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4913 Sycamore DrDate: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 11 Tenant: (v/tdd 14\1 AY 3 Orrli ci Use BLUE or BLACK Ink Permit #: ;9339 Permit Fee: 4Pgc D� Date Received: 3/-)1 Staff: 2011 MECHANICAL PERMIT APPLICATION SiteLICI t Address: *OOor Suite #: RESIDENT / OWNER Name: 4/`� Vtc 1 74 b } ()/ Phone: t'� �I ✓ 5 {� Address /City /Zip: ( 1(T3 5)(l.,al fO( r)1elf/II() 5'1 24 CONTRACTOR Name: Ron's Mechanical Inc License #: Address: 12010 Old Brick Yard Road City: Shakopee State: MN Zip: 55379 Phone: 952-445-8585 Contact: Linda Email: TYPE OF WORK New Replacement Additional Alteration Demolition Description of work: 8 PERMIT TYPE ,/ RESIDENTIAL COMMERCIAL New Construction Interior Improvement zTurnace 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: $55.00 Minimum Add-on or alteration to an existing unit (includes burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $5.00 State Surcharge) $ 5 50° TOTAL FEE $95.00 Fire repair (replace COMMERCIAL FEES: $75.00 Underground tank $55.00 Minimum (includes installation/removal OR State Surcharge) $10,010, surcharge is $ 5.00 surcharge increases by $.50 for each $1,000 Permit Fee requires a $ 5.50 surcharge) Contract Value $ x 1% $ Permit Fee - If the Permit Fee is Tess than Fee = $ Surcharge - If the Permit Fee is > $10,010, (i.e. a $10,010-$11,010 Permit = $ TOTAL FEE 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.000herstateoneca l.orq I hereby acknowledge that this information is complete and accurate; that the work will be in c Eagan; that I understand this is not a permit, but only an application for a permit, and work is not t with the approved plan in the case of work which requires a review and approval of plans. X ..\ nthQrade( Applicant's Printed Name x formance with the ordinances and codes of the City of tart without a permit; that the work will be in accordance Applicant's Signature . . 1N~Y~(:'1'lUN K~(:Ulll~ ~ C1~=Y OF EAGAN PERMIT TYPE: ~ ~ ' ~ ' ~ 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: r' (612) 681-4675 , ~ ct . , SITE ADDRESS: ~ ; ~ APPLICANT: . , . ~ .-Il~,ftt ~~~i ~ , „ ~ : i ~ i t ck~~'~~~ ~ ~ ~ , . , ~ ~ . , ~ ~ . , , I I'~ PERMIT SUBTYPE: TYPE OF WORK: ' ~ , ~ , . . , ~ r~~, ~:~~~~i ~~v+; , , i . ~ ~ , , i . ~ ~ . , . . , .~~i~,,, ~ i I t fic r t r,,;i ~ ~ . . . , I ~ , ~ , ( ~ { ~ t . & LS k'1 ~IMttF:lt : ,1~. ~ • ~ ~ ~ F Permit Holder Date Telepho~e M ~ PLUMBING , ~ HVAC " . 9 ~ 9 79 Inspection ate Insp. Comments FOOTINGS ~lQ~' ~ FOUND 1 % FRAMING ~9/9~ 6 ROOFING ROUGH PLUMBING PLBG AIR TEST H~EATING ;3 `'t/ ~r G 1/ e h,TG 41 GAS SVC ~ y) TEST ~C INSUL ~ qi~ .~.p.~ GYP BOARD FIREPLACE - - - - - FIREPI.ACE AIR TEST FINAL PLBG (~/C~~C g ~1a 7 d~r7 FINALHTG ~~~/~^g A 1~ ORSAT TEST BLDG FINAL ~~plp~ ~ DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC TEST BSMT R.I. BSMT FINAL DECK FTG DECK FINAL _ . _ ~ ~ : . . . . C~~ei.~ti~cate o~ ~ccu~anc~ ~it~j of ~agatt ~e~artm~at of ~xitbing ~n~reccion Tlus Certifcate issr~ed pursuant to the requirersents of the Uniform Building Code eenifying that at ti+e time of issuaRCe this strercrure was ire compliance with the various ordirrances of the Ciry regulatireg building corrstructrort or use. For the followirtg: Use Qassificuion: S F ~WCi Bldg. Pertni~ No. ~ 2 2 S 9 o«„~, T~ R- 3 U-1 zo,,;,~ n~n;~ R-1 ryv~ ca~5~. V n ~~g,,;b;~ ROBT L GLARK ~ONSTA~ 14906 MANITQU RD NE.. PR10R LAKE, MN ~ 4913 SYCAMORE DR ~;,y L8, B3, PINETREE FOREST ns ) ; , e~ a~~-7~r o"`~ ~ ~ i POST IN A CONSPICU~US PLACE Adtlress 49 13 SYCAMORE DR Zip 5512~_ LAt 8 Blk 3 Sub PINETREE FOREST THESE ITEMS / WERE NOT COMPLETE AT THE TIME OF THE FINAL INSPECTION. Date: 9 Yes No Inspector. Final grade (6" from siding) v Permanent steps (gazage) ~ Pertnanent steps (main entry) ~ Permanent driveway Permanent gas i/ • Sod/Seeded grass Trail/curb