3015 Shields DrINSPECTION RECORD
1
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
SITE ADDRESS: r
I I ld/1 1 ?,i l 11 1 1 1 .
PERMIT SUBTYPE:
I1'
TYPE OF WORK:
MI 11
INSPECTION INSPECTION TYPE DATE INSPTR.
i rt II! (5 1 111 r1 t f 14x11
1 MARKaf S & 14 P1 (Ik %fAk Pt Hsi
F ak
APPLICANT:
t I. :I,
t 1? 1 . ) 71."? 01-w
Permit No. Permit Holder Date Telephone #
S/W
PLUMBING 4V7-6
HVAC i1 /s 93 ?1?'
ELECTRIC Qf?? I-L
f0
y? ??
ELECTRIC 5 f0 y193 ?81OP
Inspection Date Insp. Comments
Footings l
s
S
Foundation
Framing 11 fJ
Roofing
Rough Plbg. /? Q3
ALI-
Rough Htg. ?f
Isul. f13 ?
Fireplace
Final Htg. Ll_6 elq
Orsat Test //
r
Final Plbg. Plbg. Inspector - Notity Plumber
Const. Meter
Engr./Plan
Bidg. Final /? l y
7
Deck Fig.
Deck Final
Well
Pr. Disp.
/ ,231/"
A-% I..
-..r!
Werti f .cote of Cccoauc?
Wit4 of "an
zcow utut of 13mo * 3xO*CCtion
This Certificate issued pursuant to the requirements of the Uniform Building Code
certifying that at the tine of issuance this structure was in compliance with the various
ordinances of the City regulating building construction or use. For the following:
Use Classification `¢ DW Bldg. Pernrit No. 164
O-fW-y T)W R3/)41 Zoning District PD/R1 Type Const. VN
owaa of Buiwing ADSQd HMS Address 8412 W LOOT H ST. BLICM
MdWing Am,% 3015 SHIELDS DRIVE al; , I, B3, IRW LAKE HMU
POST IN A CONSPICUOUS PLACE
Address 30 15 RDIIDS DRIVE Zip 5512 1
Lot 1 Blk 3 Sub IRCY LAKE HILLS
THESE ITEMS WERE / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION.
Date: 1111,19V Yes No Inspector:
Final grade (6" from siding)
Permanent steps (garage) t/
Permanent steps (main entry)
Permanent driveway
Permanent gas
Sod/Seeded grass
Trail/curb damage t/
Porch
Basement finish A 3
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
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS: LOT:
3015 SHIELDS OR
LEMAY LAKE HILLS
PERMIT SUBTYPE:
SF DWG
TYPE OF WORK:
NEW
BUILDING
022164
10/08/93
INSPECTION TYPE
FOOTING .DATE INSPTR. INSPECTION
FRAMING DATE INSPTH.
INSULATION FINAL
FIREPLACE
s.
t
REMARKS: S & W PLBR - STAR PLBG
INSPECTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
1 BLOCK: 3 APPLICANT:
ADSON HOMES
(612) 829-0688
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
SITE ADDRESS:
P.I.N.: 10-44650-010-03
DESCRIPTION:
PERMIT
3015 SHIELDS DR
LOT: 1 BLOCK: 3
LEMAY LAKE HILLS
B,u"ildiny Permit Type
Building Work Type
?UBC Occupancy,
Construction Type
zoning
Building Length
Building Width
PERMIT TYPE:
Permit Number:
Date Issued:
SF DWG
NEW
R-3 M-1
V-N
PO R-1
58
48
BUILDING
022164
10/08/93
REMARKS:
S & W PLBR - STAR PLBG
FEE SUMMARY-
Base Fee
Plan Review
Surcharge
SAC
SAC
SAC Units
Lic. Search Fee
Subtotal
VALUATION
$650.00
$422.50
$51.50
$750.00
100
1
$5.00
CONTRACTOR: - APPiicant - ST. LIC. gWN=C"
ADSON HOMES 18290688 0005679 A SON bMES
8412 W 100TH ST 8412 W 100TH ST
BLOOMINGTON MN 55438 BLOOMINGTON MN 55438
(612) 829-0688 (612)829-0688
I hereby ac nowledge that I have read this application and state that the
informat n correct and agree to comply with all applicable State of Mn.
Statues a Ci of Eagan Ordinances.
