4241 Valley Forge Pl
t.;,,~ CITY OF EAGAN 11584
' 3830 Pibt Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8700
BUILDING PERMIT Receipt #
To be used for SF DWG/GAR Est. Value $67,000 Date MARCH 10 19 86
Site Addresa 4241 VAL'LEY P'f)RGE Erect L~ Occupancy R3
Lot '15 Block 2 sec/Sub. NORTHVIEW MEAD5 Remodel 0 zoning Rl
Parcel No. Repair ? Type of Const t¦
Addition ? No. Stories
~ Name BURR OAIC SLDR$ INC nnove ? Length .38
W 1a.473 GOLDENROD Demolish ? Depth ¢6-
o Address Int Impr. ? 5q. FL
city C04N R,:1R~S 755--9513 Install ?
- a SAMF APProvab Fees
` o Name
°t Addresa Assessment Permit $ 334.00
U~ Ciry Phone Water 8 Sew. Surcharge 33. 50
Police Plan Review 167.00
,
~ W Name Fire SAC 575.00
Address Eng. Water Conn. 500. 00
< W City Phone Planner Water Meter 63.50
Council Road Unit 290.00
1 hereby acknowledge that I have read this application and state that the gldg. Off. 3 4 8~ Tr. PI. 156.00
iniormation is correct and agree to comply with all applicabie State of
Minnesota Statutes and City of Eagan Ordinances. APC Parks
Signature of Permittee 'X''~~" ~z- ' Var. Date COpleS Total ' • o0
INC
A Building Permit is issued to: BURR OAR BLDRS on the express condition that
all work shall be done in accordance with all applicable $Rate of Minnesota Statutes and City of Eagan Ordinances.
f
Building Oificial •'r
~ ?
. Parmft No. Pwmr1 Moldw Dat@ TNepho" N
~umbing f 7 $
H.VA.C. Y~z 4
Electric C Sl ~ e 8{~ -
ft""W
lespecllon Dab Itap. Comrtw,4
foodngs I
fooqnpe u
Founa.ebn ~6PG LC'• ~C
F..ming ~tl`6b w~,
RaoMp
Rouyh Plbp.
Rouyh Fity.
Insul.
Fheplaee
Final Mtq. 7 . ~ •
FMaI Plbp.
swy. Fw+.l 7- 1-jo E. A.
c.d. oec. ~ .
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Dock Frmq.
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P.. oisp.
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1,
PERMIT CITY OF EAGAN - FEE
/n MECHANICAL PERMIT
RECEIPT 454-8100 S/C ~
~ MINIMUM RESIDENTIAL FEE -=10.00 ;=.50 TOTAI f'~
DATE MINIMUM COMMERCIAL FEE - $20.00 + $.50
1. BJdg. Type: Res ~ Comrs2 Inst 2. New -X- Add Alter Repair
3. Total Bid Price 4. Job Address 4241- 112 r i~f~ l ~-j a i
-r.-
Lot ~Block -77 Sec ~ri
6. Contractor J J•~" 0 hl )_.1
(Name) ` ($treeq (Cfty) (Zip)
7. Contractor Phone 0 a1 -1
RESIDENTIAL HEATING - Ot -100,000 BTU's -$24.00. Each additional 50,000 BTU's or fraction -$6.00
RESIDENTIAL COOLING - 01-24,000 BTU's -$12.00. Each additional 6,000 BTU's or fractfon - $6.00
MODIFICATIONS/ALTERATIONS -$10A0 minimum fee ,
•
,L- HEATING VENTILATING HOT WATER STEAM AIR COND.
?;!:A'R PIPING PROCESSED PIPING AIR HAND. EQUIP RtFRIG.
RES. GAS PIPING OUTLETS - $1.50 TANKS: LP. UNDEHGROUND OTHER
COMM./IND. RATE -196 OF TOTAL BID PRICE PlU3 a.50 STATE SURCHARGE FOR EACH $1,000 OF FEE.
Si9ned: , l r' / - i for
Approved inspections: Date Rough Insp. Date Ffnal Insp.
!9:
PERMIT #
PLUMBIN(i PERMIT RECEIPT #
CITY OF EAGiAN
3830 PILOT KNOB ROAD, EAGAN, MN 55121 DATE: `
CONTRACT PIi1CE PHONE 454-8100
~ Site Addr q ~ LLc V OR E. gLpG. TYPE WORK DESCIiIPTION
Lot~ Block Sec/Sub ~
~ 0.
