2135 Silver Bell RdCity of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Mechanical
Permit Number: EA096728
Date Issued: 10/29/2010
Permit Category: ePermit
Site Address: 2135 Silver Bell Rd
Lot: 000 Block: 079 Addition: Section 18
PID: 10-01800-021-79
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector,
952-445-2840
Renae Freinwald
2200 Hwv 13 W
Fee Summary:
ME - Permit Fee (Replacements) $50.00
Surcharge -Fixed $5.00
0801.4088
9001.2195
Total: $55.00
Contractor:
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
- Applicant -
Owner:
Judy L Herrick
2135 Silver Bell Rd
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
19
RECEIVED
FROM
AMOUNT $
4 DOLLARS
goo
? CASH ? CHECK
/i l ? 1 'e d '..g ` _"
i -
FUND CODE AMOUNT
`
fr.
Thank You
BY
r'J
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN Remarks I 1 _ ??».(1ts
Addition Section 18 Lot Blk Parcel 10 01800 021 79
O, e? , ti?? ` '- d- '?/ Street 2135 Silver Bell Road State Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 1821.38 364.28 5 .1821 . 3 0010471 53-1812t
STREET RESTOR. 1-98-2- 18=T6- -36-.&& -&
GRADING
SAN SEW TRUNK 1968 $100-00 $3.33
* SEWER LATERAL (4 3 1982 3571-70 2 38.3.1 15 ie;R7 C007736
1989
'
!)33
08
19887
1 r,
1-Q3-A 0Q
C008743 -14-83
WATERMAIN -
-
• WATER LATERAL 1982 15
WATER AREA,;' 00 F. rr c< ._ • r f -
* Services 1982 15
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN. 185.00 24404 4-28-81
BUILDING PER.
SAC 525.00
PARK
a A-f.??ud'? ? /.J?¢s-sc.ti?'.? r? Gi?i^a?:-,.?/A?/NI??C'^u7??? t? G?c?f'??G G ./7?'Y?J4?t/?
4f 6 9 S. ?° ?'' ?u,?,?aa/a?S.????• 4a-r1 c?.z o? « ,r.?
' yam- ?' ??? --? ? . / 9?/ • ? G ?. ? 98?
[ITY OF EAGAN
795 r Knob Road
San, MN 55112
ing:
ner:
dress:
ite Address:
lumber:
1 agree to comply with the City of Eagan
Ordinances.
Rv
Date of Insp.:
SEWER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
Connection Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Total:
Dote Paid:
CITY OF EAGAN WATER SERVICE PERMIT
3795 011- Knob Road PERMIT NO.:
Eag--n, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Meter No.: Connection Charge:
Size: Account Deposit: _
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
By
Date of Insp.:
Total:
Dote Paid:
?°s
?
56
'
3
p
5 1g
do°
Request Dale
S s/
Z Fire No. Rough in Inspection
Required?
?ieady Now ? Will Notify Inspector
When R
d
?
7 _ Yes No y
ea
licensed contractor ? owner hereby request inspection of above electrical work at:
Job Address (Street. Box or Route No.)
-Z) 3 S S, /vc r ??Jr Kck City
G. avN $S/i
Section No. Township Name or No. Range No. County
Oecupaot(PRINT)
6ro
-e
Z Phone No.
L{Sy-114
v
- vl
a- rncc.
Power Supplier Address
Electrical Contractor (Company Name) ConiraMOrS License No.
Mailing Address Contractor or Owner Making Installation)
Spa; Z 7'".?-t. se n7 /S .v SS
Authorized Signature ContractooOwner Making Installation) Phone Number
,n i --/ /Yi P..t?o 7l -6466
MINNESOTA STATE BOARD OF ELEAICITY THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bldg. - Room S-173 BE ACCEPTED BY THE STATE BOARD
1821 University Ave., St. Paul. MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 662-0800 ENCLOSED.
a
f/?? jp? REQUEST FOR ELECTRICAL INSPECTION r'' 22 Ee-00001-0
? See instructions for completing this form on back of yellow copy, ,
T:H:°?.? LL?P
-? "X" Below Work Covered by This Request
evJ (Add Rep! Typeot Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Electric Healing
Apt. Building Dryer Other (Specify)
Comm./Industrial Furnace
Farm Air Conditioner
Other (specify) contractor's Remarks:
Compute Inspection Fee Below.: GO1??''tt "o
# Other Fee # Service Entrance Size Fee # CircuitsrFeeders Fee
Swimming Pool 0 to 200 Amps 0 1'OQ Amps
Transformers Above200_Amps Aboi -Amps
Signs Inspectri Use Only TOTAL
Irrigation Booms ? V d , S d
Special Inspection
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 18 MONTHS.
I, the Electrical Inspector, hereby Rcugmin Date
certify that the above inspection has
been made. Final Date
f J
OFFICE USE ONLY
This request wttl 1B months from
Liz ? 77
21-z g- P
°' ®s??ea (?p?r -
EAGAN
TOWNSHIP
BUILDING PERMIT
Owner \e.r --?-u//y/ -+- -- ,( .....--'---/-1.?.-?-- --'------
Address (present
Builder .............. k CYti!^.c:`U ------ _...------ ----- '----- ---------- --------'--..
Address .................
DESCRIPTION
/O I Srdo C946;>Y
N° 177
Eagan Township
Town Hall
Dale .:.......py!...---0'../.-....'---....
Stories To Be Used For Front Depth Heigh! Est. Cos! Permit Fee Remarks
_
LOCATION
t or
This permit d not authorise the use of streets, roag, alleys or sidewalks nor does! give the owner or his agent
the right to cr to any situation which is a nuisance or which presents a hazard to the he4lth....9a_fety, convenience and
general welfare to anyone in the community.
THIS PERMIT MUST B5_ T R MISE WHILE THE WORK IS IN PROG SS. f
This is to certify, that..- .....°.. .. .--`----........has permission to erect a ------------------------ ...................................upon
the above described premise sub" ! pr visions of the Building Ordinance for Eagan Tow ip adopted April 11,
1955.
