2093 Quartz LaneINSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55122-1897 Date Issued:
(651) 681-4675
SITE ADDRESS: APPLICANT:
. .; i , t:? ?t I ' ' f r11Y? • -
i't lJlrar fl•ikilf ii.l F.'rt<s
PERMIT SUBTYPE:
TYPE OF WORK:
Permit Holder Date Telephone #
SEWER/
WATER
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING ???
/
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
DOMESTIC
METER
IRRIGATION
METER
FLUSH
MAINS
CONDUCTIVITY
TEST
HYDROSTATIC
TEST
BSMT R.I.
BSMT FINAL
DECK FfG
DECK FINAL
CITY OF EAGAN Remarks
Cedar Grove Acquisition
Addition CEDAR GROVE #4 Lot 13 eik 4 Parcel 10 16703 130 04
Owner'---'"? /' ' Street 2093 Quartz L3lle State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
* SEWER LATERAL N 1972 1,304.00 52.16 2$ Paid
WATERMAIN
WATER LATERAL
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
. . K •.Y : . . . .
PERMIT #
MECHANICAL PERMIT RECEIPT #
CITY OF EAGAN C?
?
?
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: 6
CONTRACT PRICE: PHONE: 454-8100
Site Addrqss 2 C ` BLDG. TYPE WORK DESCRIPTION
Lot Block ` Sec/Sub
X
x N
R
o ATE
Add102 ExeG sior
o '
• r ew
es.
Mult Add-on
Comm. Repair
c City
g3f3•-1 ? ? Phone Other
,
Name
FEES
c Address RES. HVAC 0-100 M BTU -$24.00
p City Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
ADDITIONAL 6 M BTU - 6.00
TYPE OF WORK GAS OUTLETS - 1.50 EA.
Forced Air M BTU COMM/IND FEE - 1% OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Heater M BTU MINIMUM - COMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent. CFM BEYOND $1,000.00)
Gas Piping Outlets #
,
Other(t;1136v 2
FEE:
S/C: , SG SIGNAT Y E OFJPERMITTEE
TOTAL: ? SO
FOR: CITY OF EAGAN
; .
?.
EAGAN TOWNSHIP
BUILDING PERMIT
owae: .....G?I?...?.1..4-?*:-.................................................
Address (H:eseni) ??.93._???'`?'? .??.:..---•-----------•------
v
Builder ..... ? :._.-•?-,--.-?-"-p-? --..---•----•-----••-•--•---.....-•-•-----
Address
.... ...... -- •--•----••-•-...... •---°.......... -._.. .-•----............
N° 2199
Eagan Township
Town Hall
Date ..........................................
:....
53ories Tq Be Used For Front Depth Heigh! Est. Cos! ' Permi! Fee Remarks
LOCATION
Stree2, Road or other Description of Location I Lo! I Block I Addiiion or Trac!
J 3 I y 1 e. - 4 y
This permit does not suthorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the righi to create anp siiuation which is a nuisance or which presenfs a hazard to the heal2h, safely, convenience and
general welfare fo anyone in the communily.
THIS PERMIT MUST BE K PT ON THE PREMISE WHILE THE WORK IS. ?IN`PR?,,OGRESS.
This is to certify, fha!____ ..has permission to _.._
...... /? . .-..?....-..?._....._........_upon
. ------••-•
--•• ---------------------------------------
the above described premise subject to the provisions of the Building Ordinance for agan ownship adop2ed April 11,
1955.
?e
. ....................... Per ................... -•..... - ............... ,f -._...•---......-•---------°----°•
-•Chair-?n of Tnwn. Board Buildin Inspec2or
B,
? Eagan Towriship
Dakota County, Minneso3a
Application for Bailding Perauit
PERMIT NO. ...................
nate ............_i?/?8.----
Type of building or work contemplated. Circle correct descripiions.
Resideniial Commercial Indusfrial Olher.............................................. -................................
.
Euild Enlarge Alter Repair Install Move Wreck Other-----------------------------------------------------------------------
Dimensions.._1,7 . ./.A-15 . . /•---...•-••---••• Cost... ?_ 7 ?.s. '-?J
........