L I
A LI01111RMI1EE SIGNATURE ISSUED BY: I ATURE
$1,879.00
$103,000
MISCELLANEOUS $1.744.50
Total Fee $3,623.50
REACTIYATE _ CITY OF EAGAN _
PERMIT ?"'??? 93 BUILDING TION
681-4675 $.3?
b C T 0 ? 1993
r 10 ))(1 fL 10
SINGLE & MULTI-FAMILY --------------
2 sets of plans, 3 registered site surveys, copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, I copy of energy calcs.
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.
Date 10 95 Valuation of work _22P00
Site Address: Sh-AJs 'D i? 301<
STREET SUITE N
Tenant Name: (commercial only)
LOT
BLOCK e,w"a+d- L-Akq_ f4l"s
S 'F9__
P.I.D. N
Description of work: Nc?
The applicant is: ? Owner Contractor ? Other (Describe) -
Name 5»oY'n =MACK Phone
Property LAST FIRST -
Owner Address '6VQ LJ Jbo? ST ! e.70' C>vr?5?7g
STREET STE N
s?sY3Jr
City NE;aµr+? /0%) State ZiP
Company 50--l New?3 Phone
7"7
Contractor 1
Address License # ti(o?y Exp. 3-3/-Y
City State Zip
Company DIA+'I CCU Phone ?5- a-o?,4 /
Architect/ Name Registration y
Engineer
Address
City State Zip
Sewer & water licensed plumber S TPW TL-41" hrr? Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this application and state that the information is
t
f
C
y o
i
correct and agree to comply with all applicable State of Minnesota Statutes and
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish
0 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'l. ? 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
X31 New ? 33 Alterations ? 35 Tenant Finish ? 37 Demolish
? 32 Addition ? 34 Repair ? .36 Move
GENERAL INFORMATION
Const. (Actual) V _ N Basement sq. ft. MWCC System
(Allowable) 1st F1. sq. ft. City Water ?
UBC Occupancy 3 rn-1 2nd F1: sq. ft. PRY Required
Zoning Po R-1 Sq. Ft. total Booster Pump
/ of Stories Footprint Sq. ft. Fire Sprinkler
Length ss On-site well Census Code Ib!
Depth A• On-site sewage SAC Code 61
APPROVALS r
Planning Building Assessments
Engineering Variance
REQUIRED INSPECTIONS
? Site ? Footing ? Framing ? Insulation
? Wallboard ? Final ? Draintile ? Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment Pl.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
SAC % 100
SAC Units I
valuation: g 103, 00o.
GftS- ' zZ x 2LJ, S28
4 x 4 s 6?-
?CMTl Z8x2 51Z xl(= SH2_
(o?IVa
I'?d1114 = ZI
18yl2 =Z1`
x 151
IsT ?c,ooi?;
54xxLb; M04
3x14-'-12
`6 ? "1= 3Z
14'18 x 54
/ LI) 4'1 S-
I? ?, $12
102, t? 79.
.. VV. Brown Land Surveying, Inc.
I I ?/
Survey For:
ADSON HOMES.
n
z
a
U
900 East 79th St. Suite 105 Phone (612) 854-4055 WOODROW A. BROWN, R.L.S
Bloomington, Minn. 55420 Fax (612) 854-4268 President
a I4EI PB
F?iiii
lu c ???\//\,IS ° I ?r 14 a
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ry)
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pb
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NL"4-le ?
°?` I m2S d9
0 9? NORTH
J%9 R
/ 144130t ya o reale 40
6g yp5.9` .0e4oles /ro4Monu/4e4t
N 931 / Denotes Eris4il9 Elewllbv7
_ (93/.-/) De4ples /°ro0osed E/eyelibn.
/Y69°59 39"N 90E? XN% /°ro?oased E/evofb4s
99 00
g3 Co?ayt i/oOr = 909.9
yP yf ??41= ?re?nenl f%r ° 906. S2
908.39. front E4lry ' 9/2.23'
Mole: /Yo rca e.4 War /lie
a emenfr•
R Pon
BY
Property Description
Lot I, Block 3, LEMAY LAKE HILLS, Dakota Countyk gPWta- -_
I hereby certify that this survey, plan or report was prepared T
me or under my direct supervision and that I am a duly registered
Land Surveyor under the laws of the State of Minnesota.
