1775 Serpentine DrINSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Fir, Minnesota 55122-1897 Date Issued:
(612) 681-4675
SITE ADDRESS:
1776 Sf:RID
urIAP ftr;I,VF 6"r1,l
I Or . H 1141 Oct
FNII'mr 11R
APPLICANT:
PPOTFCTTVI' Nnq
(612) R"4-01-3
rill I I It i MO
031 r•4kr
Vl-
H
s? k E ?3?` F
f
PERMIT SUBTYPE: TYPE OF WORK:
t;i • 11 LION
Permit No. Permit Holder Date Telephone #t
ELECTRIC
PLUMBING
HVAC
Inspection Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL
GYP BOARD
FIREPLACE
FIREPLACE
AIR TEST
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL '
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
Receipt MECHANICAL PERMIT
CITY OF EAGAN
Permit No.
Fee
Fill in numbered spaces S/C
Type or Print legibly
Tot.
1. Date 2. Installation Cost
3. Job Address <_ Blk. Tract
4. Owner
5. Contractor Phone
6. Address
7. City State j,; Zip 5 ?s2?
8. Building Type: Residential Commercial ? Institutional ?
9. Work Description: New ? Add 0 Alter ? Repair ?
10. Describe ! Fuel Type
11.
No. Equipment BTU - M. Ea.
Forced Air No. Equipment CFM
Mfg. Air Handling:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Othe
Air Cond. r
Mfg.
Gas, Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : i -1 11 1 -1
for
Rough Final
Inspections: Date (-?31nsp./ Date '? nsp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-6100
CITY OF EAGAN
2795 Pilot Knob Road Eagan, MN 55122
PHONES 454.6100
BUILDING PERMIT -,r,
Receipt #
i rr??
6874
TO be Used far Est. Value Date 19
Site Address Erect ? Occupancy
Lot Block Sec/Sub. Alter ? Zoning
Parcel # Repair ? Fire Zone
Enlarge ? Type of Const.
Name - Move ? # Stories
W
Address Demolish ? Length
b city -Phone Grade ? Depth Sq. Ft.
a
,o Nome
u Address Assessment _
t5
city Phone Water $ Sew.
W Police
r Nome Fire
? Address Eng.
G
cc z
<'
City Phone
Planner
Council
I hereby acknowledge that I have read this application and state that Bldg. Off. _
the information is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances. Approvals Fees
c
APC
Permit
Surcharge
Plan check
SAC
Water Conn. _
Water Meter -
Road Unit
Total
Signature of Permittee I
A Building Permit is issued to: on the express condition thin
all work shall be done in o=rdance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Permit No. Permit Holder Misc. Permit No. Holder
Plumbing
H.V.A.C.
Well
Water
Disp.
Sewer
Electric
Inspection Date Insp. Other
Footings _
Foundation
Framing X941 Ay, r ?'ztr ?
Rough Plbg.
Rough HVA
Insulation
Final Plbg.
Final HVAC
Final a
Water Describe Location:
Well
Sewer
Pr. Disp.
CITY OF EAGAN Remarks Sew & Wtr Conn. PD. 11-14-68
Addition Cedar Grove #6 Lot 8 Blk 5 Parcel 10 16705 080 05
Owner l?, d 15??r1 C1 of Ll I Q- I Street 1775 Serpentine Dr. State_ Eagan,EN 55122
X64., ti ???-- -
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATERAL 1970 1 2.00 20 Paid
WATERMAIN
WATER LATERAL 1970 20
WATER AREA
STORM SEW TRK 1970 20
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 200.00 1072 11-20-68
BUILDING PER.
