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3314 Rolling Hills DrINSPECTION RECORD CITY OF EAGAN PERMIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55123 Date Issued: (612) 681-4675 SITE ADDRESS: , ,, , r 'fit, 111 I i DR Hilb I)At 11I I I'. .'No PERMIT SUBTYPE: . , 7,. APPLICANT: TYPE OF WORK: F{II 1 1 If 1 Nti 011.'4) i 1 wo/".- /f )i INSPECTION TYPE .DATE INSPTR. INSPECTION TYPE DATE INSPTR. (4i tt,I,1 I N o I wf MARlk a & W 14HR - SCHFkLR PI 66 ` °'•_,,s?;, Permit No. Permit Holder Date Telephone # S/W PLUMBING 9? .?? ?r3 HVAC ELECTRIC oevr94? ELECTRIC Inspection Date Insp. comments Footings 1 Foundation O Q Framing I Roofing g r Rough Pibg. Rough Hig. Isul. f ?Oc?2 L - Fireplace ? Cv a/ Li ?, Final Htg. ! D? Orsat Test S Final Pibg. Pibg. Inspector - Notify Plumber Cont. Meter Engr./Plan Bldg. Final Deck Fig. Deck Final Well Pr. Disp. 16-? I i Wertif icate of Cccupanc? With of Wagan Odownwent of Owshis ax#oetNOM This Certificate issued pursuant to the requirements of the Uniform Building Code certoing 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 following: Use Chka t mlialn: Sp nx. Bldg. Permit No. 2203 Occtlpsxr Type R3 AII Zoning District R I Tree Canst. VN OwlletofBelldirg H1MVT W HWS TAY'. Address 17354 TIM" (Ts LATMM.TF. eidming Ad&m 3314 Rf1,TJW, ? S IVEIC [ out. .36* 82, MIR OAK tM I G 2RD ( D,le DECEMBER 15, 1993 POST IN A CONSPICUOUS PLACE Request Date L Q Fire No. / U Hough-in Inspection 117 1 tl' Re Inspector Ready Now ? l Wh R T tl _ No 1 s en en s Ba 1 licensed contractor ] owner hereby request inspection of above electrical work at: Job Address (Street. Box or Route No.l 33/ el city _ Sao= Na. Township Name or No. Range No. County 44 Occupant RINT) ?` ??'cc? ?? Phone No. ?5; Z-3.2 Power Supp ier - AOtlress lC Electrical ontremor (Company Name) eJ00,i ??ecfda C© Contractor's License No. C"i O ! pj Mailing Atloress (Contractor or Owner Making Installation) Auth 6ign ur Coniractoo0 Ma g Installation) ' - Phone Number y?s / . 32 21 5 - MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD 1621 Universlty.Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0600 ENCLOSED. ST FOR ELE .TRICA6 INSPECTION ??a9?g? C ?? eeoooor.oe ? See instructions for completing this lone on back of yellow copy. 28796x4_? O[Of? "X" Below Work Covered by This Request W Add Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Other(Specify} Comm/Industrial Furnace Farm Air Conditioner Other (specify) Conirador5 Remarks'. Compute Inspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming pool Transformers 0 to 200 Amps -aa Above 200 Amps ( 0 to 100 Amps Above 100 -Amps Sb v?= Signs Inspectors Use Only: TOTAL Irrigation Booms /? /a Special Inspection t J 7 Alarm/Communication THIS INSTALLATION MAY BE O DISCONNE Other Fee CTED IF NOT COMPLETED WITHIN 16 MONTHS. I, the Electrical Inspector, hereby certify that the above inspection has been made. Rough-m f Final Data •, G ?/ q V G oa -3a OFFICE USE ONLY This request void 18 months from Addmss 3314 ROLLING HILLS DRIVE Zip 5512 1 Lot 36 Blk 2 Sub BUR OAK HILLS 2ND THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECHON. Date: Yes No Inspector: Final grade (6" from siding) Permanent steps (garage) Permanent steps (train entry) Permanent driveway Permanent gas Sod/Seeded grass Trail/curb damage ? Porch ? Basement finish Deck Please verify with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to the outside lawn faucet before freeze potential exists. Contact engineering division at 681-4645 before