Details or semarks.......... ?--- -- `- --•••---?-`??---•-------•••-•--•-•----------------------°•-••--•--•---•-----•----------•-----•-------°-•------------------••--• --°
Location 2.e) 9-3 . ?
Number I Sireet I Between whaY cross streets I Sizo ? Est. Valuation
or
?3 I z1 I C - ?6 • ? ?
Owner -- •----.....-•-°--•-•--•---•--•?-l•-----°-------•--••--------
Contrac2or ..--------------- ......... ...... ...........
?
$ .... Y............
............
Total fee collected.
Permit fees are not
refundable.
.................. AddrQSS .__---•-----------••------•------------------------------------------°-----------------------
•---•-._......__. Address
---•--... •----• •--•-• •-•-•---?!es??h?-?h?-•---------•----------•----...---•°-----
?
The undersigned hereby makes apnlica on for a permit 30
do work as herein specified, agreeing to do all work in strict
accordance with the building ordinance adopted Aprii 11, 1955
by the Eagan Township Board of Supervisors.
,
.
---••-• -•--• C?/?.-•• --" ----- -------•--•---•----•-----•--•----------•------•-•-•----•-----
? 5igned ?
i 1 n, ? T Z ?Cvv?
v?yt
EAGAN TOV1/N S H I P
BUILDING PERMIt
Owner -•5,,?%¢'ui`--.`--.,?-a--e`'-?--:__?`-'?------?"?---'-•-•----_
Address (preseni) _ 3J-/ ------ - --- ...:i-----_-•?:./
Builder -----•-----•••----------------- ---- --- ----------- ------------------•----•--
Address .-•-- --- ------ ----------------= ?- - • ---•---------•-------.----------•--------- ---
DESCRIPTIOld
N° 826
Eagan Township
Town Hall
Date z-
------- -- --- --
ilories To Be Used For Froni Depth HeighY Est. Cost Permit Fee R"emarks
rTc? "75
v LOGATION
Streei, Road or other Descripiion of Locafion I Lof 1 Block I Addiiion or Tract ,
:?. + LY=-
s-- ? -- 9-/? - i3
This permit does not authorize the use of streeis, roads, alleys or sidewalks nor does it give the owner or his agenf
1he righ! 2o creaYe any siiuaiion which is a nuisance or which presenYs a hazard to the healfh, safe2y, connenience. and
general weifare to anyone in ihe community.
THIS PERMIT MUST BE KEPT OI? THE PE?MISE, WHILE THE WORK IS IN PROGRESS!?'M"
This is to certify, ihat.._ ....... ........ - _......... __.has permission fo erect a---- ___.__ --- --? . .. . ------ upon
?-t?rio . C----°--- •••---•
ihe above dESCribed premise subject to the provisions of the Buildinq Ordinance for Eagan Township-'adopted April 11,
1955. ......... /
............
'??_.--/?"/--•-_••----•-------------•.-.. Per --------------•-------------- - ?-----?............ -:.1 --•-??L?= --
Chairman 4 Tnwn Board Building Inspeclor
?qpqZ
2005 RESIDENTIAL BUILDING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reauirements RemodeVReoair Reauirements Office Use Onlv
3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and ell roofed areas 2 copies of plan Ced of Survey Recd _ Y_ N
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _ Y_ N.
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y _ N
1 set of Energy Calculations Addition - indicate if on-site septic system On-site Septic System _ Y_ N
3 copies of Tree Preservation Plan'rf lot platted after 711193
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Date Construction Cost ? ,`?
Site Address 4".0- Unit/Ste #
3
i
Description of Work
Multi-Family Bldg _ YX N Fireplace(s) _ 0 2
PropertyOwner Zo--p- QQ.-. Telephone # ("( ) 6- 61 `? -7 Li-
Contractor
Address C?tY
State Tele hone # ('76.3)
1/ 111 ! r? '?
•1,,r????hd
1ll '??i1i?* ?:
COMPLETE THIS AREA ONLY IF CONSTRU ING A NE l? ING
- Minnesota Rules 7670 Cateeorv 1 - - 11 °""" ?"' ',",`
Energy Code Category Residential Ventilation Category 1 Worksheet • New n ode Worksheet
(4 submission type) ? Submitted Submitted
. Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
N If so, 25% plan review
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
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
O 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
Work Types
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 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 Plbg_Y or_ N? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 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* ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement *Demolition (Entire Bldg) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) Final/No C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final
_ Framing Siding
Stucco
Stone
Brick
_ Fireplace _ R.I. _ Air Test _
_ Final _ _
_
_
Windows
_ Insulation _ 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
W6V
2005 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Requirements
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, eic.