..._....._._.-- Per ....... ............ _...----.......-`.----.....-- --...`..._ ...............................
Chairman of Town oa Buildingg Inspector
l
RUG-13-2008(WED) 16:01 Dakota County PDD
(FRX)9528917000 P.002/002
G7 UU N
WATER RESOURCES OFFICE
GROUNDWATER PROTECTION SECTION
14955 Galaxie Avenue - Apple Valley, MN 55124
9s2.891.7557 - Fax 952.891.7588 - www.co.dakota.mn.us
MUNICIPAL NOTICE OF WELL SEALING PERMIT APPLICATION
DATE: August 13, 2008
TO: Tom Colbert/Wayne Schwan (EM)
RE: Well Permit 4. 08-H257827
Municipality: Eagan
Fax #: (651) 675-5694
Well Type: Domestic
Water Resources Specialist: Luehrs
The Dakota County Water Resources Office has received the following permit application for the well described. If
you require further review of the application or if you have any questions or concerns about it, contact the Water
Resource Specialist listed above or our office at (952) 891-7557. If there is no response from your office within 24
HOURS (excluding weekends and holidays), we will assume that you have no objections to the issuance of the
permit. Please note that permit issuance is always conditioned on the permit applicant's observance of and
compliance with all applicable state, county, and municipal laws and codes.
Well Contractor:
Date Application Received:
Anticipated Drilling Date:
Anticipated Grouting Date:.
Property Owner:
Well Owner:
WELL LOCATION:
Bohn Well Drilling
8/6/2008
Eunice Groven
Eunice Grovcn
Time:
Time:
PLS Coordinates: 1/4, SW 1/4, SW 1/4, SE 1/4, Sec 18 Town 027 Range 23
Street Address: 2135 Silver Bell RD
PTN Number: 100180002179
WELL TNFORMATION:
Diameter..
Casing Depth:
Total Depth:
Static Water Level:
Aquifer:
COMMENTS:
PLEASE COMPLETE FOR SINGLE FAMILY DWELLINGS. ALSO, FOR TOWNHOMES AND
CONDOS WHEN PERMITS ARE REQUIRED FOR EACH UNIT.
NEW CONSTRUCTION
X ADD-ON A/C
_* ADD-ON FURNACE--XPE, -e?-6r.r(
FIREPLACE INSERT
DATE
FEES
HVAC: 0-100 M BTU $ 24.00
ADDITIONAL 50 M BTU 6.00
GAS OUTLETS (MINIMUM 1 @ $3.00 EACH)
ADD-ON/REMODEL (EXISTING CONSTRUCTION) $ 20.00
STATE SURCHARGE .50
TOTAL
SITE ADDRESS:
OWNER NAME/. TELEPHONE #:
INSTALLER:
ADDRESS//:__
CITY: C ?j_Vozoq? STATE: ZIP CODE: S?/v
TELEPHONE
SIGNATURE -OF PERMITTEE
1994 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN 55122
(612) 6814675
1994 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN MN SS122
(612) 6814675
PLEASE COMPLETE FOR ALL COMMERCIALANDUSTRIAL 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:
CONfRAUF PRICE:
FEES
1% OF RMIM FEE $
PROCESSED PIPING: $25.00
MINIMUM FEE: $25.00
STATE SURCHARGE $.50 FOR EACH $1,000 OF FEE.
TOTAL $
SITE ADDRESS:
OWNER NAME: TELEPHONE #:
TENANT NAME: (IMPROVEMENTS ONLY)
INSTALLER:
ADDRESS:
CITY:
TELEPHONE
STATE: ZIP CODE:
SIGNATURE OF PERMITTEE CITY INSPECTOR
C
!d't rIUi TFO:i AM AU*rKJH 'X.'1O:T FOR DCZ;%YEP 1'i.'l.-L= iii 74::
7.4 cPV.-L1L AS3EL;SAMrr3 =OR SENIOR CITIZENS' 1.10MESTEAD
r.1US 1.374, CFLIPT= 206
STATE OF HIMMZOrA )
COUNTY OF DMOTA ) DATE AT) l 20, 1982
'.b: Co;rnty Audi:cor, Dakota County, 14innesota
I, the undersigned, declaru ;order penalties of perjury:
Thai: I rezida at 2135 Silver Bell Road, Eagan, MN SS122
That I as !tut Isez; -*,Ian 65 years of age and that the date of my birth is Oct. 122 1916
`That i att the owner of the property legally described as:
see attached sheet
Property Identification No. 10 01800 021 79
That my interest in the ownership of the above property was aquired on April
19 63 and is as follows:
1. Solo ownership (Enter yes, if applicable)
2. Joint tenancy- held with
3. Other undivided interest (Specify) That on January 2, 19 or June 1, 19_6a.__ I owned and occupied the Sbove property
as my homestead and such occupancy began en k L 19yz
TUat the installments for improvements on the special assessments duly adopted in
ordinance by the r; rv r? . r; t o£ F,_ as of cec
which h;:ve been allocated against the subject property would create undue personal
hardship or my behalf and I respectfully request that payment be delayed and that
n ch ins; ailme-nh. x so deferred for the y
ears 19 1?9 ;,,,;;,??;.,,ite?p
Signed
Owner
I, ?,S• Vo ..?v t-Ab± e- , Clerk of the of? n a
in a county, State of 14inneso , do hereby certiiy at the
agplica"On of Ln%-2 ,,even above named, has been duly reviewed and that it
accordance with the minates of official record in said chambers was duly
APPROVED or %QqMP As of That in accordance with approval granted, the special assessments listed below e: tb:
affiants subject property levied for annual collection in the amounts and for the
years shown be so deferred with interest at the annual rate shown until such tirna
it is deemed the applicant no longer qualifies or,the property loses its eligibiiit;•
Years of
Nave of Auditors D/P 'IotaR CollleatIon Tntb rust
- Assess nt Ntanl?er No. Amount (Inclusive) Rr to
n ?? ?trret
Seeger F. Wgr-nr Tntc
F;?