damage ~ Porch ? Basement finish Deck ~ Please ve~y with the builder the removal of roof test caps from the plumbing system and the shut-off of water supply to ihe outside lawn faucet befote freeze potential exists. Contact engineering division at 681-4645 before working in rightof-way or installing underground sprinkler system. ~ White - City Copy Yellow - Resident Copy Pink - ConVaclor Copy (r~I'l ~(o ~ J- 2005 RESIDENTIAL BUILDING PERMIT APPLICATION C,Q~,~~„ p~/2~ City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telep6one # 651-675-5675 FAX # 651-675-5694 New Constructbn Reouirements RemndaVReoair Reaulrements Office Use Onlv 3 registered site surveys shawi~ sq. R. of lol, sq. ft. of house; and all roofed areas 2 copies of plan CeR oi Survey Recd _ Y_ N (20%maximum lot coverage allowed~ 1 set of Energy Calculations for heated additions Tree Pres Plan Recd _Y _ N, 2 copies of plan showing 6eam & window s¢as; paured found design, etc. 1 sile survey for add'N'ons & decks Tree P2s Required _ Y_ N isetofEpergyCalculations Addition-indicateilon-sdesepNcsystem On-sileSep6cSyslem _Y _N~~ 3 copies of Tree Preservatian Plan if bl pWtled after 711/93 - Rim Joist ~etail Options selectbn sheet (buildings wAh 3 or less units) Date / / p s Construction Cost ~ S Oa8 ~ ~ ~ Si[e Address ~~/.3 Sy Gsi n.~ s yG 1~ v, Unit/Ste # ~1 MnJ ss~a3 Description ot Work ~«.S e...~ a.Jt"~ ~w~~s' ti- Multi-Family Btdg _ Y~ N Fireplace(s) ~ 0 _ 1 _ 2 ~ Property Owner ]~c~V e, s ~ ~ ~I ~ ~ ~ a-/S Telephone # (/cSl ) ~a3 - /~~D l Contractor ~DSGO 172-5l~ w 6w~ ~t~ Z,~c.. Address f L~73 G`(n.i.}y~~,ti.,~o.,(e ,d~?e UJ. City l`-~Se.w)kev'f' State /'7 ~ Zip SSD~ ~ TetepNone #(ESl )~a 3-1L~l~ l COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING - Minnesota Rules 767D Cateeorv 1 Minnesota Rules 7672 Enecgy Code Category . Residential Venfilalion Calegory 1 Worksheet • New Energy Code Worksheet (~Jsuhmissiontype) Submitted Submitted • Energy Envelope Calculations Submiflad Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review fee applies. 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 re uires a review and approval of plans. ; D ~ ~ ~ ~ ~ ~ l~~`~ ~wLE`~ / ~ 4 2005 ~ AppIicanYs Printed Name ApplicanY ~ nature J BY OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory 81dg ? D2 SF Dwelling ? U8 D6-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 E#. Alt - SF ? 04. 02-plex ? 10 08-plex O 18 Deck ? 23 Porch (screenlgazebo) ? 36 Multi Misc. ? 05. 03-plex ? 11 10-plex ~i" 19 Lower Level ? 24 Storrn Damage ? 06 04-plex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous Work 7ypes ~ 31 New ? 35 Int Improvement ? 3S Demolish Interior ? 44 Siding ? 32 Addition ? 38 Move Building ? 42 Demolish Founda[ion ? 45 Fire Repair ~ 33:Alteration ? 37 Demolish Building* O 43 Reroof ? 46 Windows/Doors ? 34~~ Replacement "Demolitlon (Entire Bldg) - Give PCA handout W applicant Valuation f! Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type af Const ~ Width REQUIRED INSPECTIONS _ Footings (new bldg) Final/C.O. _ Footings (deck) # Final/No C.O. _ Foo[ings (addition) Plumbing _ Foundation ~ HVAC Drain Tile Other Roof _ Ice & Water _ Final _ Pool _ Ftgs _ Air/Gas Tests Final ~ Framing _ Siding _ Stucco _ Stone _ Brick _ Fireplace _ R.I. _ Air Test _ Final _ Windows ~ Insulation _ Retaining Wall ~ Approved By: ~ ~ , Building Inspector Base Fee Surcharge ~.L ~~/.,,~.~~j~}* Plan Review ~ ~ ~ MC/ES SAC ~ t City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ~~~Sg ~ s~.5a 2004 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date 2 ! I ~S ' Site Street Address "~~JT Unit # Property Owner tt.~.Cl~ Telephone # (65/) Contrector 'f)1 ~e.~ i~~~ n Telephone# 4~.3-3~~ Address / City ri~~L State~_ Zip .53'068~ The Applicant is: _ Owner ? Contractor _Other Alte~tions to existing dwelling , d p $ 50.00 ~cuo.rxz -t~utx.