3661 Ridgewood DrCITY OF EAGAN
Addition
Street
10 84473 040 0
Owner
ve
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK Fj ,
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA 1.57 1972- 640. 2U 3 2. U 0-- --ZCF
water area 4L- 1977 02.00 40.14 15
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
CASH RECEIPT
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
GATE 19
RECEIYCO
FROM
AMOUNT $
E] CASH n CHECK
DOLLARS
FOR '
BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank You , ,?
BLDG. PERMIT N 0 . 01-3210 3ldg'. Permi_
01-3422 Plan Check
01-3445 Surch. /Adir.. _
01-3446 SAC/Adm. _
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 Water Meter
20-2252 Acct. Dep.
20-3713 Water Perini
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
CASH RECEIPT
"" CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE t
RECEIVED
PROM
AMOUNT $ I
? CASH 0 CHECK
FOR 1.J CY
v,
FUND CODE AMOUNT
Thank You
BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
/c_?
GOLD COPY-PERMIT RELEASE FORM
PERMIT # H/ I ?ADDRESS
PICKED OF
L4 6
PERMIT #
PLUMBING PERMIT RECEIPT # 2`626
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
Site
Name
Addre
c City _
Name
W Addre:
p City
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
APT. BLDGS - COMM RATE APPLIES
TOWNHOUSE & CONDO - RES. RATE APPLIES
MINIMUM - RESIDENTIAL FEE -$12.00
MINIMUM - COMM/IND FEE -$20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
FOR: CITY OF EAGAN
BLDG. TYPE WORK DESCRIPTION
Res. New
Mult. Add-on
Comm. Repair
Other
RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
NO. FIXTURES TOTAL
Water Closet - $3.00 $
Bath Tubs - $3.00
Lavatory - $3.00
Shower - $3.00
Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
Water Heater - $1.50
Whirlpool - 53.00
Gas Piping Outlets - $1.50
(MINIMUM - 1 PER PERMIT)
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE:
STATE S/C:
GRAND TOTAL
airl ..
(Urtifiratr of (frrupanry
Citp of (f agan
MPvarbumt of wunwo jwpruan
This Certificate issued pursuant to the requirements of Section 306 of the Uniform Building
Code certifying that at the time of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the fellowing.•
Use Classification Bldg. Fartnit No.
Occupancy llYx Zoning District Type Coast.
Owner of Building Address
Building Address Locality
BLdIding Official
Date:
POST IN A CONSPICUOUS PLACE
CITY OF EA,GAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ?? .
PHONE: 454-8100
BUILDING PERMIT Receipt#
12938
be used for SP DWG/GAR Est. Value $1151,000 Date DECEMBER 4 19 85
Site Address Jv v 1 f[ 11ly r. rrwu ?Jc[
Lot- 4 Block 3 Sec/sub. WINDTREE 4TH
W Name ASPEN RIDGE ASSOC
c Address 7400 ,',4T`TR0 BLVD
City ED_INA Phone 888-1001
Erect ( Occupancy R3
Remodel ? Zoning R1
Repair ? Type of Const. V
Addition ? No. Stories
Move ? Length 72
Demolish ? Depth - 34
Int. Impr. ? Sq. Ft
Install ?
ADOrovals Fees
o Name GUSTAFSON i# ASSOC
_0
0 i Address SA °lE
~ City Phone 888-1U01
Assessment
Water 8 Sew.
~ W Police
FW Name 452-3 592 (J.BAR)
z Address Eng.
w City Phone Planner
Council
Permit $ 470.50
Surcharge 57.50
Plan Review 23 5 , 2'-
SAC
Water Conn. 500.00
Water Meter 63.5(
Road Unit 290.0c
I hereby acknowledge that I have read this application and statethatthe Bldg.Off. 1126/ 6Tr. PI. 156 • Off'
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
Var. Date Copies 34 7 . 7
Signature of Permittee -' Total ?
GUSTAFSON & ASSOC
A Building Permit is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Date Telephone M
Plumbing
Electric
`7
44/ 4
c C
Softener
Inspection Date Insp. Comments
Footings I ?a
Footings 11
Foundation
Framing
Rooting
Rough Plbg.