99
/G38 e a
S 4
TS 8°
Dated April 20 19 82 ld QAMA,}Lk
Yz (; k or authorized Deputy)
y "
(t
r'4
.
CITY OF EAGAN
Addition Secti
Ov%rher
Remarks
Lot Blk Paroel 10 01800 021 79
Street 2135 Silver Bell Road State Eagan MN 551
U.r. tr IL.1L K /.1i -Sri a?.Ll4_ 1Z1L
u- -... Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. Grr,l 1821.38 364.28 5 _ _
J??l 4
9 /fl y7
? :
.B 3i' BcS?
STREET RESTOR. 1982 182.76 36
55 $ 1 -
.
GRADING
- SAN SEW TRUNK
1,968 Sion-no $3-33 30
*SEWER LATERAL 4 hI
-- 1982 3571.70 238.11 1
I As C, 2
_
igg? 1933 08
/S o
L,ta
u 3
WATERMAIN
* WATER LATERAL 1982 15
WATER AREA
* Services 1982 15
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
/.N. STREET LIGHT
WATER CONN.. 18$.00 24404 4-28-81
BUILDING PER.
'r SAC 525.00
n
u
PARK
f
tw Ku? c?
a
/ ? _ D f. - _r . ?,?[ ,.QS-,a.?.? C?...? ?,?! ? c/M¢,G?.-tc. •L±-:L ?"iec?.x-.u-2'?G G
?...C' _ /?' //i -EYa-- l?"-?ir?+fiv C?sr?.ir?i L/ nG??-C a.-• ??/?/ . ? CJaevL4I ?//?a
44 46a.Ln u-.?52
f
/ D - 67,/- 7,
of pagan
3830 PILOT KNOB ROAD THOMAS EGAN
EAGAN, MINNESOTA 55122-1897 Mayor
PHONE: (612) 454-8100 DAVID K. GUSTAFSON
FAX: (612) 454-8363 PAMELA M4CREA
TIM PAWIENTY
April 17, 1990 THEODORE WACHTER
Couxil Members
THOMAS HEDGES
City Administrator
MR LAWRENCE GROVN EUGENE VAN OVERSEKE
Cay Clerk
2135 SILVER BELL RD
EAGAN MN 55122
Dear Mr. Grovn:
I appreciate your stopping by the Municipal Center to see me. As
my secretary told you, I don't keep regular office hours at the
Municipal Center but she has passed along your inquiry to me.
Our records show that you hooked up to City sewer and water in
April of 1981. Residents in the Wuthering Heights neighborhood who
were recently hooked up to City water received that service because
of concerns regarding contamination and because some of these wells
were beginning to dry up. The Metropolitan Waste Control
Commission paid for the hook ups.
The City is not in a position to offer to rebate any of the costs
to those who hooked up to City water in the past. If you wish to
appeal to the Metropolitan Waste Control Commission for a refund,
I would suggest you write to:
Gordon Voss, Chief Administrator
Metropolitan Waste Control Commission
230 East 5th Street
St. Paul Minnesota 55101
I'm sorry I can't help you with your request but I hope you will
feel free to contact me at any time you feel I can be of service.
Mayor
TAE/kf
A.
THE LONE OAK TREE ...THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY
Equal Opportunity/Affirmative Action Employer
J ? 3
Z -16
rt f? .
i
- -- ----- -- -- -------- - - -- - -
BEA BLOMOUIST
,
MAYOR •. _•
_
'h y„
'
PA ..Sdr1
CITY
OR EAGAN
MAR
RRANTO ; -
JAMES A. SMITH
THEODORE WACHTER - '
••?j.y,y ?9TD6 PILOT ;KNOB ROAD'
:•
COUNCIL MEMBERS EAGAN." MINNESOTA •°
55122
?.
PHONE ./840100
_,
?•
v
Y2
aY?
April 20, 1982
THOMAS HEDGES
CITY ADMINISTRATOR
EUGENE VAN OVERSEKE
CITY CLERK
Dakota County Government Center
% Auditors Office
Hastings, MN 55033
Attention: Peg
Dear Peg: RE:' Parcel 10 01800 021 79 i
Lawrence E. 8 Eunice Groven
2135 Silver Bell Road, Eagan, 55122
This letter is to notify you that the special assessments that
were levied for 1982 for the above mentioned legal have been deferred.
The deferrment is on data processing numbers 681 and 637. Please
issue a new tax statement showing the correction for payable 1982.
If you need additional information please call me at City Hall.
Thanks for your assistance.
Sincerely,
Ann Goers
Assessment Clerk
THE LONE OAK TREE ... THE SYMBOL OF STRENGTH AND GROWTH IN OUR COMMUNITY.
x
NOTICE OF SFE"It F.SSESS''E^;T
The Eagan city council meeting on June 16 1981 approved and
adopted special assessments against the follaaing described property :
SEWER AND WATER LATERALS AND SERVICES X"Parcel # 10 01800 020 79
for the following irprovemnts in the designated amounts:
K%TER
Area
El I Laterals
?X Service
El Lat. Benefit/
from Trunk
STOP-M
0 Area
M Laterals
SA.=APY
F-1 Area
® Laterals
Service
Let.Benefit/Tnuk
STREE.': S
PtKXP`1'I' (YPS)
45g 79
c, -15
?
?
1158.46 15
Grading/Gravel Base
0 Surfacing
Q Res. Equiv.
AHCUMf (YRS)
TOTAL $ zLZ 30
Any portion of the total amount of these special assessments may be paid within
thirty (30) days of adoption of the assessment roll without interest at the Eagan_
City Hall after which any remaining amrnmt will be certified to the Dakota County
Auditor at Hastings for annual installment payments (principal and interest) w`zich
will appear on your future property tax statements.