SAC 200.00 1072 11-20-68
PARK
This request void ? / !? z ? j f /% /
16 months from ( J D / `/
A,97557. LOS 605 Cad'broof_ o '3cI.('i
Request Date
I L! G
a o Fire No. Rough-in Ins peciion
Rrpui
retl? y-y
Ready Now aQ Will Notify Inspec-
! motor Wh
R
s No
u en
eady
Licensed Electrical Contractor
I hereby request inspection o1 above
Owner electrical work installed at:
Street Address, Be. or oute No. City
ection No. T wnship Name or No. Range No. County
_ ry
Occup- I (PRINT) Phone No.
e r,lgl I O (1 N g 0 RJ
Power Supplier Address
Elect al
Contractor (Company Name) Contractor's License No.
l
o W n
Mailing Address (Contractor or Owner Making Installation)
Aut ized Signature ( ontractor Owner Makin, Installation) Phone Number
MINNESOTA STATE BOARD F ELECTRICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD
1621 University Ave-, St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 297-2111 ENCLOSED.
5?a REQUEST FOR ELECTRICAL INSPECTION EB-00001-04
4 ' Ses instructions for completing this form on back of Yellow copy. A
(? ?g
1
117 ?1 ?ry I n . ""X"" Below Work "Coveted by This Request d D
Nrr4 Addj Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heating
Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm the, Spec, Y Other IsOeeeify)
other pecify Other Other
Compute InsDectlon Fee Below
N Fee Service Entrance Size h Fee Feeders /Subteeders # Fee Circuits
0 to 200 AMPS 0to 30 Amps 0to 30 Amos
Above 200 Amps 31 to 100 Amps 31 to 100 Amps
Swimming Pool Above 100-Amps Above 100_Am)s
Transformers Irrigation Booms 50 1 Partial, Other Fee
Signs Special Inspection
S • SQ
TOTAL
L
Remarks
e '
rt[ f' /,
t
Rough-in
V
` ^ Oate ,the El cal
Q ' nspec for. hereby
certify that the above
Final ?-" /D
o ?J?L/ D.A. f
r pecti00 has been
t ede.
This request void 18 months from. t
S W% /Yl y R p r o ` t
EAGAN TOWNSHIP
BUILDING PERMIT
Owner ..... .-------------- .......... ......... ............. ..............................
Address (Present) .. : ........-
Builder cZ..??
Address
DESCRIPTION
N° 1887
Eagan Township
Town Hall
Date ..:/q?OS_tJlF ..............
Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks
LOCATION ' ?WcP'0 sus.-o<-Y /-'Vqd AW4 ai )
f Street. Road or other 17escnpiton of Location Lot Block Addition or
..+?` y_I/-,x.?-?'y-Y?-4? ?f7-so-s'i-s'i ? G - Lr ? 6
A3-?8'
This permit does not authorise the use of streets, roads, alleys or sf0ewalks ncfr does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general! welfare to anyone in the community.
THIS PERMIT MUST BE EPp,T ON THE PREMISE WHILE THE WORK IS IN PROGRESS. /
This is to certify, that ..... ...f!....... ::c~ ----------- ................. has permission to erect a----- A..,( .....sK-r:.'? ?Y? upon
..'..' ._. .-
the above described premise subject to the provisions of the Building Ordinance for Eagan Townsh'Ip adopted April 11,
1855
n
. ...............X':?&];a °ffl /........:.fx-............--"--..------. Per ce t?l<.?.-?
ddd ......I? ` (.. eci.........................
f Tnwn Board d. .. .... Building I?ialecfor...
4 6
A
CITY OF EAGAN
7743 Pilot Knob Rood Eoyon, MN 33142
PHONE% 434-8100
BUILDING PERMIT DECK
Site Address +"/ a+cawcaa vaaac aiaa-c
Lot 8 Black 5 Sec/Sab. Cedar Grove 6
Parcel # 10 16705 080 05
rc Name Veru-LU A. dVnne3Vn
w
Address 1775 SPatt -10t nP Tlrinra
b .n
o Name Ron 11eladahl
A Address -
i- rit. Phone
Name
I hereby acknowledge that I hove read this application and state that
the information is correct and agree to comply with all applicable
State of Minnesota Statutes grid City of Eagan-Qdinwnces.
N? 6873
Receipt
Erect ?
Alter ?
Repair ?
Enlarge ?`aJ
Move ?
Demolish ?
Gmde fl
Assessment -
Water & Sew.
Police
Fire
Eng.
Planner
Council -
Bldg. Off.
APC
Occupancy R3
Zoning R1
Fire Zone RA
Type of Const. V
# Stories
Length 10
Depth 22 Sq. Ft.-
Fees
Permit _P:
Surcharge -
Plan check _
SAC
Water Conn.
