1592 Sherwood Ct�City afEaQan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: 4q66 0
Permit Fee: f
Date Received:
Staff:
2009 MECHANICAL NI CALPERMIT�APPLICATION
Date: 5,-/q--10 Site Address:
p;/ �59 9 Sherwood d -
Tenant: A!€x TSor(�/1rc�l(.tsK
Suite #:
RESIDENT / OWNER
Name: i
lL � �e:�! f�(s(s Phone: (SSI' 14/I6)-0 0 1
Address/City/Zip: J5dd Sherwood c 1aai , 61,v 66S) a
CONTRACTOR
/S�t�e
J* +/- 5 e 71- L
Name: Th' l o f P lt-f kt(%v License #: v3 `7
Address: ./ D Mem ori 41 0 s�s-s '
City: &I{waCr State: ( Zip: 66Ogd
Phone:66)4i 3t- 5770 Contact Person: .1 iti/vY\ a JOK 11SCNn
)
TYPE OF WORK
New yl Replacement Additional Alteration Demolition
U1sf atU Lennoy air ctit -oncr
�se'P
3 . F E d
_' -�
•!
"s
0 8 B
a, ca
t 1 ®' 6 Y 4 OA A 8,�.?S i .•
11 r•rma fnp _. ff r
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
New Construction Interior Improvement
XAir Conditioner
_
Install Piping Processed
Air Exchanger
_
Gas Exterior HVAC Unit
Heat Pump
Other
Under / Above ground Tank ( Install / Remove)
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge) 50'
O S
$90.50 Fire repair (replace bumed out appliances, ductwork, etc.) (includes $.50 State Surcharge) $ V TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x 1%
$50.50 Minimum (includes State Surcharge)
= $ Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
= $ TOTAL FEE
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.aooherstateonecall.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.
x
Applicant's Printed Name
x
Applicant's Signature
?asu Pilot Knob Road SEM/ER SERVICE PERMIT
P. O. Box 21199
Eagan, MN 55121 PERMIT NO.: l
Zoning; (? DATE:
Owner. `o fs No. of Units: i
Address:
Site Address: 7:92 Sherwood Court Ll of ?ritt.?r,V r:«?
Plumber. Cenz
I "ree to oom* W"
Oraooaos Ow 017 of Boom L. 0 0
Connection C NM),: 425 . 00 r)d
Account Deposit: Olt
Permit Fee:
BY Surcharge. P4
Date of Insp.: Misc. Charges;
Insp.: Total:
Doh Paid:
CITY OF EAGAN WATER SERVICE PER
3830 Pill' Knob Road MIT
P. 7. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: :Z 1
No. of Units:
Owner iildrs
Address:
Site Address: i. Sherwood roust L.i '. - ?; : v Uth
Plumber: Benz R4,e,n
Meter No.: Connection Charge- 3 t1
Size:
Account Deposit:
Reader No.: Permit Fee:
1 some to oon@* W" the City of Eager Surcharge: . S sou
ordlaoaco& Misc. Charges 3 • ?;? pd net_cr
Total:
By D
d
P
ate
ai
:
Date of Insp.: Insp.:
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199-
Eagan, MN 55121
Zoning: "
Owner.
Address: %ddress:: ?
to 60044 akb tbo City of to"
WATER SERVICE PERMR
7 j
PERMIT NO.: _
DATE: 1
No. of Units:
1 o . or) nd
,Accour* Deposit: 1 .00 pd
=Pemit " Fee: , 5 0 d
Surcharge: ?? • :, p
? d st t car
Misc. Charges: -
Total:
Date Paid:
Date of Insp.:
CASH RECEIPT
CITY OF EAGAN
P. O, BOX 21-199
EAGAN, MINNESOTA 55121
DATE 19
REC61Yfi0
FROM
AMOUNT $
CASH 0 CHECK
DOLLARS
100
FOR
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
Thank ou
/ ,., ' BY
CITY OF EAGAN NO 8885
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100 //
BUILDING PERMIT
Receipt ?; ?- /
*
HF DVx'/Q7 R ? 10 3 , 0 0 0 MARC i 13
3 4
To be used for
Est. Value Date , 19
1592 SF'FRP700D COURT R3
Site Address Erect IN Occupancy
Lot 1 Block 1 Sec/Sub. BRITTANY 6TH Alter ? Zoning c
Parcel No. 10-15005-010-0 1 Repair Q Fire Zone `
W Name _
Z Address
City -
O Name _
6L) Address
F- City _
W Name _
_? Address
GO
City _
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.