If the special assessment balance is not paid within this 30 day period but paid
prior to Octot r 15th in the year of adoption, interest will be charred fror the
date of adoption to December 31st of that year at the rate of 5.9
If the assessiment is not paid by October 15th in the year of adoption, it will be
certified to be paid in annual installments at the rate of 11 % per year interest.
The first year's installment to show on a tax statanent will then include interest
from the date of adcpticn to December 31st of the following year.
The law provides that unpaid assessments will became a lien against the property.
State law, :Minnesota Statutes Section 429.081, provides that you may appeal your
assess.,ent within 30 davs after the adoption of the assessment by serving a notice
of appeal upon the mayor or City Clerk of Eagan providing that a written objection
sinned by the affected property gamer was filed with the City Clerk prior to the
assess,ent hearing or presented to the presiding officer at the hearing. You
must file the notice of appeal with the Clerk of District Court, Dakota County,
within 10 days after serving it on the Mayor or Clerk.
SPECT-AL ASSESSME24T DEPAP!L04T
City of Eagan
3795 Pilot Knob Road
Eagan, Minnesota 55122,
. Social Security r
Award Certificate {
From: Department of Health, Education, and Welfare
Social Security Administration
1 r.I-, ,-
Date MAR. 14. 1980
Claim Number: 472-28-Ob14 HA
LAWRENCL E GRCVEN Type of Date of Monthly
F IV RANCH RD gc^.afit Entitlement Benefit
BX 14
ESTERO FL 335261 DISABILITY 10/79 f 492.50
THE AMOUNT OF YOUk FIRST PAYMENT IS $2462.50.
INCLUDE ALTLERBE3N/L07FI/609 AFPAYMENTYFORT$492C50 WILL
SHORTLY
WILL Bc SENT CV ut. AdOJT 4/03/80. AFTER THAT, A PAYMENT FCR $492.50
WILL BE SENT LASH ML,NTli.
YCJ
TTHISARLEERTNIOTFIECLAIIGEIOL6EFNTOIRTLANY ANC•THERFIENCFITRONHTHISTOREANYN
CTHLR RECORD IN THE FUTURE- REQUIRES A SLPARATt APPLICATION.
IF YCU BELIEVE THIS CETERMINATICN IS NuT CORRECT. YOU MAY REQUEST
THAT YOUR CASE at REEXAMINED. IF YOU WANT THIS RECONSIDERATION, YOU
DATE RECEI
MUST KE?.UEST IT -1
NOIIC'L. YCU MAYyHAKEAYCUR THAN DAYS M ANY THE SDLIALYSECURITYVE THIS
OFFICE. IF ADCITIONAL EVIDENCE IS AVAILABLE, YOL SHCULD SUBMIT IT
6ITH YCJR REGJEST.
00
this certifies that you (or the person(s) on whose behalf you
applied), became entitled under the Social Security Act to the.
_ t ?arnrity benefits shown.
Commissioner A2 Security
. _'sxn;t;i.^^:.,:?`"='Et°:11:CSlR•d tBY-.ii1(!!f•7:2t Rlaet:eR?1Q:??'
Assessment Committee
September 8, 1981
/o oBbo ,2ao 79
(oa l)
LAWRENCE GROVEN, SILVER BELL ROAD STREETS -- PROJECTS #274 AND #285
A request of Mr. Lawrence Groven, whose home is on Silver Bell Road in
the Wuthering Heights area under Project #285 and Project #274, that he be
allowed to have his assessments deferred under the ordinance providing for
senior citizen deferral. It was noted that Mr. Groven is permanently disabled
and also will, on October 12, 1981, be 65 years old which is a requirement
under the age stipulation in the ordinance. Upon motion by Rahn, seconded by
Vogt, it was Resolved that the hardship provisions of Ordinance No. 66, Senior
Citizen's Deferral, be authorized for the assessments to the Groven property
under Projects #274 and #285 subject to compliance with the ordinance provi-
sions. All voted yes.
ADJOURNMENT
Upon motion of Wilkins, seconded Egan, the meeting adjourned at 6:05 p.m.
PHH
3
Cities Mai
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1..- a .) ?." uy L ?tik 'Y, r e. n 4"..? ..Ltt"wi '& ?Ir'ar?„ ,, }xi f r d i :3 re
e ' ? y°x4'"''g i w < 3. { 5 ) , ,; as ? "r ?*)?.°''uiy.y ' `r4;
S ?r? 9 @My+4? 't hY? xay. r r ? ? Sx 1-a f i :"' r
.ro n?? <.,aT??MS??hh ?t"Y'ti.Gl?.t"t?$ Y??`4.r?r??IZI T1E4JBIISIC7ESS ?r ?y ?g.'?R'?k??jU? f?ta?73k(?rs?
P"Al 7 _ .y?, °eS.?M4iki SrS? f ,l?ql A yYjr=. :y. ,.. <. m,_ .r ai P./"'rhrl3rys 'l?,Asr.`s Aq 3Ty '.
Project 274 and 285, Silver Bell Road Streets and Utilities (Iawrerioe "Grover) "
T r r?gII}D?A_ {{fi?r„-',?
t) FAi a°?Yhh§+ayy'Cp'J?A33?L3?§s Y? iFa1r` R?"?F ,(rs '? ;y i$' L? ^ k'" R.t??'k ?A yu?*x ?Y+n ?t Sxv ?w j
.r'' t S? L"l y.: r3 2a.)(F p ?.. 1` 2 1 rye?xw , JsS y, 7a .,.k1?'?J`% $ .:»5"..'L
have received a request for special consideration pertaining?to utility
Assess- Amts that were installed to the silver Bell Road/wuther Heigh ts area (Pm j
ing ? ect
'1 X ?•?, , L
iIr 11285) with the final assessment hearing being held on July _7, 1981 _,,Under Project '
Mr.' Graven was assessed $3;571.70 for his 97.37 feet of frontage 'for :;the in- .
lation of sanitary sewer, wateniai and r ?n`3" ,which has a sdheduled final assessnentnheaz ngfotr September services.