Rough Htg.
Insul.
Fireplace
Final Htg.
Final Plbg. - _?
Bldg. Final
cart.Occ. /
Deck Fig.
Deck Frmg.
Weft
Pr. Disp.
PERMIT #
MECHANICAL PERMIT RECEIPT # CITY OF EAGAN -
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE:
CONTRACT PRICE: PHONE: 454-8100
Site Addr BLDG. TYPE WORK DESCRIPTION
Lot Bloc : ? /Sub
Res. V New
m Name Mult Add-on
V Addre Comm. Repair
C City Phone ;?Z/ f- 7,:f 4 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
?y i 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 B?'f6ND 1,000.00)
Gas Piping Outlets # f
Other -
FEE -
5 ATURE OF PER ITfEE
S/C:
I S
TOTAL
FOR: CITY OF EAGAN
PERMIT # =?? 7
• PLUMBING PERMIT RECEIPT # y \
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE '
NTRACT PRICE PHONE: 454-8100
Site
m Name
Addre
c city "
Name _
3 Address
O City -
FEES
COMM/IND FEE - 1% OF CONTRACT FEE
MINIMUM - RESIDENTIAL FEE - $10.00
MINIMUM - COMM/IND FEE - 20.00
STATE SURCHARGE PER PERMIT - .50
(ADD $50 S/C IF PERMIT PRICE GOES
PERMITTEE
FOR CITY OF EAGAN
BLDG. TYPE
Res.
Must
Comm.
Other
NO. FIXTURES
Water Closet - $3.00
-2,.,-Bath Tubs - $3.00
Z- Lavatory - $3.00
Shower - $3.00
=Kitchen Sink - $3.00
Urinal/Bidet - $3.00
Laundry Tray - $3.00
Floor Drains - $1.50
WORK DESCRIPTION
New
Add-on
Repair
s ? AL
C
y
-$3.00
g Outlets - $1.50
Softener - $5.00
Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50
FEE_
STATE S/C:
GRAND TOTAL S '
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilgt enob Road v t
0 -B'ox 21199
P PERMIT NO.:
.
Eagan, MN 55'121 DATE:
i.
12-11 -
Zoning: Tt". No. of Units: 1
r«rron Cc+nst.
O
wner:
lddro: 3661 Ridgewood iI rive B 'in tree to
Site AddresE
oen Plumbing
Plumber
a• -
1 yroe to enaplf v*% Ike CUT 475.
onii...as. d??g?rg cal i . ]_ 5 . JjDje t mt&N . E ' unit ..
BY '7Nisc. Chorom
Date of Insp.: Totol:
i..#z._. Date Paid:
CITY OF EAGAN SEWN SINVlCE PERM
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: No. of Unto:
Owner:
Address:
Site Address:
Plumber:
101"" h em* With the CkP Of Began Connection charge:
ordlemese. Account Deposit:
Porn* Fee:
Surcharge:
By Mlsc. Chorgm
Dote of Intp.: Total:
Insp.: Doh Paid:
CITY OF EAGAN
3830 Pilot Knob Road
P.O. Box 21199
Eagan, MN 55121
Zoning:
Owner. _
Address:
Site Addess:
Plumber. _
Meter No.: _
Size:
Reader No.: _
WATER SERVICE PERMIT
PERMIT NO.:
DATE: 1^ 1?
i
No. of Units.
L4 83 `'T tree
1 agree to comply with the CItY of
Ordinances. Eagan
By
Date of Insp.:
Owner _
Addre, a: -
Site ,ddess: 3661 Ridgewood r B3 T'inetree
PP-jmber. Thoen Plumb AKI ".1w
Meter No.: •3 ?S 7 0 3 Sf OhlAt es 0
Size: o c. S _ Be Ore6 D --3?
