1199 Spoonbill CirCITY C° EAGAN
3 1 95 Pilot Knob Road
Sagan, MN 5S122
Zoning: -
owner: r'
Address:
Address'
PERMIT No.:
DATE-
No. of Units:
Site I I.,()
Plumber: , . f,.
with the City of Eagan
to comply w Connection Charge:
sit:
1 agree Account Depo
Ordinance& Permit Fee:
Surcharge:
Misc. Charges:
By Total:
Date of Insp.: --- Date Paid:
insp.:-
-WATER SERVICE PERMIT
N
f PERMIT No•'
CITY o
K?b R004
3795 Pilot
MN 55122 DA f E-.
No. of Units:
Eagan"
Zoning:
owner:
Address'
Site Address: Charge: f
Connection
Plumber' _
Account Deposit:
Meter No Fee:
Permit f,
Size: -? Surcharge:
Reader No•: -
cOmpl'1 with the CKY of Eagan Charges.
?d?isc.
1 agree to Total:
prdinances. Date Paid:
By InsP•
Dote of Insp•:
CITY OF EAGAN
5795 Pilet Knob Road Eagan, MN 5515 N? 5360
PHONE: 454-8100
BUILDING PERMIT Receipt #
To h u. A for Get Vn6 "e 17n?e 19
Site Address
Lot Block Sec/Sub.
Parcel #
of Name _
3Z Address
b
City
Name _
0
d Address
~ Ci
Name _
Lull
r z
Address
Erect ? Occupancy
Alter ? Zoning
Repair ? Fire Zone
Enlarge ? Type of Const.
Move ? # Stories
Demolish ? Front ft.
Grade ? Depth ft.
Approvals Fees
Assessment _
Water & Sew.
Police
Fire
Eng.
Planner
Council
Permit
Surcharge -
Plan check
SAC
Water Conn.
Water Meter
I hereby acknowledge that I have read this application and state that Bldg. Off.
the information is correct and agree to comply with all applicable
State of Minnesota Statutes and City of Eagan Ordinances. APC Total
Signature of Permittee
A Building Permit Is issued to: on the express condition that
all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Ave. 1;mith
pwMIt ?j pate Issaed Penni tsw
Plumbing
Mechanical 7 Q ! ^ (o - 7 (()?
("sr
?
INSPECTIONS DATE INSP. Rough-In Final
Footings -? t Date Insp. Date Insp.
Foundation Plumbing -?,,t
Frame/ins. -29 f0-?? = 7 cj' Mechanical
Final
Remarks:
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
Phone: 454-8100
HFATIW-i PERMIT
Date: 11-6-79
Site Address:
Lot _-_ _
1199 SpocabiIl Circle
1
Block _
^ackw ood Estates
Sub/Sec. _
Qui t AM TMOUIIM
No. 1570
Receipt No.: 615:7
Single
Residential
X
Name - New/Alter. / Repair
0800 L•yrrxlale Ave. Smt:l-
c Address Cost of Installation
G IV,
8R4-7?. ?? 7ft,1[1
City Phone: Permit Fee
Name Surcharge
.
4637 C" zicaao !-?outh
g Add
City Phone: Total
This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Building Official
CITY OF EAGAN
3795 Pilot Knob Road
Eagan, Minnesota 55122
Phone: 454-8100
PU MBING PERMIT
No.
1491
Date: SeiptewberU, 1979
Site Address: 1199 Spoonbill Circle
Lot '+4 Block 1 Sub/Sec. Ductiwood gatates
Name Jadron
°e Address 10800 Lpndale Ave. So.
City uloomizwton 55420 Phone
NameR'Qille Plumbing Inc.
g Address 1200 Leisure Lane
c
0
v City 'urnsville 55337, Phone:
Receipt No.: 16747
Single
Residential
Multi Res., Comm./Ind.
New/Alter./Repair nA1?
Cost of Installation
Permit Fee 20.00
.50
Total 20 .