151981 ?J?Gmven
.;r? yr is proposed to be assessed $1,821.38 for street improvements on Silver Bell Road
7 for the same amount of frontage. 'As indicated in Mr. -Groven's letter, be has a peiinanent disability'wbich has prevented him fraim being employed since '1978 ; 1.1
addition `cam bctcber 12, 1981, Mr. Groven will be 65 which would qualify him for
deferment of special assessments. for senior ei.tizens 'A copy of'. this ord nance
is attached for your infornatim.As can be seem, the amount of_ special assessment
"for street and utilities does, in fact, exceed the $300 amount stipulated in that
+ +,grdinance.'"'The average annual payment of principal alone would equal $720, which
`" s s ;e?cceeds 1% of the adjusted t
gross incame of Mr. Grover -? ?N o:A
STAFF' >nMY ?+n itt k r ?
tY H? S3} F 1 K xttyt u+a+.y^x f*%'1 }
S hMe'?MTION Yr'? h'.??{{ F ? t`'? y i;?'W t• !eH n d? s..? r
at'L'? /? r%f $+c a G"' k{r? r.
"f??? YC rs?' t° FL ?S4? Di y x tl ?C f rS3 °I
^Based on the amount of assessments levied against Mr. Groven property asa result
f Project 285 and 274, a7abined with .the fact of his existing permanent disability
and his forthcoming qualification for senior citizen special assessapnt deferment,
"' '...'it it the staff's reowmanP?dation that all assessments associated ?ai.th these refer-,,.
arced projects be deferred mmt11 such time as stipulated minder the provisicos of. +";
Ordinance #66 r .+ i K7i rp fn xe?11s p+ a/ a ?, i y e y] rsk `t ?y+?p'w?a' `a'?{ ?' `?,?ry'? F'
l?.e ) SDsH`s4 ly++M L. v :.Lt-. a k Ah i... .?.?_ V?cti +.r ,'ati?
,ae
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i1 'f`"r x ??we <z?R",!A"Y ?! k? C'" a^.h'Sy Y - ,$ r?''F.? t Y;r? &Y"??r.?r'v'ta r "P 4?'e aTr
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7-12-76
APPLICATION FOR DEFERD04T OF SPECIAL ASSESSUENTS MaER M.S.A.5435.193
P1A4IE: Lawrence E. Groven $ Eunice Groven
ADDRESS: 2135 Silver Bell Road Eagan MN 55122
I am not less than 65 years of age, being born on: October 12, 1916
I am the owner of the following described property: Section 18, Township 27,
-Range 23. E 97.37' of W 208.7' of 5206' of Government Lot 7
I have the following interest in the above described property: - fee
:F joint tenancy - undivided - other (please specify)
On January 2, 19 or June 1, 19 63 , I owned and occupied the above property
as my homestead and such occupancy began on April. 1963
Special Assessments for public improvements have been or will be levied or. :.;y
'./ property, in accordnace with the assessment rolls of the City Clerl:-- RE: imp.
Project # 274 These assessments would create a personal hardship on my behalf
and I respectfully request that payment be delayed until such time as prescribed
by Eagan Ordinaace No. 66
To substantiate my claim of personal hardship, I have attached a copy of my
19 81 Federal Income Tax Return.
Applicant certifies that all information in this application is true and
complet:, to the best of her/his knowledge.
DATED: April 20, 1982
410588 D03412 638 GROVEN
1040
_ /? U?® Department of the Treasury-Intemal Revenue Service
U.S. Individual Income Tax Return
on Su
fer to z
i
10, Ta
not ha
he to
lount i
get-o7
3S offit
11.:.Ota,
ity Re
nulty
and
nutty 1
U.S. GOVERNMENT PRINTING Of FICE. 1901-0-343-D57
1981 YOU7_4 ??1
For the veal January 1-December 31, 1981, or other lox year beginning . 1881, ending ,19 OMB No. 1645-0074
Use Yom lire) name mod initial lif joint return, also give spouse's name and Milieu bog name Your social security aumbei
IRS LAWRENCE E AND EUNICE GROVEN 472 28 9614
label.
Other- Present home addles. (Number and street, including apartment number. or rural route) Spouse's social security no.
wise. 2135 SILVERBELL ROAD 471 22 1853
please
print City, Iowa Or non office, Sul, and ZIP code tour 'p¢upMA ? DISABLED
or type. EAGAN MN 55122 spouse's o<cuwlion ? HW
Presidential Do you want $1 to go to this fund? r,e N'p e ng
o will
o
re
Election Campaign ?
If i
oint re .
turn. does our spouse want $1 to o to this fund?.
r,s
xo u
n
ticreas
l
not nnease your ua or r<-
it-
duce v'pur relnna.
Filing Status 1 Single For Privacy Act and Paperwork Reduction Act Notice, see instructions.
2 X Married filin
joint return (even if onl
one had incomel
Check only 3 g
y
Married filing separate return
Enter s
ouse's social securit
no
above and full name here ?
one box. .
y
- - - - - - - - - - _ _
p
.
4 Head of householdlwith qualifying personl.(See page 6 of Instructions.) It he or she is your unmarried child,
enter child's time ?
5 -----------------------------------------
Dualif in widowler) with dependent child (Yearspouse died ? 19 1.(See page 6 of Instructions.)
Exemptions X X
6a
Yourself 65 or over Blind Enter number o
X boxes checked 3
b L_J Spouse 65 or over Blind on 6a and It
Always check
e First names of your dependent children who lived with you ?_ _ _ _ _ _ _ _ _ _ _ _ _ Enter number
of children
the box labeled
Yourself.