working in right-of-way or installing underground sprinkler system. White - City Copy Yellow - Resident Copy Pink - Contractor Copy I -I CITY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55123 (612) 681-4675 SITE ADDRESS: P.I.N.: 10-15501-360-02 DESCRIPTION: PERMIT PERMIT TYPE: Permit Number: Date Issued: 3314 ROLLING HILLS DR LOT: 36 BLOCK: 2 BUR OAK HILLS 2ND B;u ld'i;ng)_Permit Type Puilding aerk Type r=UBC Occupan-oq,, 'Construction TppF Zoning Building Length Building width f- SF DWG NEW R-3 M-1 V-N R-1 62 36 / BUILDING 022031 09/22/93 L aCU If REMARKS 5 & W PLBR - SCHERER PLBG FEE SUMMARY: Base Fee Plan Review Surcharge SAC SAC % SAC Units Subtotal VALUATION $639.50 $415.68 $50.00 $750.00 100 $1,855.18 $100,000 MISCELLANEOUS $1.744.50 Total Fee $3,599.68 CONTRACTOR: HIGHVIEW HOMES INC. 17354 ITHECA CT LAKEVILLE MN (612) 892-3282 - Applicant - ST. LIC 18923282 0005493 55044 HIGHVIEW HOMES INC 17354 ITHACA CT LAKEVILLE MN (612)892-3282 55044 I hereby acknowledge that I have read this application and state that the In-formation is correct and agree to comply with all applicable state of Mn Statutes and City of Eagan Ordinances. PLI NT/PERMITEE SIGNATURE ISSU BY: ATURE Abk REACTIVATE / CITY OF EAGAN, PERMIT ENE®1 93 BUILDING PERMIT APPLICATION 9-?2 6 1993 681-4675 .SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy talcs. COMMERCIAL & structural plans, 1 set of 2 sets of architectural . specifications, 1 copy of energy talcs. Penalty applies: 1) when permit is typed, but not picked up by last working day of month. in which request is made, 2) address is changed or 3) lot change is requested once permit is issued. n of work e CI ? Date 9 / / Valuatioo // nn Site Address: 33/ x{ kz'1(,j4 Hir_ STREET SUITE / Tenant Name: (commercial only) LOT BLOCK Z SIIBD. ?,? O- r[ < f P.I. D. 0 k Description of work: ( G? ;l b The applicant is: ? Owner JZContractor ? Other (Describe) Name +lf Phone l` Z Property LAST FIRST Owner Address 17v- (( 'T t-( C" STREET STE M City ?6 State e'Al ) Zip 5 Company f` If it, ? a 9 z- as a, ec Phone Li I _ Contractor Address ;o„'.E8 1.1^ License # .9 9 3 Exjyj ? 9 City 17354 ITHACA COURT State Zip Company V DgE". ?g6 Farms Phone 7 Architect/ Engineer Name )9 If 4L,) f?c>*!.s ruv--,. Registration # Address f r -7 / /1/o r-f° City ,li t< ?Q v( State w16(l Zip Sewer & water licensed plumber c Processing time for G? sewer & water permits is two days once area has been approved. Pc c?,kc_.c?U I hereby acknowledge that I have read thi ?9pp, ication and state that the information is correct and agree to comply w' a a icable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY BUIL DING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging . 16?-BaAment Finish It 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool ? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind. ? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc. ? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck ? 20 Public Facility ? 21 Miscellaneous WORK TYPE R 31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish ? 32 Addition ? 34 Repair ? 