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4160 Raptor Rd04/21/2014 12:20 Les Jones Roofing, Inc. (FAX)9528817009 P.0111011 4111' City of Eaaa 3630 Pilot Knob Road Eagan MN 66122 Phone: (651) 675-6675 Fax: (651) 675.5694 Use BLUE or BLACK Ink For Office Uso /Permit #: Permit Fee: 361: Date Received: Staff: J 2014 RESIDENTIAL BUILDING PERMIT APPLICATION 'z52%/9 Date: 470431/54 f Site Address: WO- 4i// S/-W(a8 */?. if'4P12, Roo' Unit #: sn�� , � � ice. o ; �� ���at� ��,,�,,,,-1 �� -� ,, � tzcam.;, "' y 0 G �vG. 94 Name: a f� T� rt�.�" � Phone: �' �� �9 Address / City / Zip: y p: Applicant Is: , B 2 5 v �O 01c ?� /N a2� G�o�.s 6,r�-s /12i✓ 5324ro Owner _X. Contractor 1. � sh ; '''p'a,- ' ,'�t .:'st''' ` Description of work: Construction Cost p' ,4ii/t.1 Z16PMC.E44"6 - 2-9 c2 , 2. 9s Multi -Family Building: (Yes...X./ No ) � � 1,: li%- it 4'Address: rho a fw a��o)` v 'ql 0 .' r: `: ; -'; To QaFin1C�` � nTG Contact CH�RtS �jp51�.`�� Company:• L Ott W S' L—� -�City: .3.hDM.troCTT?Al State: MLN Zip: S----.14-2-0 Phone: Si9'—$g(-2-241 License #: (aSc,O Lead Certificate #: NAfi q0.372--1 If the protect Is exempt from lead certification, please explain why: (see Page 3 for additional Information) In the last 12 Yes _No months, If Contractor: Contractor: COMPLETE THIS has the City of Eagan yea, date and address AREA ONLY IF CONSTRUCTING A NEW BUILDJNG Issued a permit for a similar plan based on a master plan? of master plan: • Licensed Plumber: Mechanical Sewer & Water Phone: Phone: — Phone: c"ii ` c U e4o e r, ° aro " i',`he ff., " �q �i i k. d i //( (/,.�� �� 1 4 � it 1. � r ...-" i) /i��"�'e� �� / 1� , u���- ity�,`�dt(ij ;p{' s ' � �t .,Ai Idy�A ..', / " e`'° e r k 'j. .i I i4 (} � X 77 �j�A''' r��Y it .d.i0° ri02' ) ° Ir° 1. 91l / 9411 �7�ri u% '�"o /2y�,C �..}1�i. t;, 'k/�-. 1. ������� �l � y 4'���,i9s� G i��l��q)�!� �'L(�yiyPLb C71(�rr�'_ ��'.n rF 1 �, ��' n r /n Y Cl �y 1�,, �,1. ! °Y�°.f?.t'° �f u.li10;i ik°F J ��01*;, 7 �'¢A� ).0 1i° 4/, �Q, �r�t( jrtfo '� ;�,yf��,r. ��'�'•' ,�.cl � �r ' � � ' .. � fyr�-ppb-y'� ii �� (�;i'XAA° r al-l�A� 0,?f, 1-i(-0' A I �trJr..l. r. t. ,,: ,.r; ,,,,, !r•. .:i 's : "jF CALL_BEFORE YOU DIG. CaN Gopher State One Call at (661) 464-0002 for protacUon against underground utility damage. Cab 48 hours before you Intend to dig to receive locates of underground utilities. www.000herstateonecall otq I hereby acknowledge that this Information is complete and accurate; that the work will be In conformance with the ordinances and codea of the City of Eagan; that I understand this Is not a permit, but only an application for e 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 leeued In accordance with the Minnesota State Building Code must be completed within 180 days of permit leeuence. 40.14is 47%/4e-72,5 ate! x Applicant's Printed Name X Ap Ilcant's Signature Page1of3 NOV-06-03 01:50 PM JUDKIMS EMAN FNr3+C0M 15EU i 96514234181 0514234189 NC1. 308 ? icak'L $ubd. t? .? ?? 