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1732 Talon Tr04/21/2014 12:18 Les Jones Roofing, Inc. 4,1111 City of Badu 3830 Pilot Knob Road Eagan MN 55122 Phone: (661) 875.5675 Fax: (661)675.5694 T'AX)9528817009 P.004/011 Use BLUE or BLACK Ink ham For Office Use Permit*: °D Permit Fee: � 1 I Date Received: Staff: 2014 RESIDENTIAL BUILDING PERMIT APPLICATIONzszPi9 Date: W/vt/ f Site Address: /724-17.8-1734- /736 774-1.1001 7', -Atc— Unit #: 1 Name: Yo 1/200 T+/ 4A-QE� /Na-. Phone: ( 53 -LE_ 99 419 ti .ry Address / City f Zip: /�O BDAC 2125' /' 6-Apves h‘erirrs /lA/ c507 w''.r. Applicant is: Owner Contractor Description of work: &UWE A7r/O 'c.Ih r Construction Cost: i 15/• 57 Multi -Family Building: (Yes / No `) Company: • (--E$ ..lo N ES - cr:"i J( Ne- Contact: 04121 S A,,WIEs1P--21or•-..l Address: 941 W. s-nzeer City: �Jt.c okti Ait"7i7111 State: M,fJ Zip: 5'5-11-2.0 License #: (e)C. cD Phone: 9s-s-13gt^2.2`f1 Lead Certificate #: NAS 10372—/ If the protect Is exempt from lead certification, please eicplaln 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 elmilar 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: 4.4.44 cALL BEFORE YOU DIG.. Cell Gopher State Ona Cait at (661) 484.0002 for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utJIIUes. www.gooherstateoppcalLorg 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 le not to start without e permit; that the work will be In accordance with the approved plan In the case of work which requires a review and epproval of plans. Exterior work authorized by a building permit Issued In accordance with the Mtnneeota State Building Code must be completed within 180 days of permit issuance. x em/as /4e,“ za1 Applicant's Printed Name X� Ap ae; Ae-e06e..- llcant's Signature Page 1 of 3 Address: 1732 Talon Tr Lot: 14 Block:4 Subdivision: Greyhawk 2nd Zip: 55122 THE FOLLOWING ITEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON 03/23/05 Yes No Comments Final grade - 6" from siding Permanent steps - garage Permanent steps - main entry Permanent driveway Permanent as Retaining Wall or 3:1 Max Slope Sod/Seeded lawn Trait/curb damage Porch Lower level finish Deck Fireplace • Verify with your builder that roof test caps from the plumbing system have been removed- • Turn off water supply to the outside lawn faucets before freeze potential exists. • Call the City's Engineering Department at 651-675-5646 prior to working in right-of-way or installing irrigation system. J BUILDING INSPECTOR: Terry Zelenka CONTRACTOR: MW Johnson Construction 17645 Juniper Path, #!00 MN 55044 bo 8 s 9 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 ?LllerltW?»s9`l/. New Construction Recuirements Remodel/Repair Recuiremenls Office Use Only 3 registered site surveys showing sq. fL of lot, sq, ft. of house; and all roofed areas 2 copies of plan Cart of Survey Reod _Y _N (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions Tree Pres Plan Rood -Y _t( 2 copies of plan showing beam & window saes; poured found design, etc. 1 site survey for additions & decks Tree Pres Required _Y _N 1 set of Energy Calculations Addition - Indicate Hon-sleseptic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail options selection sheet (buildings with 3 or less units) Date -? / /0)- Construction Cost Site Addres s C 0. Unit/Ste # a h?1 n/ >> 1 22 1 z Description of Work Low t?U St^ Multi-Family Bld g l_Y _ N Fireplace(s) _ 0 _ 1 - 2 Property Owner Pr • d ?] \/ 7RXZ c o? A,- v eJ . Telephone # ( (::?s_ I) --L 77 Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (J submission type) Submitted Submitted . Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _Y _N fee applies. Licensed Plumber Telephone # Mechanical Contractor Sewer/Water Contractor Telephone f 0 T) Telephone If so, 25% plan review I hereby apply for a Residential Building Permit and acknowledge that the info "" ' accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of NIN 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. Applicant's Printed Name L Q ..c. Pf, , ??E:- . Applicant's Signature OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 10-plex I 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg(Yor_ N ? 25 Miscellaneous Work Types ? 31 New ? 32 Addition 4 33 Alteration ? 34 Replacement Valuation ?7 D U Census Code SAC Units # of Units # of Bldgs j Type of Const ? - Footings (new bldg) Footings (deck) Footings (addition) Foundation Drain Tile / Roof _ Ice & Water _ Final Y Framing _ Fireplace _ R.I. _ Air Test _ Final _Y Insulation Occupancy R, ?) MCES System Zoning P City Water Stories Booster Pump Sq. Ft. PRV Length Fire Sprinklered Width REQUIRED INSPECTIONS _ Final/C.O. Y Final/No C.O. ,( Plumbing I-IVAC Other Pool _ Ftgs _ Air/Gas Tests _ Final Siding _ Stucco - Stone - Brick Windows Retaining Wall -N- Approved By: 1J 6 vS ,Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total ? 30 Accessory Bldg ? 31 Ext. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors 'Demolition (Entire Bldg) - Give PCA handout to applicant bg-M 2005 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. X50. S a Date ?j I ( I _ ,'e ? 1 ?z o, L ?,- ' Site Street Address l Uni t# /I Property Owner L A V- < Of M-e kP 0-ti Telephone # (6 1 ) 7? ? Contractor S"Zl /d- Telephone # ( ) Address city State Zip The Applicant is: Owner _ Contractor -Other Alterations to existing dwelling $ 50.00 - Add plumbing fixtures (excludes water softener and/or water heater--complete next section if installing these appliances). -Septic System Abandonment 1 " meter is required) -Water Turnaround (add $125.00 if a 5 8 1 , , Water Softener -Water Heater $ 15.00 new _ replacement Lawn Irrigation _RPZ _PVB new -repair -rebuild $ 30.00 State Surcharge U lo $ .50 APR 0 1 2005 ?j Total $ I hereby apply for a Residential Plumbing Permit and acknl"rlw? "tion 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. L , `?. 