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2014 Shale LanePLUM)l3kNG 0 CITY OF V CONTRACT 3830 PILOT KNOB ROAD, PRICE PHONE 454 Site Address - e-. Lot I__- Block ?.amc Address 4747 TWIN LAKE AVE Cdy BROOKLYN CENTER, MN 55"one I Address 1-0 14 City L:P C. ?, FEES COMMAND. FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDO - RES. RATE APLLES MINIMUM - RESIDENTIAL FEE $12.00 MINIMUM - COMM.IND./FEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $.50 SIG PER EACH $1,000 OF PERMIT FEE) CITY OF n T" A' - For Office U,saPr?ly PERMIT # MN 55122 RECEIPT # DATE: , 19 . 51 ?0? G. TY4Zt WORK DESCRIPTION New Add-on m. Repair it KrM. VUSU. UNLr - LoUM CIC Ii NO. FIXTURES 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 - $3.00 Gas Piping Outlets - $1.50 (MINIMUM -1 PER PERMIT) Softener - $5.00 Well - $10.00 Private Disp. - $10.00 Rough Openings - $1.50 U. G. Sprinkler System - $12 00 PERMIT FE FOLLOWING: TOTAL $ TOTA : r r!' s++^?. e-'^ `. -+as ?; .. :n .•i..,,T,. -. _ MECHANICAL PERMIT For CITY OF EAGAN PERMIT # . 3834 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIPTA DATE PHONE 4548100 DATE: --? >ite Address ;?rjr N• BLDG. TYPE WORK DESCRIPTION of ,Block Sib Res. New Const. Mult. Add-on Comm. Repair Name Other Address c City t ?- Phone` / FEES RES. HVAC 0-100 M BTU - $24.00 Name ADDITIONAL 50 M BTU - 6.00 m. - • • (RES. HVAC INCLUDES A/C ON NEW b; City Phone TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & TYPE OF WORK REMODELS (INCLUDES GAS PIPING) - 12.00 TU GAS OUTLETS (MINIMUM -1 PER PERMIT- Forced Air M B $ NEW CONST.) 1.50 EA. Boiler M BTU $ COMM/IND FEE -1% OF CONTRACT FEE Unit Heater M BTU $ APT. BLDGS. - COMM. RATE APPLIES Air Cond M BTU $ MINIMUM COMMERCIAL FEE - 20.00 . STATE SURCHARGE PER PERMIT - .50 Vent CFM $ (ADD $.50 S/C PER EACH $1000.00 OF PERMIT FEE) Gas Piping Outlets # $ Other $ J t t i 10% $ ? `o CommAnd. Con rac Pr ce x SIGNATURE I PERMIT FEE: 1,.1UUU' S/C: FO : CITY OF EAGAN TOTAL: A0 -2e - PERMIT # ? - yrs. MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: CONTRACT PRICE: PHONE: 454-8100 Site Address 1 d ` anG BLDG. TYPE WORK DESCRIPTION Lot Block Sec/$ uq Res. New Name -son Hty . A, C . , 7 tic , Mult Add-on cc Address v s ? l?2ilflwbvt: D . Comm. Repair v. 452-2 Other ?? - c City Phone Name K, zL?otL FEES RES. HVAC 0-100 M BTU -$24.00 C Address • `'"° ' ADDITIONAL 50 M BTU - 6.00 p City Phone (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIT) - 1 50 EfA . . TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air -' M BTU APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Unit Heater M BTU REMODELS - 12.00 Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00 STATE SURCHARGE PER PERMIT - .50 Vent. CFM (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets # BEYOND $1,000) Other FEE: S/C: SIGNATURE OF PE I EE t i ..w I TOTAL: ! FOR: CITY OF EAGAN Iso CITY OF EAGAN Remarks- *Cedar Grove Acquisition Addition CEDAR GROVE #4 Lot 1 Blk 2 Parcel 10 16703 010 OZ Owner Street 2014 Shale Lane State Ea4an, MN 55122 K?nL) 5yN Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. $ 1970 338.25 33.82 10 Paid STREET RESTOR. GRADING SAN SEW TRUNK SEWER LATERAL 1972 1,304.00 52.16 25 Paid WATERMAIN WATER LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. SAC PARK EAGAN TOWNSHIP BUILDING PERMIT Owner : ... . Address (present) Builder .... -----.__ __-.....__- - Address ...... _. -__. -- N° 977 Eagan Township Town Hall Date 6 -17 /1 . _..._...._.---- .......... Stories _ 't'o Be Used For Front Depth Heigh! Est. Cost Permit Fee Remarks .•i o -- rr p Aa3 -Ny/LOCATION Street, Road or other Description or Location Lot Block Addition or Tract This permit does not authorize the use of streets, roads, alleys or sidewalks nor 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. fhB£ KEPT OI?,uTHE PREMISE WHILE pTHE ermission I5 I PROGRESS. THIS AMMUST certify. This i to a.-.has ermrssion to erect a---- /l-------- .........upon the above described premise subject to the provisions of the Building Ordinance for Eagan Township adapted April 11. 1955. _ .:...........Wf^--.•.k''_.(!. ----- Per ---- _.___.__e.4.__Li?--. .....,...r._ _..... _....... Chairman of Tnwn Board - Building Inspector EAGAN TOWNSHIP BUILDING PERMIT Owner ...... 2( J ? ........... ................. Address (present) ... ?..1.-.f------ -?.J. .:...