4292 Sunrise Rd CITY OF EAGAN Remarks ~i , - ``i
Addition SUN CLIFF 1ST Lot 8 e1k 4 Parcei 10-72975-080-04
owaer street 4292 SiTNRZSE ROAD state EAGAN MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRAOI NG
SAN SEW TRUNK • - i-ig-84
EWERLATERAL 2 0-12-84
WATEAMAIN
WATER LATERAL 2 SZ 10-12-84
WATER AREA Zp STORM SEW TRK 0 96 75 C00879 7-19-84
STORMSEWLAT 1985 789.70 157.94 789.70 C009652 10-12-84
SPrvieec 1989 776.63 159-13 5 3 C00 2 10-12-$4
CURB & GUTTER
SIDEWALK
STREET LIGHT
ROAD UNIT 260.00 315 5- -
WATER CONN, V70.00
BUILDING PER. 4055 sac 525.00
PARK
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Prin[ legib/y
Tot
1. Date 2. Installation Cost
3. Job Address ~ Lot Bik. Tract
4. Owner
5. Contractor " Phone
6. Address •
7. City State 2ip
8. Building Type: Residential O Commercial O Institutional ?
9. Work Description: New ID Add ? Alter O Repair ?
10. Describe Fuel Type
11. No. EQuioment BTU - M. Ea. No. EpuiAment CFM
Forced Air Air Handling:
Mfg.
Boilers Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with all ordinances and codes governing this type of work.
Signed : for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
, CITY OF EAGAN ~J~ 905~
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipr #
To be osed fer SF DiQG/GAF'i Est. Volue $$1 ,U U Q Date MAY 11 1 Q b 4
Site Address 4292 SUNRISE RD Frect E~ Occuponcy R3
Lot 8 Block 4 5ec/Sub. SUIN CL I FF 1 ST qlter
Parcel No. 1 0-72975-U80-04 ? Zoning N/A
Repoir ? Firc Zone
W Name ~7flHN & UIRGINIA RANDA.LL ~oVee ? Type ot Const,
z 1194 VFi21 BUREN O # Stories
Address demolish p Length 40
~ City ST PAUL phane 645-8981 Grode ? Depth ~4 Sq. Ft.
GRAND OAY.S Approrofs Fees
,o Name
o~ Address Assessment Permit • U
U~ City L11K FV I LL i; phone 4 3 2- ti 5 61 Woter 8 Sew. Surchorge 40.50
Police Plon check 188.00
PW Na'"e Firo SAC 525.00
p`~r~g Eny. Woter Conn. 470.00
~W City Phone Planner WaterMeter 63.00
Countii Road Unit 260.00
I hereby acknowledge that I have recd this application ond stote that gldg. Off.
the information is correct und ogree to comply with all opplicoble ,922 , 5U
Stote of Minnesata Statutes and City of Eogon Ordinonces. APC Totol
Slynuturc of Permittee
A Bullding Permit is issued to: CRAND Ci'!"; on The express condition thrn
oll work aholl 6e done in c}ocordorxe with oll applicable-Stote of Minnesota Statutes and City of Eapqn Ordinances.
Ildinq Official . ~ ~ - ` " ( G -6•
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Receipt PWMBING PERMIT Permit Noq ~)yQ,~
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Print legibly ~
Tot. 0 . ~
1. Date 2. Installation Cost "-ir
3. Job Addre
J;.:= Lot ract ~
4. Owner ;_r,~~•-: ,r22. ,2._, r .
5. Contractor / I l,< G't, `7 i' Phone
6. Address
7. CitY ~((-Vf-U State Zip
8. Building Type: Residential Er Commercial ? Institutional ?
9. Work Descripiion: New ~ Add ? Alter ? Repair O
10. Describe
11. No. Fixtures No. Fixtures
~ Water Closet CesspoollDrainfield
~ Bath tubs Septic Tank
Lavatory Softner
~ 5hower
Well
~ Kitchen Sink
Urinal/Bidet Other
~ Laundry Tray
~ Floor Drains
Drinking Ftn.
Slop Sink
~ Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
5igned : fcrr;:°i , •
Rough Flnal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN WATER SERVICE PLRMIT
3830 Pilot Kno6 Road pERµIT NO.:
P. Oa Box 21199 6._20-=',
Eagan, MN 55127 QATE: 1
Zoning: R1 t3o. di tbntts:
Owner. Cran.d Oa: _
^
/lddross: > c: S f1t~ , } f` u S u n C 11 f f 1 S t
JSite Mdress: 'Y; .