1 set of Energy Calculations
3 copies of Tree Preservation Plan if lot platted after 7/1/93
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
70, v?
_
Remodel/Repair Requirements (,?frce tJse t7iilu
2 copies of plan Cert of:survey Reed _ Y N:.
1 set of Energy Caiculations for heated additions Tree Pres Pfan Recd
1 siie suroey for additions & decks 7ree F?res Requitetf
Addition - indicate if on-site septic system Om-s3fe:SeRtic Systsm
Date C, 60
Construction Cost
Site Address 04?_? 4 11Q_ Unit/Ste #
D
ri
ti
f W
k 0
&n
ZW_ X;"
esc
p
on o
or :
Multi-Family Bldg _ Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner Ae'7q
\1 ?T Telephone # (65 1
a
cG"?
Contractor
Address City
State 4 d G°d'1 Zip-553 Telephone # (7d3) 2 7 14•'s•
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categgry 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(?l submission type) Submitted Submitted
. Energy Enveiope Caiculations 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
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
Statutes; I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval o plans.
_ ? ?Ekr ?ark
Applicant's Printed Name
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 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 Plbg_Y or _ N ? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
Work Types
? 31 New ? 35 Int improvement ? 38 Demolish Interior ? 44, Siding
? 32 Addition 0 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement "Demolition (Entire Bld g) - Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
? Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof
Ice & Water Final Pool _ Ftgs _ Air/Gas Tests Final
_
_
_ Framing _
s Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wa11
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 ^
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN 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°k 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 711/93
• Rim Joist Detail Options selection sheet (bldgs with 3 or less units)
DATE
SITE ADDRESS
TYPE OF WOR
???? • 00
IULTI-FAMILY BLDG _ Y _ N
FIREPLACE(S) ._ 0 ?1 _ 2
RemodellReoair Reauirements
• 2 copies of plan
• 1 set of Energy Calculations for heated additions
• 1 site survey for exterior additions & decks
• Indicate ff home served by septic system for additions
VALUATION
APPLICANT lC?/
STREET ADDRESS CITY
TELEPHONE #_ ? ?- L3-eELL PHQNE # FAX #
,TE ? ZI P ???`?
PRQPERTYOWNER rk'24 TELEPHONE#
COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ NIINNESOTA RULES 7670 CATEGORY 1 MINNESOTA RULES 7672
(4 submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted
• Energy Envelope Caiculations Submitted
Plumbing Contractor: Phone # _
Plumbing system includes: Water Softener Lawn Sprinkler Fee: $90.00
Water Heater No. of R.I. Baths
_ No. of Baths
Mechanical Contractor:
Mechanical system includes:
Sewer/Water Contractor:
Phone #
Air Conditioning E 4 e?- ,$?70.00
? ?L a
Heat Recovery System
J
Ph
I hereby acknowledge that I have read this application, state that the informatigm is c=ae-to comply
with all applicable State of Minnesota Statutes and City of Eagan ' an .-
lxz??
Signature of Applicant
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ? - -
OFFICE USE ONLY
Certificates of Survey Received Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
? 01 Foundation
0 02 SF Dwelling
? 03 01 of _ plex
? 04 02-plex
? 05 03-plex
? 06 04-plex
? 07 05-p{ex O 13 16-plex
? 08 06-plex ? 16 Fireplace
O 09 07-plex ? 17 Garage
? 10 08-piex 0 18 Deck
? 11 10-plex 0 19 Lower Level
? 12 12-plex Plbg_Y or _ N
? 20 Pool
p 21 Porch (3-sea.)
? 22 Porch/Addn. (4-sea.)