Reader No.a /5 TELEP \'
._,. ...; 10
I agree to comply with the P EQcArje: L^ e. Opp d
Ordlnan hCG? Misc. Charges: 1567OOpd Tp
P? m
Total:
By Date Paid:
Da of In sp.: Insp ;
_ U -zL -F 7
Barron Const.
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Total. ---?
Date Paid:-
DATE: 12-11-86
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 NO - 12938
PHONE: 454-8100 Receipt # 1(c) BUILDING PERMIT
To be used for SF DWG/GAR Est.Velue $115,000 Date DECEMBER 4 g 86
Site Address 3661 RIDGEWOOD DR Erect lJ Occupancy R3
Lot 4 Block 3 Sec/Sub. WINDTREE 4TH Remodel ? Zoning RI
Parcel No. Repair ? Type of Const V
Addition ? No. Stories
a ASPEN RIDGE ASSOC Move ? Length 72
W Name Demolish ? Depth 34
o Address 7400 METRO BLVD: Int.lmpr. ? Sq. Ft
City EDINA Phone 888-1001 Install ?
o Name GUSTAFSON & ASSOC Rpprovr
$ Address SAME Assessment-
City Phone 888-1001 Water & Sew.
20.
F xe
aW
Permit $ 470.5(
Surcharge 57.5(
Plan Review 235.2_
SAC 575.0(
Water Conn. 500.0(
Water Meter 63.5(
Road Unit 290.0(
Police
Name 452-3592 (J.BARRAM)
Address
Phone
Eng.-
Planner
I hereby acknowledge that l have read this application and statethatthe Bldg Off 11/26/8 Tr. PI. 156.0(
information is correct an gree comply?W? h all applicable State of
Minnesota Statutes and n f jna ces. APO Parks
Ir Var. Date Copies r
Signature of Permit/? Total 7 . 7
A Building Permit is i ed to: GUSTAFSON & ASSOC on the express condition that
all work shall be do ` in accordance with all applicable Statgtof MinRes?ted City of Eagan Ordinances.
Building Official ,L
0•A
470.50+
57.50+
235.25+
575.00+
500.00-F
63.50+
290.00+
156.00+
21347.75*
V
3
1986 BDILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS - RESIDENTIAL RENTAL UNITS FOR SALE UNITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURVEY - CHECK WITH BLDG. DEPT.,
1 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF \
ENERGY CALCULATIONS, \\
$2,000 LANDSCAPE BOND
115,or?o
To Be Used For: Valuation: // - Date:
Site Address
Lot Bloc k
P
S
b GL
`
arcel/
u
y/ i
uc
/ma
Owner
Address %2 -o 0
City/Zip Code
Phone ,5? (j
Contractor
Add
ress
City/Zip Code S ?? 3 5
Phone ry?, zoo/
Arch./Engr.
Erect ? Occupancy R'3
Remodel Zoning 2 i
Repair Type of Const
Addition # of Stories
Move Length -74-
Demolish Depth -74
Int.Impr. Sq Ft
Install
APPROVALS FEES
sa
Assessments Permit
Water/Sewer Surcharge 5"1•x°
Police Plan Review 2 3 5.
Fire SAC
Engr Water Conn SSoo
Planner Water Meter 403.5_°
Council Road Unit 29 0.
Bldg Offp•I& Treatment P1 15(c,.
APC Parks
Variance Copies
Address
TOTAL
City/Zip Code
Phone #°'a 3y??
y5 ?
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHARGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
32- x
2 3 Cn
1 ? x
(2 -
S'3 z
Z5 1? Z7 " X75 x 4q - Z?700
J 20 - boo 4q- - 13ZOO
3-7 2
Hedlund Engineering Services
Land Surveyors Civil thilnaas Land Planners
Surqor4s artifAwe
9201 Eastlan, aghmRranar
9banNptan,VAWO eta 65420
Phone: 999-0299
BOOK 98 PAGE ?8
J0B N0. efe-480
SURVEY MR. Aspen Ridge Asso 'ateS
DgS"jqEj) AS: Lot 4 Block R'IN.. 1s71: 4th ADDITION, City of Eagan,
? easements of record.
iennepin County, Minnesot and rese 'n?
