1525 Royal Oak CirCOMMERCIAL BUILDING
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
5 10 Telephone # 651-675-5675 FAX # 651-675-5694
J ??44yU
1f-19-03
Foundation Only New Building Interior Im rovement
• Structural Plans (2) sets • Architectural Plans (2) sets • Architectural Plans (2) sets
• Civil Plans (2) • Structural Plans (2) • Code Analysis (1) "
• Certificate of Survey (1) • Civil Plans (2) • Project Specs (1)
• Code Analysis (1) " • Landscaping Plans (2) • Key Plan (1)
• Project Specs (1) • Code Analysis (1) • Master Exit Plan (1)
• Spec. Insp. & Testing Schedule " • Certificate of Survey (1) • Energy Calculations (1) not always-
• Soils Report (1) • Spec. Insp. & Testing Schedule (1) " • Elec. Power & Lighting Form (1) not always"
• Meter size must be established • Meter size must be established • Meter size must be established-if applicable
1 • Project Specs (1)
1 • Energy Calculations (1) " 1
1 • Electric Power & Lighting Form (1) 1
1 • Master Exit Plan (1) 1
1 • Emergency Response Site Plan (1) 1
1 • Soils Report (1) 1
• SAC determination -call 651-602-1000 • SAC determination - call 651-602-1 000 SAC determination -call 651-602-1000
Call MN Dept of Health at 651-215-0700 for details regarding food & beverage or lodging facilities.
** Contact Building Inspections for sample and if required when it states "not always".
*** Permit for new building or addition will not be processed without Emergency Response Site Plan.
Date, Q
Construction Cost OCR
Site Address eI G ??Ie e4lell Unit/Ste #
Tenant Name Former Tenant Name
Description of Work 12Qccf-e- ?lc 9,;-? -
Property Owner ray c
i r9 Q•7 Telephone # (1) /"o ?-r- ?
Contractor `C h 4F? Z_/ c ` G.Q/?j 3"L . l_/JC
Address e f % J l if? City
State s7?/I Zip S J`a Telephone # ( ?r? /off ?? ?p
Arch/Engr Registration
Address 1 L?
City
i
State Zip Telephone # ( ) "Ir J
L
I
Y -
Licensed plumber installing new sewer/water service: Phone #:
I hereby apply for a Commercial Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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.
dw,
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
l.- 01 Foundation
L 14 Apartments
? 15 Lodging
? 25 Miscellaneous
Work Types
? 31 New
? 32 Addition
?t 33 Alteration
34 Replacement
01-1 4(!7010-
Valuation
Census Code 3 7
SAC Units
Nbr. of Units
Nbr. of Bldgs
Type of Const
26 Public Facility ? 30 Accessory Bldg.
? 27 CommerciaVMdustrial ? 32 Ext Alt - Apts.
J 28 Greenhouse ? 34 Ext Alt - Comm.
? 29 Antennae L 35 Ext Alt - PF
? 37 Nail Salon
? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 37 Demolish (Bldg)" ? 43 Reroof ? 46 Windows/Doors
"Demolition (Entire Bldg only) - Give PCA handout to applicant
Occupancy MC/ES System
Zoning City Water
Stories Booster Pump
Sq. Ft. PRV
Length Fire Sprinklered
Width
REQUIRED INSPECTIONS
Footings (new bldg)
Footings (deck)
Footings (addition)
_ Foundation
Drain Tile
Y Roof _ Ice & Water X Final
-?_ Framing
Fireplace - R.I. - Air Test - Final
Insulation
_ Final/C.O.
Y Final/No C.O.
Plumbing
_ IIVAC
Other
Pool _ Ftgs _ Air/Gas Tests _ Final
Siding _ Stucco _ Stone
_ Windows (new/replac went)
Retaining Wall
Approved By 1:2, -, Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
SAN Permit
SAW Surcharge
Treatment Plant
Park Dedication
Trails Dedication
Water Quality
Copies
Other
Total
`v D G
ROYAL OAK CIRCLE
1525
(EAGAN WELLS 8 & 9)
24
4?L.61?