36 Move GENERAL INF ORMATION Const. (Actual) V-N Basement sq. ft. MWCC System (Allowable) n! 1st Fl. sq. ft. City Water c UBC Occupancy I 2nd F1. sq. ft. PRV Required Zoning JR-1 Sq. Ft. total Booster Pump #? of Stories - Footprint Sq. ft. Fire Sprinkler Length Z' On-site well Census Code 1dl Depth 3 G' On-site sewage SAC Code APPROVALS Planning Building Assessments Engineering Variance REQUIRED INSPECTIONS ? Site ? Wallboard ? Footing ? Final ? Framing ? Draintile ? Insulation ? Fireplace Permit Fee vatuatiao: $ Cy?? 00 L7 Surcharge Plan Review 6ARAaIC' ByvY z fxz? = 5 e x 14 License MWCC SAC 2 yx'z!r = 6 77- City SAC Water Conn. 5?6 3 6x /6 - Water Meter `_ f 2v? xJ?r /8 -7 Acct. Deposit Isr V:L,, A_ , S/W Permit S/W Surcharge L35 s 19.44 Treatment Pl. Road Unit Z67z /v Park Ded. IYxz 2$ Trails Ded. /1/0 to Copie s I 2Sf er Y. 5y Total: 133 Cl ? 09 /a SAC % 100 , SAC Units -1- t , CONSULTING ENGINEERS 1116HUI,Ew 11O/11a ROOF. PLANNERS and LAND fURVEVORf X 599/.0/ m= ENGINEERING 6K, 19s 1 ?'. COMPANY, INC. PQ, 5 1000 EAST 1461h STREET, BURNSVILLE, MINNESOTA 66337 PH 4323000 CERTIFICATE OF SURVEY Legal Description: _LOT_S6, B?ocK 2?AI,e?OAK WIzzS ZyD 1 Tngl ag'y Div urt/TY /?7/rUNESOT? (g7?) DENOTES EXISTING ELEVATION ( S? S o) DENOTES PROPOSED ELEVATION r.----- INDICATES DIRECTION OF SURFACE DRAINAGE 878, FINISHED GARAGE FLOOR ELEVATION 870,&Z = BASEMENT FLOOR ELEVATION 7 66 = TOP OF FOUNDATION ELEVATION SCALE : V m 30' BE.4/eHAPj4ieK . 77VIl @ Z4 TS /Z,, xzic 5 E[Ev. > 862.74 (872,411 0 3 30 P"T GRDN7' 801OW& SETBACK L//VE CS J7. Hog= $7,5,ZZ 1j j $ ?y 1 4 O 1 864' 4 (864 4) ROLUn/6 N?l1 S IIe/vE +F--- "' 1873.9_81 Cf3746¢? N 0 Ci 9;0-) I ° %e: (ass % t` va L j. 977,16 709 4oxo PROP0CROP4 9ED NOusE j6ARA6E Im - 81 2Z. 00 z+ 00 pp ? w?Nwwr oo . ?:o, ?6wo?875.4? l°73,$? By r Dal? LO T 3 L?v '- 85.00 N 89°38, /3°E ©28.00 i 0 N ?o . O DEPT ,PV1A14GE AA-R UTiuTy 6;4sEAeA/7• I hereby certify that this is a true and correct representation of a tract of lan??yy as shown and described hereon. As prepared by me this /6 ry day of SC?iVls? 19 _QL Minn. Reg. No. 16 0X - LOT SURVEY CHECKLIST FOR RESIDENTIAL U w° BUILDING ERMIT APPLICATION ID t L ¢ / m PROPERTY LEGAL: Le w m /G? Date of Survey: Z 2 DOCUMENT STANDARDS ? Registered Land Surveyor signature and company C3 ? 0 Building Permit Applicant e-'M ? Legal description ? 00? ? Address 0' ? ? North arrow and bar scale fY ? ? House type (rambler, walkout, split w/o, split entry, lookout, etc.) IYO ? Directional drainage arrows with slope/gradient ?. ? P1? ? Proposed/existing sewer and water services 0' ? ? Street name D ? Driveway ELEVATIONS Existing ? 8?0 Sewer service 0' ? Lot corners ?? Top of curb at the driveway ? p' ? Elevations of any existing adjacent homes Proposed ?? ? Garage floor n' ? 0 First floor B? ? ? Lowest exposed elevation (walkout/window) ? .? Property corners ? Front and rear of home at the foundation PONDING AREAS (if applicable) ? 0' ? Easement line ? C3? ? NWL ? D' 0 HWL ? Q"[] Pond # designation 0 ? Emergency Overflow Elevation DIMENSIONS 0' ? ? Lot lines la- ? ? Right-of-way and street width (to back of curb) 6?? ? Proposed home dimensions including any proposed decks, overhangs greater than 21, porches, etc. (i.e. all structures requiring permanent footings) 8?? ? Show all easements of record and any City utilities within those easements ? ? Setbacks of proposed structure and setback of adjacent El ?"D existing hom-j Retaining ?reuirements, if any Reviewed: October 1992 S E P-? 1- 9 3 .?? CITY OF MAN EXTERIOR Efl4£l:M ILVERACE #U' CMpVTATION OWNER: _ epem. SITE ADDRESS: ?' ? / H It ? ?' lei l ?A7eEs PHONES ee? CONTRAC?ORs .•.?..-?--•? Determine working square rootage of 08011" 84. ft. 2 1. Total exposed wall area ... INW7 a. Total root/ceiling area ... sq, ttq x .026 Total exposed wall area above floor a -? I ......... ?"' T U E 1 1: 5 6 P_ 0 1 he Total foundation window area...