~ ~Add fixtures to rooms, excluding water softener and water heater _Septic System Abandonment _Water Turnaround (add $121.00 if a 5/8" meter is required) ~ Other: Water Softener _ Water Heater $ 15.00 _ replacement _ additional Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00 State Surcharge $ .50 Total $ ~ I hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in accordance with the approved plan in the event a plan is required to be reviewed and approved. E/a~ne.l`l~. l.ukavriez fl~".~ ApplicanYs Printed Name Applic nYs Signat r~-~~__-_ I,II~ l-;'f 'i II i FEB ~~~0~5 I~~ ~ ~ll i ~ 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) I~' 1 3830 PIL~OT KNOB RD • 55122 5 r ~ 651-681-4875 ~W R~~re~~ R~,~~R~re~~, Caucd q-a2-c~0 > S registered ~Ite wrvays Yww~ng fq. k, d bt, fq. R. ol house 2 copiea W pian ~ o~W ~I roofetl areaa (1096 maxlmum bl covaraae allowaN 1 set of enaryy cadCUlaNOns tor heafed addlMons D 2 eoplea of plana (show beam k wintlow sizea; poured Ind. design: etc.) 1 slta wrveY ror exlerior addiHOna # decW a 1 set ot enerpy cdculallons > 3 copiea W hee preservalbn plan H lot plalted atler 7/1/93 DATE: S~6~I00 p CONSTRUCTION COST: 'r ~1 ~U DESCRIPTION OF WORK: SG~~-1-, Y~ ~f STREETADDRESS: ~{~~3 ~c.~ r'4~.-0~~- ~~~1 ~2 LOT: ~ BLOCK: ~ SUBD./P.I.D.~: ~ ~r~~°~'"~S~ Name: ~ S v~-, w~ 0~ ~w... Phone i: ~a.~~ > ac~ Jz 3 PRQ~k'r( Lp61 FI~St OWNER Sheet Address: ~1 3 5 y G w~ ~-d~ CBy c, c.,~ / State: _ Lp: . Company: ~ ~e/f L . C'~a~ ~ 5~ Phone t: ~f ~ ~7- ~O `/~'U (area code) COMRAGTOR .f" License ~ l U ExP• 3~"JI Sheet Address: ~ ~ y0 (o !?2 ~.-L , ~ ciy ~~~w G.~_ /G srate: ~1 zip: S S 3~~ ARCHITECT/ ~ L ( l ENGINEER Company:~,d~~> ~ ~ ~ ~ ~ Nome: Telephone ( ) Sheet Address: Re9~~~ Ctly r State: 7~P~ i Sewer/water licensed plumber l`If i~tallina sawerJwaterl: P~e I herebY acknowledpe that I have read this appi(catbn, state ihaf Ihe infomwtion is coRed~ and agtee to compy wilh a0 apPr~ble State of Minnesota Stalutes and Ciy ot Eayan Ordinances / Signature of Applicant ~~~/~-'~~,r~~~ OFFICE USE ONLY Certificates of Survey Received _ Yes _ No ' - " ~ - - Tree Preservation Plan ReCeived _ Yes _ No _ Not Required SEP 21 2000 ~`Y'---~J~-. OFFICE USE ONLY r ¢ ~ BUILDING PERMIT SUBTYPES ? 07 Foundatian ? W 05-plex ? 13 16-plex ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi ? 02 SF Dweiling ? OB OB-plex 17 Garage O 22 Porch/Addn. (4-sea.) 0 33 Ext. AR - SF ? 03 01 of _ ptex ? 09 07-plex ~ 18 Deck ~ 23 Poroh (screened) ~ 36 Muw ? 04 02-plex ? 10 OS-plex 19 Lower Level O 24 Storrn Damage ? 05 03-plex ? 11 10-plex Plbg _Y or _ N ? 25 Miscellaneous ? O6 04-plex ? 12 12-plex ? 20 Pool ? 30 Accessory 81dg. WORK TYPE ? 31 New ? 36 Move Bidg. ? 43 Reroof ~ 32 Addition ? 37 Demolish (Bldg)' O 44 Siding 33 Alteration ? 38 Demolish (Interior} ? 45 Fire Repair ? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors ' Give PCA handout to applicant for demoiition permlt GENERAL INFORMATION SAC Code D l # of Stories sq. ft. No. of Units ~ Length sq. ft. No. of Buildings / Width Footprint sq. ft. ~`T Const. (Actual) .s' .r/ Basement sq. ft. Census Code (Allowable) ~ Main level sq. ft. MC/ES System UBC Occupancy sq. ft. City Water Zoning ~ sq. ft. Booster Pump PRV Fire Sprinkiered MISCELLANEOUS INSPECTIONS ? Stucco/Stone APPROVALS Planning Building ~ Engineering Variance ~v Permit Fee Valuation: $ ~G~C>= 4~-~~~a Surcharge Plan Review !s~ ! L~ y ~ ( ~ ~~O ~ 30~ License l lr MC/ES SAC ~ City SAC Water Conn. ' Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment PI. Park Ded. Trails Ded. Other Copies Total: SAC Units % SAC ~ AOBE aqNEERS. BOB CLARK CONST. ~ENGINEERING ~N~ ~d ~D SURVEYORS PRO~C7 N0. E45~.o0 COMPANY INC. B~` ~S i PAGE 39 ~1000~EAST 1~Bth S7REET, BIlRNSVILLE, MINNESOTA 55337 p11 ~72_yppp'~.. CERTIFICATE OF SURVEY Legal Description: LOT 8 BLOCK 3 PINE TREE FOREST DAKOTA COUNTY MINNESOTA. ~80_5, DENOTES EXISTING ELEVA710N ~ 83. ~ DENOTES PROPOSED ELEVATION ~ 4 00 _ INDICATES DIRECTION OF SURFACE DR/UNAGE FINISHED GARAGE FLOOR ELEVATION ~ ~ 6 • ~ = BASEMENT FLOOR ELEVATION 5•~ = TOP OF FOUNDATION ELEVATION SCALE : 1" = 30' ~ARK : 7,~H AT COT /2~ d~'.t' 2. E1.6~/. = 983.45 • ADD,~SS ¢9/3 SYCAmaPE DRi~.