Plumber. - ' 470.00 pd
~Mater No.: Corn~tmbn Charge:
r 15 . G4 pd
Slxe: r 1~c~otkwt tDePosit: 10.00 ~
. ~3
Rea t*1o.: Permit Fee: , 50 pci
~---~-r~ r
1 egeae to comPly wftb the Clty of Eagan Surcharge. 63 . OG pd meter
Misc. CFar9es:
~ Total:
Dote Poid:
I Date of lrtisp.: ` Insp.:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road P. O. Box 21199 PERMIT NO.:
Eagan, Nti"A1 55121 flATE: 1
p 1 No. of Units:
Zoning: r;ra.,kd Oaks Dev
Owner: -
Address: 4292 sun Road L.": B4 Sun Cliff lst
Site Addresa: ;i, 4
Ptumber: urr P l.b n,' 1 G 7 Q. 40 pd
Metar No.: Conr?ettion Chorqe: 15 . 00 pd
Account Deposit:
Size: 10.00 pd
Readei No.: Permit Fee: .50 pd
1 ayrm to aowsPhr with tm C'h' °F E°g°° Surchorge: 63. 00 pd meter
Ordiwoncn. Misc. Charyes:
Totol:
8y Date Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEVIIER SERVICE ~F.71~MIT
3830 Pilot Kno6 Road " ``P. O. Box 21199 PERMIT NO.:
Eagan, MN 55121 DATE' 1
Zoning: f°i No. of Units:
ran a ev
Address: u~~ a v~ g~
Cliff
Site Address:
~
Ptumber: . urT F M..,., r_
425.00 pd
1 pree to wmplf whb His G1Y ef Eagan Cannection Charge:
Crdieaeca. Acoourit Deposit: , P LUUU Permit Fae: p
5urchoroe:
~ By Misc. Chorpes:
Date of Irup.: Totol:
Insp.: Date Paid:
- _
CITY OF EAGAN ~T
~ ~6 3830 Pilot Knob Road, P.O. Box 27-199, Eagan, MN 55121 jr ? 9055
~ PHONE: 454-8100
BUILDING'PERMIT Receipt # ~"~/5-/
To M wed for SF DWG/GM,p )Est. Value $81 , 000 pate MAY 11 1984
SiteAddress 4292 SUN9;@W RD Erect C~ pcwponcy R3
Lot 8 Block 4 ~ec/Sub. SUN CLIFF 1ST Alter ? Zoning - R~
Parcel No. 10-72975-080-04 Repolr ? Fire Zone V
Enlurga Type ofi Const.
W Name JOHN & VIRGINIA RANDALL Move ? # Storces
Z Address 1194 VAN BUREN Demolish ? Length 40
~ City ST PAUL phone 645-8981 Grade ? Depth___(A_Sq. Ft.-
o Name GRAND OAKS AVDr~'ofa Faea
o~ Address H Assessment Permit 376. ~ 0
uF- City T•AKEVTL•T.F. phone 432-6561 Water85ew. Surchnrge 40.50
Police Plan check 188. ~0
Name Fira SAC 525.0 0
u~ Address Eng. WaterConn. 470.00
'W City Phone Plonner WaterMeter 63.00
<
Councll Road Unir 26o_n0
I hereby ackrwwledge fhat I haVe read this opplicotion ond sfate thot gldg. Off.
fhe intormation is correct and ogree fo comply wifh oll upplicoble APC Totol $1, 922.50
Srote of Minnewto Statutes and Ciry of Eogan Ordinances.
Sfgnofure of Permittee
A Building Permit is issued to: GRA13D OAKS on fhe ezpress condiMon thnt
oll work sholl 6e done in 9c6rdgncq wit all ppli . blr5tofe of Minnewto Stotutes and Cify of Eagon Ordinancea.
Building Officiot
This request wid l~~ O O C( y~
18 mooths irom
A' 057781 L. 0g oq 5t., CL(
Naquest Date Fire No. Rough-in Inspectio
~ - Required? ~Reatly Now ~II Notity InsPec-
& eg ~NO or When Reatly
''censed Elecvical Gontractor 1 beraby repuasf inscection of ebova
Owner electrincal work instelled eC
Sheet Address, Box or Rou e No. Ciry
2.
ecbon o. ownship Name or o. ftange No. Gounry ~ ~
a
Occuppnt JPqINT) Q Phon 3~ 6 56 /
G ~
Po Sup ier Address ~
~G. i f/ecf ~G/J nua ~
Elec ~cal Contr tor iC mpa Namel/ Cor~~s LicenSe No~
yo'
Maiiin4 Atldress IContre r or wner Makinp InStailatioN
I~ -77 live AuMoriz ~clo Owner akinp Installationl Pho Numbor
p-35
MINNESOTA STATE Afl0 OF ELECTRICITY THIS INSPECTION PEQUEST WILL NOT
Grigga-MidwaV BIdO• - Room N•197 BE ACCEPTED BY THE STqTE BOAND
UNLESS PPOPEP INSPECTION FEE IS
7827 University Ave., St. Pau1, MN 56104
Piqna 0121Zy7 Z111 ENCLOSED.
y lR b Y REQUEST FOR F07,75fl(CAL INSPECTION EB/-00001-'0!4
Af ' See inatruefions tor completi~q this fwm oo beck of vellow copV.
" X" Below Work ~ oveied by This Request
MV4Addj Rep. Type af Builtlinp AOClinnee! Wiretl Equipment Wired
Home Range 7emporary Service
Duplex Water Heater Lighting Fixture:;
Apt. Buiiding Dryer Electric Heatin
Commercial Bldg. Purnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tnnk
Farm ffier peo v ot er (SVer,ify)
t r Uon y t e, ' Other
ompute lnspection fee 8elow p Fee SetvfceEnironce3ize #Fee Feeders/SuEteeders k Fea Circuits
U to 200 Am s0 to 30 Am s 2 to 30 Am
Above 200 qm 31 to 100 Ainps p 31 to 100 Amps
Swimmin Paol Above 100_Am s Above 700_Am s
Transformers Irrigation Boorcis 50 Partial.'Other Fee
Signs Special Inspection g ~ TOT ~EF
Ramsrks
~
Rouph-in OaZio Dale .