This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Building Official
CITY OF EAGAN
3795 Pilot Knob Rand
Eagan, Minnesota 55122
Phone: 454-8100
Water Softener _ PERMIT
11/29/79
Date:
Site Address:
1199 Spoonbill Circle
Lot .. #1116 _ Block 4 L_ Sub/Sec."Xl(/z zl'i' 4-ye
305
16857
Receipt No.:
Single
Residential
Multi Res., Comm./Ind. I
''>rian Bystedt
Name /Re
air
New/Alter
.
p
11.99 Spoonbill Circle
Address Cost of Installation
Eagan, M
City Phone: Permit Fee
Comers Soft Water
Name Surcharge
3301 Calmforl iv
g Address
e
City Phone: Total
This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
No.
Building Official
CASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
RECEIVED -
AMOUNT $
$ DOLLARS
too
CASH ? CHECK
FOR _.c1?
? 4 , 7 i
FUND CODE AtA OU NT
Thank You
BY
i
White-Payers Copy
Yellow-Posting Copy
15 5 4 2 Pink-File Copy
CITY OF EAGAN Remarks
Addition DUCKWOOD ESTATES Lot 44 Rlk 1 Parcel
Owner W 10 t , C J J Street 1.199 Spoonhi 1 1 Circle State Eagan, MN 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR. f, 1981 1739 3S 347
97 1739.35 0005623 10/15/80
GRADING .
SAN SEW TRUNK .J 1971 109.77 5.49 20 54-97 AODR696 1
917
/79
* SEWER LATERAL 1990 2984.16 192.29 1 7ral
SZQ A008696 -
1
11/7/79
-
WATERMAIN
t WATER LATERAL
WATER AREA 1972 111.81 5.59 20 12/7/79
• service
w STORM SEW TRK
* STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
road unit 75.00 15542 8/15/79
WATER CONN. 270.00 tr rr
BUILDING PER. 5160 it
SAC
12-9-00
15-542
911S/79
PARK
CITY OF EAGAN
3795 Pilot Knob Rood Eagan, MN 55122
PHONE: 4548100
BUILDING PERMIT APPLICATION
To be used for SF Dwlg & Garage Est. value 75,00
Site Address 1199 Spoonbill Circle
Lot 44 Block 1 Sec/Sub. Duckwood Estates
parcel * 10 21900 440 01
a: Name JADRON
Adders 10800 Lyndale Ave. South
City on Phone 884-7225
rc Name cI[le
S0
Su Address
CI Phone
r?
,y,w Name
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: JADRON
all work shall be done in accordoA90witlxa
N9 5360
Receipt # Z5;?5
Erect XM Occupancy R3
Alter ? Zoning RI
Repair ? Fire Zone 3
Enlarge ? Type of Const. y
Move ? .# Stories
Demolish ? Front 50 ft.
Grade ? Depth 52 ft.
Approvals Fees
Assessment -
Water & Sew.
Police
Fire Eng.
Planner -
Council
Bldg. Off. _
APC
Permit i r r • uU
Surcharge 37.50
Plan check 88.50
SAC 525.00
Water Conn. 270.00
Water meter, 60.00
Total 11158.00
on the express condition that
Statutes and City of Eagan Ordinances.
Building Official
RECEIVEOrIEC 1 081
r.
It li!:'1'It7CT N)N!:
COVENANT!: AND
KNOW ALL MEV BY THESE PRESENTS, that the undersigned,
Edward E. Parranto and Valentine Parranto, husband and wife, of the
County of Ramsey, State of,.Minnesota, Robert H. Karatz and Naomi
Karatz, husband and wife, of the County of Maricopa, State of Arizona,
and Kenneth Appelbaum and Sally Appelbaum, husband and wife, of the
County of Hennepin, State of Minnesota, being all of the fee owners
of the following described lands situated in the County of Dakota
and State of Minnesota, to-wit:
- Lots 1, 3, 4, 5, 7, 8, 10, 11, 12, 13, 15, 16, I
17, 18, 19, 20, 21, 24-, 25, 29, 30, 31, 32, 35,
39 „40-,- 4-1,,,43, 43, +14,-45, 48, 49, 50, 52, all
in Block 1; -and Lots 1, 2, 3, 5, 6., 89, 10,
11, 12, 13, 14, Block 2; all in, Duckweed Estates,
according to the recorded plat thereof, sometimes
hereinafter referred to as "the land",
do hereby set out the following covenants and restrictions, which
- shall run with the land and.bind the parties hereto, their respective
heirs, representatives and assigns, and all subsequent purchasers of
the land or any part thereof, and their heirs,representatives, suc-
cessors and assigns, to-wit: -
1. These covenants and restrictions are to run with the
land and shall be binding upon all parties and all persons claiming -
through or under the undersigned for a period of thirty (30) years -
from the date hereof, after which time said covenants and restrictions
shall automatically extend for successive, periods of ten (10) years
rN each unless an instrument signed by the majority of the then owners
of the above described lots has been recorded, agreeing to change such -
covenants and restrictions, in whole or in part.
