pd
I agree to comply with the Yilloge of Eogan Surchazge:. • 50 pd
Ordinonces. Misc. Charges MwteZ' 60. 00 pd
Total:
BY Date Paid:
Date of Insp.: Insp.:
vtLLadE roF EacaN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 2287
Eagan, MN 55122 DATE: 7/15/74
Zoning: PiiD No. of Units:
Owner: Crpat iVe HOusinq
Address:
Site Address: 3158 QuaYYy Court
Plumber: Klamm Plumbing & Heating
1 ogrea to comply witb the Village of Eogan Connection Chazge: 400.00 pd 7/1/7,
Ordinonces. Account Deposit:
Permit Fee: 10.00 pd
Surcharge: • 50 pd
BY: Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
RSS{DINT{AL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EACAN MN 55122
651-681-4675
New Construction Reauirements
• 3 registered site surveys showing sq, ft. of lot, sq. ft. of house; and all roofed areas
(20% mauimum lot coverage allowed)
• 2 copies of plan showing beam & window sizes; poured found design, etc.)
. 1 set of Energy Calcula6ons
• 3 copies of Tree Preservation Plan if lot platted after 7/1/93
. Rim Joist Detail Options selection sheet (hidgs with 3 or less units)
DATE 0 - C) C. " O Q
RemodetlReaair Reauirements
• 2 copies of plan
• 1 set of Energy Calculations for heated additions
• t site survey for exterior additions & decks
• Indicate 'rf home served by septic system for additions
VALUATION A0alp
StTE ADDRESS ?)IS4? QU,Q,'( (U COU6,_ MULTI-FAMiIY BLDG
TYPE OF WORK 11' "r\&Q_X?b tA11? FIREPLACE(S) -
APPLICANT
i !
STREET ADDRESS
TELEPHONE # (z(.'oZCQ4,•4444- CE
_Y _N
0 _ 1 _ 2
RE\TEVWAL BY ANID'ERSEN, I?iiC. ;
1920 COUNTY RaAD "C" WEST I STATE ZIP
ROSm VILLE, MN 55113
?a??s9s3 i#
PROPERTY OWNER ?O?\%-.) W?Y`-. TEtEPHONE # (?SI • ??I 2(SCoy ?
Energy Code Category
(4 submission type)
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
- MINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
Plumbing Contractor: ___
Plumbing system includes:
• Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
. Energy Envelope Calculations Submi#ted
Phone # ? __
Water Softener ? Lawn Sprinkler Fee: $90.00
? Water Heater _ No. of R.I. Baths
? No. of Baths
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor:
Air Conditioning
Heat Recovery System
Phone #
?^ ?, Fee: $70.00
,
Phone11,#
i hereby acknowledge that I have read this application, state that the in ormation is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Or ' ances.
Signature of Applicant rIAPA
OFFICE USE ONLY
Certificates of Survey Received , Tree Presenration F'lan Received _ Not Required _
. Updated 4/02
OFMCF-JUSE ONLY
? 01 Foundation
? 02 SF Dwelling
0 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex ? 20 Pool
O 08 06-plex ? 16 Firepiace ? 21 Porch (3-sea.)
O 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 10 08-plex p 18 Deck ? 23 Porch (screened)
0 11 10-plex ? 19 Lower Level 0 24 Storm Damage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
Nbr. of Units
Nbr. of Bfdgs
Type of Const
? 30 Accessory Bldg
0 31 Ext. Alt - Muiti
? 33 Ext. Alt - SF
0 36 Multi
? 35 Int Improvement ? 38 Demoiish (Interior) ? 44
0 36 Move Bidg. ? 42 Demolish (Foundation) ? 45
O' 37 Demolish (Bldg)* ? 43 Reroof D 46
*Demolition (Entire Bidg only) - Give PCA handout to applicant
Occupancy 'MC/ES System
Zoning ' 'City Water
Stories Booster Pump
Sq_ Ft. PRV
Length Fire Sprinklered
W idth
Siding
Fire Repair
Windows/Doors
REQUIRED INSPECTIONS , -
Foorings (new"bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Fool ` Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final
Windows (new/replacement)
_ Insulation _
_ 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
..,...,.,..?... ?u? ??.?? r?. ?o? a?? •ggoo.,x?u??w nrmrunec?mr
reoa1 ..
s?r.+xo?• .
Juna '7, ZOOI
c- ity of Ea.gan
3836 Pilot Rnob Road
Eagan, MN 55-122
?
To Whom It May Concgrn: _
Elder Jones is authorized to p'all bnilding permits for Rgnewal fiiy Andazsen_ plcase allow
Elder Joncs to proti•ide this Servicc for us in
date beyond 616I01; watil a?`anewal b And?xsen ' 'ITua auth cx?zahtm ?s valid foT ??y
?