3;tr ?ress, ? r ? " l.Ak 1' • ?.? On April 15, 2000 the Mlnnesota Energy Code, GetegOry ISuldt Ftequirements fot insulabvn pratection, air tightnegt, and vent;lation, w&s adppted. As e result, th9 Ciry of Ea9an is requiring that the following RnfbrmaUon 6e submitted prlor ro issuancse oi a CeMificate nf arcuRancy. TNS SWchura, 16 00+'4tructsd to rnoet min:mum re?4uirements of ths Mn EnergY Cade, Chapter 7970 ? 4R _;hip spveture: w1f4hM aan,tructed ta meat mars re;ff+ctlv9 roqulrernenta af Chapters 7672 ar 7674 ? ? P.0a APPU14NCE GAS rLtC MANUP,4GTWRER MOGE6 9 LU'S IIEKtiNG 11fPE Witer HB?tC? ? y? ' ? ? ] qo Fwn acp? a pryet ? iXFiAUST SYiTEIVI LGCATIOFi TYPE MOQEL CFM's ochen Barhroorn ! B?thraom 3 ki?d??n 1rU c'11? ? Bathroom 4 Dth?r L.- FfRE ffi tOCATIQN GtS WQpb iMNIJFACTURER ?IODEL #NtJ'i VRIITRlO DIl1?C'f lITIMID? 1 heraby wlcnvAdp0 fhat the above Aformabar. is cmrrect arr. aqroe to tomp? wlth tne Minnesote F.nergy Gods ana ciry ot eaW r??iroM?nls. I -.s?Z- .63 -- s?gna?+t? At 141_ oote Compeny Kams " Tt+is lorm is the reapcroriblAly of tna GereriLl CDnltBCtar. I ? Address: 4160 Raptor Rd Zip: 55122 Lot: 4 Block:2 Subdivision: Greyhawk THE FOLLOWING ITEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON I 117163 Yes No Comments Final grade - 6" from siding ° ACk Permanent steps - garage Permanent steps - main entry Permanent driveway ? Permanent gas Sod/Seeded lawn Trail/curb damage Porch Lower level finish Deck Fireplace ,4 C,.,j v 6 ,, • Verify with your builder that roof test caps from the plumbing system have been removed. • Turn off water supply to the outside lawn faucets before freeze potential exists. • Call the City's Engineering Department at 651-681-4645 prior to working in right-of-way or installing irrigation system. BUILDING INSPECTOR ?lk V _ cd/bldginsp/forms/2002/final inspection checklist L--? __17?? RCSIDENTIAL BUILDING PERMIT APPLICATION CITY OF EAGAN f P 3830 PILOT KNOB RD - 55122 651-681-4675 New Construction Reauirements RemodellReaair Reauirements 1._ • 3 registered site surveys showing sq. ft, of lot, sq. ft. of house; and all roofed areas • 2 copies of plan I? ??° •`??j (20°k mauimum lot coverage allowed) . 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window sizes; poured found design, etc.) . 1 site survey for extedor additions & decks • 1 set of Energy Calculations • Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan 'rf lot platted after 7/1193 • Rim Joist Detail Options selection sheet (bidgs with 3 or less units) DATE Q2)' VALUATION ? ?5S)000 JOB SITE AD RESS - T-- Q., 0 - 4 0 Y ?OC-o GA L'? ?Q- ??l h,? /?. IF MULTI-FAMILY BUILDING, HOW MANY UNITS? 4` PROPERTY OWNER W ?Jo ? TYPE OF WORK FIREPLACE(S) )?0 _ 1_ 2 APPLICANT ? W ? O YI son PHONE# q `J-? '69 a 7070 ADDRESS l-7?°r ? ?1 v n / 1? P?1 1--G?. & Vj t t? ZIP CODE ?564 ? PAGER # CELL PHONE # ?)2--_I01 ??,(7_I FAX # ??J" Q-- ?Q- ?? ? NEW RESIDENTIAL BUILDING ONLY - FILL OUT COMPLETELY Energy Code CatNQLy__-?