1z, L 2, c K, ? Applicant's Printed Name Applicant's Signature Address: 1732 Talon Tr Zip: 55122 Lot: 14 Block: 4 Subdivision: Greyhawk 2nd THE FOLLOWING ITEMS WERE/WERE NOT COMPLETE AT FINAL INSPECTION ON Yes No Comments Final grade - 6" from siding Permanent steps - garage Permanent steps -main entry Permanent driveway Permanent gas Sod/Seeded lawn Trail/curb damage 3:1 Max. Slope/Retaining Wall Porch Lower level finish Deck Fireplace • Verify with your builder that roof test caps from the plumbing system have been removed. • Turn off water supply to the outside lawn faucets before freeze potential exists. • Call the City's Engineering Department, at 651-675-5646 prior to working in right-of-way or installing _ irrigation system. V BUILDING INSPECTOR: CONTRACTOR: MW Johnson Construction 17645 Juniper Path #100 Lakeville MN 55044 Lov I`4 ?1°c4 4 2f w (-, 3I? - ?31 ???0? ?y RESIDENTIAL BUILDING W C?V I?e?w Permit Application -7 O •511 * City Of Eagan ?b 3830 Pilot Knob Road, Eagan MN 55122 P P ?P3?? Telephone # 651-675-5675 FAX # 651-675-56941 y a q New Construction Requirements Remodel/Repair Requirements Office Use Only4 3 registered site surveys showing sq. ft. of lot, sq. ft. of house; and all roofed areas 2 copies of plan Cart of Survey Reod _ Y _ N (20% maximum lot coverage allowed) 1 set of Energy Calculations for healed additions Tree Pres Plan Recd =Y 2 copies of plan showing beam & window saes; poured found design, etc. 1 site survey for additions & decks Tree Pres Regd Y ,_,y, 1 set of Energy Calculations Addition - indicate don-site septic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan if lot platted after 111193 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date / 04" 1-7-5 Construction Cost a . 000 Site Address --^?? Tot, to v-\. -T v a . 1 Unit/Ste # f I lie Description of Work Multi-Family Bldg ox y _ N Fireplace(s) _ 0- 1 _ 2 hone # R 5a 9 a 7-7 a6 JU LU -5-6 h n5 o n Tele O wner Property p Contractor A J (,t) :Ib h n sc n 5 ':31) rl i !1P Ir' Address J'7 (0 4 1 ?., ?y, PO_I ? City L CL UV; 1 , State /U N Zip ?)5Q A Q Telephone # (? $ c __7701-0 COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING V Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? )Y _ N If so, 25%a plan review fee applies. n Licensed Plumber Telephone #gQ -/r Mechanical Contractor Comodled At Telephone #b?4 C?Jaa ?zer Telephone Sewer/Water Contractor t?ye Phone J \ 4 ?U I hereby apply for a Residential Building Permit and acknowledge that the informatilon is a and accurate; that the work will be in conformance with the ordinances and codes of the City ?o f Eagan and he _.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. ,-1, ,,M m,,,j Cot ce y c? Applicant's Printed name Applicant's Signatur OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool w ? 30 Accessory Bldg ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi eAl 03 01 of _qplex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF ? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc. ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-plex Plbg_Yor_N ? 25 Miscellaneous Work Types 5 A G'C K V? C 1.1) 7)16 /o?lP/r7r 1 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding ? 32 Addition ? 36 Move Bldg. ? 42 Demolish (Foundation) ? 45 Fire Repair ? 33 Alteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/Doors ? 