2. No lot shall be used except for residential purposes.
No building shall be erected, altered, placed or permitted to remain -
- - on any lot other than one detached single-family dwelling not to ex-
teed three stories in height and a private garage for not more than
three (3) cars.
3. The size of any dwelling, exclusive of one-story open -
porches and garages, shall be: (a) in the case of a single floor
structure, not less than 1,200 square feet in area on the main floor; _
or, (b) in the case of a split-level structure, not less than 1,200
square feet in area on the floor directly under the roof; or (c) in
the case of story and-a-half structure, not less than 900 square feet
on the ground floor, and a total on the main floor and second floor
of not less than 1,300 square feet; or (d) in the case of a two story
structure, not less than 750 square feet on the ground floor and a
- -total on the ground floor and second floor of not less than 1,400 square
feet; or (e) in the case of a split-entry structure, not less than
1,200 square feet in area on the upper level, but a 258 credit will be
given for finished area of lower level which is 50% exposed over fin-
ished grade. No structure shall have a side exposure more than three
stories in height from ground to eave line, considering as a story, an
exposed walk-out basement.
. -4. No dwelling shall he constructed or maintained on the '
above-described property without a garage. The garage may be either
a separate structure from the house or attached. If an attached or a
basement garage is utilized, then the overall length of the dwelling
structure, exclusive of eaves or open porches, shall not be less than
forty (40) feet. All garages shall harmonize with the house as to de-
sign, materials and finished floor elevations.
5. Easements for installation and maintenance of utilities
and drainage facilities are reserved as shown on the recorded plat.
Within these easements, no structure, planting or other material shall
.r be placed or he permitted to remain which may damage or interfere with
the installation and maintenance of utilities, or which nay change the
direction of the flow of the drainage channels in the easements, or
_1_ 1 .
which may obstruct or retard the flow of water through drainage chan-
m•lr: in 1'hn n,??r•m rntr.. Thr na-;rmrnt nrrn of rnch lot- an,l all imprnvr-
ments in it shall be maintained continously by the owner of the lot,
except for those improvements for which a public authority or utility
company is responsible. Lots which border on wet lands (Lots 24, 25,
20, 30, 41, 42, 43, 45 and 50, all in Block 1) will not be cut or
filled within the easement area bordering the wet land, as shown on th,
recorded plat. -
5. No noxious or offensive activity shall be carried on
upon any lot, nor shall anything he done thereon which may be or may
become an annoyance or nuisance to the neighborhood.
7. No structure of a temporary character, trailer, base-
ment, tent, shack, garage, barn or other outbuilding shall he used
on any lot at any time as a residence either temporarily or permanentll
8. No sign of any kind shall be displayed to the public
view on any lot except one professional sign ofnot more than four
square feet, one sign of not more than eighty square feet advertising
the property for sale or rent, or signs used by a builder to advertise
the property during the construction and sales period.
-9.- No animals,- livestock, or poultry of any kind shall
be raised, bred or kept on any lot, except that dogs, cats and other
household pets may he kept, provided that they are not kept, bred or
maintained for any commercial purposes.
10. No lot shall be used or maintained as a dumping ground
for rubbish, trash, garbage or other waste, and any such materials may
be kept on the premises only in sanitary containers. All incinerators
or other equipment for the storage or disposal of such material shall
be kept in a clean and sanitary condition.