~' ~ ~-i so.oo ~i I ~ DRAINAGE AND q~¢, g UTI~IlY EASEMENT ' 589'41'52"YV ~g=96c,3z ~g,,) ~974.~'~ 136.50 o~z,oo C9@o:!% ~$i i°' ~ ws~.oo ~i i~ N~e= 915. a4 ~q 83 $ p~ to ~ /Q74.5~ • ' I I V.~__~ a20.00a 48C.7i ° i ~ O Wv p - !'n I oo ~ 8.6y;1 ° i~31 ?I p0 oo.o Q~ ~R ~ 00 ~ ; } -.--~~i4~ ° ~ ~,o N ~ ~ ~ ~ o r a.oo ~ ' W ' oo°• F- ~__,o.oo m I O ~ ~ - ~ ~ ~ ~ `v 98h 30.33 ~ ~ ~ ~ o I J ~ .1 S~ o v~w ~ ~ oo z ~ o o cn ~.oo~ 9d3•7 lo-~ moo ~ Q i.t ~i.~ a O O o ~ I ~ m0 }I I " , z.ooo 813.7~ I c°n 975.3 ~ ~ ~ 979 l ~ . to L--- 978.} 0 8~3,2~ -~f''a ~ 9 0~00 uJi i~ (~jjj,~ Hug=975.65 136.50 043.So 8/,S+ I~ lao /9~,~ N89'41 52"E Iiu9=981,45 ~81,~ l . ; ;.~1 .r : .i 1 1 I hereby certify that this is a true and correct representation of a tract as shown and described hereon. As prepared by me this 28~' day of AY 19~ R~~55~ P/~~ ~~'S. 6-5- 98 _p ~l~„ Minn. Reg. No. ~ 90$6 ..:y,.~. . ,av °~e.~-,~~;~•o-g< . $cN:: L$;$.. . ,.(.,,.~tYn;ns. :.1~t:F'4,sYZ'.. , ~ a.. ~ ;g7l: `~F.",i`: . .I(n: ~ ~:.:C7V t:!~ I=.:;G~1N ~::.-^,'G!{Ci;:Fie S i"!"r;:~S7:~tn!... A:17e 73J Pr'~~i-rr, pri,!~Lr,iSd<~; ;:;:t'iP.;; .-.,:~r4~r,;:?;; iT!~ ,i ti f-. ~.a...~..," I r. t'; " l . f t1-.~'4._,; i^-..].~;_r:.( . .;L n. . t.LiQ...l .~.h.., . . . r?`~E, ~.)CiI.)1. t..`:a:1..:5 ;'~'~'i^,ri(:1:iP.: D 1~a r.r!i i I. ~ 4 . ~ . ...r~.~...~ ..~.r]i:;9.1. ~1.ErbF27.17'F r;'irtis.EY}'r,E A~.~;.>r..~~'1 i~ Q`_'~1; i.°i:rliv~ ,.f' ~ .rrll' Idr.'~'^'d ll,o,:..... "ile~.. 1[;^M',~:Y~:Xi""1,::~iipYC9F~Y!:MNa;.i;iti:ifY !:Y6 iii:r:C;t)n>}:%'Sti::4~;:;.i::;';i;~:~}l'i}; PERMIT ` CITY OF EAGAN pERMIT TYPE: 3830 Pilot Knob Road B U I L D I N G Eag~an, Minnesota 55122-1897 Permit Number: 032259 (612) 681-4675 Date Issued: 0 6/ 16 / 9 8 SITE ADDRESS: 4913 SYCAMORE DR LOT: S BLOCK: 3 PINETREE FOREST P.I.N.: 10-57650-080-03 DESCRIPTION: 6-uilding~Permit Type SF OWG Building Wgrh Type NEW r'UBC OcCUpancy,, R-3, U-1 ( Cpnstruction Type VN Z~o~nin9 ~ R-1 Building Length 40 ! Building Width ' 66 Buildirlg stori~s ~~r 2 $~~tare Fee~t 2,000 C~;p~S,.,Cad=v~° 101 1- PAM. ~ETACH V`y;, ~t i t~ ~ ~ x } ' . . . F, . `y' t ~k~l'~_ e _ _€c j t'~, - , . REMARKS: PLAN REVEWE? BY MIKE BARCK S & W PLUM6ER: FEE SUMMARY: VALUATION $179.00@ Base Fee $1,282.25 MISC FEES $1,592.50 Plan Review $833.46 Total Fee $4,797.71 Surcharge $89.50 SAC $1,000.00 SAC ~ 100 SAC Units 1 Subtotal $3,205.21 CONTRACTOR: - Applicant - sT. ~IC OWNER: R~ BERT L CLARK CONS7 14476990 1180 ROBERT L CLARK CONSTRUCTIO ?JA906 MANI70U R? NE 14906 MANITOU RD NE P'RIOR LAKE MN 55372 PRIOR LAKE MN 55372 #612) 947-6990 (612)447-6990 I hereby acknowledge that I have read this application and state that the information is correet and agree to camply with all applicable State of Mn. 5tatut~s an'd City of Eag~n Ordinarices. L J i~`1a~C~um~ ~~Qn~ APPLICANT/PERMITEE SIG TURE ~SSUED BY: CaNATUFE ~5~,~! ~998 BUILDING PERMIT APPLICATION (RESIDENTIAL~ ~ < CITY OF EAC3rAN ' 3830 PILOT KNOB RD • 65122 681-4676 New Construction Reauiremants RemodeVReoair Reauirements ? 3 registered site surveys ? 2 copies of plan ? 2 wpiea of plans (inGude beam 8 window sizes; poured fid. deeign; etc.) ? 2 site surveys (exterior edGRions 8 dedcs) • 1 energy calculations ? 1 energy calwlatians for heaMd addNions~ ? 3 copies of tree preservation plan H IM plaked after 7l1/93 required: _ Yes No DATE: Co ~ O CONSTRUCTION COST; DESCRIPTION OF WORK: ? w G STREET ADDRESS: I J ~ ~ BLOCK: ~ SUBDJP.I.D.