W. BROWN LAND SURVEYING, INC.
//y DATED:
111-93 Woodrow A. Brown, NO. 0
.. 22625 _ - - - -' ip
% ?-- --93.00•-'
1
L
-- --_ _•%' 9/9.4 (9iS.C) C9id.C):I- !0
? I ry / ? e2
j? z ?Oro?.red//nnse \0 w I I? I? / C
?i LOT SURVEY CHECKLIST FOR RESIDENTIAL
BUILDING ERMIT APPLIC ION
m
W 52 PROPERTY LEGAL:
m
Date of Survey:
2 DOCUMENT STANDARDS
L9'?? 0 Registered Land Surveyor signature and company
0?0 ? Building Permit Applicant
W ? ? Legal description
D Cis ? Address
8' Q D North arrow and bar scale
R?- D ? House type (rambler, walkout, split w/o, split entry,
lookout, etc.)
210 0 Directional drainage arrows with slope/gradient $.
D EyJ 0 Proposed/existing sewer and water services
V 0 Street name
? ? Driveway
Existinq
? H? ? Sewer service
0? ? ? Lot corners
L'? ? ? Top of curb at the driveway
D ?? Elevations of any existing adjacent homes
r,D Proposed
? Garage floor
0 0 First floor
0' ? ? Lowest exposed elevation (walkout/window)
F-0 ? Property corners
? ? Front and rear of home at the foundation
ONDING AREAS (if applicable
? Er' 0 Easement line
Q ff' ? NWL
D 9? ? HWL
? 13 Pond # designation
El p/? Emergency overflow Elevation
D' ? ?
Er ? D
0' 0 ?
0'? ? ?
? E( ?
Lot lines
Right-of-way and street width (to back of curb)
Proposed home dimensions including any proposed decks,
overhangs greater than 2', porches, etc. (i.e. all
structures requiring permanent footings)
Show all easements of record and any City utilities within
those easements
Setbacks of proposed structure and setback of adjacent
existing
Ret
Reviewed;
October 1992
`y 1.1IH?i$.oTL fiT TY ENERGY CODE CNLCULLMila
??JI
BASED OH CHAPTER 5 OF THE
l D(Q_EI_ENERUSD_DE - 1903 EDITION
Adoption Effective
e Date
Site Address
contractor Phone
Building Classifications Type Al (Single Family 6 Duplex)
Type A2 (Residential, 3 stories or lees)-(Over 3 stories) (Other)
hoTEs com lete pages I and 1 first.
• c •?LT?INFO? MAB Ttn_N n, G .
1. Building Perimeter I?? ft.
tt
2. Wall height (ground to save) ft.
3. 1. X 2. (above) gross wall area sq.tt.
4. Building dimensions (L) 'X (W) =1sq.ft.root 6 floor area
5. Sq. foot area of rim joist - Floor joint size (2 X ' IU )
_W_ X _Ut r5(Perimeterj _ J8t sq.ft.
12
6. Doora - Area 1 117
Thickness in U. factor +1 + f
Type of Construction Perimeter ft.
Hanufacturer
7 Total door's perimeter ft.
•6. Hindows't Hanufacturer We>Ub' «Nff State approved
U factor TYPE SIZE AREA (Sq.Ft.) NUMBER OF TOTAL
EACH Ut1IT9 3Q FEET
9. Total sq.ft. Glass •
10. Fireplace areas Width X Height = X -eq.ft.
11. Exposed foundations llelght X Perimeter X ??OCJ ?I eq.ft.
COHPLETIOH OF THIS FORM IS REQUIRED FOR ALL HEW COHSTRUCTIGHt HAJOR
REMODELING AHD BUILDIHG9 BEING MOVED WHERE EIIERGY, OTHER THAN 11011E MIIIIHAL
CODE ALLOWANCE, IS USED.
.12, Framing area - 10% of+ groan Wall area, ?? .
17, Groan Wall area I??V sq.ft.
Window area A-, sq.ft. U windows - 7-)( UxA -
Rim joint area A J& sq,ft. U rim joiet. f? UxA .
_4
-120 Door-. area A eq.ft, U door area---=1?- UxA -
`.other doors area Ao_sq, f t, U other doors- # 1// UxA -?