11. The exterior of all structures shall be finished in
wood, stucco, brick, stone or other approved exterior hard materials
12. No filling or storage of refuse, discarded materials,
junk or other obnoxious matter shall be permitted upon said premises,
except within the house or garage. No storage of commercial, struct-
tural or business equipment or materials shall be permitted upon the
premises, except within the house or garage. No parking or storage
of commercial vehicles shall be permitted upon the land, except for
the making of usual and customary deliveries to and from the premises,
and except that each owner may park one (1) commercial vehicle owned
by him and not exceeding one (1) ton upon his lot at any time. Pri-
vate vehicles upon the land shall be kept within a garage accomodating
normal passenger-size vehicles.
13. No fence in excess of a height of six M feet shall be
permitted upon the land or any part thereof, and all fences constructer
thereon must be of new material in metal mesh, wood or metal picket or
ranch type wood construction. All such fences shall at all times he
properly painted, stained or lacquered, and shall be maintained in a
neat appearing condition.
14. Enforcement shall be by proceedings at law or in equit}
against any person or persons- violating or attempting to violate any
covenant or restriction contained herein, which proceeding may he eithe
to restrain violation hereof or to recover damages for such violation.
15. Invalidation of any one of these covenants and re-
strictions by judgment or court order shall not affect any of the other
provisions hereof, which other provisions shall remain in full force
and effect.
IN TESTIMONY MIEREO£, the undersigned have hereunto set
their hands this day of ? 1979.
-2-
i
i
BUILDING PERMIT APPLICATION
DATE /
Include 2 sets of plans, 1 site plan w/elevations and 1 set of energy calculations.
To be used for tCes 1jz'C ?
Site Addresc: 11,79 s peg ° N 0-1 M,
Valuation /'?&zd
Lot Block f Sec. Sub. ! Parcel Number ?Q a/%CXJ ???/GI D?
Dockw?.[ ?5{7r{rS
Owner aTPrb 7013 Telephone Cy72 ?s
Address
o
Contractor Telephone c d y"zz 2 4 4 42 Address
0
Arch./Eng. K N S E L _
Address
Telephone 5`y C O 970
OFFICE USE
Erect
Alter
Repair
Enlarge
Move
Demolish
Grade
OFFICE USE
Date of Approval & Initial
Assessment
Water/Sewer
Police
Fire
Eng.
Planner
Council
Bldg. Off.
A.P.C.
Occupancy 3
Zoning A°f
Fire Zone _
Type of Const. I
N of Stories
Front d O
Depth
FEES
7 7
Permit J
7
Surcharge
Plan Check $ a -a
SAC 3a -
Water Cron. 270
Water Meter oO
TOTAL
EXTERIOR ENVELOPE.AVERAGE_* "U" COMPUTATION
OWNER I I W 'J VPf6 N b i
SITE ADDRESS.
CONTRACTOR T4 O RM ..1 - DATE PHONE
Determine working square footage of each.
1. Total exposed wall area ..... IS sq. ft. x .17 = 6 9,a
2. Total roof/ceiling area ..... l3B'ff sq. ft. X .05 =
Total exposed wall area above floor = I JS
a. Total wall window area ........................... ai 0
b. Total door area ................................. 7-0
c. Total sliding glass door area ................... a
d. Total fireplace wall area ........................
e. Total wall framing area (average 10%)............ y
f. Total net wall area above floor ................. ars,(p
g. Total rim joist area
Total exposed foundation area = S(h. Total foundation window area ..................... /o.
i. Toal net foundation area above grade ............
Determine "U" value of each wall segment.
•6P a. ;Z a X ..U. = 7S?
.?> 45 1?,cP b. a a X .,U,. ?
3 l1.GG l.P?, c. N X .,U.. .'f3 = A
= Z
94 1.22
?? 1.22
9y
d.
y X
?
..U..
37 re
,17 +7 17 e 1
V f X "U"
.
f. ? 569 X .,U.. 070 = 1. 9
s. 133 x
h. /D X "U"
i . 7,;-- x --u-, L/ 7
3.. ..........................Total =3 f?,3
If item #3 is the same as, or less than item #1, you have met the intent
of SBC 6006(c)2.
