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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: ? /? ?? 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. 'IL Cf 2=1( Applicant's Printed Name x nt404-'7 Applica s Signa re