------------------------------------------- p
listed on 6c
Check other d Other dependents:
12) R
l
i
hi 131 Number of
li
th
d 141 Did dependent
h
i
of IS) Did you provide
-hall
th
f
boxes if they Of home at
ons
p
e mon
s
ve
in r name ave
ncome
1000 more' an 'pare
more
o
On, 4 ms Enter number unit,_ I
apply. of other
dependents
Add
s
ed in
e Total number of exemptions claimed . . . . . . . . Noes above
. . . . . . . . . . . 3
ncome p C
7 Wages
salaries
7
,
, Imla?'n Stnedple
d 11'orer
5100 or ' ' . ' i • 55171 "
8alnterest income You have an
Au-Savers Imeresll B
ll
ease attach
B
f
i y
to Dividends launch Schedule 8 if over $4001
py
o
your .
W-2 here.
,rms
c Total. Add lines 8a and 8b ac 5
d Exclusion (See page 9 of Instructions) 40
you do not have
f 8e 5117 1
00
W- e Subtract line 8d from line 8c (but not less than zero) .
2. see . . . . . . . . . .
age 5 of 9 Refunds of State and local income taxes (do not enter an amount unless you de- 9
nsuuctions. deducted those taxes in an earlier year - see
a
e 9 of Instructions)
p
g
. . . . .
10 Alimony received
10
. . . . . . . . . . . . . . . . . . . . . . • .
11 Business income or (loss)(atuach Schedule C)
? 11
. . . . . . . . . . . . . . .
12 Capital gain or llass)(attach Schedule 0) 12
. . . . . . . . . . . . . . .
13 40% of capital gain distributions not re
orted on line 12(See page 9 of Instructions) 13
.
p
14 Supplemental gains or IlossesHattach Form 4797) 14
. . . .. . . . . . . . .
15 Fully taxable pensions and annuities not reported on line 16 15 948 .00
16a
16a Other pensions and annuities
Total received
. . . •
.
b Taxable amount
if any
from worksheet on page 10 of Instructions 16b
Please ,
,
.
att
h
h 17 Rents
royalties
partnerships
estates
trusts
etc
(attach Schedule E) 17
ac
c
eck
or money . . . . . . .
,
,
.
.
,
,
18 Farm income or (lossHartach Schedule F)
? 18
order here. . . . . . . .
Total received 19a
19a Unemployment compensation Insurance)
.
b Taxable amount
if any
from worksheet on page 10 of Instructions 19b
. . . . , •
,
,
20 Other income (state namr and sour - ee page 11 of Instructional ?- - - - - - - _ _ _
A
IN :• ?
L
ND R
T
-----------------
-
--
--
-- 20 2660 .00
-------
-
-----
------
21 Total income. Add amounts in column for lines 7 through 20 . . ? 21 8 7 2 5
Adjustments 22 Moving expense (attach Form 3903 or 3903F) 22
to Income . . . . .
23 Employee business expenses (attach Form 2106) 23
. . . .
24 Payments to an IRA (enter code from pa
e 11 24
(See g
I
-
25 Payments to a Keogh H
R
10) retirement plan 25
nstruc
lions on .
.
. . . .
26 Interest penalty on early withdrawal of savings 26 4
page 111 . . .
27 Alimony paid
27
. . . . . . . . . . . . .
28 Disability income exclusion. (attach Form 2440) 28
. . .
29 Other adjustments-see page 12
_
?- - _ 29
- _
_ _
. . .
30 Total ad ustments. Add lines 22 through 29 . ? 30 491 .00
Adjusted 31 Ad usted gross income. Subtract line 30 from line 21. If this line 15 less man
6
'
'
Gross tneome ,000 see Earned Income Credit
Ihne 571 on papa 15 of Irstruciians
$1 31 8676 00
,
If you want IRS t fi ure our tax a f In tru tl n . ?
,
.
343-057-1
88 D03412 638 GROVEN
• Ifu9eu
r? =
Page 2
32a Amount from line 31 ladjusted gross income) . . . . . . . 32,
32b If you do not itemize deductions, enter zero 321
If you itemize, complete Schedule A (Form 1040) and enter the amount from Schedule A, line 41
CAUTION: If you have unearned income and can be claimed as a dependent on your 1
parents return, check here ?? and see page 12 of the instructions. Also see page 12
of the Instructions if:
you are maffied filing a separate return and your spouse itemizes dMuclions. OR
You the Form 4563. OR
You are a dual-sinus alien.
32c Subtract line 32b from line 32a . . . _ , , , . 32d
33 Multiply $1,000 by the total number of exemptions claimed an Form 1040, line 6e 33
34 Taxable Income. Subtract line 33 from li?n-?y 32c . 34
35 Tax. Enter tax here and check if from F' Tax Tables. [j Tax Rate Schedule X, Y, or Z,
? Schedule 0, ? Schedule G, or ? Form 4726 . . . . . . . . . . . . . . . 35
36 Additional taxes. Isee page 13 of Instructions.) Enter here and check if from ? Form 4970 36
. [] Form 4972, [] Form 5544, or ? Section 72(m)(5) penalty tax . . . . ..I 7M
38 Credit for contributions to candidates for public office . . .
39 Credit for the elderly (attach Schedules R&RP) . . . . . .
40 Credit for child and dependent care expensesWtach Form 2441)
41 Investment credit (attach Form 34681 . . . . . . . . .
42 Foreign tax credit (attach Form 1116) . . . . . . . .
43 Work incentive (WIN) Credit (attach Form 4874) . . . . .
44 Jobs credit (attach Form 5884) . . . . . . . . . .
45 Residential energy Credit (attach Form 5695) .
we .m.. ...._...__ ... _. __
8430.00
3000.00
3
280.00
280.00
28
48 Self-employment tax (attach Schedule SE) .
49a Minimum tax. Attach form 4625 and check here ? ?