RECEIVED
MAY 0 7 2001
Environmental Management May 3, 2001 EAGAN
Barry C. Sthade ENGINEERING DEPARTMENT
D,mctor Mr. Tom Colbert
Dakota County City of Eagan
Western Service Center 3830 Pilot Knob Road
14955 Galaxie Avenue Eagan, MN 55122-1810
Apple Valley, MN 55124
RE: Annual Registered Well Permit for a well associated with 1525 Royal Oaks Circle,
952.891.7557 Eagan, MN
Fax 952.a91.7SR8 Dear Mr. Colbert:
www.co.dakota.mn.us
A registered use well permit is required by the Environmental Management Department
(Department) for all Registered Use Wells located in Dakota County by Dakota County
Ordinance No. 114, Section 1203, for the purpose of ensuring compliance with State and County
requirements. This is necessary to protect groundwater resources, verify approved operation,
and to expedite permanent well sealing upon disuse or permit termination. Fourteen months
after the construction of a monitoring, dewatering, product recovery, or other special purpose
well, a registered use well permit is required. It is the property owner's responsibility (or the well
owner's responsibility if specified in a written agreement) to apply for an initial registered use
well permit and to renew such permit annually.
The Department must receive a completed registered use well permit application, which is on
the reverse side of this letter, by the expiration date of June 30, 2001- Please carefully complete
the application, attach items 1 through 4, if applicable, sign the application, and submit it prior to
the application deadline. The Department may impose a surcharge of,50% of the total permit
fees for incomplete or missing data.
The fee for registered well permits is $100.00 per well annually. If this site is under investigation
for a petroleum leak, the cost of permitting may be eligible for reimbursement through the
Petrofund. State and municipal governments are exempt from the permit fees but are subject to
the 50% surcharge for incomplete or missing data on its application and late fees based on the
$100 per well permit fee.
Late Fees will be assessed as follows: an additional 10% ($10 per well) if payment is received
within 30 days after the expiration date; an additional 25%, bringing the total to 35% ($35 per
well), if received between 31 and 60 days late; and an additional 40%, bringing the total to 75%
($75 per well) if received over 60 days late. Well permit fees, other bills, and all penalties not
paid within 90 days of the permit's expiration date may be assessed against the property owner
by certification to the County Auditor for a special tax against the real property.
A well that is not in use must be sealed. A monitoring well is "in use" if it is used for water level
measurements or sampling at least on an annual basis. Should you choose to have the well
sealed by a licensed well contractor instead of renewing the permit, please submit your intention
to do so in writing to this office before the permit's expiration date in order to avoid permit
renewal, permit fees, and late fees. Upon failure to renew the permit, the well will be considered
to be unused and must be permanently sealed by a licensed well contractor with appropriate
permits within 90 days.of the-expiration date or you will be required to obtain the registered use
well permit. The permit fee and. all. late fees are applicable.: ; _ .
Should you have any questionsyou can contact me at (952)891-7010.-
Sincerely,
V ?r+? CXd l
Vanessa L. Demuth
Environmental Specialist
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AN epuu o1o11 a.nv Env,orca
Annual Registered Use Well Permit Application
For County. Use Only.
Dakota County Environmental Management Department
14955 Galaxie Ave Approval Date:
Apple Valley, MN 55124 Check No.:: .
(952)891-7010 Fax (952)891-7588 Check Amount:
Date Received: .
The well that requires permit renewal at this time is listed below:
t
439770 1525 Royal Oaks Circle City of Eagan
Total number of wells associated with this site, including those not applying for registration:
The property owner or well owner if specified in a written agreement shall ATTACH the following to this application,
if applicable [should any of the items not apply to this well, write in "NA' next to the item):
- 1. A scaled site map with the location of the well identified by Unique Well Number; if a site map has been previously
submitted and there have been no structural changes, NA can be indicated, and
- 2. Water sample test results from the previous twelve months. This data is required in an electronic format, see our
website for the format and sample files; web address http://www.co.dakota.mn.usienvirontwell_permits.htm, and
3. Table of groundwater elevations (msl) and dates the measurements were obtained.. If the water levels are
measured to a local datum, the elevation of the local datum must be provided.
4. Check for $100 per well, made payable to "Dakota County Treasurer, unless exempt.
Note: If this application is submitted late, add the following late fee to your check: $10 per well if 30 days late; $35
per well if 60 days late; or $75 per well if 90 days late.
Note: If the local identification of the well is used in any of the data, then a table of corresponding Minnesota Unique
Well Numbers must be provided.
The Department may impose a surcharge of 50% of the total permit fees for incomplete or missing data.
If there have been any changes to the construction of the well, property or well ownership, please describe below:
DECLARATION
I declare that the above information is correct. I understand that I must apply to renew the Registered Use Well Permit
for this well annually. I also understand that it is the property owner's responsibility to obtain the permit or the well
owners responsibility if specified in a written agreement. This well has the required protection and is labeled with a
unique well number. All wells are maintained in accordance with the Minnesota Rules Chapter 4725 Wells and Borings
and Dakota County Ordinance No. 114.
Property or Well Owner (Signature) (Print) Date