9ir.9 ,
H6 338 ???
\ 9?9, F F?OO
01;
0191 ?
N 6 j. sit
4j. d o
s,
? ,y ?? ` <' jFg2 ?jL N.N. LNVw l9.1
a 9/
64k N ry / ? ?i9 905
\ X o A'K as! 1144.
dZ \ / `??G 904.0 $J AY. 906.4
\Xy6> ?S /
e,v
,'Q ZZ 'S
? N
w
TOP OF .FOUNDATION .9112
5
y,
• GARAGE FLOOR
BASEMENT FLOOR .
a 904
0
? ,
.. SEWER SERVICE ELEV.
'.% PRQpQS D ELEVATIONS 0
'•?' $gW1STING -ELEVATIONS , :_---
DRAINAGE DIRECTIONS n
pENevrE3 OFFSETRSTAKE: 0
DEN
CldTlilCATE OF SURVEY
I hereby certify that an f I / S /$6 I surveyed the property described above and that
the above plot is a correct representation of sold survey.
License No.
k .1
.? .._, e?' NINttC#oT? .ffi?Tf afrt'RG?' NIrNB ?:?tcucAfr6NS ? ?-4'1S
1A ID) DM 01AP7i.0 i riF T.NE
HO ERGY CC)6 l9 EDLTION
Aduptlun Effaetlva 111/114
honer ?? ?P Phone. Sa }`j J,atP
ilte Address
:ontractor
? Phone /ys
Wilding Cl s cat o ype Al (S1ng1ee Family S Duplex) - Type A2 (Residential
3 stories or esS
(Other) (Over 7 stories),
iEHERAL IHFORMATIOH
I. Building Perimeter 4im
'41JWl ft.
2. Wall height (ground to eave) ft.
1. 1. x 2, (above) gross Ha11 ix€A ? t, •
1. Building dimensions (L)
S. Square foot area of rim Joist
6• Doors - Area ra
Inic ness
Type of Construct on
Manufacturer
x (W) --
- Floor joist size
/0 x Perimeter
-Tr Z?S
n. actor.
'.JolelL_ft.2 roof S floor area
(2 x o 2
Rini Joist-area ¦ .ZZ8 ZSft
Perimeter. ft.
7. Total door's perimeter ft
B. Uindoxs: Manufacturer -b1-l-t?_?-I_ IlAile-lm-
U factor
TYPE SIZE AREA (Ft.2)
EACH
State approved
MBER OF TOTAL FEET 2
UNITS
9. Total f t.2 G1 ass- -D36
104 Fireplace area: Width x height ¦ x Ft.2
11 Exposed foundation: Height x Perimeter IL x 14o 711, 4- Ft.
:IMPLETION OF THIS FORM IS REQUIRED FOR•ALL NEW CONSTRUCTION 'MAJOR REMODELING AND BUILDINGS BEl
i)YED WHERE ENERGY. OTHER THAN THE 141HINAL CODE ALLONANCE. Its USED.•
12.
13.
oor area A + j (p, Lo ft.
iff4i -area AL--A? ?d ft.2
Exposed foundation•A ", ¢ ft.2
Framing area A' 28? ft.,
Net wall area A / 7(??j, ft.
.. # Sm=47S
Window area A' _ft.2 U windows i 7(0 U x 'A
¦ °(
Rim Joist area A 7 7?$?ZCa' ft.2 U rim joist ¦ •04?. U x A ¦
2 - ?I t
0
Framing area - 10% of gross wall area,
Gross wall area 2??p, 4S ft.2
U door area ¦ U x A -
U fireplace • •?? U x A ¦??,4a
U foundation ¦ ? ?¢ U x A • (?,q
U framing area ¦ , 054?7 U x A ¦ Z1ill
U wall ¦' '04b U x A •T J(9
(13B) TOTAL ... U x A ¦ Z-V
14.