--, (checkone)?',?~? ? I? L ` i Plumbing C B?firaCtor: ' Plumbing System Includes: MINNESOTA RULES 7670 CATEGORY 1 - Residential Ventilation Category 1 Worksheet Submitted - Energy Envelope Calculations Submitted u I MINNESOTA RULES 7672 New Energy Code Worksheet Submitted Water Softener ? Water Heater No. of Baths / Phone#:?j5;?a <2 01 a (P4 7S Lawn Spilnkler Fee: $90.00 No. of R.I. Baths Mechanical Contractor: Phone # _16?3 *7 3 Mechanical System Includes: Air Conditioning Fee: $70.00 Heat Recovery System Sewer/Water Contractor: I IZ Phone #(OE) All above information must be submitted prior to processing of application. I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. -__ ralynlyn U?6 A (2 Slgnature of Applicant _ o V U Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 2002 OFFICE USE ONLY ? 01 Foundation ? 02 SF Dwelling x 03 01 of ? plex ? 04 02-plex ? 05 03-plex ? 06 04-plex ? 07 05-plex 0 13 16-plex 0 08 06-plex ? 16 Fireplace ? 09 07-plex ? 17 Garage 0 10 08-plex ? 18 Deck ? 11 10-plex ? 19 Lower Level ? 12 12-plex Plbg_Y or _ N REQUIRED INSPECTIONS ? 30 c- y Accessory Bldg ., ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)* ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Owoo Occupancy R-J' MC/ES System - Census Code O.2 Zoning RQ City Water "- SAC Units 0/ Stories 9- Booster Pump ? Nbr. of Units ? Sq. Ft. PRV ' Nbr. of Bldgs Length ?d Fire Sprinklered ? Type of Const Width 'I Footings (new bldg) _ Footings (deck) Footings (addition) ? Foundation ? Drain Tile ? Insulation ? FinaUC.O. ? Roof _31? Ice & Water ? Final Framing a14y Fireplace _ R.I. Y Air Test Fin _ FinaUNo C.O. _ Plumbing HVAC . ? Other 90,ttG14?., l,?Sa OUZA?wj?- 6kD PiriL _ Pool Ftgs Air/Gas Tests _ Final _ Siding Stucco Stone 11 _ Windows (new/replacement) _ Retaining Wall ? 20 Pool ? 21 Porch (3-sea.) ? 22 Porch/Addn. (4-sea.) ? 23 Porch (screened) ? 24 Storm Damage ? 25 Miscellaneous Approved By Building Inspector Base Fee g ? 3 2-'5-- Surcharge Plan Review MC/ES SAC city sac Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies #g 16 ' ? ?? all %??6? ? h ?V°- Other Total IL r MNcheck COMPLIANCE REPORT Minnesota Energy Code MNcheck Software Version 3.0 COUNTY: Dakota STATE: Minnesota ZONE: 2 -CONSTRUCTION TYPE: Single Family DATE: 1-2-2003 DATE OF PLANS: 01/02/03 PROJECT INFORMATION: Lot 4 Block 2 Greyhawk Eagan, MN COMPANY INFORMATION: MW Johnson Construction Inc. 17645 Juniper. Path #100 Lakeville, MN 55044 COMPLIANCE: PASSES Required UA = 419 Your Home = 288 31.3% Better Than Code Permit # Checked by/Date Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value U-Value - --- UA ----- -------------------------------------------------------------- CEILINGS 1850 44.0 0.0 ------- - 50 WALLS: Wood Frame, 16" O.C. 2322 19.0 2.0 130 BSMT: Conc. 4.0' ht/4.0' bg/4.0' insul 464 10.0 0.0 32 GLAZING: Windows or poors, Above Grade 132 0.480 63 DOORS 38 0.350 13 HVAC EQUIPMENT: Furnace, 90.0 AFUE --------------- ------------ ----- ----------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet thee ?reme,? the Minnesota Energy Code. Builder/Designer DateQ' c??2. D ? ai-- f LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTY LEGAL: LD f'S' ?