? 23 Porch (screened)
? 24 Storm Damage
? 25 Miscellaneous
? 30 Accessory Bldg
? 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi
? 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
0 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
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addirion) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool ? Ftgs _ Air/Gas Tests Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation ? Retaining Wall
Approved By
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
Building Inspector
PERMIT
CITY OF EAGAN
s a-331D Pilot Knob Road
Eagan, Minnesota 55122-1897
(651) 681-4675
SITE ADDRESS:
PERMIT TYPE:
Permit Number:
Date Issued:
2093 QLIHRTZ t_AiVE
LClT- 13 BLClCiC: 4
CEDAR GF?CIVE #A
P<I>Ne e 10-16703-130-04
BuxLDrNG
033977
11109l98
DESCRIPTION:
E R oaF
sToRri nAMAGE
REPATR
434 AI 1`, RESIDEN+f"IAL
a ?.
41?dd;
ib 0 ?§4a e o °...5
REMARKS:
FEE SUMMARY:
C:UN I FiAI: I VF(:
VVVIVtti: App].a.cant --
RA DRE
2093 QUARTZ LANE
EAGAN MN 56122
( 651 ) 681--1 749
)Q)?? C"t-40
APPLICANT/PERMITEE SIGNATURE SUED BY: SIGN URE
1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAGAN
3830 PII.OT KNOB RD - 55122
? 681-4675
New Construction Requirements
? 3 registered site surveys
? 2 copies of plans (inGude beam & window sizes; poured fnd. design; etc.)
? 1 energy catculations
? 3 copies of tree preservation plan if lot platted after 7/1193
required: _ Yes _ No
RemodeURepair Requirements
? 2 copies of plan
? 2 site surveys (exterior additions 8 decks)
? 1 energy calculations for heated additions
DATE:
?
DESCRIPTION OF WORK:
STREET ADDRESS:
CONSTRUCTION COST; O? 0
ot - sybrm _-Dapn 0
A
U
LOT: ( 3 BLOCK: 14 SUBD./P.I.D. #: ??-- G(U ?l _--? ?--
(Z? D?c
Name: XIS? Phone Z
PROPERTY Last First
OWNER
Street Address:
Ciry State: Zip:
Company: Phone #:
CONTRACTOR
Street Address: License #
City State: Zip:
ARCHITECT/
ENGINEER Company: Phone #: ,
Name: Regisuation #:
Street Address:
City State: Zip:
Sewer & water licensed plumber (new construction only): . Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that I have read this application and state that the
State of Minnesota Statutes and City of Eagan Ordinances.
is coRect and agree to comply with all
Signature of Applicant:
OFFICE USE ONLY
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No
D 1:9 ?-q-lu \jV a .
?i Nt, l - 9 1998 ,
Not
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation 0 06 Duplex
O 02 SF Dwellins ? 07 4-plex
? 03 SF Addition 0 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
?? .
? 11 Apt./Lodging ? 16 Basement Finish
O 12 Mulfii Repair/Rem. '? 17 Swim Pool
? 13 Garage/Accessory ? 20 Public Facility
? 14 Fireplace ? 21 Misce{{aneous
? 15 Deck
? 36 Move
0 37 Demolition
Basement sq. ft.
Main levei sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
MC/WS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
Planning Building Engineering Variance
Permit Fee
' Surcharge
Plan Review
License MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/V1l Permit
S/VN Surcharge
Treatment PI.
Park Ded.
Trai{s Ded.
Other
Copies
TotaL•
Valuation: $
% SAC
SAC Units
Use BLUE or BLACK Ink
r----.----'---------
For Office Use
l i fr ;
Permit
City of EaRd [
Permit Fee: L05.
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: l
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Cate: -L 3 Site Address: 0? 0 73 qL"q e~~ Unit
Name: Ct Phone:
RESIDENT / ,
OWNER Address /City! Zip: ova1?3 yqq--~Z kk 6gyl g
Applicant is: Owner Contractor
TYPE OF WORK Description of work: ~~Q:5 t!
Construction Cost: Multi-Family Building: (Yes / No )
Company: rLk Contact: G ~ e
CONTRACTOR Address: 7ab~ a4 t-(0~ City: 5" Lz~(_5
State: V k`i` + Zip: J73 b Phone: ~6d
License yG~ 36s?_6 Lead Certificate
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.gopherstateonecall.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 Minnesota State Building Code must be completed within 180
days of permit issuance.
x e- e-r x I(4tw~~
Applicant's Prin ed Name s Sig ature
Page 1 of 3