491b Alternative minimum tax. Attach Form 6251 and check here ? ? _
50 Tax from recomputing prior-year investment credit (attach Form 4255) .
513 Social security (FICA) tax on tip income not reported to employer (attach Form 4137) .
51b Uncollected employee FICA and RRTA tax on tips Ifrom Form W-21 .
52 Tax on an IRA (attach Form 53291 .
53 Ad.,,.. .....w
tents 55 Total Federal income tax withheld . 55
56 1981 estimated tax Payments and amount applied from 1980 return 56
57 Earned income credit If line 32a is under $10,000
see
W-2, ,
Page 15 of Instructions . . . . 57
and 58 Amount paid with Form 4868 . 58
it 59 Excess FICA and RBTA tax withheld (two or more employers) 59
60 Credit for Federal tax on special fuels and oils (attach
Form 4136 or 4136-T) . . 60
At R._..i_._. ._..___. _ . . . . . . . . . . . .
,
,
Or 63 If line 62 is larger than lin
54
,
,III
ce e
, enter amount OVERPAID . .
64 Amount of line 63 t
b
RE 63
o
e
FUNDED TO YOU .
65 Amount of line 63 to be applied tc your 1982 estimated tax ? 65
66 If line 54 is larger than 62, enter BALANCE DUE
A
.
ttach check or money order for full amount Day
-
able to "In al Revenue Service."" Write your social securit
numb
d" 19
1
-
66
be
y
er an
8
Form 1040
on it
(Check ? if Form 221012210F) is attaehee
S
ease b .
ee doe 16 of Instructions.) ? S
nle' penrllies of per ury, I declare that I have examined this return
nclodiq
knowl
a
i
d
b
gn .:
ccom anv
e
ge and
no Schedul!
.nice
elief it is true, correct and complete. Declaration of prepare r father than landfall is (Lased e
g
preparer has any knowledge.
on and information of
Ire L
id p son, "pram'. One Spouse s sionature fit tiling ioinuy BOTH most sign even it oniv one had income!
reparers
s
Caere'' a Check it
'4mtnre BETTER TAR SERVICE
nd Date o
preparers social srsaril'/ no.
e Only ;
?
220 We 98TH STREET 47
1 34 1055
F.I. no. ?
BLOOMINGTON, MN 55420 4 2
zip rode ?
343-057-1
Posting Check List
Poaced
-..3rd RY_ Date
Defoxrcd TaAes!As,essment. Pock _
Tran°s-er Cen: (Red Doi:)
Lr^?i ;a.:=o rnr..snt Aises meet Card _
Data t•YOae::siilcR Notified
Termination Order
Date Terminated
l
- k,
APrIlUITTON AIM AUTKJRIZA.IOH FOR D=vED £AYZ = Or VL,.
n. SPE^IAL ASSESSi'iEtTt5 20P. SENIOR CITIZENS' HOMESTEAD
LATIS 1374, CRAFTER 206
STATE OF MINtmsOm }
COUNTY OF DAtOTA } DATE April 20, 1982
Sb: ::o-anty Auditor, Dakota County, Minnesota
It the undersigned, declare under penalties of perjury:
That I reaido at 2135 Silver Bell Road, Eagan, MN 55122
That T arA nic :-.han 65 years of age and that the date of my birth is Oct. 12,1916
That i aw the owner of the property legally described as:
see attached sheet
Property Identification No. 10 01800 021 79
That my interest in the ownership of the above property was squired on April
19 63 and is as follows:
C 1. Sole ownership (Enter yes, if applicable)
2. Joint tenancy. held with if,
_
3. Other undivided interest (Specify)
That on. January 2, 19 or June 1, 19_6y I owned and occupied the above property
as my homestead and such occupancy began on April 191,2
TLat the installments for improvements.on the special assessments duly adopted in
ordinance by the City Cn„nz 1 of Fga as of?ey?L 19.21_
which I„ve been allocated against the subject,property would as
undue persanal
hardship or my behalf and I respectfully request that payment be delayed and that
such installment. bo w deferred for the years 19 19_ide;Einite
Signed
Owner
Clark of the of
in County, State of Minneso , do hereby certiry at. tiie
applicat:oon of )s.aren,s reve.\ above named, has been duly reviewed and that ir
accordance with the minixtes of official record in said chambers was duly
APPROVED or k as of Soo}e.,..b4r IS 19_.
Cy
That in accordance with approval granted, the special assessments listed below o: tb.
affiants subject property levied for annual collection in the amounts and for the
years shown be so deferred with interest at the annual rate shown until such tiraa
it is deemed. the applicant no longer qualifies or the property loses its eligibiiit;.
Years of
Name of Auditors DIP Total. Colllection Interest
Asseasrusnt Number No. Amount (Inclusive) R:?a
Street - 99 6R1 .G1921 3R S g%
Sewer £ Water i.ntc 99 637 T3571.70 1 R%
Dated April 20 19 82 VbM OA J 412
( •k or Authorized Deputy)
(over)
'
. U.
r
2 AS
CITY OF EAGAN Remarks r r
Section 18 Lot Blk Parcel 10 01800 02/ 79
Addition !
Street 2135 Silver Bell Road state Fagan- MN 55122
7 t , i l 9? ?o
ment
Pa
ceipt
Re
Date
improvement y
! M R
1?11 0(
* SEWER LATERAL 1 2 1. U 2 8.11 1
WATERMAIN
* WATER LATERAL
WATER AREA
* Services
1 2
/17 7
1982
O
1
15
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER _
SIDEWALK
STREET LIGHT
WATER CONN. 185.00 24404 4-28-81
BUILDING PER.
5
QQ
n
25.