#: ~l 7`/~C ~ ~ S~ Name: S~ ~ Phone PROPERTY Last Fim OWNER Street Address: Ciry State: Zip: Com an ~~KJLi2r ~ 1l~ IC ~0 N ST Phone ! ` 7 ~ ~ ~ ` V P Y- CONTRACTOR c, ,I / ~ ~ Street Address: l ( D ~ T~ U .N ~ License # 1~ City l b~ L l~'l« State: ?Yl Zip: ~ S~~~ ARCHITEC7/ ENGINEER Company: Phone Name: Registration Sueet Address: City State: Zip: . Sewer 8 water licensed plumber (new construction onty): u "T Penalty applies when address chang and lot change is requested once permit is issued. I hereby acknowledge that I have read this application and state that the informat~on is co~~to comply with all applicabl Sfate of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant ~ p~c~~od OFFICE USE O CeRficates of Survey Received ~a'~ Yes _ ~UV 9~~~i Tree Preservation Plan Received _ Yes No _ Not Required ~ I ` - a,...~„ „ . , . ` . . w a ~ a OFFICE USE ONLY ' ~ , BUILDING PERMIT TYPE ? 01 Foundation ? 06 Duplex ? 11 Apt./Lodging ? 16 Basement Finish ',~1, 02 SF Dwelling ? 07 4-plex ? 12 Multi Repair/Rem. ? 17 Swim Pool ? 03 SF Addition ? 08 8-plex ? 13 Garage/Accessory ? 20 Public Facility ? 04 SF Porch ? 09 12-plex ? 14 Fireplace ? 21 Miscellaneous ? 05 SF Misc. ? 10 = plex ? 15 Deck WORK TYPE `~1, 31 New ? 33 Alterations ? 36 Move ? 32 Addition ? 34 Repair ? 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. i3k7 MC/WS System (Allowable) L Main level sq. ft. i3v4 City Water UBC Occupancy Z~3, J-J 2r'° Sq, i 347 Fire Sprinklered Zoning R-J hrr¢A~E sq. ft. a3/ PRV # of Stories 2 sq. ft. Booster Pump Length ~fD sq. ft. Census Code. t v I Depth L~, Footprint sq. ft. ~~o SAC Code v I Census Bidg i Census Unit t APPROVALS Planning Building ~ Engineering Variance Permit Fee Valuation: $ ~ 7 9, o o~, ~ 5urcharge ~'`'yE'~Nr Plan Review qv ~o. s Gy ~ License s K L i i v s MC/WSSAC 3o.sx3~ ~09$ City SAC +u z 3. S ~3 S WaterConn. zx ~3 ~ Water Meter ~ 3 N7 S_ Zp Z~ r Acct. Deposit ~ s,- S/W Permit S/W Surcharge Z~"'"^y n~ u s ~ 3 V7 Treatment PI. ~ 2 S~f . r~ 7 r~-.~+ Park Ded. Trails Ded. Z,,,n~ t3 ~ y rb ~I S~ _ ~3 Other ' ~ 2~' _~i~, - aRruc R~s c~ '7z,73~.- " , J'r ~'.~Y7 ~7l~ 5~( _ ToWI:' i~; if ~i,ef~FE - t ~ax 3c~ °k SAC , f;;;~ a~` 2o.s y t 5AC Units - zj r ~ ~ i'° o4L.- . ~ A6c~ ~31 ~'!/tG. i ~ too,^-- t~ Q, t bS'. - ~ CONSULTNG ENqNEERS, BOB CLARK CONST. R~~E PLANNERS ~d LAND SURVEYORS PROJECBO~ 8~500 ENGINEERING C~MPANY, INC. PAGE 39 ~ 1000 EAST 748th STREET, Bl1RN5VILLE, MINNESOTA 55337 PH 432-3000 CERTIFICATE OF SURVEY Legal Description: ~oT s, BLOCK 3, PINE TR~E FOREST, DAKOTA COUNTY, MINNESOTA. (~80 5~ DENOTES EXISTING ELEVATION ~ 83• DENOTES PROPOSED ELEVATION 4 _ INDICATES DIRECTION OF SURFACE DRAINAGE ~ 6•~= BASEMENTGF OOR ELEVATION~A710N 5•~ = TOP OF FOUNDATION ELEVATION SCALE : 1" = 30' ~~,N ryj~{,QK :~ij'H AT CDT /2~ BLLC',(' 2. E~v. = 983.45 ADDRESS ' ¢9/3 SYCAilIDRE DR/l.L~ , 3o.oa ~ DRAINAGE AND ~q7q-_~ UTILITY EASEMENT yr~g:98o,i2 9So~6 S89'41'52"W 9~4.8~ 136.50 ~2Z,oo C98oJ ~gi io~ ~ - u~ ~37.00 v~ ~I I~ ~ N~6=9'15,34 983.1 ~ °0 10' ,o ~ . ' I~74_5i o 20.00 a 480.7, i ° Wc/ o I ~C ~ I Q Y.00 n 8 6 e I a ~~i j z I 00 9~b.g oo.o Q~ ~~R i~ { ~ o ' ~n c°~ ~ ~ 0 O ~ ~ i ~q~4=Z~ 6.00 ~ ~ ~ ~p I ~ ~__10.00 W W f~ p in 30.33 oca 3~ w N 98/,3~ Qo O ° I -J ~976•5~ o O (w/1 i.oo~n ~ ~983.7~ ~ o~ Q N I I~ Z ~ o o ° ' ~y ~ ° o ~ ~ ~ I ~x 0-' S 2.OOo I3.7~ I\ f~A ~ 975.3 ~ ~ r°i 979{ _4~ ~o L--- 978.~ 0 913,2~ --~'o J ' ~ , ~ Q o~00 ° ~ ~°;i ~ol ~~b H~6 = 975.65 136.50 Q45.5o 8l, $~i I~ j~ . I (97~• N89'41 52"E N~g=9B1,45 ~8~,5'S ~ ~ i r L~sQ~~°, R9 ~~MD N~i°~~~ ~~~~~,r!=? e - ~ ~a-~ G- ir- 98 - - ~ ~ . . ~~u?~-..... tUIL~ING INSPECTIONS DEPT. :°~.~:^.rT:~~'~'c~~" ~,r' I hereby certify that this is a true and correct representation of a tract as shown and described hereon. As prepared 6y me this 28~' day of AY , 19.`~B. ~ev+5c~ P/rovt~a C-r~~ 5• 6-s- 98 Q n~.lyc„ Minn. Reg. No. ~ 9~8~0 < ~ ~ • LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION a • PROPERTY LEGAL: ~~S~XiC~-~ ~~'N o ~.f~ i ~ DATE OF SURVEY: S~ ~Z_.P ~ ~ ~ LATEST REVISION: ~.