Total exposed roof/ceiling area =
j. Total skylight area ............................. 0
k. Total roof/ceiling framing area (average 10%)... j3 ,V
1. Total net insulated roof/ceiling area........... la xZ
Determine 11U" value for each roof/ceiling segment.
J•
i
V 111'11x-
1. A 11,111 a.3( _ y3. 7S
4 ............................... .Total
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006(c)l.
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the
sum of items #3 and #,4 shall not be greater than the sum of items #1 and #2.
3. _ ?rl+ 4. tel. 6? Iaf 01 / ,
O RV
EIAKKE
IINSULATION?
%48 QIFF BpM' BIIWJSY MN5 w'Xf!
ORV BAKKE
RES! 920-3552
890-0188
CONTP ACTORS-<PR?iC2TpR9 ? OLG UKET 6 PLOW V YFPyC<TiOrvS' FOnM B[YPO
.??=o?ae ?ngineeri?z.g? Com?cxsry
QO/. Tresyel?r-'s Trat? .Bur?sarilZe, Minn
?h os?e 890-47?
Ces'-?i?'i ccs?e v? Surz-e y
egaZ ,DescrlaUon: Lot 44, 81ock 1, DDCKWOOD ESTATES, -
Dakota County, Minnesota.
NORTH 4
` SGgLE f"=30'
? p/oT£: ,441'SEAR+NG$ SHAWN ARE ASSLM ED.
? i71by n?,?/
N ?. J V' 9' 12
O
F3LOGK i
C 3° N l t,?' ±
-41
IS 6 `:? r o, ( 0 N
0
LOT 44 10
N i ? ?1 ltd
? X
30
--
C
X40.3 ! -J
W ?,o . ? s g$oJ 3 iii
cps /N'VGE ,q NO w /
4 LT/c/TY 7
j ?SEhEr1T1"
I hereby certify that this is a true and correct representation of a tract of
land as shown and described hereon. As prepared by me on this 8 day of
March , 19 79.
Minn. Reg. No. 5156
;y
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan NIN 55122
Telephone # 651-675-5675 FAX # 651-675-5694 _?_d. 690
New Construction Requirements Ronodel/Reoair Requirements Office Use Only
3 registered site surveys showing sq. R of lK sq. R of house, and all roofed areas 2 copies of plan showing footings, beams, joists ' Cert of Survey Recd _Y _ N
(20%maaimum lot coverage allmw ) I set of Energy Calculations for heated Wdions Tree Pros Plan Recd -Y _ N
2 dies of plan showing beam & window sizes; poured found design, etc. I site survey for additions & decks Tree Pres Requbed -Y _ N
I set of Energy Calculations Addition - indicate N onsse septic system On-site Septic System _Y _N
3 copies of Tree Preservation Plan If la platted after 7IM3
Rim Joist Detect Options selttdon street (buildings with 3 or less units)
Minnegasco mechanical ventilation form
Date/
l
U7 Construction Cost
Sit
Add
? ]
?Qconloil ita
S
el#
e
ress 1 9
tt/
t
Description of Work r
Multi-Family Bldg _ Y G N Fireplace(s) _ 0 _ 1 12
Property Owner .( a Ve- l '(,L-rIt r Telephone ft (W)
Contractor 11.1
Ra n S 1 (_1
!/I
Address
'951P VA?(Jahh?2? Wx City 171
.I
State MA) _
Zip _ ?,e
Telephone # (?;) ' v/
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Energy Code Category - Minnesota Rules 7670 Category I _ Minnesota Rules 7672
• Residential Ventilation Category I 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 plants
- Y - N If yes, date and address of master plan:
Licensed Plumber Telephone #(
Mechanical Contractor Telephone #( )
Sewer/Water Contractor 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.
Applicants P ' ted Name Applicant's Sigma
RESIDENT OWNER
Name: A. ,:10.1 \C\ -fi k Phone: L2 `1 5 0
i
Address City Zip: \X''�`\ i t✓ ',I.,' I.,' v
CONTRACTOR
Name: Residential Heating License t.- q zl 3°-t "D 1-
Address: Air Conditioning, Inc.