Signature of Permittee
A Building Permit Is issued to:
all work shall be done in accordance "v!o all
Building Official ?'?
Enlarge ? Type of Const.
Move ? * Storte
Demolish ? Length
-
-
Grade c] Depth
Sq. Ft.
Approvals Fees
Assessment _
Water 8 Sew.
Police
Fire
Eng.
Planner
Council
Bldg. Off. _
APC
Permit ' r 0
Surcharge 5' • 00
Plan check----72-6-.50
0SAC -? 0 O
Water Conn. ' G 0
Water Meter ? ? 0
Road Unit
Total • 0.5 • 50
on the express condition that
Minnesota Statutes and City of Eagan Ordinances.
it No. Permit Holder Misc. Permit No. Holder
7
!,
J
r 4 2 er `? --36
4?.yv
Inspection Date Insp. Other
Footings
Foundation
Framing S
Rough Plbg. _ Q g d
Rough HVA _? _
Insulation
Final Plbg. D
Final HVAC
Final
] C Q
Water
Describe Location:
Well
Well
'rl
Py
-;/V
Sewer
Pr. Disp.
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly
Tot.
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner
5. Contractor Phone
6. Address
7. City State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe
11.
Type
No, Equipment STU - M. Ea.
Forced Air No. Equipment CFM
Mfg. Air Handling:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
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 : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454.8100
Receipt PLUMBING PERMIT
CITY OF EAGAN
Fill in numbered spaces
Type or Print legibly
1. Date L 2. Installation Cost
3. Job Address Lot ? Blk.
i,
Permit No. `
Fee
S/C v
T
Tot. 5o
Tract 77-
4. Owner
5. Contractor Phone
6. Address
7. City - State Zip
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New [} Add ? Alter ? Repair ?
10. Describe
11.
No.
-- Fixtures
Water Closet No. Fixtures
Cesspool /Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet ther
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I 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 :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-6100
CITY OF EAGAN
Addition Brit
Y) , % i ? It)(- 1!!, x
'/If,
Lot 1 Rik
Improvement Date A ount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK 3Q 1976 130.10 8.67 15 52.07 014450 8-17-84
SEWER LATERAL
WATERMAIN
WATER LATERAL
WATER AREA (P ? 1992 269.93 .99 5 107.99 A014450 8-17-84
STORM SEW TRK 1982 571.13 114.23 3 228.47 A014450 8-17-84
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD TINIT - -no
-Z60; #'41924 -3--13-04
WATER CONN. ?t7 n n
BUILDING PER.
SAC 5.00
n
tt
PARK
CITY OF EAGAN 1?T0
3830 Pilot Knob Road, P.O. Box 21.199, Eagan, MN 55121 N? 8885
PHONE: 454.8100
BUILDING PERMIT Receipt #
To be used for SF DM/GAR Est. Value $108.000 Date MARCH 13 Iq 84
Site Address 1592 SHERWOOD COURT Erect M Occupancy R3
Lot 1 Block 1 sec/Sub. BRITTANY 6TH Alter ? Zoning R1
Parcel No. 10-15005-010-01 Repair ? Fire Zone N/A
W Name TOLLEFSON BLDRS.
z Address 1655 NORWOOD DR.
City EAGAN Phone 454-6873 Enlarge ?
Move ?
Demolish ?
Grade ? Type of Const. V
# Stories
Length 60
Depth 56 Sg. Ft.
SAME Approvals Fees
o Name
ou Address
Assessment
Permit .00
u? City Phone Water & Sew. Surcharge 54.00
Police Plan check 226.50
VW Name Fire SAC 525.00
uZU, Address Eng. Water Conn. 470.00
<W City Phone Planner Water Meter 63.00
Council Road Unit 260-00
1 hereby acknowledge that I hove read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable $2
051
50
State of Minnesota Statutes and City of Eagan Ordinances. APC •
•
Total
Signature of Permittee ??QQ
A Building Permit Is issued to: at-1-L/-f? - on the express condition that
all work shall be done in accordance wo all appli to of Minnesota Statutes and City of Eagan Ordinances.
Building Official
This request void
8 months froma '15
A 9AgR91--1 ,P1? (n
4`-3O-kq
1? Rj;6
Request U to
?? _ F -
(/ Fire No. Roug_ Inspection
Requ? d7
es ? No ,.?/?
?Ready Now IpcW ill Neu Inspec-
r Por When Ready
? i.eased Electrical Contractor I hereby request inspection of above
Owner: electrical work installed et:
Street (Address, 00. or Route No. f
/ Z-- G ib""f UbY ??t City
E v0,z') 1
ecuon No. Township Name or No. ange No. County
Oceu/p/ (PP?RRI/NT)). f(` I Phone No.