! New
Name EAt- L Mult Add-on
Address ti04Vf'v 91 & Comm. Repair
~ c Ciry 1~ Phone Other ~
A~ NO. FIXTURES TOTAL
Name ~Water Closet - $3.00 $
~ c Address Bath Tubs - $3.00
p- City Phone Lavatory - $3.00
Shower - $3.00
FEES =Kitchen Sink - $3.00
Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE -T1 jaudry Tray -$3.00
, MINIMiJM - RESIDENTIAL FEE -$10.00 Floor Drains - $1.50
MINIMUM - COMM/IND FEE - 20.~ I~Wat-e_r Heater -$1.50
STATE SURCHARGE PER PERMIT - .50 Whirlpool -$3.00
(ADD $.t0 S/C IF PERMIT PRICE GOES ~[_Gas Piping Outlets -$1.50
BEYONEf$1,000.00) Softener - $5.00
' Well - $10.00
~ - _ Private Disp. - $10.00
-:7-Rough Openings - $1.50
SIGNATURE OF PERMtTTEE FEE
STATE S/C:
FOFt CITY OF EAGAN GRAND TOTAL: ` S`
CITY OF EAGAN Remarks
Addition NORTHVIEW MEADOWS Lot 15 e1k 2 Parcel fu` .=~r6%,fialm
Owner Street 4241 VALLEY FORGE PLAa State EAGAN Mlri 55123
I
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 10
STREET RESTOR.
GRADING
1981 15 89 .79 20
S 6.92 20
5AN SEW TRUNK ~j 1981 118.65 8.48
SEWER LATERAL 1984 22 !b• 4 15
5 77 1 81 2. 28 1.46 ~1- is
WATERMAIN 1984 0.67 4. 71 15
WATER LATERAL j $j .24 -43 ee-IS
WATER AREA 7 19$1 138.4$ 6.92 20
3 1982 29.52 1.41 I-r" 20
STORM SEW TRK 1984 392.32 ,4L 33':'~'3 S
STORM SEW LAT
DRAINAGE 1984 33.97 3q 3:-" 10
CURB & GUTTER '
SIDEWALK
STREET LIGHT
WATEFi CONN.
BUILDING PER.
5AC
PAR K
i CIT1F OF EAGAN 1IVATER SERVICE PERMIT
' 3830 Pilot Knob Rosd ?40"
~ P Q,-Box 21199 PERMIT NO.:
Baqan, MN 55121 DATE: 5- 2-8b
'Zo^inD: No. of Unlfs: 1 I
pwrwr; 3urr Oal: :iuilJers ~
Addnm '
She Addron: 4241 Valle For ,e Tt.o J L15 B2 rlort v ew Mt ws
pluniber nav icI Sh
~Mw.. No.: 370/8/ qq oro.; 5 p
Slu: " • `N Ware 1 ~ t; 15.00pd
)
'I Ro,e.. No.: 6 3N ~ ~~twa~lt~E - ELBA ~,„n . _ pT
' ' ..N. ",.n.,, D
Miw. Chorgm~1. . U p P ~
' Total: 63• S0Dd meter l
' eY Dato Pbid: I
Deft I ~
~
~ of Irap.: ~ ~ ~.b I^Q's
,
~
CITY OF EAGAN SEVM SERVWE PERM
3830 Pilot Knob Rosd , P. O. B^x 21199 PERMIT NO.: ' •
Eapan, MN 55121 D/1TE: -
ZwWnp: No. of Units: -
OIY1Mf• x'f 22.k r:u:,...t' IS ~
AddltfS: - ~
' Site Addns: 4?:1 V812EV :.ls '?o: _;r~ i.:~.• ;
Plumber Ds•. t-I
1_ I0..
I yDM h Nm* wA& tw Cky of MM11 fOnxMCtiOn C1f0W: j`• -~juixl i
0 '0~woM. AGi10Y11? QlpOflf: - . • ~ r•.i~ NmWt FN:
, Surriwrpe:
By Misc. Chorpm
Daft of Irop.: Total:
' Irop.: QaN Pold.