City: 1815 East 41st Street State: Zip:
Minneapolis, MN 55407
Phone: (612) 724- 1899ntact Person: L ._C: X\ -CA rPY
TYPE OF WORK
New X., Replacement Additional Alteration Demolition
Description of work: l'I it Vli °1 L.D, C v ??.t-' )1, A� cxyct') 5
NOTE Roof n nd ground t u tted t Irlri l ul ipment is req ui red t cre erred y ,City,
l I t r r` r on itt d i ods.
a I ,Ii n
PERMIT TYPE
RESIDENTIAL
f Fumace
Y,
COMMERCIAL
New Construction Interior Improvement
Air Conditioner
Install Piping Processed
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
Under Above ground Tank Install Remove)
Other
When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add
or alteration to an existing unit (includes
burned out appliances, ductwork, etc.) (includes
$.50 State Surcharge) f
$.50 State Surcharge) b� TOTAL FEE
$90.50 Fire repair (replace
COMMERCIAL FEES:
$70.50 Underground tank
$50.50 Minimum (includes
installation /removal OR
State Surcharge)
surcharge is $.50.
increases by $.50 for each
$2,000 Permit Fee requires a $1.00 surcharge).
Contract Value I x 1%
1 f Permit Fee
If Permit Fee is Tess than $1,000,
Surcharge
If Permit Fee is $1,000, surcharge
$1,000 Permit Fee (i.e. a $1,001
TOTAL FEE
Date:
City otEaQau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
2009 MECHANICAL PERMIT APPLICATION
Site Address: c %Y,Ot C 0
1 hereby acknowledge that this information is complete and accurate; that the work will b
Eagan; that I understand this is not a permit, but only an application for a permit, and work
with the approved plan in the case of work which requires a review and approval of plans.
x
Ap
conformanc
of to start with
Use BLUE or BLACK Ink
Permit Fee: 67 J
Date Received: "D 2 l
Staff:
Permit
„Trent" Suite
1
CALL BEFORE YOU DIG. CaII Gopher State One Call at (651) 454 -0002 for protecti n against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstateon ca or
antes and codes of the City of
at the work will be in accordance
Use BLUE or BLACK Ink
r----------------�
I For O�ce Use �
I L. �� I
� I
Clty of �a��� , Permit#: �
� a�'�� ;
� Permit Fee:
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I �
Fax: (651)675-5694 I Staff: i
I �
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
„��u�M,�...,�.,��,�,.�
.� ,��.4��..�_,�,�.,�,��„� ...�,.��..�- -�..�.�� �
�. Name: � C I�t,�l S �►� �f'' Sf V'`'L _Phone:��Z—?��-I �f lld'
R�siden� f
O�y��� Address/City/Zip: l � �� �r � L1 Qr � � �i�r��`e
, Applicant is: �Owner �Contractor
�� ��� ' � Description of work: " ��t � ���r� �t,�c"��``��"" C — S�� °
Ty�pe t�f W4rk ;
' Construction Cost: (�.�� �� � Multi-Family Building: (Yes /No�
Company:�C� i h (.UHsi�ru ��r`o-�. 1�.., �` Contact: �i�lfk La �--
� Address:( 6 Z l �' �G'i r�'�� � City: �x�C v�'��`e
�orttra�ctor .
Stat�/�/Zip: S'5��� Phone:�'CZ�?SG 3�tLo EmaiLF-�f1,r2ccMs'fihk a��°c� ��-w��`c� w �.v.n7�
License#:.Q� 5� Z� ��{ Lead Certificate#:
If the project is exempt from lead certification, please explain why:
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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:
Fire Suppression Contractor: Phone:
ND7'�':i�l�ns a�aal�r��Ovrtin�alocu�nen�s tha�,�a�r s�r�bar��t are can�ic�t��d#o'be p�rbl�c i�:fvrF»�ti�. Fai�on�:of
t�te int'orma#ic�n rr�ay 6e c;�assi�ed a�n�n:publr'c if you�r�v�d��eci�ic reasor��tl�at�au�d perr��t�he Cf#y t�
cor�c�t�d��h�'��e are�de secre�w '
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 per it issuance.
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Applicant's Printed Name Applicant's Signature
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