- Lf g lp, k, DATE OF SURVEY: LATEST REVISION: f 2- 2 6-- U? m ? c ?o t C? Q O ? z Q DOCUMENT STANDARDS q/? 0 • Registered Land Surveyor signature and company L? ? V ? • Building Permit Applicant ? ? • Legal description F?? ? ? • Address ? ? • North arrow and scale V/ ? / ? • House type (rambier, walkout, split w/o, split entry, lookout, etc.) W ? ? • Directionai drainage arrows with slope/gradient % D/? ? • Proposed/existing sewer and water services & invert elevation , 12/0 ? • Street name [8/ ? ? • Driveway ??p ? • Lot Square Footage ? • Lot Coverage ELEVATIONS Existinq ? Z/o • Sewer service (or Proposed) P/ ? ? • Property comers ? va • Top of curb at the driveway and property line extensions ? C9? ? • Elevations of any existing adjacent homes 0 • Adequate footing depth of structures due to adjacent utility trenches ? ? 0 • Waterways (pond, stream, etc.) Proposed U/0 0 • Garage floor v ? ? • Basement floor V/ ? ? • Lowest exposed elevation (walkouUwindow) o ? • Property comers C? ? 0 • Front and rear of home at the foundation PONDING AREA (if applicabie) Y ? ? • Easement line ? ? ? . NWL V? ? • HWL v' ? ? • Pond # designation ?0 0 • Emergency Overflow Elevation ? la/o • Pond/Wetiand buffer delineation DIMENSIONS L9' ?? • Lot lines/Bearings & dimensions Vio ? • Right-of-way and street width (to back of curb) giE7 ? • Proposed home dimensions including any proposed decks, ovefiangs greater than 2', porches, etc. (i.e. ail structures requiring permanent footings) ??? i l • Show atl easements of record and any City utilities within those easements ??Y? ? • Setbacks of proposed structure and sideyard setback of adjacent existing structures G?[7 C] • Retaining wall requirements, if any Reviewed: n v ? ??? '? G:/FORMS/Building Permit Applicatlon Name Date 1-?'b? .? B°"?en CERTI?ICA?TE 0? SURVEY ?-??# Surveying ? Engineering ; ;F?R 31462 Foliage Avenue 4735123M Street W. ? Northfield, MN 55057 Suite 200 M W, J p H N S ? N C 0 IV S T R U C T I 0 N F Savage, MN 55378 , Phone:(507)645-7768 ` Phone:(952)895-9212 Fax: (507) 645-7799 Fax: (952) 895-9259 ? 9?4,7 ! bohlen@rconnect.com bohlen-e@integraonline.com i? ?Q ? ^ 0 30 60 90 r,' ? ? ?ti? ,"?; / r?' +?6 ADDRESSES: . `"? ,' ''' ??? } ? ??'?J9 ? L?T 1 - 4172 Raptor Road , ? ? LEGEND r ;, ? ,, ?,, , ?-5?? ?r ? ,??? ? .? ?or z - ,?6a Raptor Road ?' , ?,? -• ? ?, ?,? L?T 3 - 4164 Raptor Road ? ,y , ' ' ? ? = ? ': Q 1 ,r ,? lOT'4 - 4160 Raptor Road (IN FEET) - - - - - DRAINA6E?&kUTILITY EASEMENT ' 4 ? l-? ` f /? , ? i? ? .,?-""'? ,..'- ?;? '? ,?' ? PR?PERTY DESCRIPTION -------898°-^--- EX]ST1NG COt?TpUR ?- ??; ? ?, ' , ? ? T A A : `?? ? ,k?- ?? ?? ;--?- ?;? ? ? ; ? , L?T 1- 35,345 sq. ft. L?TS 1 THRU 4, BLOCK 2, GREYHAWK ADDITION, ` I..