--.... Builder -----..Jd?. ... .L -------- ................-----------......_.._..-. Address ................ ?a.prt :a!-- -------------------------------------------- ...... F/ DESCRIPTION N° 1505 Eagan Township Town Hall Date .... I.?''_47?.-&I1 ................. Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks _ J.2-o- l 9, a.rn ' V LOCATION II Street. Road or other Description of Location Lot I Block I Addition or Tract i 1;2- 1(2,. This permit does not authorise the use of streets, roads, alleys or sidewalks nor 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 KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that...!-.-1.ez. ?5c.r? ... .................has permission to erect a----- ..... ..-....... ...... upon the above described premise subject to the provisions of the Building Ordinance for . an T adopted April 11. 1955 ....... ..................... ?& .....1....:...°^.`.: :............. Per ......................... JgL4?_!: <...... ..?-.t..:i ? _.'.'?e /?.-'--'.. Chairman of in' Board Building InWector 4 Y1-15- EAGAN TOWNSHIP BUILDING PERMIT N° 2849 Owner ....... ''."/..... D ....................... Eagan Township Address (Presentt))/...?aL..z...?...>.... ^(? -...?°?--.... Town Hall Builder .---t-..-..°---------------------------------- Address -------------_..............-----............................................---........... DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost ermit Fee Remarks a d d` 0 / c, 30 or 3.1'0 This permit does not authorise the use of streets, roads, alleys or sidewalks nor 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 BEYKEPT . OWN THE PREMISE WHILE THE WORK IS IN PROGRESS. This is to certify, that .... -?`?'J..L ........ has permission to erect a..."..ae? ..-r? .................... ...........-upon the above described premise subject to the provisions of the Building Ordinance far Eagan Township a pled April 11, 1955 .. .....°. ---°- ....-:.- ............. Per ----- -------...... A-lee...... V.. ............................. Chairman of Town Board Building Inspector A aQ ------------------- For Office Us j Permit#: ?? ?/? j 2 I Permit Fee: 7.5 Date Received: j I I I Staff: I 2008 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q- Z -06 Site Address: 2©1 T 5 i k941- ) Tenant: r "12 m tve,Y , Suite #: j RESIDENT/OWNER Name: 1 e ` mock" 1 ock" Phone: j .p - Address / City / Zip: ZOlV I !?/V/, L#4e Applicant is: -Owner V__?Contractor TYPE OF WORK pp ? ) ?-7 Description of work: ?? l2ornr d-Gi/J2VIn? / Z 47dv D bY5e- Multi-Family Building: (Yes No Construc ti on Cost: oop CONTRACTOR c io 9 2,7z Name: 77,jipn©o it /4mc 4raa License#: 90 Address: / Z- WzJ &?! JAd- y? r` City: .i/)..QFJ)f0 SState:ft), zip: T?(!o I 1 ./ ? Phone:(D!Z `y??o S Contact Person: (??li(? ?f? IHiLrLF COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7672 _ Minnesota Rules 7670 Category 1 _ Energy Code . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted (J submission type) • Energy Envelope Calculations Submitted 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. Portions of the information maybe classified as non-public !f you provide specific reasons that would permit the City to conclude that the are trade secrets. 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 Mprov,,If A pplicant's Printed Name Applicant's Signature Page 1 of 3 (G7o3 oio oa ?r1 Asa oq - 0A- 4 All CC c G Gr Ao le" e -- --------- ---------- MASTER CARD LOCATION OWNER STRUCTURE AND LAND USED AS Permit No. Issued Issued To Contractor Owner BUILDING PLUMBING CESSPOOL - SEPTIC TANK WELL ELECTRICAL HEATING GAS INSTALLING SANITARY SEWER OTHER OTHER Items Approved (Initial) Date Remarks Distance From Well FOOTING /- 10- 7 'y SEPTIC FOUNDATION FRAMING CESSPOOL TILE FIELD FT. FINAL ELECTRICAL HEATING DEPTH OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS PERMIT NO. CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE OBSERVED. ? ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. DATE OF INSPECTION ITEMIZED AND DESCRIBED NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. ? REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTI FI CATION -1 certify that I have carefully inspected the above in which 1 have no interest present or prospective, and that I have reported herein all significant conditions observed to beat variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require- ments for off-site improvements relating to the property inspected. 