~5,~ ~ . - ~ ~ DOCUMENT STANDARDS a ? ? • Registered Land Surveyor signature and company ~g ? • Building Permit Applicant m~~o ? • Legai description [Y g ? • Address p~~ ? • North arrow and scale ? • House type (rambler, walkout, splft w/o, split entry, lookout, etc.) C9" ? • Directional drainage arrows with slope/gradient ? ? • Proposed/ebsting sewer and water services & invert elevation [3~~ ? • Sheet name CT ? ? • ~fireway ELEVATIONS Ew'stina f3/ ? a • Sewet sesvice (or Proposed) [~l ? ? • Property comers ? • Top of curb at the driveway ? • Elevations of any ebs8ng adjacent homes Prooosed ~ ? ? • Garage floor .e~ ? ? • First floor ~ ? ? • Lowest exposed elevatia~ (walkouVwindow) p~ ? ? • Properiy carners qi ? ? • Front and rear of home at the foundation PONDING AREA fif appiicable) ? ~ o • Easement line ? p~ ? • NWL ? ~ ? • HWL ? e~ ? • Pond # designation ? o% • Emergency Overflow Elevation DIMENSIONS ~7 ? ? • Lot lineslBearings & dimensfons ? • Right-of-way and street width (to back of curb) ? • Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc. (.e. ali strudures requiring permanent footings) pi ? ? • Show all easements of record and any City utilities within those easemeMs [3~ ? ? • Setbacks of proposed structure and sideyard setback of adjacent ebsting structures ? • Retaining wall requirements, if any Reviewed: ~ Na e / at January 1996 ~ CMK'atBBelBLDGPRMT FM j L d~" ~~S ~ ~ f'~ he r r~ec' ~~e s ~ / r ~ ~ " ~ ~ f ~ S' ~ ! ~ 'l_ ;^~2 ~ v~ ~ ~ 5.~ ~~Cles ~ _ ~ ;:.z...~_.w - 4 ~ Ct M...Yer•'rw° ~ . ,.:t.i, I 1 Q ~ ..w I ~ 3a' ,~h~~ ~'_f,~:,i4 ~o ~ o,~ G~~ , s... ~ ~ ~ d ~ ~ y ' Gv ~ ~ ,~..~~:~Q~_ ~ ~ ~ o~~ ~ ~ ~ y _ ~ ~ ~N~~,.~,. ; r r. , ~ ! , 3 ~ I _ . ~ , ~,N~ ~~r~= y , ~':rGi ~ ~1 _ ~ - r ~,~.n . o- ~r _ - ~ i i rti titl-Y?'L ~1 µ _ ~ , ~ 3 6 ~ 1~ _ . , , d ~ !T _ r.. ~ ~ 6 ' ~.c~ ~ ~ ~ ~i t.,~ i r ~ ,-.-v G.t S ' ~ °'7i . . _ p~Vf1S@O . _ r.a~ c~r ~l hC _ . ~ ~ ~ 'r f ~.I ~ a / ~ `6d A rU'J a~.) ~ t ~.~p~ \ . .,.r.:.. . ..1'.~..... ! , . -~--1 .as IJ`~ ~ qp i ~f. s' t l~;N C?.:~ r4~~_t~.,L1 ~`E ~.,1. ~ . ~r.~,....~ . f . . . . ~ A ~ / ~ I ~I _ . . .1V ~-1#! ~ ~?'~1 k t.. _ 'S r ~ ; ' I i ~ ~ ~ ~ ' %~d~ ~`4, ~ ' ~ ~ • ~ ` s~ t!. 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H•~a.~ ~~S i,~°j ~ ~ j ti. ~ , i ` ~S 7 f ~ ~ ~~?f~E~dbEn FOR TREE RRES~RVATIOAt,.y ~ /~,,o~ o S~ C:~:,;.~ ~S~LIANC~ ~~"'-~",L'¢ ~ ~ ~~/'*7~ci~~~~i:".-}S~.,i F~,::;~r.~s ~~~~+:.±~P"~ ~.a. ~ . + # 7 . ~ r , / r y 6~ k..-~,_ ,~y,,,y ~~~~y.~ 4~4`.1c~- .,f~ity 6„~-'';' ' v ~I ~t~r'~ ~9 s ~ . . • . ~ ~ ~1^ ~ ~1 i J N00' 18'08"W o 88.00 ' v o ~ ~~t ~ 0 5 5 cv i~~ (/3~~ ~ ~ ~ ^ LOT,` 8 ~ ~D ~ , ~ I ~ ~ b~ ~ i `4"~~ ~ ~ m , a ' Y: 4; v i,r r~ S+ e:-:-~L,~~~~,,,t ~l W m D .D ~ ` v ~ ~ '~~d~ C~) ~ .~I m ' ~ ~ ~ ~ ~ks~ir r r-- Z~_~ I V i o~ "`-~IS ~(6~ ~ ,~'~z_ d drfvi ~ ~ ~ ~ ;~'fl iA 1. ~ OD a'~~ ~~t~"`'~ ; ~ ~ W $ ~w~r«~ a ~ cp ~_h S I 41.00 ~'`iu~K' oo~ C~ ~ ~ ~ - ~ ° (n a . ~s N° PROPOSED 9,00-~ ~1;,~~ ~N ~ ~ HOUSE!~~ o ~~'~I ~ CC1 o r 16.00 ~ o'o ~ 3.00 ~ 0.25 12.25 GARAG E o ,`g ~ o D~oP IC o ~ ~ .c ~p 0 20.50~10.00 00 Zl Q a+ . ~ t~i .~o ( u~~~ 98~ o 0 ~ W . ~'W ~ ~ I O ~ . ~ ' ' S CWw~ ° ` 5 ~ 1 1 O~',~' ~ /N1/~= ~71 ~ ~ 1~ ~ ~ ~V~~ O S&~?/C~ - - - - ~ \ ' -'S0.0^ - ~ 88.00 , S00' 18'08"E w...... _ o- - ~~_9~; _ (~D, 28; Bo, oo ~ °o 02 SYCAMORE DRIVE ~18a iv~ ° ~ ~ Po~Rlt° brand fdx tfenBmftlPl mertW 787'I ~ay~y~~ r . . . . ~ l i i ~ ~ ~IW C C~.. ~ ~ s~xM ~ ~ 1.~1~ ~ ul~~ ;ao,; o0 vu.vv v o ~~iH ~ 0 5 (sl (/3)~$ ~ ° ~ ~.4r 8 C z F' ) ~ ; r~ r-. 1~,~ ~ ~ ~ • ~ I ~ ~I 6 . i `4~ ~ ~ (pr~ FTI y Y~ C) ~-w r N f ~:~j'1,,7~•~:e :i i~ D a I , ~t {~e) LB) ~ l7~ ~ I . Z ° ~ i~ ~ 2~ a ~ ~ n~~, w 8 ~ ~h ~ d r~,p'~ g ui f''°'"~.~+~-~ . ~ ~_Cj(~f~+-~. .n,l • J ~ ` • v t,a ~ i 41.00 ~ a O~ ~ ~ ~j NQ $ • ~ : ~ ~ , PROPOSED 9.00-~ ~cu;~~ oN I~- HOUS~~ ~ ;~%~I ~ c.a ~ ~ ~--r- , s.oo ~.o i 3.00 ~ o.2s° ~ z.zs GARAG~ o ~ o aRo 1 Q ,D~ c 20.50 ~t0.d0 00 1 `p ~ ~'ia~ ~'~l~'~ ~ ~ 9~~~'•°'c~' ! $ ~ ~ Op . `~J ' p . . , . 