Power tier ///?C n
14 x&114 iF--C L?" Address
Electr'c ontractor (Compan ame) Contractor's License No.
6-00
k'
At,? I 3S-
Mailing Ad res. (Con
162, actor or Owner Making,n.tailatioul y l_?
//Ccldt« /U s ?G 3
Authorized Si n ure ( ntractor/ wn
er Making Installation) Phone Number
n
(//./fry ;%'/- 3 ?y Z /
MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION BEQUEST WILL NOT
Origg.-Midway Bldg. - Room N•191 BE ACCEPTED BY THE STATE BOARD
1821 University Ave.. St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 297-2111 ENCLOSED.
y,' a 15 REQUEST FOR ELECTRI C"p?A ' INSPECTION I'FB-oooot °°
./ , See instructions for completinjithi s form on beck of yellow copy.
^ r . .
"'X" Below Work Covered by This Request
kAvA Add Rep. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Building Dryer Electric Heating
I Commercial Bldg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Other Spec v the, l5 ned fvl
t m Sued ry Other Other
Compute Inspection Fee Below
# Fee Service Entrance Size # Fee _ Feedars/Subfpeders # Fee Circuits
O U 1o20 0 Am s 0 to 30 Amps
0 to 30 Am
Above 200 Arnps 31 to 100 Amps 31 to 100 A s
Swimming Pool Above 100-Amp; Above 100_Am s
Transformers Irrigation Booms Partial:Other Fee
I I I Signs I (Special Inspection s? CAS I Remarks TOTAL F
/ / t?yl
......e. -... / .i /?? /ly -_..? "the Electra
fMJ p' •'C/? i _ Inspector" hereby
certify that the above
Final n/ f Date7,? inspection has been
_.L 1 1-1 j mad&.
This request void
CITY Or L?AGAN
Lei U BUILDING., PEMIT APPLICATION
To Be Used For Valuation 0g ??
-"3z 1
'
Site Address ?wd ('61A
Lot Bloch ?_?Sec?. Sub. 61-
Pasoel i s /D I, /? U
Queers X,& VJ",6)
Address.
City/Zip Code:
Mwns !:
Omtractors jgl yS V,
Addzess: J 5 /JDYWDD(_ F IV-6
City/up Ocdes _
Ptvxw #: -
Address: •
City/Zip Code:
Phone #:
n/ 3113
Include 2 sets of plans,
1 site plan w/elevations L
1 set of energy caloslAtlians.
_ Date ?p ?f Ll ! f ?l??l
OFFICE USE. ONLY
Erect r,,l_ occupancy
Alter Zoning
Hair Fire Zone
Enlarge _ `type of Const.
hove M Stories
Demolish _ Front !00 ft.
Grade Depth ?y ft.
r
APPRVAIS FEES
Assessments Pernut3
Water/Sewer Surd"rge
Police Plan ChwA ai
Fire SAC 4:- ?2g-
EM. water Conn,
PLjuvrar Water meter
Council
' wwad Unit ? 6
Bldg. Off.
AM
?MAL c2i ? 5j• 57
? W
?? ?
? ? ??C?
? ?
s ? a ,?
Tollefson Builders Inc.
JACKSON - SURVEYORS
sacle: 1° 30, RROIRTERED UNDER LAWS O/ VTATR OF mINNUCTA
a Denotes Iran
000.0: Existing Bia
-?=Drainage ! 8616 EAST 554S
:Drainage 6 f ??C
Utility Easement T
"v
D
MINNEAPOLIS. MN SH17 7273111
Ourbcpor's 6trUfa tc
n lti
r
'?1 > >
Io° ° !/ /? i3 A ?l
1 D ?° r \ LJ N
Or. 11494
188-5
i
f
1
S'
Proposed Garage Floor Elev. ?
Proposed First Floor Elev.
Proposed Basement Floor Elev.
\/ -
pra( ?"? f
1 HERESY CERTIFY THAT THR ABOVE IE A TRUE AND CORRECT PLAT OF A SUIIVEV OF L S
Lot i,glock 1,Brittany 6th. Addition,
Dakota couaty,Minnesota.