1, the I
~ Inspector, hereby
Final ce. ' y that the above
aocfon nas oeen
de.
tIW iepuealwlOlBmonttrofrom
~ Fw Olflce Use I
I
4111~ ~nq• p (1 j PermO
A 1 /
~i~Y O LL~~ I Pertnit Fee:
3830 Pilot Knob Road i ~
Eegan MN 55122 Date Received: ~
Phone: (651) 675-5675 j ~
Fax: (651) 675-5694 i ~
2008 MECHANICAL PERMIT APPLICATION
Date:2-,)5-Q60g SileAddress: '1IX9o( .sUW/'ISC ~CasL
Terani: SuRe .
RESIDEMT ( OWNER Name: Sa~ ~ 1~ ah~G-t ~ Phone: l y~-
Address / City! Zp: yo~4~ S!AN 1' 1 S C 1U
CONTRACTOR Name: f~.,O r Lci Kc- License LZ~' ~0 ri
Address:/t,,(:T
Ciry: 1'/'' ) D r State: IVA-,~ Zp-,s SL_
Phone:9&-yy7'RLL~ ContactPerson: DMc.v-,
TYPE OF WORK -New -Y-Replacement _ Additional _ Alteralion _ Demolftion
oescripuonof .onk: kepla-Lc, Gc. s v.~ a.c.
NOTE: Both roof nrourtfed artd grow?d mounfed meshankkW equlpmenf Is reqWred to
be screPned by CHy Code. Pleese comact the Mechanica/ Inspector or aie o/ the
on ftfed scrwnin mefhods.
Planrters for Wnonpwm
RESlDEN77AL COMMERC/AL
PERMIT TYPE _X New Co~wcbon Interior Improvement
Fumace -
Air Conditimrer - Install Piping _ Processed
Air Exchanger - C'as _ E#eriot HVAC Unit
• HVAC units musl be screened
Heat Pump Under / Above ground Tank C- InSWiI!_ Femove)
Olher " When installinglremovfrig tank(s), call tar inspection by Fre
- AAershal a/d Pltunbi Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unft (includes $.50 State Surcharge)
$90.50 Fre repair (replace bumed ad app6ances, ducnvonc, e[c.) (irxludes $.50 State Surcharge) c
$ ,r~Jd TOTAL FEE
COMMERClAL FEES:
$70.50 Underground tank installation/removal OR Coniract Value $ x 7%
$50.50 Minimum (includes State Surcharge)
- $ Permi[ Fee
- Ii Permit Fee is less than r,00111, wrcharge is $.50. .
- Ii Perrrf( Feg is > S7,000, wrcharge increases 6Y $.501ar each State SulCharge
$1,000 Pertnil Fee (i.e. a$1,007$2.000 Permil Fea requires a$1.00 surcnar9e).
$ TOTAL FEE
I hereby acknowledge tlW tlft infomiation is compkte anA accurate; Iha[ the worc will be in carfwmarce wflh ft orCinancas aM codes ol the Gty ol EaBan: tha[
I umlerstaiM ihis is rot a permi6 bu1 onty an wplicabon for a pemitt, amt wwk is rat to star[ Milhout a permd: tliat the wak wtll be in azwrdance Mth the aPPmed
plan in the cese M work which reqWres a revfew and approval of plans.
x a'~. co.v, Are ~L~ X
ApplicanYs PrlMed Name Ap anYs Signature
FOR OFFlCE USE Reviewed By: 'Date:
Required Inspectlore: Under GrouM _ Rough In _Air Tes[ _Gas Service Test In-floor Heat _Fnal
3 CITY OL' FnC11N Include 2 sets of plans,
1 site plan w/elevations &
BUILDING PP•.RMIT APPLICATZON 1 set of enerqy calculations.
1b Be Used For aluation Date .5~ -/-ol-
$1t.2 PdCLT'C'SS A
, -s 1 OT'['ICE USE ONLY
Int _ olock L/ Sec./SUb. Su„ (;I1142- 1~ect Oc;cupancy j
Parcel / L) ~ 7 a 9 7 ,'~--D9O --6C`Alter Zoning
p ~I ~ Repair Fire Zone
Owmer: Q~d- le.~e~a 'p~c.~.dtI-0 L•'nlarge 7ype of Const.
Address: j/~ ~,~,~y„_ 1"b~ _ # Stories
, Derolish ' Front -9/0 ft.
City/Zip Cocie: nz!~ 2-ua _ Giade Depth ~y ft,
Prmne kM
11P{'I2UVALS I'F.E',$
Contractor: d,,,p/ Assessments Pcrnut 3 7
Watcr/S«ver Surcharge j~
Pddress: ~i - Police Plan Check / F~
City/Zip Code: Pire Sl+C ~-6- -'01
Phone E"g• water conn. -y > a -oo
I'lanncr Water Meter
~~.~g.: • Council Road Unit ~Gp ~
IIldg. Off.