1-1 ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE zz L BL CITY USE ONLY ? SUBD. CiAg Je RECEIPT #: ? 1 1 7 RECEIPT DATE: PERMIT # 31 ?zcl 1999 PLUMBING PERMIT (RESIDENTIAL) 'CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (651) 681-4675 Please complete for: > single family dwellings > townhomes and condos when permits are required for each unit > backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Bath tuh a nn Floor drain 3.00 x = $ Gas I in outlet ` minimum - 1 3.00 x = $ Hot tub/spa 3.00 x = $ Kitchen sink 3.00 x = $ Laundry tray 3.00 x = $ Lavatory 3.00 x = $ Minimum fee alterations to existing dwelling 30.00 x = $ 0,2> Private Disposal System new/refurbished ' requires MPC tic. 75.00 x = $ Private Disposal System abandonment 30.00 x = $ RPZ new installation/re air 30.00 x = $ Rough opening 1.50 x = $ Shower 3.00 x = $ Underground srinkler if dwelling is under construction 3.00 x = $ Underground srinkler if existing dwelling 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x $ Water softener if dwelling under construction 5.00 x = $ Water softener if existing dwelling 30.00 x = $ Water turnaround 30.00 x ---- _ $ State Surcharge .50 > > ----> $ 50 Total -> > > ----> $ 50. SO Reminder. Call for inspections of alterations, Le. water heaters, water softeners, etc. I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable Ciry of Eagan ordinances. It is the applicant's responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and.maintenance.acfivities.to.the.facilides constructed under this permit within City property/right-of-wayleasement. SITE ADDRESS: UPTON, NORBERT 2014 SHALE LANE EAGAN, MN 55122 OWNER NAME:: (951) 454-3391 INSTALLER NAME: TELEPHONE #: (AREA CODE] TELEPHONE #: NORSLO"i PLUMBING CO. (AREA CODE) STREET ADDRESS: .r 121) 82 / - J, CITY: 290b 6ARFIELD AVE SO STATE: ZIP: SIGNAT E OF PERMITTEE 2006 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 ' 651-675-5675 Please complete for modifications to existing residential dwellings. O Date _j l Site Street-Address 'r?)nwl llia L41 Unit # Property Owner '?(I r Telephone# (60:) Contractor T)1rl W l? Telephone # (7?{ r S Address Cj City State Zip S 3 / The Applicant is: _ Owner ? Contractor -Other Septic System - New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-built $ 10.00 Alterations to existing dwelling $ 50.00 _ Add plumbing fixtures. This fee includes installation of a water softener and/or water heater at the same time. If you are installing only a water softener and/or water heater, do not complete this section; move to the next section and check the appliance(s) you are installing. -Septic System Abandonment -Water Turnaround (add $130.00 if a 5/8" meter is required) Other: - $ 15 00 = Water Softener Water Heater /replacement new ? . - _ Lawn Irrigation _RPZ _PVB -new _repalr -rebuild $ 30.00 State Surcharge $ .50 56 $ Total ?- I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is requir to b reviled and approved. N?fk ? I? FD) G(K? E11\ F. Applicant's Pri nted a e pp i i nature MAY 2 1 2007 /?' ? 1 ? ,?„ Fni '. M M ,? .?? - ? ?? ?.?.w... ri?'? ?? , . °? i ?` ??? . ?? ? .., ?? ?'??? ?„ , y, t `? ? ?:? ? .v ?t:??.;?ti ?.?'?? ?,. °:; '?, Q > ? ??: ?° ?. r :: K (? r '?'`?_? r ?"` g c i:. ,., ?"'J f, . Fg'? 4 ? ,`a ?? r t,? J ? ? g ?? ??. ???'7a. ?i ',"?" fm ' ? ? v' C? 4; (,? F'' ? ' ? 7 ? ?, ? ?? r?TwU:a?? ?? •:;??1JC a;; G`; I ,' U ' /' f rte` C:, i €-?+? 'r r if . 7 / f'„ r /?' ?" a , ? ?; `` ?' ki!.tf ?r Date: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2012 RESIDENTIAL BUILDING PERMIT APPLICATION RESIDENT OWNER TYPE OF WORK CONTRACTOR -3 -27-/2, Site Address: Unit #: Name: qr • /t4 c4 Address / City / Zip: ?