•••a•'•••••••••••••• J. Total net foundation area above grade ..... .+••••••• window area ...1....0.0..ei•••• I a. Total wall be Total door area ..+.........• .............•..•..s•. 0. Total sliding glass area ....oo•::;?::;;:;;:e•?a..• d. Total fireplaee wall area eae... e, Total wall framing area (average 10th) e...••......• f. Total net wall area above floor ....•.......s...... g. Total rim joist area ..•••••••°••°° " " " ° " " Total exposed foundation area a ?, - - Determine .Ul Valae 6t each wall Segments so be ,0. d* ev to S. he 1. k, Total 1. Total toot/ceilin x . u' .+++++.oo+eoe.eeeeee tE J. Total skylight Are8...... ..... x Sul x +u+ x Sur x Sul x Sul x Sul x 'U+ x `0e 3. .••.......•....+.+.100..0+. e.••• a +.. .. ............. If item 63 is the same as or less than item $19 6006(c)2e OVER a s a r G a is a Total a you have met the intent of 800 Total exposed roof/ceiling area a j,_,s2........? 09-21-93 11:59AM P001 #19 SE P-21 - 9 3 T U E. 1 1: 5 4 P_ l as Determine IU1 value for each roof/balling/segments j. x lot _._L2 S? _.... = Q.......W.. k. !yS x tug ?? . .................................................o.... 'T'otal ° .17- It total of 64 is the same as or less than 02, you have met the intent of BBC 6006(o)7. Alternate Bal.liding Envelope Design To utillse the total envelope system method, the values established by the sum of Items 03 and #4 shall not be greater than the gam of Items 01 and 82. 1. +2.? 3. f 1 + 4.? .Qy ® ...xl...,? a R-92% 09-21-93 11:55AM P005 #18 LOT &4 BLOCK /?cZ SUBD. /?AarAQ4 RECEIPT # L,p ? 40nN? & DATE `K-A 4 4 ? 1994 CITY OF EAGAN IRRIGATION PERMIT (FOR BACKFLOW PREVENTER) COMMERCIAL INSTALLATIONS - FORM MUST BE COMPLETED BY LICENSED PLUMBER Date: ZZ Commercial GPM Residential (boulevards) GPM Existing residential -Area/address to be irrigated: 15-1y .90t/yy /Fill/ ea t? <- Installer: 4Coti , xcl, AK,,l / Owner ? Plumber Street address: o2e) ,/ 7 .f? ' GIj. City, state & zip code: A, 4 /Z-- S 3 Dr7 Phone 11: - T_ Owner Name: Street address: sL3 l(L City, state & zip code: Phone N: Irrigation contractor, if different than installer: Telephone #: I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply wit "I applicable City of Eagan ordinances. Signature Title If construction activity occurs in public easement or City right-of-way, signature of property owner is required. The property owner agrees to hold harmless the City of Eagan for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of-way/easement. Property Owner Approved by: PRV ? yes ? No New service ? Yes ? No Date Date: Meter Size & Coat Fees due: Calculated by: PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. O. FIXTURES EACH TOTAL 1 SHOWER 3.00 3- WATER CLOSET 3.00 3 - BATH TUB 3.00 i LAVATORY 3.00 3- i KITCHEN SINK 3.00 3 - i LAUNDRY TRAY 3.00 3- HOT TUB/SPA 3.00 3- WATER HEATER 3.00 i FLOOR DRAIN 3.00 i GAS PIPING OUTLET • minimum • 3.00 3 , o 3 ROUGH OPENINGS 1.50 WATER SOFTENER 5.00 PRIVATE DISP. • DaLcty. iic 15.00 U.G. SPRINKLER • home under Must. 3.00 ALTERATIONS • to existing 15.00 WATER TURN AROUND 15.00 31.E STATE SURCHARGE .50 3 2, oo TOTAL: SITE ADDRESS: 331 OWNER NAME: !?; -s lk?s INSTALLER: %chertr ADDRESS:_ 4- ? c n-J CITY: Pt .or ?4 ?