' ??8 Ly y manam expressly revokes it in wiiting
tY-
I rcquESt this authorizatian be a'ccepted- - ?
aur baildin ?P?dously, as to not delay in the proccssing of
S P--mit3 i+ay faxthcr. Plcasc call mc If thcm acc aay qucsttona.. I can Ua
cvntacted. at 763-502,4706. _ , .
, -
9. ? .
YOU[ it111riolft SftIILiOII LO thiS IbSttCi' I3 appBCiflYed. -
;
Sinceiely, , vnd'R. Rau
tistallation Ma?n,ager .
Remowal by A,udascn Corporatiton .
('.c:: Ks?ra-Fdc?p:r T?nee • ?
ou2
:
C?H p
MWY?a?
Received Tia+e Jun. 7. 1:01PM
wuuxsu
CERr?FiCATE OF SURVEY
r r OR
CR EA T/ VE HOUS/luG /NC. - ?
s
(JTILITY ESl'7'7-
8y"Y8"W • - ti
7 00
137.30 - , 620
30 i 46•0 pROPOSEa
D o ?? z o o1
I ,
T
? DW'FLLINGQ /
? ? i y O I ?O PLRN
#7Re0 ersed ? ? ?Z [/
• ? v1 V? y -1 ? ?? 0 0
?g •p ? ? z6,o . ??
.
, o
sca?E ')Q1 ? -?y H? 3°E
?
1 - 30, ? ? 30 \ -' lJ
, -,
O DEN0TES `nCiN 1 ?'??•
MONUMENT
Lot 9, Block 3, Donnywood
Dakata County, Minn6sota
mmm?
'
TRANSPOFiTAT10N ENGpJEERING ARCHI7ECTURE
dATNER. RINGROSE. WOLSFELD. INC 612!831-2300
7101 1IppK AVENUE SOUTM EDINA. MINNESOTA 55435
I hBreUy ceri fty tho' th?; survey wcJS pr8pOr8d
by rm,(,r urider my (Jirect sjpervision and
that I am a duly Registered l.and 5urv2yor
undet e )aws of tt& 'iN te of Minnesota
C)'. I td e'l - / 3 -7/--'ZReg. No. _7?95 -
?`aot ;z 8?? j 9 7 ?
I agree that the City of Eagan is granting me a
building permit in Donnywood Addition with the
understanding that Eagan shall not be responsible
for any assessments or improvements levied against
my property and further that I assume further
responsibility for any assessments or costs of
Improvements.
?
? ?
? ?.
?? .
ilk
ir
CONSTRUCTION EASEMENT
This agreement made this 22nd day oF September, 1975
by and between John and Mary J. TancheFF, (hereinafter identiFied as
TancheFf) and Creative Housing, Inc. , a Minnesota Corporation,
(hereinafter identified as Creative).
Whereas TancheFF is the owner of property identified
as Lot 9 Block 3, Donnywood Addition, Dakota County, Minnesota,
(hereinafter identiPied as the property), and
Whereas TanchePP proposes to construct a swimming
pool on the property, and cannot complete construction of the pool
without accessing the rear oF the property From outside the property, and
Whereas Creative holds Fee Title to Outlot A of Donnywood
Addition From which the property can be accessed,
Now thereFore it is agreed as Follows:
Creative hereby grants to TancheFF an easement until
November 15, 1975 to utilize Outlot A, Donnywood Addition as an
access to the property For the purpose oF constructing a swimming
pool on the property.
This easement is contingent upon the Potlowing:
1. TanchefP shall remove, at his own expense, the sod from
Outlot A and shall stockpile the sod for as long as equip-
ment is accessing the pool construction area, or until
October 30, 1975 whichever First occurs.
2. TanchefF shall restore the grade levels of Outlot A to
the grade levels which existed on September 22, 1975,
supplying any necessary Fill at his own expense, prior
to re-planting the sod previously removed.
3. • TancheFF shall replace the sod on Outlot A in a
wormanlike manner, rolling and watering the sod
to promote growth. In the event that any or all of the
stockpiled sod is determined (in the sole opinion of
Creative) to be damaged or dead and to be un-plantable,
then Tancheff shall purchase suFFicient new sod oF a
quality acceptable to Creative to replace the damaged
or dead sod and shall install the new sod on Outlot A
at his own expense.
4. TancheFf shall deposit with Creative the sum of $250.00
upon execution of this agreement to be held in escrow
pending satisFactory completion of conditions 1, 2 and
3. In the event that TanchePf has not completed con-
ditions 1, 2 and 3 on or beFore November 15, 1975,
then Creative shall have the right to complete `any
uncomplete or unsatisFactory work, utilizing any or
all of the $250.00(escrow Pund.
5. Prior to commencement of any work on Outlot A, ?
Tancheff shall deliver to Creative,
prooF of builders risk insurance in an amount not less than
$10,000, and prooF mof public liability in an amount oF -
not less than $1,000,000.00.