-=-?'" j ? LOT 2- 2,802 sq. ft. CITY OF EAGAN, DAKOTA COUNTY, MINNES?TA, 900 PROPOSED CON1TOUR '" ? '? iC° ? LOT 3- 2,700 sq. ft. " ? ?` q2? / ?`.? ? LOT 4- 3,799 sq. ft. PROPOSED STpRM?. SEWER B CB • /`? ,? / .S, ? I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED u `?. ,-??. ? . ? ? BUILDING AREAS? BY ME OR UNDER MY DIRECT SUPERVISION AND THAT DENOTES IRON MONUMENT FOUND ? ? lS? q• t. (3.4%) . ? LOT 1- 1,211 5 f I AM A DULY LICENSED LAND SURVEYOR UNDER THE ?y2 LOT 2- 1,218 sq. ft. (43.5%) S? ?? o E \ l?T 3- 1,21B Sq. f t. (45.1%> LAWS OF THE STATE OF MINNESOTA. f?ti y r?. 0 LOT 4- 1.211 sq. ft. (31.9%) ` / ? \ / ? ? ? ? . ?? TB=926x3 DENOTES PROPOSED TOP BLpCK ELEVATIpN % , I,?v ?\ ° ?_?EROY H. BOHLEN, R.L.S. q2p ? ?i \\ a DATE: 1-20-02 REG. NO.: 10795 926x0 DENOTES PROPpSED GARAGE FLOOR qZo ? ?? i ?L1 ?? N? R DATE: 12-26-02 revised / ? I i ??i9A / \ ?p P7 DATE: 12-31-02 revised ? DENOTES PROPOSED ELEVATION ?j \? ??/? % 9r ' ? ,0?0 TO ? ? ? O ` j ? . 000¦0 ?NOTES EXIST1NG ELEVATIDN / \ ? ? ?? ? qOf?O ? \ ? ? ? N ? DENOTES PROPOSED DRAINAGE DIRECTfON ?1' r •" ? C ? \ • ? ? ? ? r ? q?0 -' ? ???RFOq? 92A A?B`- "`1j ...-. ? ? _11 ? F J ? , . ?.. ? ? ,? CONTRACTpR SHALL MAINTAIN 2% MINIMUM SLOPE/ ? i . C?R ?`" ?? ?I ' ?~ FROM SERV]CE END TO SEWER. ? ? ? POND 1 I I: OS` e g I ?? b ??,.?--'""?? ? ? ? NWL=917.9 ? ? ?'? ?` ? ?" 5" STORM WE? XXX.XX DENOTES SANITARY SERVICE ti J 9 p `? i i ? fNVERT p END OF SERV]CE LINE ? ?.? p ?Z NWL=922A ?c? ? I X j ? ? ? ? ? ?. X X X. X X C S L E N OATS?T O P O F C U R B S T ??? /I q? q ? I ES 1 ? ? -_ ? ' ?? - ? ' S89'35?18"E i ?? 92? ? DAa ? ? ? ?"_.?,?C NOTE? ALL STORM SEWER SHOWN IS PROPO?ED ???f ! 1 1? 1? `` ? \ N ?? 80% x> ` 92 x ,? „ --- b ? /\ ? p U ? ?? i= esxi 915 0 x ?aa=9 s.i o ?? ; az ? / NPG? ??^`? ^?' 1 83 ° 925.3 C 916.4 0 3 82 - 30 ?,p ?" ? ^ ri ? 5.0 e.a•r. ? ?' ? ?? ? ? 1"? I? ?? a'' 9 5.2CS 5.6i 996.4 S 1 1° q? ?/ / \ , ? - 92a ?? 92 4 ? ? '..._....?- ro • 2. 20.0 ?y° 20.0 ??? ? ? ? ? ------ i ? M ? ?°? ????4?? g?1 ? ? ? j? N x ? 926x0 6x0 < 27x `? 928x1 ? 9? ? ln " 1 ?? ???@?0? j? Sp ?. ?'? 9?4 923 ,i??... . . N ? g.8 X W ? S 6.0 ? UNIT b.o = X 5.82 Oxp r,,,.-. ? ' ? ° ,,. ?.,.?. ,?._......._ , ^ I ?p O? o X M f7 r ? ? p N ? ? ? ? ?`?,,, ? ? __? ? o, :.r ?, --?- ? W x o ? 4 N ? ,,' 5 ??? . ? \? ? ? \ g?? ``?.._ ??,. ?i, ... vi ? ? N ? Q O ? ui N N M ? ? . ? _ O ? _?. 1 ? ? ° ?, \??0 -? `:? C??J ? WE.? ??S S CI C I - N_--?-? F?`? o?``'' o ?? ?~ 9? x ..?---... w..?..-_ ? z ? __.. o .f.?T ? F?AT ? ?..? / ? (? 0? .? 9? EASEMEf?-PE???, D?C? N0, 8?681 _.._ ?- 9?. z6.o Z ? .sz 9?.a ?.,,?-. ....?-?- ?- ? ?.?. a 1?.m.... ----? ?---?- --_.._.I. ?? ? 5x8......_. ? ?..s ? a - 930 ,------ ? ??? \ ?..?. 9z? °' ? S 1 L o .?---~m o ° ? _ / 927 /` ?.. _._.---- ?f. 928??G? .- N 926 -.o ?""°-- $ -'"",,-^ ?b?(? ,, `?,.' _"°- \ 193.94 ?L LJ l..l\ ? ? I _ - XO ?'.,. / 2 .?°'? ?? ?----°?- T ??_ % ' ?928 ¦ ~' "°a` _ _ - ? p 928 .,?a ? ? Z7?.JJ.