I - .4; . w~~
CITY OF EAGAN (v ~ 11584
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8100
BUILDING PERMIT Receipt R
7o be used for SF DWG/GAR Est Value $ 67 ,000 pate MARCH 10 19 86
SiteAddress 4241 VALLEY FORGE Erect Occupancy R3
Lot 15 Block 2 Sec/Sub. NORTHVIEW MEADS Remodel ? zoning R1
Parcel No. Repair ? Type of Const. ~T
Addition ? No. Stories
m Name BURR OAK BLDRS INC Move ? Length 3R
z 11473 GOLDENROD Demolish ? Depth-~-_
3 Address Int.lmPr ? SQFt.
° CiN COON RAAa4S 755-9513 Install ?
o Name SAME Approvals Feee
Atltlress Assessment Permit 334.00
~ Ciry anone Water & Sew. Surcharge 33 . 50
~ Police Plan Review 167.00
ww Name Fire SAC $75.00
~i Address $Q0.QQ
Eng. Water Conn.
<w City Phone Planner WaterMeter 63.50
Council RoadUnit 290.00
Iherebyacknowledgethatlhavereadthisapplicationandst ethatthe gldg.off. 3/4/86 Tr.PI. 156.00
inlormation is correcl and agree to comply with all i State of
Minnesota Statutes and Cityql E Ordinance APC Parks
Var. Date Copies--$ '.0
Signature of Permitlee
BURR OAK DRS INC Total
A Building Permit is issued Io: on the express condition that
all work shall be done in accordance with all applicable te of Minnes ta Statut nd Ciry of Eagan Ordinances.
Butlding ONicial
~
. J
~
1985 BUILDING PERMIT APPLICATION - CITY OF EAGAN
NOTE: ALL CONTRACTORS NUST BE LICENSED MITH THE CITY OF EAGAN
C014IERCIAL SINGLE FAMILY DWELLINGS
INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS
& STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY
SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS
ENERGY CALCULATIONS
$2,000 LANDSCAPE BOND ~,7 ocd
To Be Used For: Lousp Valuation: N~--- Date: 3 O G
Site Address 4,~L41 i/a llr;e /'Orq~_ OFFICE USE ONLY /
Lot ~ Block Z Ereet k Occupancy L3
I Remodel Zoning fZ•/
Parcel/Sub /t/o^-)I-h dltW Repair _ Type of Const ~
D Addition 11 of Stories
Owner Q~rh Move ~ Length 38
/ Demolish Depth (v
Address y?~ Cr~Jj Int.Impr. _ Sq Ft
Install
C i t y/ Z ip Cod eCo o ~~`f ,//A. -
r•
Phone 7~5 ~S I3 s SqAPPROVALS FEES
Contractor Assessments Permit
Water/Sewer Surcharge 3 ,s-
Address Police ~ Plan Reviev I(a .
Fire SAC 575,
City/Zip Code Engr, Water Conn Soa
PlannerWater Meter -if
Phone Council Road Unit Z~'ip
Bldg Ofl%,Z'_ Treatment Pl /Slo.
Arch./Engr. APC Parks
Variance Copies
Address TOTAL
City/Zip Code
Phone
~
~
~
l 9-4 x ~ ~ 83SZ • ,
iz
l o Slo
2 Zx 2Z -
(o(p (28
North Oflles - 371•6088
V~YQSAN ggJS Highway No.65 N.E
l~plNlt/~INO
Mmnsspoha. Mmrwsou 55432
j ~ IJ <'rvil. Munn ,pu/ dl f"m~mnme•nio( 6qpinrrnng SOUt 12350 r'R~ er R dge B5 do
~ • londSurvri,ng 0 lunJYlonnmg . ,y,gJ IrumR Bumsa~le, Mnmesots55337
1[J
~ 11War6'4cafe o(Survey ~'or ltlorfhwiFw ,4SSoc.
~
0 b
v
N
n
O p- n O:
S89°6Z'//f~',-'"./ZO p , a .•;ot - ~
M
i'~'-'----~'~-------1---h-~ 30 ^rl
~~,P4/r/AG~I C uTi~iry EASt ENT ' a
trrr i ~~zs i
;y I ~ ~ " ' " N ' V O!