Tddress : APC: -
City/Zip Code:
Phone # : IOTAI, I S Pa
~ - '
3S
T3 6 6
~ 3>~
:2-
~
1~aq M
1 ~
~
.
Prepared fa A 6mli/~.[„~>~~p-n~ Sheet No. ZVLL
RESIDENTIAL Address oate
HEAT GAIN & LOSS Job No. G;3
RAPID ESTIMATE estimator `.,6 AID 1.5.1
aev z
Salesman DATE 7/15177
DESIGN CONDRpNS INSULATIOHOUSE FACES OVERHANG OR SNADING
COOLING DB °F HEATING DB °F CeiGng ? North - ~6~ -
Oulside Temp _~ja Inside Temp 7S yyyi ,pi East
Inside Temp ?"o Outside Temp Floor South
Temp DiH ?n Temp DiN 9-~ Window ? West LOAD TMPE AREA COOLING HEATING
FACING Factor Sens Btuh Factor Btuh/OFTD
1 GROSS WALL AREA = ° ' •
2 WINDOWS & N - NE . . _ -
3 GLASS DOORS E- SE 9 .
4(Tables I and II) S- SW 7
s w - Nw
s
7
a
9
10 DOORS -l 3'
11 (Tables II and III)
12
13 NET WALLS ~
o ,o
14 (Table III) r-- ,06
15 i5 3os~ ~o ,06 .3
1s e?, o , a i.i
17 CEILING OR ROOF ,yL O ~fL o 3~l0
18 (Taule IV)
19
20 FLOOR
o? lo _ lo
21 (Table V)
22
23 PEOPLE (NO.) 3 300 y'oo ~ " ' . • ~:r"
24 COOKING 1200
A Total Sensible Heat Load (Add all Btuh)
B Duct Heat Gain (See Table No. VI.)
C Grand Total Sensible Heat Gain (Line A+ B) a ~
D Grand Total Heat Gain (Line C x 1.3) 3 S ' L"'' E AdjusteA GTHG (Line D x Swing Factor) F Totai Heat Loss (Line A x Design Temp Difference) S ~7 / 5
G Duct Heat Loss (See Table VI.) 0 9~ ~ 7
H Grand Total Heat Loss (Lines F+ G) 72
C. R. WINDEN 3 ASSOCIATES, INC.
LAND SURVErOR5 fal t45•3640
138I EUSTIS SL. 3T. ?AUt. MINN. 96100
For:
GRAND OAKS DEVELOPMENT COMPANY N
Q ~
" 4)
/'q 9b c O
Scale: 1" = 30'
~ ~''?i~ ~ ~ ~ O Denotes Izon
Monument •
J ~°,h~' / ti^ ' v
s
qh~ o
,o~
ti
~ G
a h
..5-
o ~
-c6 ? r' \ t0 y
N 1
~ ` ~2 ry q ~ ~
S
S2e > ~ti
~9• \ i \
NOTE: /
c Denotes idooden Stake
?roposed Garage Floor E1. 902 59 O
(902.5 ) Denotes Proposed \l~~
Finished Ground E1.
t-- Denotes Direction 0 ~Z ~p 56
Of Surface Drainage ej
Vertical Datum - N.G.V.D. 1929 /'a> S(O
`89~ 0
Lot 8, Block 4, SUN CLIFF FIRST
ADDITION, Dakota County, Minnesota.
WE MEREOY CENTIiY TMAT iMIS IS A iRUE AND CORRECT tE?RESENTATION Of A SURVEY Of TME
tOUNDARIES OF TME IAND ASOVE DFSCRI6FD AND OF TME IOCATION Of All 6UILDINGS, If ANY,
TMEREON, AND All ViSIIIE ENCROACMMENTS, If ANY, FitOM OR ON SAID LAND.
Ooted Ihis 01) deY oI MoTA.D. 198¢ C• RZ:: t ASSOCIATES , INC.
?r a
Surrersr, Mine*wta Rynerotien Ne 772~
M7iSIO ,
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Construction Reuuiremen6 RemotlellReoair Reauiremenis OKce Use OnN
3 registered sife surveys showing sq. ft. of lot, sq. ft. of hase; and ali roofed areas 2 copies of plan showing foofings, beams, joisffi Ced af SurveyRecd -.'_Y - N
(20°k marimum lol coverage allowed) 1 set of Enerqy Calculations for heated addNOns Tree Pres Poan Recd . _ Y_ N.
