1237 Timbershore Lane
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I For Office Use I
-7 q
Permit
City of Ea I
® I
E I Permit Fee: Z90-0
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 Staff: I
2009 RESIDENTIAL BUILDING PERMIT APPLICATION`
Date: Site Address-
Tenant: 0--tt kl~ 3") GA ( kW Suite
t2 4 SoS- O( )
RESIDENT /OWNER Name: Phone: n
Address / City / Zip:
Applicant is: Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: [O Multi-Family Building: (Yes / No
CONTRACTOR Name: ~-C 1. License
Address.
City: State: Zip:
Phone: 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
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 maybe 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 or inances 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 permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and appr of plans.
X X
Applicant's Printed Name Applr s Signature Page 1 of 3
D
AUG172009
or 0 /2S77 t-0,
DO NOT WRITE BELOW THIS LINE 6-7
l
SUB TYPES
? Foundation ? 05-plex ? 16-plex ? Accessory Building ? Pool
? Single Family ? 06-plex ? Fireplace ? Porch (3-season) ? Ext. Alt. - Multi
? 01 of - Plex ? 07-plex ? Garage ? Porch (4-season) ? Ext. Alt. - SF
? 02-Plex ? 08-plex Deck ? Porch (screen/gazebo/pergola) ? Multi Misc.
? 03-Plex ? 10-plex ? Lower Level ? Storm Damage
? 04-Plex ? 12-plex ? Miscellaneous
WORK TYPES
? New ? Interior Improvement ? Siding ? Demolish Building*
? Addition ? Move Building ? Reroof ? Demolish Interior
? Alteration ? Fire Repair ? Windows ? Demolish Foundation
Replacement ? Egress Window ? Water Damage
* Demolition (entire building) - give PCA handout to applicant
DESCRIPTION:
Valuation 00 c~ Occupancy MCES System
Plan Review Code Edition ~ti 2v7 SAC Units
(25% 100% Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Const. Width
REQUIRED INSPECTIONS
Footings (new bldg) Sheetrock
Footings (deck) Final/C.O.
Footings (addition) Final/No C.O.
Foundation HVAC
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings Air/Gas Tests Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace:_R.I. Air Test _Final Windows
Insulation Retaining Wall
Reviewed By: 1 , Building Inspector
-
RESIDENTIAL FEES:
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
Total
Page 2 of 3
Jul 28 2014 09:48AM HP FaxGates G.C. 7634987710 page 11
Use BLUE or BLACK Ink
� For Offloa Use �
� j Permit!!: �� �� / � I
Cit of Ea�aIl � �� �' �
� PeRnit Fea: �
3830 Pilot nob Road � , �[ �
Eagan MN 5122 � Date Received:� �T j
Phone:(65 )675•56T5 � �
Fax:(651) 5-5694 I S7aff: ' �
I I
014 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: • Site Address: • Unit J�•
� � Name~� �� '/yl�✓Sno��,--,._��^_... _,.,.� Phone: ���r ����` ~�•
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� Resident/ � c,
Owner ' Address I City/Zip: J''✓�-� ��'`�
� Applicant is: Owner L� CoMractor
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Type Gf Wo�k : Description oFwork:_ 'I°Q-�' f; /`� "���.�
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COnstruction Cost: � , Z�'y' ��" Multi-Family Building;(Yes "_/No_�
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Company: e:.i?<S ��✓w�'%v": �'^�✓' Contact: ''�"{ '-t-
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� Cont�actor Address: �� �'J c�ty�
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� state: IU Zip� Phone: �' L-` ��-w3�lS�Email: G��'-+u��aa��, �' ' a��: �
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License!t: ��--`7���A r �L1�•��i2 j�� 'r
Lead CeRificaie#.
If the project is ex pt from fead certification, please explain why:(see Page 3 for additional inforrnation)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW'BUILDING `�
In the last 12 mont ,has the City of Eagan isauad a pertnit for a similar plan based o�a master plan?
� _Yes _No I yes, date and address of master plan:
� Licensed Plum6er: Phone:
Mechanical Contra or: Phone:
Sewer 8 Water Con actor: Phone:
.. ...... ..__ ..,,._......._..__.� ...__...._. .....__.__ .._._..w..�._.�.....,�__._�.._�.,,
NOTE:Plans an' supporting documents thaf you submit are considered to 6e public iMvrmation. Portions of
the informationi ay be classiffed as non public if you provide spec�c reasons thaf would pennit Lhe City to
: conclude ti►at the,�r aroe trade secrets.
CALL BEFORE Y DIG. Call Gopher SWte One Call at(651)454-0002 for protection against underground utildy damage. Call 48 hours
before you intend to dig i�receive locales of underground utiliiies. www.aopherstateonecall.oro
I hereby acknowledge t t this information is complete and accurate;thal the work will be in coniormance with the ordinances and codes of the City of
Eagan; tAat 1 understa this is not a permil, but ony an application for a permit, and wortc is not to slart without a perrnit Ihat the work will be in
accordance with Ihe app ved pian in the case of wo�lc which requires a review and approval of plans.
Exterlor work or by a building permlt Issu in accordance with the Mlnnesota State Bullding Code must be completed within 180
days o1 pe t Issua
x / �it/l'i�/ X
ApplicanCa Prin ed ame Applicant's Signature
Page 1 of 3