I ~
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~
~
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~
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I
1
~I
;
i
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I i%
. vr 15- , ~cocK 2 ~
-U0,Z7WV1c4v MEA~ow~,
0Q,ki.07-A CDUN7`Yl VAINESOTA ,
'n-oved for MortAview Associates as per Architectural Control Cammittee by
Date
i
, heraby tertify that lhis wrrey, plan or report ¦as preparad bY ¦e or ¦nder mr direct suporriaion
, .•d that Ito a dulr Neqistered Land Surveyor under the lws of he State ef 11i wta.
~ "~red this day of A^el . !9lby_~/~
~ Gary R. ICa,rria, Registered Land Surveyor
i Nino. qeg. No. 10943
~ . q n,ahn ~~ese.~ed
,
.-y---
~ • ' 37e-4e47 ~
' • - • . aadit 8 auoc9~bti tnc.
• t0~ ~ 4CMI nw. 1+W~. wMn. W 17
~tCl1IIKNIa1 QoaIQMm 01 OtlttL r • • . . I
E1LTMIOR SNVEI.OPS AVERAGB "0" COD4POTATIODI ~-QON.f. SPLIT !
owc~R - PLnta Eo. aV-W l, arJ
SITis' ADDRBSS DAT&
CONTRACTOR ~'JVZQ. riA1L BuiLv~as PHoNE
Determina vorldng square footage of eaoh
1. Total exposed wall area...... ~.M sq.ft, x,L
2. Total roof/ceiling area...:.. ~O 5 aq.ft. x•D~O= ~
- 3. Total floor/canto area....... sq.ft; z
Total ezposed xall area above floor 85% '
- 8• TOt.81 1T8u 1d'jT/3ON 82'98* *@I.., IC0.45
b. Total door area I-
c. Total aliding glsss door area................
d. Total fireplaca xall area -
0 • TOt.81 M911 fr8IR'jT1g 82'68 (average 1 0%) ~ ~ • ~ ,
Y• TOEd'1 I10Y. L191l 81'98 BDOVB fl00l* g. Total rSm 3oist area
Total ezposed foundation area _~777_
h. Total fourdation xindoa area
1. Total net foundetio» area above grade........
Determine "II"_value of each xall segment
a.L x "o^
b. ,
z "U" ,
O•== .O x •U"
d. 7C ^II^ -
9.~ E nQp o
n n
B•~ x ~IIn
1
h. s "II" _ oo~
. 1.~Z°U°~a ,
4. Totall =
If item f4 is the same ass or lesa than item #1, pou have met
the intent of SBC 6006(0)2.
~
~ .
i
. ~ ~
' ~ • Total exposed roof/oailing area =W-0 ^ ^ , ' , • ~
, ~n , . . , . . , ' . . ' . . :
Total stqlight area
k. Total roo!/ceiling framing area (aver. (.10@16"0/0),,.,,
~ . (.0625924"0/0)...~
1. Total net insulated roof/ceiling area..................
/
Detarmine "0" valne for eaoh roof/ceiling segment
i• x °n° = I~
k. ~ x "U"
1• S °U°' .07.0
5. Total
If total of +5 is the same as, or less than #2v you have met the '
. intent of SBC 6006(o)1.
Total exposed floorioant. area = -
m-. tOt.81 fl002'/C8f1t.• h'BRIiII area (average •10%) ~ •
A• Total net ipsul~.ed floor~CBIIt• 82'98~~~~~~~~~~~~~~~~~~~•
Determine "U" value for eaoh floor/cant. segment
M. x "tT' -
a, x "II" _
6. Total
If total of #6 is tha same as, or less than $9, you have met the -
intent of SBC 6006('0)3.
wLTERNATS BUIIDING ENVELOPS DESIGN
To utilize the total envelope aystem methodl the values established
by the sum of items #4, $5 ard #6 shall ng& be greater than the sum
of items f1g #2 and #3.
E
i. ~4b. 13 2. 2-7,17 3. = 5~ ~
o. Ilq~~$ 5. 21~Z1 6. = 135,°Sa
- !
Preparea by
nate c~-
. '
• `~q sTOn ~
int. Air. i . 068 14iRII 33s. {iAtd, Int. Air 668 ~
f'v/ S.R. 8 SIDINO 1/2" S.A.. .45 w/ 9R. i~'SIDIHO' 1 2• S.R.