--'"r~ ? ""....--?^". ?\?°'"...?0 ",.---/' ? aa_932x7 ?1? ?s 3s,? EOF ? _? ?3 -?'== `.?,. ` °_..W.` .,y..?.. /r' ? -___ -~?,.. ; ? ?,?-- p, .? i ? _--.,._ - - - - S89'35'30"E ,? /`? ?? 9 2x 30,0' ? x6 4 . 4 M RECEIVED JAN 0 6 2003 EAGAN ENGINEERING DFPARTMENI' Geo pier soil strength Engineering and special inspections Info for this address is in the parcel file for 4172 Raptor rd 401?CRV oF eagan PAT GEAGAN Mayor PEGGY CARLSON CYNDEE FIELDS MIKE MAGUIRE MEG TILLEY Council Members THOMAS HEDGES City Adminiscrator Municipal Center: 3830 Piloc Knob Road Eagan, MN 55122-1897 Phone: 651.675.5000 Fax: 651.675.5012 TDD: 651.454.8535 Maintenance Faciliry: 3501 Coachman Point Eagan, MN 55122 Phone: 651.675.5300 Fax: 651.675.5360 TDD: 651.454.8535 www.cityofeagan.com THE LONE OAKTREE The symbol of strength and growth in our community May 12, 2003 M W JOHNSON CONSTRUCTION 17465 JLJNIl'ER PATH LAKEVILLE MN 55044 RE: LENGTH OF RUN ON DRYER VENTS GREYHAWK ADDITION TOWNHOMES To Whom It May Concern: During inspection of the townhomes at 4160-72 Raptor Road, we found that dryer vents are typically running 35 lineal feet with three (3) elbows, because of the placement of the laundry rooms and limited access to exterior walls. Uniform Mechanical Code, Section 1903b, limits the length of a dryer vent to 14 lineal feet with two 90-degree elbows and a deduction of two (2) lineal feet for each elbow in excess of two (2). There is a provision in the Mechanical Code to defer to the manufacturer's specifications for length of run. The Protective Inspections Division is concerned that this will pose problems in the future. Please advise prospective buyers of townhomes in the Greyhawk Addition of this deficiency so they can purchase a dryer that matches the condition iri their unit. If you have any questions, feel free to contact me at 651-681-4680. Sincerely, Jeff Wheeler Building Inspector Jw/) S cc Dale Schoeppner, Chief Building Official 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN ??- C) ?S3 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date 4 / ? I u"I ? Site Street Address L1 ??u Unit # ???? ? Property Owner Telephone # "-?Vu'D Contractor?a?L`? Telephone # R1, j ) .-- &' "M D Address Cqt-_?. 14 City ?I CILLDi StateZip The Applicant is: _ Owner ? Contractor _Other Alterations to existing dwelling $ 50.00 _Add fixtures to rooms, excluding water softener and water heater _Septic System Abandonment _Water Turnaround (add $121.00 if a 5/8" meter is required) Other: ? Water Softener _ Water Heater $ 15.00 _ replacement ? additional Lawn Irrigation System RPZ_ new _ repair _rebui $ 30.00 State Surcharge ? $ .50 y 49 40 Total ? • Jv .:U I hereby apply for a Residential Plumbing Permit and acknowledge tha e in mation is complete and accurate; that the work will be in conformance with the ordinances codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and approved. Applicant's Printed Name Applicant's ignature