6~ .r v, c.= g i" , ~ ~ 5 ~l~' o ~?itF ~ l~ ~ ~ - ---50.0- '~J ~ 88.00 S00' ~ 9~08"E . a (~o,_Z'8; 8o.og, ~ ' _ ~8i o_'~ _ SYCAMORE DRIVE tlBo io~ _ _ _ RervreJ~tc~/1'rli~~a~ah P~.~+n - S~-Q ~4,x.~' 1" ~ `J • . - 1~ot ~3//< 3 ~ ~1r~e.e ~~-PS~ 7,''cr 1`~'~~}~~-. Sc~Ze~c~/~e ~z v~ ~ v~ 2 r 7`o Trie e $'~D cz c~~ ~U r~e,, ~rvrrl 'f ~~e 7 G r lM . lTiD/~!'o~ L o C 4.?`i rri, S j'~j r~ r~~~ ~ ~ /4 t/~7y' v u- h ~ p 1 d J~ ~ l~, ~ ('Fr~„~f ~ Sic'c ~ J ~ .~',~~k .~~-,s~ s L, ~ ~ ~ ~ c'+/ BL ? CITY USE ONLY RECEIPT / ~ ~ / ~ lj d' SUBO. ._2^,+?.C.~ i;~ ` SNQl~AC~ RECEIPT DATE: a~ p 1998 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT IQiOB RD EAGPN, MN 55122 (612) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system FIXTURES EACH # TOTAL Shower 3.00 x ~ = 3•l~ WaterCloset 3.00 x = 9.~ Bath Tub 3.00 x _ ~o lavatory 3.00 x ~ _ ~ Kitchen Sink 3.00 x = i. w Laundry 7ray 3.00 x f = a,~ Hot Tub/Spa 3.00 x = Water Heater 3.00 x _ ~ Floor Drain 3.00 x J_ = 3.~D Gas Piping Outlet ' minimum -1 3.00 x 1 = ~ UC~ Rough Openings 1.50 x _ ~ro Watef Softenef "fordwellings under constmction 5.00 x = _ Water Softener " for existing dwening 20.00 x - _ U.G.Sprinkler 'fordwellingunderwnst. 3.00 = U.G. Spfll7kle~ `forexistingdwelling 20.00 = Alterations " to ezisting residence 20.00 = Water Turn Around 20.00 = Private Disposal System * MPC iic. 75.D0 = (new and refurbished systems) Private Disposal5ystems"Abandonment 20.00 = RPZ (~ew installation on{y) 2D.00 = 5TATE SURCHARGE 50 TOTAL ° I hereby acknowledge that I have read this application, state that the infortnation is corred, and agree to comply with all applieable Ciry of Eagan ordinances. It is the applicant's responsibility to notiry the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal operational and maintenance activities to the facilities constructed under this permit within Ciry propertylright-of-way/easement. SITE ADDRESS: ~ I.~~ ~yC ~ m n fL~ OWNER NAME: C L-_-~ R C~ tr~S~F INSTALLERNAME: nC.S ~--..J ~~.-IA VY~~=E o?b _ TELEPHONE#: ~3.~-"I ~7 ~J STREET ADDRESS: ~D 13 ) ~ ~ i ~ ~ cirr: _T~p~ E v~? ZLF r~ STATE: /Y)+~ ziP: ) d. y SIGNATURE OF PERMITTEE CO(PERMIT FORM5(RPlBG PERMIT (RES) - 1998 ~ I ' / CITY USE ONLY v p~ LOT ~ BL ~ RECEIPT 9Cp 6 g 9 SUBD~ M a~l i~ ~ RECEIPT DATE: g/~IN 71 1998 M~c~~viC~L ~~~rr (~sin~rri~[a crrY o~ ~ne~?iv S$SO PILOT KA09 RD EAHAA l~1V 551 SE L}`2 _ C~~ [sr$l s8~-as~s Date: r ~ r Complete this section onlv if you aze installing HVAC in single family, townhomes or condos under construction and not owner /occupied ' • HVAC: 0-100 M B T U $ 24.00 ADDITIONAL 50 M BTU 6.00 • Gas outlets ( m;n;mum ofone required $3.00 ea.) ~ ~91"f~ ~ - (~as ~e,.c • (~/~-s /~'~AVtw.n.a • State Surcharge: .50 . TOTAL: ~ ~U Complete this section onlv if you aze remodeling, adding to, or repairing existing single family dwellings, townhomes, or condos. Note: Mechanical pemut is not required for alterationladd-on to ductwork in existing residential units; but is required for the following: _ Install fumace _ Install air conditioning _ Install air exchanger, i.e. Vanee system, etc. _ Other Minimum fee applies to all remodel or add-ons of existing residences $ 20.00 State Surchazge . .50 Total: $ 20.50 SITE ADDRESS: `T ~ ~ 3 S (/C~~nQ+ OWNER NAME: ~C~YJ ~ ~ ~ K ~ ~,Q-w~ ^E' PHONE `-f T 7'ro / g ~ INSTALLERNAME:r ~R L PHONE#: ~ ( Y R ~ / 3 ~ STREET ADDRESS: ~ ~ I~ ~ G~ CITY: ~`LW 3 U ~ I~ Q STATE: ~ ZIP:~ ATURE OF PERMITTEE 75/FORMS BLDJMECH PERM[T (RES) - I998 CITY USE ONLY L BL _ RECEIPT#: SUBD. RECEIPT DATE: APPROVED BY: ,INSPECTOR 199$ ~~C~l~kNICAL ~£{;M1T (COblM~ERCIiRL) CITY OP ~EH~k1V S$SO PILOT KNOS gD ~A&~kN.1NP 55188 (61E) 6$1-4675 Please complete for: all commercial/industrial buildings muiti-family buildings when separate permds are not required for each