34 Replacement *Demolition (Entire Bldg) -Give PCA handout to applicant / Valuation /O 000 Occupancy 2 ' MC/ES System Census Code /D Z Zoning FAD City Water SAC Units Stories 3. Booster Pump Nbr. of Units 1 Sq. Ft. ) 2 I PRV Nbr. of Bldgs d f' Y Length. Fire Sprinklered Type of Const Width Z ?D REQUIRED INSPECTIONS Footings (new bldg) Final/C.O. Footings (deck) Final/No C.O. Footings (addition) _ plumbing Foundation _ IIVAC Drain Tile _ Other Roof f , Ice & Water 1C Fi nal _ Pool _ Figs _ Air/Gas Tests Final YJ Framing Siding _ Stucco _ Stone _ ?l Fireplace _K R.I. ;K Air Test / Final Windows (new/replacement) 71)` Insulation - Retaining Wall Approved By At i , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC n?AVI City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total 3A5eIv)eA-l' -7q2 59 I''t K /.f' yr,AiA 4 laarX 19Z Sp F` XS?, o? d n,p floole as ?_p RA6- c/a0 f`r D eGk r 9 A-t" Fee 2, b 0'O H MNcheck COMPLIANCE REPORT Minnesota Energy Code MNcheck Software Version 3.0 Permit # Checked by/Date COUNTY: Dakota STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Multifamily DATE: 5-21-2004 DATE OF PLANS: 01/02/03 PROJECT INFORMATION Greyhawk Mid Units t Eagan, MN? COMPANY INFORMATION: MW Johnson Construction Inc. 17645 Juniper Path #100 Lakeville, MN 55044 COMPLIANCE: PASSES Required UA = 486 Your Home = 357 26.6% Better Than Code 1? Au, Area or Cavity Cont. Glazing/Door Perimeter R-Value R-Value -- U-Value ------------ UA ----- --------------------------------- CEILINGS ------------ 980 -------- 44.0 ------- 0.0 26 WALLS: Wood Frame, 16" O.C. 2874 19.0 2.0 161 BSMT: Conc. 8.0' ht/4.0' bg/4.0' insul 464 10.0 0.0 74 GLAZING: Windows or Doors, Above Grade 152 0.480 73 DOORS 38 0.350 13 FLOORS: Over Unconditioned Space 290 30.0 0.0 10 HVAC EQUIPMENT: Furnace, 80.0 AFUE ------------------------------------------------------------------------------- COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet tkje?equi,r-1-ments of the Minnesota Energy Code. Builder/Designer a lJ 1? Date 4fL7 T LOT SURVEY CHECKLIST FOR RESIDENTIAL BUILDING PERMIT APPLICATION PROPERTY LEGAL: 1- f. 13-(6 3/L'/r. 24 r?ErP??gey??? ` v DATE OF SURVEY: LATEST REVISION: - Z 3 - O m a c m L U O z Q DOCUMENT STANDARDS X ? ? • Registered Land Surveyor signature and company 9 ? ? • Building Permit Applicant yq ? ? • Legal description 041(W • rvisSrn?) AddressC 0 • North arrow and scale X ? ? ? ? A • • House type (rambler, walkout, split wlo, split entry, lookout, etc.) ` Directional drainage arrows with slope/gradient % t` S?a? c(K? ^e ? A ? 41w6, • O Proposedlexisting sewer and water services S invert elevation CCcGY syc ??I ? ? • Street name ?' ? 0 • Driveway ? 0 • Lot Square Footage ? %Z 0 • Lot Coverage ELEVATIONS Existing ?( ? ? Sewer service (or Proposed) 0 ? • Property comers y,( ? 0 • Top of curb at the driveway and property line extensions ? X 0 • Elevations of any existing adjacent homes ? ? • Adequate footing depth of structures due to adjacent utility trenches ? X ? • Waterways (pond, stream, etc.) Proposed } 0 ? 0 • • Garage floor Basement floor Cz of ?f ? ? • Lowest exposed elevation (walkouttwindow) ? • ? Propertycomers SOU{hernn v5]` pn:Pi, Cc?•" ?(? . / ? ? • Front and rear of home at the foundation PONDING AREA (if applicable) ? g ? • Easement line ? ?I, ? • NWL ? X ? • HWL ? ,g( ? • Pond # designation ? ? • Emergency Overflow Elevation ? p? ? • Pond/Wetland buffer delineation DIMENSIONS ? 