Water Meter
Rood Unit-
Total $53.00
Signature of Permittee , 4-1? a" ' ? I
A Building Permit Is issued to: Ron Rl 4dahl on the express condition that
ail work shall be done in accordance with all ?p(pIi ble StateylillAinnesota Statutes and City of Eagan Ordinances.
Building Official -! '.
?L 1 CITY OF EAGAN l Include
site plan w/elevate' ons &
?? B ING PERMIT APPLICATION 1 set of energy calculations.
Otis
To Be Used For q?d y o Valuation Date
Site Address J 77S ?g rOP_n f n P, 1>'Z- _` ''OFFICE USE ONLY
Lot g/ Block 49- Sec./Sub. /
G = G (Erect occupancy ?3--- --
Paroel #: /0 1(0-70S-07b CIS, Alter Zoning
Owner:
Address:
City/Zip Code:
Phone #: - ' y,
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./EM.. _
Address:
City/Zip Code:
Phone #:
Repair Fire Zone
Enlarge Type of Const.
Move # Stories
DEMlish _ Front ft.
Grade Depth y 2 ft.
APPROVALS FEES
Assessments Permit Jj `5
Water/Sewer Surcharge ,5? '4?
Police Plan Check
Fire SAC
Eng•
Planner
Council
Bldg. Off.
AFC
Water Conn.
Water Meter
Road Unit
TOTAL 5 a • Co O
RECORD OF COMPLAINT
Date: 7110/00
Type of Building: X Residential _ Apartment _ Other,
Name: Gerald Johnson
Address: 1775 Serpentine Dr
Phone number: 651-454-2206 (h)
Complaint: Walk out basement caused flooding of Lower Level. An average of six
inches of water was sitting in basement.
Comment: Waste Management Q
Action Taken By: Mandy Boudreau
X;X<iX1k>k7X'(YF?kM?Y„X<?X<XtY6,tXiY?:MXS&M$ X3*,74:.MYF$: AAWA
CITY OF E('GAN
CA5HTE_Rs S TERMTNAI... NO:, 681.
DATE: 03/23/98 TIME: 1605:21
1D
NAMEa PROTECTIVE HOME COVERING INC
3210 9001 1775 SERPENTINE 1.74.75
2155 9001 1.775 SERPENTINE 5.50
Total. Recei.pt, Amount: 180.25
CRG87 400
USER TD: NANCY
All Y, lvi.fi>XX;;kYriX;ScX<X -ttAt****A*Xi„neHe=*AWA
PERMIT
CC •Y aOF EAGAN Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
031649
03/23/98
SITE ADDRESS:
1775 SERPENTINE DR
LOT: 8 BLOCK: 5
CEDAR GROVE 6TH
P.I.N.: 10-16705-080-05
DESCRIPTION:
(SIDING)
,building-Perrrit Type
aBuilding W6r* Type
Census Code `
SF (MISC.)
REPAIR
434 ALT. RESIDENTIAL
REMARKS
FEE SUMMARY-
VALUATION
Base Fee
Surcharge
Total Fee
$174.75
$5.50
$180.25
$11,000
CONTRACTOR: _ Applicant - ST. LIC.OWNER:
PROTECTIVE HOME COVERING 18840123 0004164 JOHNSON JERRY
9929 PLEASANT AVE 1775 SERPENTINE DR
BLOOMINGTON MN 55420 EAGAN MN 55122
(612) 884-0123 (612)454-2206
I hereby acknowledge thbt''I have°read this application and ,state that the,
info-rmati-on is correct and agrge,to,cgmply.with all applicable State of Mn.
Statutes and City of Eagan Ordinances. J
fot? ,l, gIm2l
APPLICANT/PERMITEE SIGNATURE (ISSUED Y: SIGNATURE
4q 1998 BUILDING PERMIT APPLICATION (RESIDENTIAL)
CITY OF EAOAN
3%
3830 PILOT KNOB RD - 55122
681-4675
New Construction Requirements RemodeVReoair Requirements
? 3 registered site surveys
? 2 copies of plans (Include beam & window saes; poured fnd. design; etc.)