x 0.23 A-2 other residential)
x .23 Other buildings)
x .28 Over 3 stories)
Gross wall area x 0.11 (A=1 single family b duplex ¦ allowable U x A/Code
(13. above)
A 2 BTUN Must be larger
x U ?4.4p__ _ ¦ 1--'T. 136 above
15. Ceiling framing area (Af) equals•10%of veiling area' C or the same as)
15A. Gross ceiling area ?L) X (W) ft .2
15B Joist area (Af) ¦ 10% calling area ¦ 0 ft.2
15C. Net ceiling area (Ac) (15A - 158) • I ft.2
U ceiling.x A c• , b27 x 85- 21, (o'j
U framing x A f¦ i O Z.-21z) X O`? Zi7
150. TOTAL U x A .........................................• 141177
16. Ceiling area (15A) 0.026 4 single family & 'duplex - code allowable U x A
x 0.033 (A-2 other residential)
x 0.06 (other)
BaUll Must be larger than 150 (above.
!T „x U?radel= F (or the same as)
NOTE: Use U and'A values obtained from nps 1. 3 and 4.
18b x IZ+.4o-t->Z64ZO) = _ / ZD?, g8
-
4ox?= - -
2X II = 22 -- ---
?/, I?v?lS
!? - Zo X !o O = 44 Y, 1 44-
ICI I- 2?xr? = II x3 = 33- -
Zax2,* =
s -
14X2
f 2- 29xr00 = 22X 1= 22. _
x too 41 12-J5
2-I(ox48 I?1157X I
2
?' P??o rte, X2 = ?4?0? . _
1q0,--- -
-A g,?, -475-
WALL •
SECTION
STUD
SECTION
2ND WALL
SECTION
km
JOIST
?U u +NLUt LALLULAIIUM
I
f 1ALUE U VALUE
Inside air fil 68
m .
Idteriar wall 'I (Wall) U .
Insulation (9i?
Sheathing
•
Siding ,?7 ??'
Outside air film .17
R TOTAL 23,63
Inside-air film .68
Interior wall , 43"
AW scud C6"? R' a:6.rj0(Framtng)U. I
Sheathing 241..
Siding d07 •aqS
Outside air film .17
R. TOTAL jb,s3
C Inside air film Ra .68
Interior wall
Insulation .(Wall) U .
Sfiea
Exterior wall ring
Extertor air film R ..
R TOTAL
interior air film Ru .68
insulation
t
1 1? inch soft wood R=1.88 (Rim U a k.
Joist)
Sheathing 21biv Oq
Exterior wall covering .67
Exterior air film R+ .17
R TOTAL ?[4, q (o
Interior air film Ra .68
1 4 1 Insulation
Foundation 12$
? w
. (Fdn
) U
Exterior air film. R= .17 .
`
- s?4
R TOTAL 7,(
?
cpoied Stuck
CEILING 'dt-H VENTED ATTIC SPACE ABOVE
R VALUE R VALUE
FRAMING CEILING
0.61• Air film ?0t.6?1
3lo?CO Insulation
39 Joist
51o Ceiling iCIO
0.61 Air film 0.61
`ti2((0 Total R
1
U ¦ lC .627
FLAT ROOF OR CATHEDRAL CEILING
R Value R VALUE
FRAMING. CEILING
?_- 0.61
0.17
'Inside air film 0.61
Ceiiina
Joist (stud)
Insulation
Air space
Roof decking
Insulation
Built-up roof
Outside air film 0.17
Total R
?•U
iindow infiltration .5 cfm/lineal foot of crack
tesidential door infiltration 0.5 cfm/square foot or door and minimum code requirement
ion-residential door infiltration 11.0 ;fm/lineal foot of crack
lb 12" concrete block na insulation ¦ :47•R 2.1
Jb 12" concrete black insulated cores .26 R 3.8 ,
Jb .12" lighv4eight block ¦ .32 R 3.1
Jb 12" lightweight block insulated cores ¦ .12 R 8.3
'1 single glass ¦ 1.13; with storm window .54
1 double glass --.55
1 triple glass .41
III exterior walls and ceilings must have a vapor barrier (0.10 perm mix.).