2 copies M plan showing beam & window, sizes; poured found desgn, etc. 1 site survey fw addifions & decks Tree Pres Required Y_ N
lsetofEnergyCalcula6ons Additlon-indicafeifoasAasepticsystem On-site.SepticSyslem . _Y _N
3 mpies of Tree Preservafion Pian H IM platted aRer 71153
RimJOislDelailOptionsselec6onshee! (6u7dingswiN3orlessunt)
Minnegasco mechanical ventilation form oil
Date 0(., 1 Construction Cost 1 , U V ~ ' 0 0
Site Address : SAt. Unit/Ste #
Description of Work
Multi-Family Bldg _ Y< N Fireplace(s) 0 _ 1 _ 2
Property Owner -7l1 ~ r k w~, l Telephone #(6 1-iir 3 S
Contractor /V\! ~ L H t r
Address /4 L c...Lv C -T City 6" H
State M M Zip Telephone # (6 51) L/ U Z-ci
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Ca[eeorv 1 _ Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet
(V submission type) Su6mitted Submitted
. Energy Envelope Calculations Submitted
In the last 12 monihs, has ihe 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 n Telephone ~
Mechanical Coniractor L)r-L- 1 9 ?UUb Telephone #
Sewer/Water Coniractor bet, 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. ~
, l,' U) w4 Q.wJ~~ "Applicvs Applicant's Printed Name Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
O Ot Foundation ? 07 OS-piex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ect. Alt - Multi
? 03 07 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex A 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvpes
? 31 New ? 35 Int Improvement ? 38 Oemolish Interior ? 44 Siding
X 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building` ? 43 Reroof ? 46 Wndows/Doors
? 34 Replacement •Demolitlon (Entire BIdg) - Give PCA handout to applicant
DOSCrIDfiOf1: WaterDamage`Yes Valuation ~ Occupancy R `.3 MCES System
Plan Review /U 100% or _ 25% lpeo _
Census Code 1131( Zoning ~ City Water
SAC Units - Stories ~ Booster Pump -
# of Units - Sq. Ft. PRV
# of Bldgs ~ Length ~ Fire Sprinklered i
Type of Const ~ Width
REQLIIRED INSPECTIONS
Footings (new bldg) _ Sheetrock
~ Footings (deck) Final/C.O. -
_ Footings (addition) ~ FinallNo C.O.
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water Final Pool Ftgs Air/Gas Tes[s Final
A Framing _ Siding _ Stucco La[h _ Stone Lath _Brick
_ Fireplace _ R.I. _AirTest Fina] _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
- - po----•--------------------------------------------------------°--------------------------------
Base Fee ~
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit 8 Surcharge
Treatment Plant
License Search
Copies
Other
Total
PERMIT# 5 -7 I I RECEIPTDATE:
8008 iiES1DENTIAL PLUM$INfi i'ERMIT ~PPLICATION
C1TY Of EA&RN
S$SO PILOT KPOB RD
EAflAA,1NN 55122
651-691-4675
Please complete for: single family dwellings, townhomes and condos when permits are required for each unit,
backflow preventer for irrigation system
SITEADDRESS: OWNERNAME: ~r1Y~ lQndQ,t( TELEPHONE#: Cc6 I 4sa-qy3s
(AREA CODE)
INSTALLER NAME: TELEPHONE -Kv3 -7S5-(D4lDn
GAVIC & SONS PLIIMBlNG (AREA CODE)
STREET ADDRESS: },~7$6 Mi~$~tinga~e NW
COON RAPIDS, MN 5544F
CITY: STATE: ZIP:
_ SEPTIC SYSTEM, newlrefurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
. MODIFICATIONIALTERATION TO EXISTING DWELLING UNIT, INCLUdING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water turnaround - existing dwelling unit 518" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
ReplacemenUadditional: _ water softener ? water heater $ 15.00
State Surcharge .50
2 2r~~ ~
,
~
Total $ ~
I hereby acknowledge that I have read this application, state that the inforznation is correct, and agree to complywi applicable City of Eagan ordinances. It
is the applicant's responsibility to nolify the property owner that the City of Eagan assumes n liability for amages caused by the Cily during its normal
operatlonal antl maintenance activilies to the facilities consVUCted under fhis pertnit within y hbof-way/easemeat.
lauI CAawc-
SIGNATURE OF PERMITTEE 1102
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB RD, EAGAN MN $5122
651-681-4875
New Conetruetbn Beaulramenta NemotlaVHeostr Requlrements
• 3 rBgl6ter6d sfle 6unByS 6hpwing Sq. tt. ot lot, Sq. fl. Of houSB; and all NOted arBas • 2 cOples Of plBn
(201% max'unum bt coverage albwed) • 1 set of Energy Calculatbna tor heateC fldtlNbns
. 2 coptes of plan showkig beam & wuWOw saes; pouretl tound design, eic.) • 1 sile survey tor e#erior edtldbns & decks