? 1 energy calculations
? 3 copies of tree preservation plan if lot platted after 711/83
required: _Yes No
DATE: ? DJ-4 0
? 2 copies of plan
? 2 site surveys (exterior additions & decks)
? 1 energy calculations for heated additions
CONSTRUCTION COST; 10 1 6?5
DESCRIPTION OF WORK:: t?R !Is koz
STREET ADDRESS: _ k l l!S- ?SE -e -f C 1) T ? AJ !! 0 2
LOT: 5 BLOCK: - SUBD./P.I.D.#: rdflhl,/7kA1 4G
Name: ?? ?{ W S Olti =7,1-r >e R Lf Phone #:
PROPERTY Last First
OWNER Street Address II I?? C R)f W-T 1V ' 9` .r-? 0 2
lf? SL ' /tV
City Z,4 ??U State: ?y Zip: S ?c7
Company: PQrj t£C71 jyt{? (0t R) A16- Phone
CONTRACTOR i1 c AK 3l
Street Address:qp L L? PVILs?t An- AK 5, License #
city
15
State: A'VV
Zip: ?5 7cj V
ARCHITECT/
ENGINEER Company: Phone #:
Name: 17- Registration #:
Street Address:
City State: Zip:
Sewer & water licensed plumber (new construction only): Penalty applies when address chang
and lot change is requested once permit is issued.
I hereby acknowledge that f have read this application and state that the information is correct and agree to comply with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant
OFFICE USE ONLY Pk
Certificates of Survey Received - Yes No rIK4R Z 3
Tree Preservation Plan Received Yes No Not
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex
? 02 SF Dwelling ? 07 4-plex
? 03 SF Addition ? 08 8-plex
? 04 SF Porch ? 09 12-plex
? 05 SF Misc. ? 10 _-plex
WORK TYPE
? 31 New ? 33 Alterations
? 32 Addition ? 34 Repair
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth
APPROVALS
Planning
? 11 Apt./Lodging ?
? 12 Mufti Repair/Rem. ?
? 13 Garage/Accessory ?
? 14 Fireplace ?
? 15 Deck
? 36 Move
? 37 Demolition
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building
Engineering
Variance
Permit Fee l 7`I• 75
Surcharge 50
Plan Review
License
MC/WS SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
1
SAC! nits
Valuation: $ /l' M eo
44
16 Basement Finish
17 Swim Pool
20 Public Facility
21 Miscellaneous
MCNVS System
City Water
Fire Sprinklered
PRV
Booster Pump
Census Code.
SAC Code
Census Bldg
Census Unit
MEMO
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECH
DATE: AUGUST 25, 1993
SUBJECT: STREETLIGHT ENERGY COSTS
CEDAR GROVE NO. 6 (141 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition
as listed below:
Block 1, Lots 1 1
Block 2, Lots 1-8 8
Block 3, Lots 1-18 18
Block 4, Lots 1-11 11
Block 5, Lots 1-9 9
Block 6, Lots 1-53 53
(Lots 54 through 61, Block 6, should not
be billed at this time)
Block 7, Lots 1-12 12
Block 8, Lots 1-18 18
Block 9, Lots 1-11 11
TOTAL 141
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Ed Kirscht
Sr. Engineering Tech
cc: Mike Foertsch, Asst. City Eng.
EK/je
a, loflmls-DNI
n S- SERPMT/iNf- Dr,
EPA A-N
aL ? - l ?{1
a+R ?on)sTI2,
435-- s-6 r1
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR WATER SERVICE CONNECTION
Date: I/ ?{ Lb Number: 1 42
Billing Name:
Owner:
Plumber:/p_! i? ^?yyyC ,
b4 -
Site Address: p ,j ( 1776 A1til?. oil
Billing Address
Size
NO I Total Chg.
Building is a:
Residence_L
Multiple No.
Commercial
Industrial
Other
Meter No. (Permit Fee 7.50
Meter Reading Meter Dep.
Meter Sealed: Yes_ 'Add'l Chg.
Inspected by
Date
Remarks:
By:
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
. i9
By: ,E
Please notify the above office when ready for inspection and connection.
r
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE
L3 1q-1
O#J4, A
PLUMBER
NUMBER 259
DESCRIPTION OF BUILDING
Industrial Commercial Residential Multiple Dwelling No. of units
Location of Connections:
Connection Charge =-Z-r--- , P.