This Agreement contains the entire agreement between
the parties relating to the property. This Agreement may not be amended
nor may defaults hereunder be waived except by an instrument in writing
executed by the parties sought to be charged with such amendment or
waiver. This Agreement shall bind and inure to the beneFit of the
parties and their respective successors and assigns. This Agreement
may be executed in any number of counterparts, each of which shall
for all purposes be regarded as an original. This Agreement shall
be governed by the laws of the State of Minnesota, and its terms and
provisions shall survive the closing of the sale contemplated herein.
'IN WITNESS WHEREOF, the P i s have ?
hands and seal this 22nd day of September, 7.
AMENDMENT TO CONSTRUCTION EASEMENT
TanchefF hereby agrees to hold Creative harmless From
any costs oP medical care, lost compensation due to loss oP work or
any other costs in the event that Tancheff or any person employed by
Tancheff is injured or becomes ill as a result oF doing the work on
Outlot A as required under the Construction Easement dated September
22, 1975.
�
Use BLUE or BLACK ink
r---�---�-----_----�
I For Office Use �
� �� � Permit#: �� � ��� j �',
�b� �1 ����� 1 P rmi F : ' .� � ��
e t ee
3830 Pilot Knob Road � � � � '
Eagan MN 55122 � Date Received: � �
Phone: (651)675-5675 I I '
Fax: (651)675-5694 I Staff: �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION '
Date: Site Address: Unit#:
Name: �J �t''�I" � 1���- Phone: (D��" �o�`_�� '
Residentl '
`Owner Address/City/Zip:� �' �i.:)u�'�'�-�� (..�"
= Applicant is: Owner �Contractor
Type of�W01'k Description of work: K.--�v�-���'�:: L r'`j`�-11Zj�'G`1� ��'L—
Construction Cost: Multi-Family Building: (Yes /No_�
Company: 'f��. � � �_ ���-�-+'�i G(:. � .J-�" 'LContact 1`"`��'�
Contractor i Address: �Zv� t,,�.3' `�,C��`}'`'` �� city: ��c�-1' //����
State:�Zip:���''7 Phone:r�fz "l9�! '"7���'anaiL• '
: License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) ,
I
I
I
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING �I
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: I
Sewer&Water Contractor: Phone:
NOTE:Plans and supporting documents fhat you submif a"re'considered to be public information. Portions of
fhe information may be classified as non-public if you provide specific reasons that would permit the City to
conclude tha't 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
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
X����� ��C�/�-��1���� �
Applicant s Printed Name Ap ' . s ignature
Page 1 of 3
,
C!ty of aaaii
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
RECEIVED
AUG 032016
Use BLUE or BLACK Ink
For Office Use
Permit #: 30 0Og
Permit Fee: (Q d Cl
Date Received: 8'3 ")
Staff:
L.
2016 MECHANICAL PERMIT APPLICATION
0 Please submit two (2) sets of plans with all commercial applications.
Date: 1 U.') Site Address: 31 S3 aIALLYY► CI .
Tenant:
Suite #:
Address / City / Zip:3 S
J
Name: Snelling Company License #:
Address: 1400 Concordia Ave. City: Saint Paul
State: MN Zip: 55104 Phone: 651-646-7381
Contact: Jody Pflipsen
Email: jody@snellingcompany.com
New Replacement
Description of work:
Additional Alteration
Demolition
RESIDENTIAL
Fumace
Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under/Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge
COMMERCIAL FEES
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
100. 0 0 TOTAL FEE
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 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.
XPhilip Krinkie
Applicant's Printed Name
x
Appli
Use BLUE or BLACK Ink
r
For Office Use
City of Eaall Permit#: I I V ,
Permit Fee: G(D ,
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675
Fax: (651)675-5694 Staff:
J
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: '2) ` q I 1 i Site Address: 3 S (2t ca.✓vJ CT €49 ctio,/►11✓..557z./ Unit#:
Name: I'\�.i I > V) t (4— Phone: 0 5/— C842—01/45—
Resident/
(rLfSResident/ JJJ (
Owner Address/City/Zip: 31 E O. (O vVj C1 GGt3Ct,�i
Applicant is: Owner ✓Contractor
r f G i'
T e of Work Description of work: -7-9 >I-bV�s( (a � S l� I 0 x
Ypfir
Construction Cost: thiitif • 17 Multi-Family Building: (Yes /No )
Company: --� D''e9 y'l-(.- Contact: V I l<v1
Contractor Address: ' i ID -1-11-0--1 13 City:tcA.,✓h 50/ ik
StateIO Zip: 5533`) Phone:952131-30°°Email: `._Arl I nel-e 4pei IS
License#: -- 1%, 15"
Lead Certificate#: f\)41-4-— 2Z 5'1(0,- OZ
If the project is exempt from lead certification, 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 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:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe 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.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must ompleted within 180
days of permit issuance.
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Applicant's Printed Name Applicant's Signature
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