~ / *45
St,d
25/32" Hild. 2.06 '
25/32" H11d. 2.06
_ 3lding 9lding ' ' . _ . . ( o7
- Ekt. Air .17 r sat. 41r , 1
Total "R"
. • . Total *$m e 25~0-s
.O
1/R a wUN 3 •OCIZ 1/g =~U•
• TBRO RIM Int. Air •.68 THRII CONC HI.OC$ Znt. Air -
.68
JOIS2
Opt. 3tyro.
- Opt• Ina.
i 1/2^ wood 1_.89
a. ~ Ert. Air
.17
25/320 B11d. 2.06 Opt. S.R.
Sltiitt6 ,(07 a,. Opt• 31d. '
Ekt. Air .17 e Total "R"
Opt. Briok
1/R ° "p*
Total "R" _
iA _nun _ ~
`
- - - - - -
THRD CLG. Int. Air .61
~o cnc. =nt. Air .61
MElIDER S.R.
IDISIJLATIODI 3.R.
Clg. llemb.
Ina.
I e•,
~i ~ 1 I ~ ,R ! - ~J~J• `b Still Air .61 _
still Air
Totnl "B" -
- ~ 1 7°O
- Total "R° _
' 1/R = °II" _ . OZO
1/
R="0"' 'Q~
60, 5a
2000 FIREPLACE PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD - 55122
651 681-4675
Date: rVI
Description of Work: ~ Construct new Sreplace IGas _Masonry _ Alterations to existing
_ Install gar insert onlv _ Install Pas line onlv
Other
Job address: ZT ~
Lot: I~ Block: ~ Subdivision/P.I.D.#: VUOI41~ k25
Applicant (c'vcle one only): Owner Contractor Permit Fee: E60.50
Name:_ yl1 Pbl l J K~ Phone a: ~OSI `~/•7S -.37~~
PROPERTY Last First
oVINER
Street Address: r
,
City La Q ~ Stau: Z4/' - Zip:
Company: /AVjir'('SAhone R« - &D /S
~ (area code)
FIREPLACE
INSTALLER Street Address. ~
ciri rbisc~r' l l e, state: Zip: .3.~
Company: PLone
(area code)
GAS LWE ~
INSTAI,LER Street Address:
v
City State: Zip:
, I hereby acknowledge that I have read this application and state that the information is coaect and agree to
. comply with all applicable State of Minnesota Statutes d City of an Ordinance
. ~
~
, S'~ ure
.
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 16 Fireplace
R'ORK TYPE
? 31 New O 33 Alterations ? 39 Gas Line ? 41 Wood Stove
? 32 Addition O 34 Repa'v O 40 Gaz lnsert
GENERAL INFORMATION
Census Code 434
SAC Code Ol
RE]VI.4RI{S
Chimney/flue must be inspected before concealing.
1
. ~i****##**************k****#****f*##
. *
- C I TY O F E A A f~ *~•rATTo m~°F~ ~ TIM oF ;
APPROVAL OF PEI2NIIT. ~
APPLICATION FOR PERMIT * >
~ nasrBMorr oF sEWM AND/ott MOM ;
,*t itlSrarramTONS WIL.L NCYf BE SaIID- ~
SEWER AND/OR WATER CONNECTION ~~M UNru PEPMIT HAS BEEN ;
» APPROVID. ;
rt rt ,
r ,
*,t*,r*~ r*t*~,ra,t*f x**,tw*:*a,tt,rx**,t~*,t*
f P ease Print)
1) PROPERTY ADDRESS: vLoK~Sc
LEGAL DESCRIPTION:
Lot Block Subdivision or Tax Parcel ID )
IF EXISTING SIRL'tMME, DATE OF ORIGINAL BIJILDING PERMIT ISSC'ANCE:
~ - Year)
PRFSENP 7ANING/PROPOSID L'SE: . I (Nbn
~ CG1'hTEl2CIAL/RETAZL/OFFICE ~ R-1 SI6IGLE FAMILY
r7 IPIDIISTRIAL Q R-2 DCPLEX (7+,o C'nits)
~ INSTI2L'TIONAL/GOV~ ~ R-3 TOWN-IOOSE (Three + Onits) ( Unitsj
~ R-4 APARTMENI'/CODIDOMINIOM ( •Units)
2) ~
NAME0_A<' S iJs Lcli ~a.-e,v~ Fo[ c ~o~
AwnxEss:_33 Sc~ / 9' 7 T!, fF~ c ~t l.ai .
czTY, srAxE, zzP:/7n.o 1e a rn~v . 3 s J a 3
PxoNE:3 - 3 ;2G C
3) i~: For City Use .