. 7 set of Energy Calculations • IntlMate H twme servetl by saptic system lor aaditions
• 3 copies of Tree Preservation Plan N bt pletled atter 7/1/93
. Rim Joisl Detail Oplbns selection eheet (bldgs w8h 3 or less unAS)
DATE VALUATION ) Y2- 73
SITE ADDRESS MULTI-FAMILY BLDG _ Y _ N
NPE OF WOR K U_ ~ Caj refOaQ ktk4-1-0- FIREPLACE(S) _ 0_ 1_ 2
APPLICANT I ,t2W LUI - (A
STREET ADDRESS 4~726 -V CIN ?OL,S STATE/kil ZIP53-16-
TELEPHONE #(aY) C~I'~~~5 CELL PHONE # FAX # 7J~i /Plo~ f
PROPERN OWNER ~1 ~Y\ ~(2lXFl ~ I TELEPHONE #
COMPLETE iHIS SECTION FOR "NEW" RESIDENTIAL BUILDING5 ONLY
Energy Code Category _ MINNESOTA RULES 7670 CA1'EGORY 1 MINNESOTA RL
(J submission type) • Residential Ventilation Category 1 Worksheet Submittetl C{}ie~o~ ubmitted
• Energy Envelope Calculations Submitted
MAY 2 2 2002 U
Plumbing Conhactor: Phone # _
Plumbing system includes: _ Water Softener _ I,awn Spruilcler gy 0
_ Water Heater _ No: of R:I. Baths
No. of Baths
Mechanical Contractor: Phone #
Mechanical system includes: _ Air Condiuoning Fee: $70.00
Heat Recovery System
Sewer/Water Contractor. Phone N
I hereby acknowledge mat I have read this application, state ihat the information is correct, and agree to comply
with all applicable State of MfnnesoTa StatuYes and Ciiy of Eagan Ordinances,
Signalure of ApplfcaM
OFF'ICE USE ONLY
Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _
uPdatea 4102
OFFICE USE ONLY
? 01 Foundation ? 07 OS-plex O 13 16-plex O 20 Pool ? 30 Accessory Bldg
? 02 SF Owelling ? OB 06-plex ? 16 Fireplace O 21 Porch (3-sea.) ? 31 Ext. Aft - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorohlAddn. (4sea.) ? 33 Ext. Alt - SF
? 04 02-plex.; ' ? 10 OB-plex . ? 18 Deck _ O 23 Porch (screenatl) ' ? 36 Mutti
? 05 03plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Oamage '
? 06 04-plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous
? 31 New ? 35 Int Improvement ? 38 Demalish (Interior) O 44 Siding
? 32 Addition ? 36 Move Bidg. O 42 Demolish (Foundation) O 45 Fire Repair
? 33 Alteretion O 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/DOOrs
? 34 Replacement "Demolition (Entire Bidg only) - Give PCA handaut to appiicant
i/aluation Occupancy MC/ES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests _ Final
_ Framing _ Siding Stucco Stone
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By , Building Inspector
Base Fee )a
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total l ~
- i
~---~r j
II ~r y ' 2/a4
L~
; CZTY OF EAGAN
APPLZCATION FOR PERtiIIT
SEWER AND/OR WATER CON[VECTIODI
(PLEASE PRINi) 1) PF.OPEf~PY ADDRESS: .SC~J7t3~US
r_Fr~r. D~u~lc:r: S~ `~l Su hC- f,'{F i1
(Int/31ock/Subctivision or Tax Parcet I.D. NLUnber)
ir W{IS':'_:G ST.'-',i;C^12E, Dti'I' G^ ORIGi :AL =tiIi.L`L:G F=;Z'*' 1c5:XN=:
~ P=.-_' ~^,;7P7:/r^:~L'nGS7 US': f3'1 R-1 Sl~iGIW r^2~.N.II.Y
? R-2 GUPL= (?Se'p LNITS)
? R-3 TG[v1iII-ICY;SE (TFIFRF'E + t]:IITS} ( UNI'i5)
? ?2-4 ApARZP1--:.^/C^vNDC'ay1rII1,M ( UTIITS)
? CObT14ERC7AL/REI'ASI,/OFFICE
? Pi9L'ST:2~S,
(3 1.VSTIILTI0NAL/GpVE.$Ix0TP
2) APPLIC-z~,'T (PLE„SE PR1Ni)
taarE: C-~j r ~v\~
aDDREss: °`74n 23 e~ ~a~ Pr ll, 7 *h ..S' .
>crrr, srAT--, zrp: i`'d 4yq
PhONE:
j) pIUMBEo (PL.ASE PRINi) FOR CITY USE ONIY
NA~~: Icy )uan b ~OC
PLUMBERS CICE45E:
ADDF2ESSc aQ J ` c CY Active
CITY, STATE, ZIP: L lj e NP, 5 1 [:y t,~ 0 Ezpired
c-µ~ic.. Not af Fecnrd
PHO,E: v(o PLUMBER LICENS'c # J
arr nitia
' Q) OCCUpp,NT/a,ZTEI1 NAME- (PLEASEPHINI) .
_ ADDRESS:
CITY, STATE, ZIP:
PHO^IC: '
5) IIVDIGiTE W[-]IC'.I PEPMIT IS BETiVG REQUESTED:
~ Ll,"'.IIJECI'ION 'In CITY SL7,•1ER
CC:':IEX..`I'ICN TO CIT1 WATER
~
? d= (PLFIISE DESC2iBE)
6) LVDIG;::: C`E:
? P=E F?OLD APPRWEp pgR,tiLIT FOR PICK-UP By ONE OF ABOVE
? PLE.:%SE tiTAIL APPROV'rD PERMIT TO 1, 0, 3, 4 AEUVE
(Circle one)
7) SIQZ~:L'ZE: _~p tl`"~M \ C` ~ 01~ A DATE:
~ J
F 0 R C I T Y U 5 E O N L Y ~ y I
PERMZT - ISSUED
Ft'ES: $ c...Eiq= Aro%jT^i` (:`7C.`.l:D~ SURC?+.:-~F+G~}
$ ° WATER PERr'[IT (INCLUDE SURCLARGE)
$ 49-Z-7-`-~ WATER METER/COPPERHORN/OUTSIDE READE3
$ WATER T;;P (INCLUDE CCRPCRATTC:I S:CP)
$ SEWER T".D
$ ACCOUNT DEPOSZT - SE:dER
$ ACCOliNT DEPOSIT - WATER
$ WAC
$ s~ --4~ a--~ sac
$ TRUNK WATER ASSESS2-SE:IT
$ TRliNK SES3ER ASSES5MEVT
$ LATEP.AL BENEFIT/TRUNK SEZJER
$ LATERAL BENEFIT/TRU:]iZ WATER
$ OTHER
$ TOTAL
$ ATM0UNT PAID/RECEZPT
DOES [7TILITY CON[VECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY?