Permit Fee 7.50
Street Repairs
Total
Inspected by:
Date
Remarks:
By.
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota
By J4 dle-•
Please notify when ready for inspection and connection and before any portion
of the work is covered.
TYPE OF PIPE dAAA i?
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1775 Serpentine Dr
Lot: 8 Block: 5 Addition: Cedar Grove 6th
PID:10- 16705- 080 -05
Use:
Description:
Sub Type:
Work Type:
Description:
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
e- Fireplace
Gas Fireplace (new)
Contractor:
Hearth and Home Technologies
2700 N. Fairview Ave
Roseville MN 55113
(651) 633 -2561
PERMIT
City of Eaan
Permit closed without required inspection(s). Letter & remarks sent to applicant on 6/8/09. (pf)
Chimney /flue must be inspected prior to concealing. Smoke detectors are required in all sleeping rooms prior to final
inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required. Battery operated types are
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Total:
Applicant/Permitee: Signature
- Applicant -
Construction Type:
Occupancy:
Owner:
Sharon D Johnson Tste
1775 Serpentine Dr
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
$88.50 0801.4085
$1.50 9001.2195
$90.00
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA087774
12/15/2008
ePermit
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA110396
Date Issued:05/09/2013
Permit Category:ePermit
Site Address: 1775 Serpentine Dr
Lot:8 Block: 5 Addition: Cedar Grove 6th
PID:10-16705-05-080
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Softener
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Josh Mcguire
1424 3rd St N
Minneapolis, MN 55411
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Sharon D Johnson Tste
1775 Serpentine Dr
Eagan MN 55122
(651) 454-2206
Benjamin Franklin Plumbing
1424 N 3rd St.
Minneapolis MN 55411
(612) 604-4285 X61
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA112812
Date Issued:08/23/2013
Permit Category:ePermit
Site Address: 1775 Serpentine Dr
Lot:8 Block: 5 Addition: Cedar Grove 6th
PID:10-16705-05-080
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar.
Pictures are not acceptable in lieu of inspections.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Sharon D Johnson Tste
1775 Serpentine Dr
Eagan MN 55122
Ashco Exteriors Inc
11164 Zealand Ave N
Champlin MN 55316
(763) 225-8333
Applicant/Permitee: Signature Issued By: Signature
-,
For Office Use
a Permit#: /6/ 1s1
s ,
Permit Fee: /t95-
Date Received
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD: (651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections(a7cityofeagan.com L
� 2018 RESIDENTIAL BUILDING PERMIT APPLICATION
QJ
Date: ) --k 4� Site Address: k 11 15 3 Vi- Av n
i ` - Unit#:
Name: S ' �V°S6 V� Phone:r J; L/ -g•DOC
I
R \`1(5 SJ,'��Gi t1Vt DMZ
Owner Address/City/Zip:
3p
Applicant s: Owner .ontractor
. Workype ofDescriptio of work: L k �C*Y�C.� j►- CA•tiS j f r I 4 1-2
Construction Cost: a U - Multi-Family Building: (Yes_/No )
PRO C Bt �I� *� d"t4r- trm!tic
1g Company: Contact: �j-k,Q.U`—
Paion
t Address: i.
9 .,t1 55;;:,i-. aCity:
Contractor
I State: Zip: Phone: /�� � � 1o�EmaiL - '�S`\v� cA\\ O \G'1
lLicense#: �G Lead Certificate#: 4" IA-1 ilfl l 1\-I
1 If the project is exempt from lead certification, please explain why:
I
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?
1 1 Yes No If s,date and address of master plan: M
Licensed Plu er: Phone:
Mechani Contractor: Phone:
ISew &Water Contractor: Phone:
re Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you s+0bMitare considered to to public information. PordOns at the i»formatio4 stay m
classified as,nen- blic if ou • °vides• cific reaso that would* it the Ci to conclude that tare trade secrets
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an ema I update on the City's
website at www.citvofeacan.com/s Jbscribe.
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.
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.gopherstateonecall.orq
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; .hat 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 Ap ' nt's Signature
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