-< STATE: K -ZIP CODE: 5 5 3 a PHONE #: (ter z) 44-1- CE`Z 34 SI A E ERMITTE 1993 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 P"T KNOB RD EAGAN MN 55122 (612) 6814695 1993 PLUMBING PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN SS122 (612) 6814675 PLEASE COMPLETE FOR ALL COMMERCIALANDUSTRIAL BUILDINGS. ALSO FOR MULTI- FAMILY BUPLDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. NEW CONSTRUCTION _ ADD ON REPAIR WORK DESCRIPTION: CONTRACT PRICE: FEE: 1% OF CONTRACT FEE. STATE SURCHARGE: $.50 FOR EACH $1,000 OF PTWIq FEE. MINIMUM FEE: $ 25.00 CONTRACT PRICE X 1% STATE SURCHARGE $ TOTAL $ SITE ADDRESS: TENANT NAME: STE. # OWNER NAME: INSTALLER: ADDRESS: CITY: PHONE #: STATE: ZIP CODE: FOR: CITY OF EAGAN APPLICANT PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT. NEW CONSTRUCTION ADD-ON A/C ADD-ON FURNACE DATE 16 - 2-S- 9 3 HVAC: 0-100 M BTU ADDITIONAL 50 M BTU GAS OUTLETS (MINIMUM 1 Qa S3.00 EACH) ADD-ON/REMODEL (EXISTING CONSTRUCTION) STATE SURCHARGE TOTAL SITE OWNER CITY: FEES 00 6.00 j y. oy $ 15.00 so (/ go//'n /?"/z Q0-- Ill { k [w ?C- 6 W ftir . r-., via a STA TELEPHONE #: v /- y2 TELEPHONE #: _32 S Z ZIP CODE:?y2_eq 1993 MECHANICAL PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN SS122 (612) 681-4675 1993 MECHANICAL PERMIT (COMMERCIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN MN 55122 (612) 6814675 PLEASE COMPLETE FOR ALL COMMERCIAUINDUSTRIAL BUILDINGS. ALSO COMPLETE FOR APARTMENT BUILDINGS OR OTHER MULTI-FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH DWELLING UNIT. DATE CONTRACT PRICE: NEW BUILDING INTERIOR IMPROVEMENT WORK DESCRIPTION: FEES 1% OF CONTRACT FEE $ PROCESSED PIPING: $25.00 MINIMUM FEE: $25.00 STATE SURCHARGE $.50 FOR EACH $1,000 OF 'R11IIt FEE. TOTAL $ SITE ADDRESS: OWNER NAME: TELEPHONE #: TENANT NAME: (IMPROVEMENTS ONLY) INSTALLER: ADDRESS: CITY: STATE: ZIP CODE: TELEPHONE #: SIGNATURE OF PERMITTEE CITY INSPECTOR ú ÿþ þýý üûûú ùýýîî ÿïýþ ðâü ìñ ðâ þýö ýüûúùø÷ö õ üúùø ÷ ÷ö õ ôöõóøò ñü ü ðìüøù ïÿ ýîü òø ëò ò îü ò û ò êé ÿööøÿ þé é òÿ ý øêé é øé ê ûòè îü ûùö ÿéòùò ê íæðåæääêäêä õù ýü æêãêã çüðþê ôó öòñ øø óö Üì ãüùó÷ ððóÿñ ó ë ôð ÿ ô àâßâ ûùöÿë øø é ò ÿ òøùöøøûý é ýü ùé ÿì ê øøõ òýÿü üùýÿü Use BLUE or BLACK Ink � r----------------� I For Office Use � 't f � Permit#: � � �� j C16� �l �� ' � � (.�j a'r� ; � Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I I 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: � Q� Site Address: � G' �)r7 j� ,��' L. Lv- Unit#: �� ,��.�� Name: Y 1(��,� �� Y G�I'�'��) �1�/l i��Y3 Phone: 6�� --�� R��Id�� : l �� Address/City/Zip: nr^�J�(�., �_� QLh ��'� ;� ' Applicant is: Owner �ontractor "�\ Descriptionofwork: /��,J'��'�/e_ �`';t�{'/G4 �� j�r��1 P � ��l'iG`� Yl�,� 4�� 1 J' ` ��l �E3��'��4�"� � "� � � �K� ��, �; Construction Cost: � � Multi-Family Building: (Yes /No� � �� y^ � � / ) / � • G�L�L�e� /c,� ��\\\ � ��\ � �'J/C1cl t.l G/ �'Y�c/ �2.6 D '11'1 Contact: ��!�� l D /C{:�t?J Ct, � � Company: , a , o � �3 / ) _J � �'�� +�'��► y�� Address:��6�� Z!C'L � �� City: �D►'l �� State:�Zip: �,�� Phone: 6�,�� ,� �aiL ��` � ��r�� ca, ! �; License#: � C �i 3 ��j � / Lead Certificate#: If the project is exempt from lead certification, please explain why: 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: Fire Suppression Contractor: Phone: ��f�� r�su,��or� ��r,�� ,yc��r��i� � �rci ��r1i��ti��. f�+� ��af ' � ��k�i �a�'ra,�b�� nr��t�or��rblic ef,�t�c��►+��al� � �.� ��r�� tFt��"o�m e , r �� c1t�'�-�`�� 5 z� e � .. r� .. ... �� , . ,.. . �'.. ��... ..z .. ..;.. ,,,..�� ' CALL BEFORE YOU DIG. Call Gopher State One Call 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.popherstateonecall.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. Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. � , �x�S 1/C�L- t CY L� /(.�',!�'1 li1 x ApplicanYs Printed Name � Applicant's Signature Page 1 of 3