SAC
PARK
;. 1Y
H
AN I:IUMTON AIM AUTYQRIZA'.ION FOR DELkYM T%A'fM:-IT OF nL:
-.,j ¢pF.:'LlL ASSE:&,arfS :OF SF.MOR CITIZL:4S' HOMESTEAD
C TWIS 3.?74, MIETM 206
STATE OF MINNESOTA
COUNTY OF Wu(OTA ) DATE April 20, 1392
4b: Cvutty Audit-or, Dakota County, Minnesota
I, the undersigned, declare ;radar penalties of perjury:
Yhat I recida at 2135 Silver Bell Road, Eagan, h1N 55122
That 1' am !,.-t i•:. llnan 65 years of age and that the date of my birth is Oct. 12 1916
`that i as the owner of the property legally described
see attached sheet
Property Mcncification No, 110 01800 021 79
That my interest in the ownership of the above property was aquired on April
19 63 and is as follows:
C ' 1. Sole ownership (Enter yes, if applicable)
2. Joint tenancy- held with
3. Other undivided interest (Specify) That on Janvarp 2. 19 or June 1, 19?g_ I owned and occupied the sbo a psopertY
as my homestead and such occupancy began on a„ '1 --
T1Uat the installments for improvements on the special assessments duly adopted in
ordinance by the_Ci y ...?;: of t e as of c __19.g"
which hwia been allocated against the subject property Would treat's undue personal
hardship on my behalf and I respectfully request that payment be delayed and that
etch insizaJmont..:M so aaferred for the years 19824flO 19i,,.la rite
Signed Z 1 -!
r Owner
I,.?. Va nwer1oe?? . Clerk of the of n a? a
in n County, State of Minneso , do here--y certify at the
appIic Zion of Lowren Croeeh above named, has been duly reviewed and that in
accordance with the minutes of official record in said chambers was duly
APPROVED or WWO as of S ?De r (5 - 19-B-1--
C:11 That in accordance with approval granted, the special assessments listed below cr.: tb-
affiants st.;ject property levied for annual collection in the amounts and for the
years shown be so deferred with interest at the annual rate shown until such tima
it is deemed the applicant no longer qualifies or,the property loses its eligibilit:..
Years of
Name of - Auditors D/P Total. Cclllectios Irtrr?st
Asseasu nt Mmuber NO. 'Amount (Inclusive) Ltn
????? Srrner Qn 6R1 ° ?r?R R
^ Sewer F. Warrr Inrc Qq 6;7 15 R„
6V+", ??\? /77g-. 6 a" pa.
Dated April 20 19 82 ?Q11t
Y ( `k or Authorized Deputy)
(over?
C I T Y O F E A G A N
CERTIFIED LISTING OF POSTPONED
SPECIAL ASSESSMENTS
LEGAL DESCRIPTION:
Section 18 Twn 27, Range 23 E 97.37 Ft of W 208.74 Ft of
r? S 206 Ft of Govt Lot 7
COUNTY IDENTIFICATION NUMBER: 10 01800 021 79
POSTPONED SPECIAL ASSESSMENT:
Water Area Assessment
Pursuant to M.S.A. 429.061, Subd. 2, as amended by the
1980 Session Laws, Chapter 560, Section 5, I hereby certify
that the City of Eagan has approved the postponement of the
special assessments as set forth above on the property described.
bated this -' tk day of T4 V1 IL- 1984
EXEMPT FROM STATE DEED TAX STAMPS
This Document Drafted By:
City of Eagan
3830 Pilot Knob Road
Eagan, MN 55122
Exe t from S ate D ed Tax
Dakota County T e urer
'?l LOA rU 04 L
E. VanOverbe e
Ci Clerk/Finance Director
Certificate
I, E'. J: VanOyerbeke, City Clerk of the City of Eaa, Hereby
certi,that-foregoing is a true co ct copE.J VanOverbeke, City Clerk
4
65
.STATE OF MINNESOTJC SS.
County of Dakota
office of County Recorder
This is ' certify that the within
instru was filed for record i
this 0. n ffluly , on the
dayA. D. 19
at 'clock M., and that
the-same wecorded in
Dakota County Records.
JAMES N. OLAN
Cou Recorder
By
Deputy
o
c c
/ 7 C
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C!ty of Eap
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
(tt.) 5G -9y
r
Use BLUE or BLACK Ink
For Office Use
Permit #: kJ/s9
Permit Fee: 96 • L/
/1 —11/-//
Date Recei
Staff:
2011 RESIDENTIAL BUILDING PERMIT APPLICATI
Date: /i'-/) --Jez,' Site Address:
,3?/' 3
Name: J Cx. /.1 &'':°Y.. l�
Address / City / Zip:
Phone: (,
N
Unit #:
/73 yI
Applicant is: Owner
Description of work:
Contractor
Construction Cost: `% Tom-'
Gi2t�-�asr:1.,1
Multi -Family Building: (Yes / No i> )
5— % �74731"01"%ed
Cmpany: 62Leib(1 .,t *1. .Contact: n4 (22.S t-7
Address: 6i/) \ 5 4 U /frt , City: c- n 1 L°"
State: /lit.. Zip:
License #:;,2061:_) y -,,c) c
Phone: /1.--3 -%`%
Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
6
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:
Mechanical Contractor:
Phone:
Phone:
Sewer & Water Contractor: Phone:
d supporting dorm
gay, be = _
................
rubrit ars
you provide spe_.
tha.y trade sec:
nformatio>
could pe
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.gooherstateonecall.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 ( 1 s :
Applicant's Printed Name
nt's Signature
Page 1 of 3
Use BLUE or BLACK Ink
r
For Office Use C,
' Permit (I 1
CRon
411100 j
l
ty of EaEdI Permit Fee:
3830 Pilot Knob Road I r l
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 i Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 0A _ kA _ Site Address: ~ \ ?J J S \1 c' C Unit
Name: Phone: (SIS l ~S cA l c~ J
Resident/
Owner Address / City / Zip:
Applicant is: Owner Contractor
Type of Work Description of work: L
C`
Construction Cost: Multi-Family Building: (Yes /No Company: Contact:
Contractor 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)
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 you submit are considered to be public information. Portions of MI
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade 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.gopherstateonecall.ong
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.
Applicant's Printe Name Applicant's Signature
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