dwelling unit DATE: CONTRACT PRICE: WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT DESCRIPTION OF WORK: FEES: 1% of contract price OR $25.00 minimum fee, whichever is greater. Processed piping - $25.00 CONTRACT PRICE x 1% PROCESSED PIPING PERMIT FEE STATE SURCHARGE (g.50 per $1,000 ofcermit fee due an all pemiifs.) TOTAL SITE ADDRESS: OWNER NAME: PHONE TENANT NAME (rn~ROVEMENrs ONL1~: INSTALLER: ADDRESS: PHONE CITY: STATE: ZIP: SIGNATURE OF PERMITTEE 4 ~ INSTANT TESTING COMPANY IT - 4~0~ BEAU D'RUE DRIVE - CO EAGAN, MINNESOTA 55122 TEST REPORT (612)454-3544 INSPECTION REPORT JUNE 26, 1998 ~~,~CEIVED ROYAL OAKS REALTY ~ JUL ~ s~9Q~ 4196 LEXINGTON AVE I~ SHOREVIEW, MINNESOTA 55126 ~ ` ~x"-,~ _ p~v < RE: ~50- ~~3 SN P~EC~i,~6Mi~ 1y-~ - - r . k~~Y£„'~.~' 1~. . ..l / DATE OF TNSPECTION: 3UNE 24, 1998 AT 8:5C A2d A VISUAL INSPECT:ON WAS CONDUrTED ON LOT 8 BLOCK 3. THE HOUSE PAD WAS STAKED. ALL TOPSOIL WAS REMOVSD DOWN TO A N.OIST BOTTOM. SHALLOW HAND AUGER PROBES WERE DONE TO VERIFY SOIL CONSZSTENCY WITH BEPTH. WATER WAS VISIBLE IN THE EXCAVATION BUT W~S NOT ENCOUNTERED IN THE HAND AIIGER PROBES. ALL UNSUITABLE MATERIALS HAD BEEN REMOVED TO A SUSTABLE BOTTOM SOIL. THE ESTIMATED OVERSIZING WAS ADEQUATE. BAS~D ON THE INFORMATION OBTAINED, THE CONTRACTOR WAS ADVISED THAT THE LCT IS ApPROVED FOR FILL. BLOCK AND LOT NUMBFR LOT 8 BLK 3 FROnT 6' OVERSIZING REAR 6' SIDE 1C' FILL REQiJIRED FRONT 6' REAR 3' DEPTX OF SUBCUT FRONT 8' REAR 3' DESCRIPTION OF EXCAVATED TOP SOIL SOILS BOTTOM CLAY RELATIVE FIRMNESS OF FIRN, SOTTOM INSTANT TESTING COMPANY DAVID KOLSTAD, INSPECTOR COPIES TO: CiTY.OF EAGAN BOB CLARK BUILDERS CHARGE CODE: SOILS INSPECTION...#602 1 U MILEAGE............#612 15 ~ ~ (j(%FJ) s~~ea CaH Andermon Prokcaional Enplneer - Re9~~~~ o. 10736. r ~ ~ INSTANT TESTING COMPANY IT - 4000 BEAU D'RUE DRIVE = CO EAGAN, MINNESOTA 55122 INPLACE DENSIT~EST REPORT (612) 454-3544 FOR: ROYAL OAKS REALTY PROJECT: PINE TREE FOREST LOT 8 BLOCK 3 ATTENTION: MR. MARCEL EBINSTIENER DATE TESTED: JUNE 24, 26, 1998 ftOYAL OAKS REALTY 4196 LEXINGTON AVENUE REPORTED: JIINE 26, 1997 SHOREVIFW, MINNESOTA 55126 TESTS ORDERED BY: MIK~' BLACK INPLACE DEIQSITY RESULTS TEST NUMSER: 25 26 27 LOCAm?ON: LOT 8 B:.K 3 LOT 8 BLK 3 LOT 8 BLK 3 DEPTA BELOW GRADE: 4' 2' ' 0' PROCTOR CUkVE NUMBER: 98-01 98-01 98-01 VISUAL SOIL CLASS: LOAMY S~ND LOAMY SAND LOAMY SAND $ MOISTURE: 6.8 8.2 9.5 OPTINUM MOISTURE, 10.1 10.1 10.1 RELATIVE MOISTURE, 67 81 94 FIELD DEIv'SITY, PCF: 132.3 133.9 124.8 STANDARD MAXIMUM DRY DENSITY, PCF: 131.1 131.1 131.1 RELATIVE DENSITY, 101 102 95 REQUIRED MINIMUM: 98 98 95 REMARKS: RELATIVE DENSITY RESULTS BASED ON STANDARD PROCTOR. TEST TECHNICIAN: DAVID KOLSTAD, ITCO COPIES TO: CITY OF EAGAN BOB CLARK CONSTRUCTION CHARGE CODE: DENSITY..~306 3 ' MILEAGE..#612 15 HOIIRLY...#601 2 ~ , sqnea Carl Andenon Protessiona~ Enpinaer- Repistre6on o. 70736. ' Use BLUE or BLACK Ink r For Office Use J9 #bl Permit Us/ e City of Ea ~l~Il )~5,or Permit Fee. l~J 3830 Pilot Knob Road I I 07 Eagan MN 55122 Date Received: Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: _ I I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: Phone: Resident/ Owner Address City Zip: Applicant is: Owner Contractor Description of work: Type of Work I Construction Cost: Multi-Family Building: (Yes I No ~..•b Company: C2 Contact: Contractor Address:iZ ~ X~~ City: Stater 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 the information may be classified as non-public if you provide specific reasons that would permit the City to I 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.oopherstateonecall.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 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 Minne ate Building Code must be completed within 180 days of permit issuance. 21 x _5ay - Applicant's Printed Name Applicant's Signature Page 1 of 3