YES IF YES, THEN A"PERMIT FOR WORK WITHIN
~ PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGINEERING DIVISION. LIST AS A CONDI-
TION.
SUIIJECT TO TEIE FOLLOWING CONDITIONS:
APPROVED BY: cf-9
DATE : G
w.ra w m
L~ BL ~ CITY USE ONLY RECEIPT 7S 9 S~ ~
SUBD. Wv~. ~ RECEIPTDATE: ~ ~a/9 7
1997 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 687-4675
Please complete for. . single famity dwellings
P townhomes and condos when pertnits are required for each unit
New construction Add-0n furnace
X Add-on air conditioning Add-on air exchanger, i.e. Vanee system, etc.
Date: -9 ~7
FEES
? Minimum Fee: Add-oNRemodel (existing residence oniy $ 20.
? HVAC: 0-100 M BTU 24.00
Additional 50 M BTU 6.00
? Gas Outlets (minimum of 1 required @$3.00 each)
? State Surcharge .50
TOTAL
SITE ADDRESS:
OWNER NAME: lT~~ PHONE#:
INSTALLERNAME:~Wrn&H&0G,ANpAW,f(IUI11TI0F11N6 PHONE#:
STREETADDRESS: 413101dSiblCyMemanalHrry.I200
ciTr: (st2) 89~.~B~Bre: ziP:
yiEpiEl HEATIN6 AND AIA CONDITIOVA
413101dSibleyMem0tial M•#200 SIG URE MITTEE
Ea9~, MR 35122
(612) 894•9998
A/G
CITY USE ONLY
L _ BL _ RECEIPT#:
SUBD. RECEIPT DATE:
1997 MECHANICAL PERMIT (COMMERCIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
(612) 687-4675
Please complete for: . all commercialfindustrial buildings.
. muw-Ydmity buildings when separate pertnits are ~g$ required tor each dwelling
unit.
DATE: CONTRACT PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: . $25.00 minimum fee gt 1%of contract price, whichever is greater.
• Processed piping - $25.00
• State surcharge of $.50 per $1,000 of nermit fee due on all permits.
CONTRACT PRICE x 1%
PROCESSED PIPING
STATE SURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME: TELEPHONE
TENANT NAME: (innPROVeMeHrs oNLv)
INSTALLER:
ADDRESS: ~
CITY: STATE: ZIP:
PHONE
SIGNATURE
SIGNATURE OF PERMITTEE CITY INSPECTOR
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
~ City Of Eagan
3830 Pilot Kno6 Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWction Reauiremenls RemodeUReoair Reauirements off" uo Q^
3 registered site surveys showin9 sq. B. of IoL sq. 4. of house; antl all roofed areas 2 copies oi plan shovnig footings, beams, joisls Ceil of 54N8y'Recd ~ Y, N
(20%maximumlotcoverageallowed) lsetofEnergyCalculatlonsforheatedaddrtwns SoilsRCpaE~, 'Y Pl
1 Soils Report if proposed building is to 6e placed on disWrbed sdl 1 site survey Iw addi6ons & decks T[~e, Pf4s PWn REW Y'N
2copiesMplanshowhgbeam8windmvsizes;pouredfounddesign,etc. Addrlion-ind'cateifon-sifesepficsysfem TieePfesReqmrCd~ Y ~N
1 setofEner9yCalwlations 6 nsil'e'S2p1(cSystem. Y._N:3copiesofTreePreurvafionPlan'rflotplattedafter711/93 Rim Joist Oetail Op6ons selectian sheet (buildings with 3 or less unAS) ~p p 9 2007 .
Atinnegascomechanfcatvenfilatlonform rrD 8 0
Date.~)_. II /6~ Construction Cost ~ U J° U'J
Site Address 9 r UniUSte #
Description of Work O{A`~ 62'
0 2
Multi-Family Bldg _ Y-k N Fireplace(s) J
Property Owner Telephone #(6SI ) L~ r l 3 SA
Contractor
Address CiTy
state nli ,11- zip5' Su Telephone #(LSf
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW /
Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category , Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
. submission type) Su6mitted Submitted
. Energy Envelope Calculations Submitted
In The lasi 12 monihs, has ihe 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 Telephone ~
Mechanical Contractor Telephone )
Sewer/WaterContractor 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 ari 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.
Applicant's Printed Name ApplicanYs Signature
DO NOT WRITE BELOW THIS LINE
Sub Tvpes
p 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bidg
$It02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Mufti
? 03 Otof_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn.(4-sea.) ? 33 Ezt.Alt - SF
? 04 02-plex ? 70 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25Miscellaneous .
