4670 Slater Rd
. 2004 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION
City Qf Eagan
~5<--~~~ 3830 Pilot Knob Road, Eagan Mn 55122 ~ i~~ ~
Telephone # 651-675-5675 FAX # 651-675-5694
Requirements: 2 complete sets of drawings and specifications
cut sheets on materials and com onents to be used
Date ~ l a g l ~7 ~P~X
Site Address: `~S~GLT~-r 1`~d
Tenant / Building Name: (/V~./~'W 6rV-~'1 f Gvt.O~-- S' .S~ !7 L~
The Applicant is: _ Owner ~ Contractor _ Other
PROPERTY OWNER V~ r'CLU/t 0' ~d'wf~ 6~ / ~ 7 '/C~~~SQ?'~
Address: ~ ~ ~ _ QdJ L2-S'~ A r ~ -
City: . State: ~ ~ Zip:
CONTRACTOR ~ V ~ ~C ~/r /ZC ~6 ~ MN License No. ~ ~
Address: oZ X P/'~ ~ i..C I-Y1 /J~t SCity: ~-/I'1 /'1 ~
State: / ' / ~ Zip: ~~~vv Phone#: ~501`S~I-~~,Q_v
ESTIMATED COMPLETION DATE: I~ l 3~ / dT
FIRE PERMIT TYPE: ~ Sprinkler 5ystem of heads Fire Pump _ Standpipe
Other:
WORKTYPE: ~ew Addition Alterations Remodel
Other:
DESCRIPTION OF WORK: ~Commercial _ Residential _ Educational
Other:
Please continue on reverse side
7/c~
2004 COMMERCIAL PLUMBING PERNIIT APPLICATION
CITY OF EAGAN
j~~~ 3830 PILOT KNOB ROAD, EAGAN MN 55122 ~
~d 651-675-5675 ~j" j ~-E' • ~
Date 7 / 27 / ~
Site Address ~/(Q 7 o`Z $ ~ p"~Ph ~ Unit # 7
Tenant Name ~OL~ ~qr-0 H-~-~UPw~! p f InW Former Tenant Name _
( nrlos~salL(~D enAn~~
Property Owner T~P J}}tOrr~ey Q~ LdW Telephone ) ~
Contractor ~,2.71~U/'~ Q~µ{n{7lYlq ~e
Address yyy Mqole 57' ~
State ~qh~'pYhP.[~i, h~ Zip 5}/I5 Telephone#((~,$~)(~53~390
The Applicant is _ Owner ~ Contractor _ Other
Work Type X A'ew Bldg _ Add-on _ Repair RPZ _ PVB _ Irrigation system *
•[tein sensors r uired. Jer Wobschall to calculate fees.
Description of Work ~ ~fy.s.os~..2 - a2 ~./is. ~ 4l ~ceo~c~- ~ Lv/..~.,._lAce1~,
To inquire if Pressure Reducing Valve is required on new service, call 651-6 5-5646
Meters - Ca11 65 1-675-5 300 to verify tha[ hydrostatiq conductivity, and bacteria rests passed prior to oickine uo meter.
Irrigation Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works
Fire Size & Price 3/4" displacement 8155.00
Domestic Size & Type ~ Avg GPM Includes high demand devices? _ Yes !-No
Flushometers _ Yes ~Ido PRV Required _ Yes :~10
i
Permit Fee $50.50 minimum (includes State Surcharge) -7 a D~
~r- OL
Conh~act Value $ ~o JdO, x 1% _ $ Base Fee
~ $ ~ . ~ -U Meter(s)
-1~ O c~ ~1
Rcquired on all new buildings & boulevard irrieation systems $ ~ l~-~ C~ Radio Meter Read
If base fee is $1,000 or less, surchar¢e is 5.50 5 $t3tB $71tC$azgC
ICbase fee is over $1,000, surcharge is 5.50 per S1,000 of the Hase Fee
Following fees apply only when installing new irrigation system ~ Water Permit
Contact Jerty Wobschall at 651 •675-5024 for requir
D ~ ~ ~ ~ D $ Treatrnent Plant
JUL 2 8 2004 $ ~'~'ater Supply & Storage
$ State Surcharge
-
Y
$ 3~J ~ S~ Total Fee
I hereby apply for a Commercia] Plumbing Permit and acknowledgc that the information is complete and accurate; that the work will 6e in
conforntance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes; that I understand this is not a permit, but only an
applicarion for a permit, and work is not to start without a pernilt that the work will be in accordaoce with the approved plan in the case of work
which requires a review and approval of plans.