Exposed fndn A -l13 eq.ft, U foundation- 076 UxA
Framing area A eq.it. U framing area=r-2 L? UxA - _
Het wall area A •?IS9?Zeq.ft, U wall- •04 UxA - D
(170) TOTAL . . . . . . UxA -
_ - . 119 --
14. Gross wall Area x 0,11 (A-1 single family i duplex) - allowable UxA/Code
(13. above)
X 0.27 A-2 other residential)
x .23 IA-2 buildings)
x .26 (over 3 stories)
BTUII must be larger than or same
A 11 x U Coder OF, as 13H above
15. Calling framing area (At) equals 10% of ceiling area
15A. Grose calling area - (L) x (W)_ ' - sq.ft.
150. Joint area (Af) - 101 ceiling area - ?1 s9.fL.
15C. list calling area (Ac) (15A.- 15B) - ? ?i v sq.ft.
U calling x Ac - ZL f/ x ,r7Z7/ -?_
U framing x A f a 4x 1i -
15D. TOTAL U x A .........:.............•,•..._ C/
16. Calling area (15A) x 0.026 (A-1 single family 6 duplex)
allowable UxA/ bode
x 0,099 (A-9 other residential)
X 0.06 (other)
BTUII must be larger then or some
A(15A)?x U Code OF, no 15D above
HOTEI One U and A values obtained from pages 1r 3 and 4.
CERTIFIGATIQiit I hereby certify that I have calculated the nuu factors and
eRa values herein and that the building here described meets or exceeds the
state of Hinnesota Energy Conservation Act.
Data
gnaturs
q?-5g5
<.. ! .x ?? y n InLUC U VALUE
l ", x y
nsl? a a(r •flln' :68
?•' f?.i 1. ?• .'• A
WALL Intccforxall . 45 i(Wall) u L
SECTION naulatlon' L R
19 ?: o
?? • Sh?ething. r. • Z ?? ? ? ?z>
tiding ?. _-
1 Outjlde kLr film .17
:a ?.R TOTAL Z3 , 0 3
STUD
SECTION
SECTION.
RIM
JOIST
Ina Lde. air f Llm: 68
Interior 'Wait .45
'stud R-- 4d3'g (0.5 (Framing) U . A
Sheathing Z.O(o
siding R,01
Outside •air film ll
:R TOTAL
a ,
TrMV-V a _c R-- RA
Interior wall
Insulation
ExteriorI iwaI cover
Exterlorlalr film'
R TOTAL
R ..17
cqr5
L) U R .
Interior.-air film Ru .68
a
Insulation Iq; 00
't} Inch .)oft wood R=);88 (Rim 8
JOIst)
aheithlni 2„0(0
xteclor•!walI covering
EXterLWgir film :R 'j7
R- TOTAL :74, 46
Interlor:air film Ro '68
Insu'latton II,?
N joundatlon ),2 a
(Fdn.) U
Ezteriozialr f.Lin R= i11
'i R TOTAL 13 .
, xpcsed'-Block "
Gradg.
0?-4
=R=
, 07(D
ST1.Tl1(UllTll? ?IIT.E[LA:tTT?9P.A?F?Ad9YFi
I W AIR
R VI.LIIE
F"MIT114 CEII T114
...l1Id 1 1, I r F i l m (_. li l_
???•? 1naulatIon •C)
--a lolat
-!L_66 Calling (ig d_
0.41 )? IrFIIm D.I,L_
Illndow lntlltratlan 4.5 atm/llnaal toot'ot crack
paaldantlal door lntlltratlon 0,0 aim/aquarm toot or door and minimum coda
reqqulremank
Ilon-realdantlal door lntlltratlon 11.0 aim/linaal.toot at crack
11h 124 aonarata black no lnaulatlon A .47 R 2.1
nh 124 conaraka Black lnaulated aorea - .26 11 ].0
11h 124 11ghtwalght Mock .72 it 3.1
Uh 124 llgilkwalgilt block lnaulatad corea .12 R 0.3
u gingla glans m 1.171•with atarn window .54
11 double glaaa " .69
tl r'rlpla glaaa 441
)II axtarlor walla and callings must hhva a vapor harrier (0.10 parm max.l.
vapor psrrlar muar.ba an the nalda (Ikaated al
idol of wall.
yapar barrlata at kha polyakha}ana khln t16 have no R valua.