-o/y skate L•ch e Applicant is:Owner Contractor Description of work: ions' 5# op f%)it c -k Construction Cost: 7c�O Phone: EA. 4,0-1 Mit 411- .221- C.393 557.22 Multi -Family Building: (Yes / No )( ) Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 4/ G ee_a4n /1.,er4,, 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 the information mayRbe:classified`as nope conclude:, ou submit are considered to btr Irc if you, provide specific reaso that,they are:traa(F e core 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.oro 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 1 understand this is not 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 -P rt 44054v Applicant's Printed Name / • Applicant's Signature Page 1 of 3 SUB TYPES Foundation Single Family Multi 01 of _ Plex Accessory Building WORK TYPES New ,r- Addition Alteration Replace Retaining Wall DESCRIPTION Valuation Plan Review (25%_ 100% Census Code # of Units # of Buildings DO NOT WRITE BELOW THIS LINE Fireplace Garage Deck Lower Level Interior Improvement Move Building Fire Repair Repair 7®o h'3tt Type of Construction 3 REQUIRED INSPECTIONS Footings (New Building) 1 Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: _Ice & Water Final Framing Fireplace: _Rough In _Air Test Insulation Sheathing Sheetrock Reviewed By: RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool Occupancy Code Edition Zoning Stories Siding Reroof Windows Egress Window Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous _ Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building — give PCA handout to applicant MCES System 0?a SAC Units R-/ City Water Square Feet ,31i Length Width 8' Final TOTAL 93 Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: _Footings _Air/Gas Tests _ Siding: _Stucco Lath Stone Lath - Windows Retaining Wall: _ Footings _ Backfill Radon Control Erosion Control , Building Inspector Final Brick Final Page 2 of 3 -Z-0114 Ski. .t 1/413 !Z b / 03S • rsi 414, W EA BY: �. DATE: �- 3 BUILD/NGTCTIONS DIVISION /", I Ai •1,140 t' ,t I -Jai, 5/1 _-)c .-•-• • 13 /lap 1._,ArAT7e 4.1 — 1 , 1 I I 1 /incise 1 nc A:51.2c 01" / „ t -2 /•. 4 A. l-r/r21 6 /1 76 - L 9,1St 3 41 y. Use BLUE or BLACK Ink r-------------------� I For Office Use � ' � Permit#: � � ���� 1 Clty of ����� � � P �,; F : b5�� � e t ee 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 2014 RESIDENTIAL BUILDING PERMIT APPLICATIOI� Date: Site Address: Unit#: ! Name:+^ ~ / 1 l Phone�Q�� ��[''"(a��� i�eSid@nt/ " Zf� � ';Qyy�gr . ` Address/City/Zip: 4 Applicant is: Owner �/C;ontractor Description of work: [-i` � ��C � r.�� Type of,Wc�rk : Construction Cost: �`L�(�� Multi-Family Building: (Yes /No� Company:��" o� ��l�.c����132���� Contact:��V�1��` ��� ��Il�t'�Gf#��' , Address: y��� ���o�lR� � City: �►01�I � . ����' State;�,�_Zip:��z� Phone:(�j��l� ���rEmail:�,��,�yrre�o,�,�iw��Ps� <C�� �.'.ir�� -�� � ���, License#: �� �fl�� Lead Certificate#: b If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: NQTE:Ptar�s and-s�pp�rting�';d��uments tha�:yra�a submi�are��rnsfalered tn be p�rblic�nforrr��tion. Por��crn5 of the fnfprmatio»may be cl��sit'r'ed as nttn;�p�rbl��r�ya�pro�ide speci��r��so�s;that would permit the C�ty to ` �or��lu�e�th�t t►re�are trad�:se�r�f�. 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.aopherstateonecall.ora 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. Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x���1)�/1�(� ��-� x Applicant's Printed Name A plicant's Signature Page 1 of 3 Use BLUE or BLACK Ink . . . . . �-----------------� I For Office Use I � � Permit#: �oC ����� Clty of ����� � � . r� -��- � Permit Fee. � �'V 3830 Pilot Knob Road � _� J , l� Eagan MN 55122 � Date Received: `7'�`"� Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: � I I 2014 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit#: Name: � [,� Phone: R i n -�.—���(�,�� es de t/ 1_� 1 Owner Address I City/Zip: �01 y ��"l�c� �-/� , : Applicant is: Owner �/Contractor Type of WOrk Description of work: - ' � �- � ��:� Construction Cost: ��'{�� G�� Multi-Family Building: (Yes /No� Company:��"���[1��L �i2� �1`����'� Contact:l�V��t�L' �/�f`2E Contractor Address:��(7 iv1`lc�����" /��i�� City: ��[S State:�Zip: ���0� Phonelr�����g --,%���(s�mail: License#: �,. �fl�f� Lead Certificate#: �_�� �f�_� If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDWG 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:P/ans and supporting documents that you submit are considered to be public information, Portions of the information may be classified as non-public if you provide specific reasons that wou/d permif the City to conc/ude that they are tratle secrets. 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.qopherstateonecall.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; 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�������- ��� X ��l ApplicanYs Printed Name Applicant's Signature Page 1 of 3