:apor barrier must be on the inside (heated Side) of wall.
taoor barriers of the polyethelene thin film have no R value.
APPLICATION FOR PERMIT
CITY OF EAGAN
SEWER AND/OR WATER CONNECTION
P ease Pi
1) PROPERTY ADDRESS:.
LEGAL DESCRIPTION: o ?g 3
vision or
IF EXISTING STRUCTURE, DATE OF ORIGINAL BUILDING PERMIT ISSUANCE:
(Mon ear
PRESENT ZONING/PROPOSED USE:
Q mm ERCIAL/RETAIL/OFFICE
C] INDUSTRIAL
n INSTITUTIONAL/GOVERNMENT
R-1 SINGLE FAMILY
Q R-2 DUPLEX (Two Units)
R-3 TOWNHOUSE (Three + Units) ( Units)
R-4 APARTMENT/CONDOMINIL'M ( Units)
2) r? --
NAME LdC. Zh [ .
ADDRESS: -7-*/s0
CITY, STATE, ZIP: Y3
PHOtE:_a;;-y?E Ss 93 - qs b
3) u c
NAME:
ADDRESS:
CITY, STATE, ZIP:
PHONE:
4) •• • ia•
NAME= J _ i R air m- OK5
ADDRESS : r/rf D ID /Yl 21 r o (a u ,
CITY, STATE, ZIP: tl i M ?? _ S 5 `) 3 J
PHONE: $ 9 3 ' q D
rtwiw)er5 i.icense:
Active
Expired
Not recorded
Stoma f Initial
5) VG?fflw_N • :• :a •o• a.
[D'?CONNF=ION TO CITY SEWER CONNECTION TO CITY WATER Q OTHER
6) n • r
PLEASE HOLD APPROVED PERMIT FOR PICK-Up BY ONE OF ABOVE -
C3 PLEASE MAIL APPROVED PERMIT TO 1, 2, 3, 4, ABOVE
(Circle one)/
NOTE: PAYMFNt' OF FEE AT TIME OF
APPLICATION DOES NOT OONSTITUTE
APPROVAL OF PERMIT.
INSPECTION OF SEWER AND/OR WATER
INSTALLATIONS WILL NOT RE SCHED-
ULED UNTIL PERMIT HAS BEEN
APPROVED.
MASTER LICENSE# o`J? / 5
FOR CITY USE ONLY
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ SEWER PERMIT (INCLUDE SURCHARGE)
$ WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ ACCOUNT DEPOSIT - SEWER
$ $ /St U I) ACCOUNT DEPOSIT - WATER
$ ,/DO-tU $ WAC
$ dr/ J C-5 -0 $ SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRUNK SEWER
$ $ LATERAL BENEFIT/TRUNK WATER
$ A Io 169 O $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$_ f 2/ 6 D TOTAL
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
0 %YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERING
NO DIVISION. LIST AS A CONDITION.
Q
SUBJECT TO THE FOLLOWING CbNDITIONS:
APPROVED BY:
TITLE:
DATE:
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City otEapn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: q1,L
Permit Fee: 96)-00
Date Received: /c2
Staff:
009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: D v [ Site Address: 3 t t/ f)4e -z J pi
Tenant: Suite #:
RESIDENT / OWNER
Name: , � 14 G /011-/A
Address/City/Zip: 5Z(/ /\)-4�
Applicant is:
Owner Contractor
Phone: Ii vs7= 2y J
1
TYPE OF WORK
Description of work:
Construction Cost:
Multi -Family Building: (Yes / N9CJ
CONTRACTOR
Name: &'/l ,e5L / ,E/C--
Address: /' 2 ZIA"'5 t
City:)3) ' 2,11A—
License #: �� 2 75 7
Phone: /51 7'Z '3/ /� Contact Person:
State: /404"/ Zip: .55j7z
4\14— 13z ijz ,(
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 Portionso
informationma be classified as non-public ifyou provide specific reasons that would permit Cit to
Y � p AP y_
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Cali 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.
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Applicant's Printed Name
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Applica s Signa re