' f 1
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 11-JP-9-3
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 8g6.00
GAS OUTLETS (MINIMUM I @ $3.00 EACH) &,a5 D61)
G?.+S ?aEAlace
ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ 15.00
STATE SURCHARGE .50
TOTAL .$ c7
SITE ADDRESS: 3615 S kre W3 fD/two,
OWNER NAME: OA J. e5 TELEPHONE #: _ 9'068
INSTALLER: Ano,.r1156•j 4t2 T„,<-
CITY: ?u,nA'sud1e, STATE: ZIP CODE: SS 33 7
TELEPHONE #: 9 9 Y ?79 31Q
SI ATUR OF PERMIITEE
1993 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
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:
NEW BUILDING
INTERIOR IMPROVEMENT
WORK DESCRIPTION:
FEES
1% OF qpO R GT FEE $_
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
0YN i RAC"i PRICE: $
STATE SURCHARGE $50 FOR EACH $1,000 OF PSFIMT FEE.
TOTAL $
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:
ADDRESS:
CITY:
TELEPHONE #:
STATE: ZIP CODE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
O. FIXTURES EACH TOTAL
SHOWER 3.00
WATER CLOSET 3.00 3• a?
BATH TUB 3.00
i LAVATORY 3.00 3
KITCHEN SINK 3.00
LAUNDRY TRAY 3.00 3 . o
HOT TUB/SPA 3.00
WATER HEATER 3.00
FLOOR DRAIN 3.00 3-?
GAS PIPING OUTLET • minimum -1 3.00
1
50
e
ROUGH OPENINGS .
WA T ER SOFTENER 5.00
PRIVATE DISP. • DstCty. lie. 15.00
U.G. SPRINKLER • come under cont. 3.00
ALTERATIONS • to existing 15.00
WATER TURN AROUND 15.00
STATE SURCHARGE .50
TOTAL: a CP • ea o
SITE ADDRESS: 3nc S Sh td s ?r
OWNER NAME: 4'1
s.,l INST.
I-,% ,,
ADDRESS: 48 cz3 A& ' A sJ cz-
CITY: Qs i o s /are c STATE: ZIP CODE: S s 3 l a
PHONE #: ((,/z) Wq7-607,34-'
SIG T F P E M EE
1993 PLUMBING PERMIT (RESLU"'MALL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
1993 PLUMBING PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN SS122
(612) 681-4675
PLEASE COMPLETE FOR ALL COMMERCIALJINDUSTRIAL BUILDINGS. ALSO FOR MULTI-
FAMILY BUILDINGS WHEN SEPARATE PERMITS ARE NOT REQUIRED FOR EACH
DWELLING UN i T.
_ NEW CONSTRUCTION
_ ADD ON
REPAIR
WORK DESCRIPTION:
CONTRACT PRICE: $
FEE: 1% OF CONTRACT FEE.
STATE SURCHARGE: $.50 FOR EACH $1,000 OF ggpM FEE.
.'..:Nudum ES: $ 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
12- 10,00-
50/91
2219`10
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone 9 651-675-5675 FAX # 651-675-5694
New Construction Requirements
3 registered site surveys showing sq. it of iqt sq. it of house; and all roofed areas
(200% maximum lot coverage allowed)
1 Soils Report If proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
1 set of Energy Calculations
3 copies of Tree Preservation Plan If lot platted after 711/93
Rim Joist Derail options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
RemodeUI air Requirements
2 copies of in showing footings, beams, joists
1 set of Energy calculations for heated additions
1 site survey for additions & decks
Addition • indicate Hon-sde septic system
90 a-D
s on
Ce ofS*py u Y t?
$wu3eP i a;xY
T(eePtesplellliecd ?"Y '
Tfgel=resReglfred } a Y =1J.
pcirsite"Septic?ystem, Y,_N
Date L? / 2 / G Construction Cost 5'I 63 rf
Site Address ?? J /
?µ + P ?`r S 0r t, P Unit/Ste #
tion of Work ( PA
Descri 04 .4 kle r e a ?
p .
Multi-Family Bldg _ Y - N Fireplace(s) - 0 _ 1 - 2
fA PK of r p
4 DLO
/r t° 11 Telephone # ( 6 56
Property Owner ? .
/)e q? bLr leol? Sj A e- 77d.-7
Contractor 1
Address ?, lA'f7 ??m d I^i'? h4/, i - ' /U . y-s ??CdLt <Z/
City .......
State /7) Al Zip vrSOP,2 Telephone#((s67)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 - Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
• 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?
- Y - N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone #(
Telephone # (
Telephone #(
I hereby apply for a Residential 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.
IAA /4 D / 4
Applicant's P 'nted Name
Applicant's Si&ature