0 • Lot lines/Bearings & dimensions 0 d"% • Right-of-way and street width (to back of curb) ? ? • Proposed home dimensions including any proposed decks, overhangs greater than 2•, porches, etc. (i.e. all structures requiring permanent footings) J? ? ? • Show all easements of record and an City utilities within those easements ? ? • Setbacks of proposed structure ji[hd side ar se ac o a latent existing structures N ? X ? • Retaining wall requirements, if any Reviewed: Name Date G:/FORMS/Building Permit Application CE'RTIFICA TE OF SUR VE'Y \ J 9 . `q? Bv?1 +J 12 ?tK 4 0 Nb i`??? ?\? ?O gy9 ? 90 / 9 2 .o o? 934,0 k0? o- Ci ?a+a ASat 9 \ 4?4, t e •JS/? t ? ? /fo, ,9 Ot yIrol Jc9 ry4 o0 \ + ts?O ? + 0 ?O ?O K?.g \ s • ? ? 0 4r ?9 a0r 4 P? 13 e0? '? as?o ?`?'4` ? .rP o41 e 47' 1a 3:1 BJl?Armm V0033 U° ?? or W111 Be jR'a;qU!1'6d e01 O? Bohlen Surveying & Engineering 31462 Foliage Avenue 4735 123rd Street W. Northfield, MN 55057 suite 200 B E Savage. MN 55378 Phone: Fax: (507))645577998 Phone: (952)) 8955 2 9259 a k 9 14 'go9 o dig ??LA 0 14 r.? 1 111?oQ' Io?- M. W. ?F Y s o x.90 m,T49?Og7 \ SJI g +?f a JJe 'rf?'Q7 'L,% \? ?r °O 15 ?P F syo .uBJ V" y 6 ??rp 9J F ?J 4 ba' y S "pL`)J l1, 9 16 ?r'k q + 7 ? 6 1 ?3gq?yJ v? a?6+937x0 ?'®016 1 ? 9,56 ? 5a ,` 12' i/ ss , O9 qa9 (, 10 11935.7 r .'L 81"04' 29 E 3387 OUTLOT C JOHNSON CONSTRUCT[ON Y LOTS 14 TO 16 SEWER SVC INV.=924.0 LOT 13 SEWER SVC INV. 923.0 EACH BUILDING AREA: 1218 SQ.FT. LOT 13 AREA = 3719 SQ. FT. LOT 14 AREA = 2719 SQ. FT. LOT 15 AREA = 2741 SQ. FT. LOT 16 AREA = 5232 SQ. FT. LOTS 13 & 14 PROPOSED GARAGE FLOOR ELEV =936.9 PROPOSED TOP OF BLOCK ELEV.=937.2 PROPOSED BASEMENT FLOOR ELEV.=929.2 LOTS 15 & 16 PROPOSED GARAGE FLOOR ELEV =936.9 PROPOSED TOP OF BLOCK ELEV: 937.2 L_. m C u U_' i? (.f1. PROPERTY DESCRIPTION: LOTS 13 THRU 16, BLOCK 4, GREYHAWK 2ND ADDITION, CITY OF EAGAN, DAKOTA CO., MINNESOTA NOTE: ALL HOUSE DIMENSIONS ARE TO OUTSIDE FOUNDATION se000xO DENOTES SPIKE/NAIL ELEV ODOx DENOTES PROPOSED ELEVATION DENOTES PROPOSED DRAINAGE DIRECTION 000x0 DENOTES EXISTING ELEVATION 0 DENOTES SPIKE/NAIL SET • DENOTES FOUND IRON PIPE MONUMENT O DENOTES SERVICE LOCATION I HEREBY CERTIFY THAT THIS SURVEY WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT I AM A DULY REGISITERED LAND SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESOTA. DATE 1-08-04 42 s ,°?, '1 ?H ?'I' REVISED 1-23-04 LEROY H. CIAUt LAND SURVEYOR MINNESOTA LICENSE NO. 10795 Fn FNA1.4' Into 13-1661k4cert.S90 My- 1101+-UJ g 1" = 30' 08/26/2014 06:51 Les Jones Roofing,Inc. �AX�528817009 P.0031006 Use BLUE or Bt,ACK Ink � Fo►OHlca Use ` ^ � � j POrtnll#: � � C�ty of Ea�a� �, , � �; , � Pertnit Fee: t 3830 Pllot Knob Road Eagan MN 6G122 j Date Received: � Phone:(651)675-5676 � � �ax:(661)676-6694 � Siatl: i ��____�.-.��.��J 20�� RESIDENTIAL BUILDING P�aMIY ApP�ICATioN Date: 8/Z��L� siteAddress; I'72y-/7a8-I'1�?�173� TA�GON T.�2�i � unit#: ".;, :.,,°,; ;,;`;,;;,:. ;`'.�,�'...�.'.;':�.•.:.'. •:'�.: .. '`';'.'.�:.;::,',.,,=.";:,':";;;-:::: Name:� P,�vPEkT� CR�2E ,Phone_ G>SI- SSLI- q��f� '� .�,.✓.. j:J.:-•�.` .,..,,�'� • • + ;:� �:.R��i:t��nt/��;,;;:' ';�` ';�:Q ne�!"� addrese i city�z�p: Po [3Ux �r.�s' /.,�� '�o_ r�il�� /J�i✓ .s'�b7la . :'I':.'.�'1:, h�.. .,!