N
I
IS
AS ?URv EYED BY MR THIS let. DAY OF March ••D.-
?.+.#???kk<Yd%kM?i1F??iYF°dXiik?k>'n?XM?,:WM?H;7.&:ikY,ek:k1;<YFM?IXCXcYF.R(Re?K
CITY OF EACAN
CA:ifl]:ER- JS Tu'RMINAL. NO, 760
DATE,. 08/24/99 TIME. 07:34e55
M.,
NAME. SEI A ROOFING & REMODELuNG WC
32iO 91.109. i5cJ2 SHF*PNOOD C 195.125
2155 9001. 1592 SHE:RNOOD C 5. 50
'io t at Receipt Amount, 200.75
Mli58(i9.
USER IM., ..3AN
>k%dM?iX?kY,Uk?X?k?k?X#?k?7,i>r7:t9i'$i?$Yn M?F?FitMd'irit?YYnh"?k>?:X(?k'F;'kM
1999 BUILDING PERMIT APPLICATION (RESIDENTIAL) a G b S
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 ?3 ql
/ 651-681.4675
ew Construction Reaulrem
D 3 registered site surveys showing sq. ff. of lot, sq. H. of house
and gll roofed areas (20% maximum lot coverage allowed)
? 2 copies of plans (show beam 8 window sizes. poured fnd. design; etc.)
? 1 set of energy calculations
? 3 copies of tree preservation plan R lot platted after 7/1/93
DATE: b c9-3-'?1
DESCRIPTION OF WORK: - P&Vz0% p kelzoo
STREET ADDRESS:
lJ??a-- 5 ?er2)N0f)d
V'/X
C?
Remodel/Repair ReauiremeMs
2 copies of plan
1 set of energy calculations for heated additions
1 site survey for exterior additions a decks
ll, ?
CONSTRUCTION COST: ot..Aff-jo . fto G1 k1 C'4'u e 'y a?1 /mom fio cg
LOT' , BLOCK: SUBD./P.I.D. Vl-
N`'rsav?hra?sl T 65
Name: I S o N f k (' a?c15 / NC PxatiCb'? Phone #:
PROPERTY Last First
OWNER st.?Vt'L C-
Street Address:
City
State:
Zip:
SELA ROOFING & REMODELING, INC.
Company 4100 EXCELSIOR BLVD. Phone #: G f a- ?? 3 8 f
ST. LOUIS PARK, MN 55416 (area code)
CONTRACTOR ID #0001050
Street Address: License# f195'-0 Exp. 3 aD
City
State:
ARCHITECT/
ENGINEER Company: Name:
Teiephone #: area code ( j
Street
City
State:
Sewer & water licensed plumber (required for new construction only):
Penalty applies when address change and lot change is requested once permit is Issued.
Zip:
Zip:
' I hereby acknowledge that I have read this application, state that the Information Is correct, and agree to ompiy with all applicabl
State of Minnesota Statutes and City of Eagan Ordinances.
' Signature of Applicant:
OFFICE USE ONLY
Registration #:
Certificates of Survey Received Yes No
Tree Preservation Plan Received Yes No Not Required
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation 13 06 4-plex ? 11 10-plex ? 16 Fireplace ? 21 Porch (3-sea.)
? 02 SF Dwelling ? 07 5-plex ? 12 12-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.
? 03 1 of _ plex ? 08 6-plex ? 13 16-plex ? 18 Deck ? 23 Porch (screened)
? 04 2-plex ? 09 7-plex ? 14 Apartments ? 19 Lower Level ? 24 Storm Damage
? 05 3-plex ? 10 8-plex ? 15 Lodging ? 20 Pool ? 25 Miscellaneous
WORK TYPE
? 31 New ? 35 Tenant Impr ? 39 Gas Line Only ? 43 Siding/Soffits/Fascia
? 32 Addition ? 36 Move Bldg. ? 40 Gas Insert ? 44 Windows/Doors
? 33 Alteration ? 37 Demolish Bldg.* ? 41 Wood Stove ? 45 Fire Repair
? 34 Repeii ? 38 Demolish (Interior) ? 42 Reroof
* Give PCA handout to applicant for demolition permit
GENERAL INFORMATION
Const. (Actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
Planning
Basement sq. ft.
Main level sq. ft.
sq. ft.
sq. ft.
sq. ft.
sq. ft.
Footprint sq. ft.
Building Engineering
Census Code
SAC Code
No. of Units
No. of Bldgs
MC/ES System
City Water
Booster Pump
PRV
Fire Sprinklered
Variance
Permit Fee S aS
Surcharge S- 5 (?
Plan Review
License
MC/ES SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI.
Park Ded.
Trails Ded.