Work Tvaes
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
5~ 33 Alteration' ? 37 Demolish Building* Q 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolition (Entire Bldg) • Give PCA handout to applicant 7 .
DescriptPoFi:~Wa~'r$aele-y)es
Valuation - Occupancy MCES System
PIanReview _ 100°h or _ 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
Footings(newbidg)--._ _ Sheetrock
Fooangs(deck)' • FinaUC.O.
_ Footings (addi[ion) - ~ Final/No C.O.
Foundation HVAC
?rain Tile Other '
Roof Ice & Water Final Pool Ftgs AidGas Tests Final _~X Framing _ Siding _ Stucco Lath _ Stone Lath _Brick Fireplace _ R.I. _ Air Test _ Final _ Windows
v Insulation _ Retaining Wall
pproved By: Bullding Inspector '
----T
Base Fee
Surcharge
Plan Review
MCJES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other Total
J
. . • 'CASH RECEIPT
CITY OF EAGAN ~
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE
~ 1 9Reccrvep
FROFt
AMOUNT $ I
- - ~ ' 3 DOLLARS
~oo
? GASH ? CHECK
J
1
FUND CODE 0.1AOUMT
, ~ .
-2
Tha
BY I
. .
White-Payers CopY
Yellow-Posting Copy ,
Pink-File Copy
. . ,k
CASH RECEIPT , - .
I~CITY OF EAGAN
P. o. Box 21-199
EAGAN, MINNESOTA 55121
DATE ~ 19
RECEIYHD
FROM • ~
AMOUNT $ I
E~ DOLLARS
oo
7
Ej CASH ? CHECK
FOR
.
. . . j
FUNO CODE AlAOUNT
= J
Thank You
BY
wnite-Peya?s coPv
Yellow-Posting Copy
Pink-File Copy
~
CASH RECEIPT
- .,CITY OF EAGAN -
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
• -
DATE - 19
RECEIVED
FPOM y.
AMOUNT $ - -
Q DOLLARS
;oo
..__-Q;GJCS CHECK
FOR •
FUNO CODE AMOUNT
Thank You
BY
i t
White-PaYe?s CoPY
Yellow-Posting Copy
Pink-File Copy
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4292 Sunrise Rd
Lot: 8 Block: 4 Addition: Sun Cliff 1st
PID:10- 72975- 080 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Window World AKA Probuilt America
2211 l lth Ave E, #130
N St. Paul MN 55109
(651) 770-5570
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
Surcharge - Based on Valuation $3K
BL - Base Fee $3K
- Applicant -
Construction Type:
Occupancy:
Permit Type:
Permit Number:
Date Issued:
Permit Category:
If altering the opening size, a framing inspection is required. Smoke detec tors are required in all sleeping rooms prior to
final inspection. When wall studs or ceiling joists are exposed, hard -wired detectors are required Bat tery operated types
are acceptable if the wall/ceiling finish (i.e. sheetroc k) has to be removed to install a smoke detector. Esther Dahl 2211 11
h Ave E North St. Paul, MN 55109 651- 770 -5570 estherd @probuiltam.com
$1.50
$88.50
$90.00
Owner:
Jon T Randall
4292 Sunrise Rd
Eagan MN 55121
9001.2195
0801.4085
Building
EA076337
01/03/2007
ePermit
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.
Issued By: Signature
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 4292 Sunrise Rd
Lot: 8 Block: 4 Addition: Sun Cliff 1st
PID:10- 72975- 080 -04
Use:
Description:
Sub Type: e- Siding
Work Type: Siding
Description: House & Garage
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Exterior Innovations
9635 Humbolt Ave S
Bloomington MN 55431
(952) 884 -0814
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
- Applicant -
Construction Type:
Occupancy:
When installing ventilated soffit material, remove existing soffit mate
take steps to ensure maximum ventilation into attic space.
Owner:
Jon T Randall
4292 Sunrise Rd
Eagan MN 55121
Permit Type:
Permit Number:
Date Issued:
Permit Category:
al (i.e. debris that could block vent openings) and
$88.50 0801.4085
$1.50 9001.2195
$90.00
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Building
EA077796
05/17/2007
ePermit
i For Office Use ? ~j I
j Permit J T I
City of Eap i
Permit Fee: 1
3830 Pilot Knob Road
Eagan MN 55122 j Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: 1
1
v
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: (n L AI M Site Address: yZ►9 Z. QdL- Unit
Name: 3:;, 4a•~ Phone:
Resident/ I
Owner Address t City / Zip: qZm S,,,r .s.t e.L
a
f Applicant is: Owner _A Contractor
T
Type of Work Description of work: (Z4--f %00
Construction Cost: '9'~t3y Multi-Family Building: (Yes /No P
Company: O .a JLy"J 424W%W 04 Contact: S-eveL--
Address: ? ( ^x) r C e City: (a
K.•s~+ ~~.+2._
Contractor
I t
State: 040J Zip: S Y~ Phone: 2C 22y `J3Email:
License 44 7 &4 44 Z 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
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) 4540002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aoaherstateonecali.ora
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
Fagan; that 1 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 !~V4 6 , I'~+✓n x
If r
Applicant's rinted Name Applicant's Signature
Page 1 of 3