�;�',��, — � ��`�:I�:;��;:�;�:: ;:;;��;I;'�: Appllcantis'. Owner � Contractor ,� .,,y,.., :;�,�e�.,,�aa.•,,j�.:•:; ,i' `.,r��:..!)'�..�.�.:'•��,is.� D� �+ . ��T �.6:�of,�l�Vor 'r Descrlptlon of work:/�iLt/JI �4N0 �GfM� J'l�iNb L��'T S/D� �a� Frr/�Gr�i�u— �yj�� ,��,' � °;,::;,,�. �. ,�,:, .�:,;:,;,., � =.;-�':•,; ,;:,.,;f;:.;;,:;;� Construction Coet: � . MuIU-Femlly Bullding:(Yes /No`� r�':: , ::�, :.r:° I�.,'� ;;.,;<j`+.`'� LE.S �UNES I� C�F'11uLT �N .i:` r��"` `;;.., ..,.. : Company- � r� L ContecE: M or�) �.�..\'�: .�..li.'�. � 1' ��,;%'�.��;��•.:.'�� s'�:1°.:�,I:Sti..,I;( p �!I `�;'.-��::';�.};'�'. ':::;.j?;,.. Address:_ 1 y� �� 51��"'r Clty: ��1UM.lN�rTbIJ ';`;� ','�.o�ii;tira��r�-; = ,; ,.,.;.r��:: ,'�", °'�``� `;,`�.'•"�;%;�:d�:�: State:�Zip: -� 2.0 Phone: Jr -��0 -Z�17 Emaii: Gl��-iSGt (A_�e�S�nnCS M'U�nq� GoM :'� ^;i;:� ,';;' �,`'` u,— '.' :.i,�,.p.j;�r,i,�'>'�°� 'v� �`y�.'`i..,,.�'!` , ;;�;';;;� Llcense#:��GO �ead Certlticate#: N.4T �03'12—J If the project is exempt from lead certificatlon, please explain why: (see Page 3 for additionel information) COMPLE1'E 7HIS AREA ONLY I�CONSTRUCTING A NEW BU�IdG In the last 12 months,has the Cify oi Eagan Issued a permlt for a slmllar plan baeed on a ma9ter plan? _Yes _No If yee,daEs and add►ess of master plen: Licensed Plumber: Phone: Mechenical Gontractor; Phone: � Sewar&Water Contractor. Phone: ��'1/,\,"r1'C r•J�,�sS.!��d'SUr p�y<;��f}.�1•1�: � �yy _r{�j�4:� :.1'�. .�:.: �w�� _ �,/w .!'. 'r N �,.a...,;� r- �r'�\�...,��♦�k�!J�.,, ..� .�,.��,�`,:�,,. .�� +��s'.r.� �� o.u�..s.''/"/�ib ��r�'•�''1��Id�.,.r"od�. -:e: �Jl :.1`fl�� `��oii:::''R`�`'�� .s�> Lr;�„ i. <;��r. _�1,�.;�,��..<,.l.rr�i T�"f:.,.�Tio�7,.�Q�!:�y F'd<.- .�r.I,r,�;';c�, �S.]., ,�.•y. �4�,...:; .�,., .i�.� �.�,...,.. ,0„, �� 1,,�r.�� =t��,��'fo►mlatiQnrhl :S'c ► ' `Ar::,.r,<--�� .,, ,n.: .., r;� ,�� Y , �:,,.� �.� r >�� _,,,,�.;�,. '`�" ,Yti �� ,�fl,$�1"&�s- n� u�,��,� �„ >�� b ��`►ti�� s ,,.,,..z� ��,.� � � ,.a..��-,; ., � :��:��,,;,.��,. �<, +� ..�.:. .. �f%i1�4�;. �,P., ..��L•,�;= �gF!^I�iG� 1`��;,a�a ,�fl��'S �,. ..,K!gtili��tm/t.;�,F�k.�C.y1�1�'.�,'Q",,;;. ;'}; .:,�..,:,.,..t. ,+'� .(.<�;•�i!•`lv� ,��, �,s;. ;�•�"' ;':��!!c,(%�alE�fl1��5��6' .C'tl!'t/�A��,�,a 1 �,, �L,i:,..":f�.`��. 'd \ � � � �, ° A.`� ,:'r-�r ��"�; ..i,x._ ,v:��:o f. .A„ e. �'��.G .�;1 �i��. CALL BEFORE YOU DIG. Call Gopher State One Call at(BG1}45d.0002 ipr prolectlon egalnet underqround uUlity demege. Cell 48 houre before you Intend to tllg to receive locetes of undarground utIllNee. wovw.aooha�atateonecall.ora I hereby aeknoWledpe Ihet thlB Informatlon Is comp101e flnd eCCUrate;lhaf Ihe wodc wlll be In conPortnance wilh the ordine�nee6 end codes oi the Clty of Eagen;thet I underetend this Is not a permil,but only an applicetlon far e parmit,and work Is nof to sla�t without e perm�l;lhal lhe work wlll be In accordenCe with the epproved plan in tha eaee of work which requirea s roview and approval o(plans. Exterlor work authorized by a building pormit 16sued in eccordanco with tho Mlnnasota Ststs Buliding Code mu6t be completed wlthtn 180 days of permlt 19suenca. x G'�f.�lS �/t/DE�SD/� Applicant's P�Inted Name A plicant'�Slgnature Pape 1 of s