Other
Copies
Total:
Valuation: $
SAC Units
% SAC
2/84
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
(PLEASE PRINT)
1) PROPERTY ADDRESS:
LEGAL DE.RIPTICN:
I EXIS_-:G STRUCTURE, DATE OF ORIGINAL EUILDDNG P? -1T T_SSL;ANC_E:
PP 5E - S^`Ti T %? PCS ,S--:-1 SD-,= FAMILY
? R-2 DUPLEX M'--O UNITS)
? R-3 TCSvNHCUSE (THREE + UNITS) ( UNITS)
? R-4 APART!, T/C Z)allMNIU i ( CHITS)
? CUML=TAL/RETAIL/OFFICE
? n\DUSTRLAL
? INSTITUTIONAL/COVE,RNL=
2) APPLIC-AN7 (PLEASE PRINT
TOLLEFSON BUILDERS, IN
NAME
ADDRESS: 1655 Norwood Drive
CITY, STATE, ZIP: Fagan, MN 55,122)
PHONE: (612) 454 - 6873
3) PLUMBER
ME
^
' IPLLASL PHINI)
% FOR CITY USE ONLY
lU1 W
C.r
. ?
-
ADDRESS: PLUMBERS LICENSE:
Active
CITY, STATE, ZIP: S?MOr / ?r- IKrNN ?
?Q?? Expired
. PHONE:
?3- r 44 _
AIL:
PLUMBER LICENSE /f )t9Aq Not of Record
<
ir
SEarr Inlti?(-
4) OCCLT'ANr/CUvNER N*fE: (PLEASE PRINT) -
ADDRESS:
CITY, STATE, ZIP: SAME AS 4PPI TCANT
PHONE:
5) INDICATE WHICH PEP.= IS BEING REQUESTED:
CO„TTECPION TO CITY SEVER
CONNECTION TO CITY WATER --
? OTHER (PLEASE DESCRIBE)
6) r;DIC E 0:JE:
? PLEASE HOLD APPROVED PERvTIT FOR PICK-UP BY-ONE OF ABOVE
PLEASE.;IAIL APPROVED PER.%UT TO 1, 23 4 ABOVE.
(Circ one)
7) SICLv1TLRE. DATE. L-- r6 ) -
?! 6! Cl.? ?1lA ? i ?! a i?_ sa ve a rt a-aii.O ?f of a ®: RS m:a :m sa fm[ w? cF.mF:sa!-m:fY ? aal !~a! ac¢?iLG• ee
F O R C I T Y U S E O N L Y
PERMIT y ISSUED
FEES: $ ie-moo
$
$ / e
$ L?7d. a?
S
$
$ "
SE.^:E°, PER-11T_T (I T- DE SURCH?..
GE)
WATER PERMIT (INCLUDE SURCHARGE)
WATER METER/COPPERHORN/OUTSIDE READER
WATER TAP (INCLUDE CORPORATION STOP)
SE14E_R TAP
ACCOUNT DEPOSIT - SEWER
ACCOUNT DEPOSIT - WATER
WAC
SAC
TRUNK WATER ASSESSMENT
TRUNK SEWER ASSESSMENT
LATERAL BENEFIT/TRUNK SE1•7ER
LATERAL BENEFIT/TRUNK WATER
OTHER
$ TOTAL
AMOUNT PAID/RECEIPT 4 417 z---l
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A "PERMIT FOR WORK WITHIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE:
. ;
sw w W :m aw M m w jmcw MUM w M w eRyu s+1+ ao--m Rm w W fl wpm R# ¦e W se sr wt?w Pkew w sre w
r-----------------
?l;?;gO/ / -7 I i
Permit #:
I Permit Fee: ----
I I
Date Received:
I I
I Staff: I
I
Date:
Tenant:
RESIDENT / OWNER Name: x / { IF', G1? S Phone:
z 54
l ?
?f
7
r/
Address/City/Zip:
Applicant is: Owner
Contractor
TYPE OF WORK /
Description of work: i<-P r04
l
i
F
il
B
ildi
Y
N
16 7n
M
-
y
ng: (
es
o
u
t
am
u
Construction Cost:
.
CONTRACTOR Name: ! ak? .14A License 0: ? O/ -?U3 9/
Address:: I7r t,, e
/W Zip:
Sta
te:
City: La (A
,
/
`
Phone: 6/ z Sr'7 36 0 Contact Person: ta? VUt
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateoorv 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
Category Submitted Submitted
(^? 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 may be classified as non-public if you provide specific reasons that would permit the Citk 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 approval of plans.
X T / Q ^ 141 tlf , 21 X
Applicants Printed Name icanfs Signature
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2008 RESIDENTIAL BUILDING PERMIT APPLICATION