~s 'Blasen a Da,mv,
ApplicanPs Printed Name App ' Ps Siymature
Lo~- ~ L~l I
~ `f`~~v~ ~OO~MMERCIAL BUILDING PERMIT APPLICATION
City Of Eagan ~ I.,J-~g
3830 Pilot Knob Road, Eagan Mn 55122
~ I l I, Telephone # 651-675-5675 FAX # 651-675-5694 ~j- Uc{.
`f
. . . s ~ . .
• SWdu21 Plans (2) seLs • ArchltecWral Plans • (2) sels • Archi urel (2) sets
• Civil Plans (2) • SWctural Plans (2) • Code Analysis ('I) "
• CertifirateofSurvey (t) • CivilPlans (2) • ProJec[Specs (1)
• Code Malysis (1) " • Landscaping Plans (2) • Key Plan (1)
• ProjeclSpecs (1) • CodeMalysis (1)" • MasterExitPlan (1)
. Spea Insp. & Testing Schedule " • Certificate of Survey (1) • Energy Calculations (1) not always`•
• Soils Report (1) • Spec. Insp. 8 Testing Schedule (1) " • Elec. Power 8 Lighting Fortn (1) not always"
. Meter size must be established • Meter size must be established • Meter size must be eslablished-if applicable
i . PrqectSpecs (1)
1 • EnergyCalwlations (1) " 1
1 • Electric Power 8 LighU~g Fortn (t) " 1
1 • ~Master Exit Plan (1) 1
1 • Emergency Response Sile Plan (1) 1
1 ~ SoilsReport (t) !
• SAC determination - call 651-602-1000 • SAC determination - pll 651-602-1000 SAC detertninaUon - call 651-602-1000
Call MN Dept of Health at 651-215-0700 for details regarding food & beverage or lodging facilities.
Contact Building Inspections for sample and if required when it states "not always".
Peanit for new building or addition will not rocessed without Emergency Response Site Plan.
~
Date 2~/ 6 Construction Cost 7~t14'J
SiteAddress ~ ~C.t~7~~ i`~~ UniUSte #
~ ,
TenantName C~i~IJ.~,N{s~~ FormerTenantName
Description of Work JL 11 IO d V T
Property Owner ~~,-~~~5 ~rG`~~ ~/~AAF~~ Telephone # (~C~ ) ~1 Z ~i
Contractor V~i'~C~vV'.n ~ f-~C1p{7GS I f`rC~•
Address ~~~0 .~v , ,¢'~,~/~d,Sc~ City ~'r l.r
State M(V Zip ~91 Telephone #(~jjr/) 77~~ / 9~~
i
Arch/Engr ~ ~ C,"fs ~ Registration #
Address City
State Zip ~y ~ Te e~l # (~r2) ~7~1 ~
~ 6' /J
O~
Licensed plumber instatling new sewerlwater service: e#:
I hereby apply for a Commercial Building Permit and acknowledge 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 pemut, but only an application for a permit, and work is not to start without a
pernut; that the work will Ue in accordance with the approved plan in the case of work which requires a review and
approval of plans.
