4637 1_2 Penkwe Way - BL 90736
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I For Office Use
I
Permit
City of Ea
R Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 Date Received: 2 .
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: Site Address:
Tenant: Suite
RESIDENT/ OWNER Name: ~-/~~•'Phone:
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work: "--z -
Construction Cost: 4_ G y Multi-Family Building: (Yes / No
7 L 9 Y f / W( License C) 1 5 1
CONTRACTOR Name: k 0/~,,> Y-- `i
Address: i Zr
City: /'Z_ G?l1'L_ State: I7 C Zip:
Phone: /j- ~0 1 Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
('1 submission type) • Energy Envelope Calculations Submitted
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.
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 pla s.
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x
x 1''
Applicant's Printed Name 'Alp icant's Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation _ Fireplace Porch (3-Season) Storm Damage
Single Family Garage Porch (4-Season) Exterior Alteration (Single Family)
Multi Y Deck Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi)
01 of Plex Lower Level Pool Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement Siding Demolish Building*
Addition Move Building Reroof _ Demolish Interior
Alteration Fire Repair Windows Demolish Foundation
Replace Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy T4 G- 3 MCES System
Plan Review Code Edition Zoo2 SAC Units
(25%_ 100% Zoning /7,2 City Water
Census Code 3 Stories Booster Pump
# of Units Square Feet e'er PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Sheetrock
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
-4
Foundation HVAC
Drain Tile Other:
Roof: -Ice & Water -Final Pool: _Footings -Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: _Rough In _Air Test -Final Windows
Insulation Retaining Wall
Meter Size: Radon Control
Erosion Control
Reviewed By: 49, , Building Inspector
RESIDENTIAL EES
Base Fee 30
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
EAGAN
REVIEWED
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TREATED WOOD MAY REQUIRE SPECIAL
-ASTENERS, HANGERS, AND
CONTACT YOUR LUMBER
SUPPLIER FOR MURL INFURMAl ION.
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C. R. WINDEN & ASSOCIATES, INC.
LAND SURVEYORS Tel 645.3646
For: 1381 EUSTIS ST., ST. PAUL, MINN. 55108
U. S. Home Corporation
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Note: As of this date Johnny Cake
Ridge Third Addition has
not been recorded.
Lots 1 through 4 inclusive, Block 4,
Johnny Cake Ridge Third Addition,
Dakota County, Minnesota.
WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE
BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY
THEREON, AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND.
Doted this r I doy of -A. D. 1960 C. R. WINOEN & ASSOCIATES, INC.
Surveyor, Minnesota Registration No.-2 92 G