T~-~+~7 ~N~~~.I
Applicant's Printed Name ApplicanYs Signature
2004 FIRE SUPPRESSION SYSTEMS PERMIT APPLICATION
City Of Eagan
j~ 3830 Pilot Knob Road, Eagan Mn 55122 ~ r~
Telephone # 651-675-5675 FAX # 651-675-5694
Requirements: 2 complete sets of drawings and specifications
cut sheets on materials and co onents to be used
Date~/~_/~
Site Address: ~~p S' GL~~2 1~-O( ~ ~T ~ l'~
Tenant / Building Name: N~l,~~.2~'1~,5
The Applicant is: _ Owner h Contractor _ Other
PROPERTY OWNER 55 16v~ Ni LL S
Address: h,(~(h ~/1 f~p 0. 0'
City: ~~/\,6 I('2 U I Q, I.J State: ~ Zip: S~1 a~
CONTRACTOR MN License No. C~ g~
e ~
aaaress: 211 Xenium Lane South city:
Minnetonka, M 5
State: Zip: Phone#: ~J~~~~~/~o~~
ESTIMATED COMPLETION DATE: ~ / S / 6~
FIRE PERMIT TYPE: ~Sprinkler System of heads _ Fire Pump _ Standpipe
_ . ~ ~ ~ ~ nn 2 ther:
~ f~ u v
WORKT c~~-',~~ew04 Addition
X Alterations Remodel
~
DESCRIPTION OF WORK: ? Commercia] Residential Educational
Other: .~-+,STO[~II ~ ~ ~/y
/ 3 -
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IMINNESOTA
MDH
!DEPARTMENToF HEALTH
Protecting, Maintaining and Improving the Health of Minnesotans
August 17, 2011
Thomas Hedges, Administrator
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
Dear Mr, Hedges:
The Minnesota Department of Health in consultation with the League of Minnesota Cities and the Minnesota
Association of Townships, has agreed to notify local government officials when a Housing with Services
Establishment subject to Minnesota Statutes 144D has been registered by the Minnesota Department of Health. This
notice is to inform you that the establishment listed below has been registered at an address located in your
community.
New Challengers Inc,- Afton
4670 Slater Road
Eagan, MN 55122
651-454-0161
This notice does not require any action by your local unit of government, nor does it create a right of the local unit to
intervene in the registration process of the establishment. It is being provided as a courtesy only. Because the above
named establishment may provide services to residents who would need special assistance in the event of an
emergency, you may wish to notify the emergency service providers for your city or town that this establishment is
now located in your community.
A list of currently registered Housing with Services Establishments may be accessed on the Minnesota Department
of Health website, through the following link:
http://www, health.state.mn.us/divs/fpc/directory/providerselect,cfm
Additional information about Housing with Services registration may be accessed through the following link:
http://www.health.state.mn.us/divs/fpc/profinfo/lic/lichws.htm
If you have any questions about this notice, please contact (651)201-4101. Other questions should be directed to
your local government association or legal advisor. Thank you for your attention to this matter.
Sincerely,
Mary Henderson
Supervisor, Program Assurance Unit
General Information: (651) 201-5000 • TDD/TTY: (651) 201-5797 • Minnesota Relay Service: (800) 627-3529 • www.health.state.mn.us
For directions to any of the MDH locations, call (651) 201-5000 • An Equal Opportunity Employer
C!ty of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use �{ %'
Permit#: 11130-
✓M3
Permit Fee: Li,)5.
Date Received: Io/(i /1,3
Staff:
2013hlrilbt • - 3UILDING PERMIT APPLICATION
Date: ID13 Site Address: `%Dv�"la,�er �el� �1�er�d �Lrc,2.
Resident/
Owner
i`TC
Name: o U C tA.0 ..� e kc £th c- S Phone: 'SiCV t 454— 01( (
, 41 tl
Address / City / Zip: 1 00 S/Q--1-er, ".,1 e"ealat„.. syn. 5S1ZZ
(
Applicant is: Owner Contractor
Type of Work
Description of work: — 70c:54-
Construction Cost: $250(X)c"-- Multi -Family Building: (Yes / No )
Contractor
Company: "F:::( t its I^ pr ices 1 (v c___ Contact: --i It "Egm*k-z._
Address: q ) r Po ncl L9 )a,City: C -e v r u :Re
State: /44 h Zip: (5038 Phone: (loiz) '718 — Sgq
License #: BC -398323 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
_Yes _No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 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.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 12A-n+z
Applicant's Printed Name
(6"-c‘"L
Applicant's Signature
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