~ME'~ n Plumbers License:
_ ADDRESS :.7 -1,~°/ / r'/ '7 7L/f fF v c /L ,c(/ Active
i CITY, STATE, ZIP:_ p /j N FScpired
Not recorded
PHONE: 753 -3;~-L ( MASTER LICE[VVSE# 37 B 3/h
St~a -Initial
4) • .
NAME: /3 O!Z R 0 Q~C
_ AooxEss: y73 G Q/Jc .v ~2 a ~J
CITY, STATE, ZIP: 00 6 N
PHONE: •
5) ~ r• , i r: : a~ - o~ - o-~
~ CONNECPION TO CITY SEWII2 Ea CpNNECrZON TC] CITY WATEEt C] p7HER .
6) ~ r-• r ~ PLEASE HOLD APPROVFD PERMIT FOR PICK-UP BY ONE OF 11B9VE -
[1 PLFASE MAZL APPROVID PEF2MIT 10 1. 2. 3, 4, ABOVE ^ .
(Circle one)
7)
171
~~~M ~ ~ • r r~ ~ •
• ~r u ~ --i- r.r .na. ~ s ~ a• a• ~ u
. FOR CITY USE ONLY 'r PERMIT # ISSL'ED
Pd w/Bldg. Permit FEES:
$ $ /G- SG SEWER PERMZT (INCLODE SURCHARGE)
$ $ WATER PERMIT (INCLODE SC'RCHARGE)
$ ~ 3- yC-D $ WATER METER/COPPERHORN/OC'TSIDE READER
$ $ WATER TAP (INCLL'DE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ /S CZ ACCOL'NT DEPOSIT - WATER
$ S/n~l~Q $ WAC
$ $ SAC
$ $ TRUNK WATER ASSESSMEIVT
$ $ TRL'NK SEWER ASSESSMENT
$ $ LATERAL BENEFIT/TRC'NK SEWER
$ $ LATERAL BEN°FIT/TRC'NK WATER
$ • O O $ WATER TREATMENT PLANT SURCHARGE
, $ $ OTHER:
$ /,~2 $ J~• TOTAL
~2~)9Y
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PL'BLIC RIGHT OF WAY?
F--j YES IF YES, THEN A"PERMZT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSUED BY THE ENGINEERI[VG
~ NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
i
APPROVED BY:
TITLE:
DATE:
- - - - - - - - - - - - - - - - -
I For Office Use I
Cit o
f Ea au
R :
3830 Pilot Kn
ob Road
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I- I
Fax: (651) 675-5694 Staff:T
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ,'kg u$F /Cl 7o0ef Site Address: 4W11 (/14 L L is y fop-6-6, PL /k l:
Tenant: Suite
RESIDENT / OWNER Name: _JO"-J /LLGI Va, to y k Phone:
Address/ City /Zip: % -1 I V ,L L E Y P096-6 Applicant is: Owner Contractor
TYPE OF WORK Description of work: /16 /l00 lF
Construction Cost: 72Cxx2 Multi-Family Building: (Yes / No
CONTRACTOR Name: 1-10' r- Co h. Sdre,4' d License 2O G 2 84 ? Z.
Address: 8/,~ L-~/vr, C l'L EIK C//ZC G.
Ce-
city: C /7~f~?~(P LJ1 " State: A N Zip: S1-31 C
Phone:.(;/ Z 19O 7 Contact Person: 10 o 1_a I-. (-a
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
('l submission type) • 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 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.
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.
x AtDet--IJ C{D; C r n4 I e x _9!~
Applicant's Printed Name Applicant's S1i atare°~ Page 1 of 3
4111k"
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use (�
Permit #:
oD
Permit Fee: 66 -
Date Received:
Staff:
INFLOW ,YNFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Date: 2 Site Address:
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Tenant: 3; ; G GCi e I t%0-7 //(4/k.
Name:
Suite #:
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Address / City / Zip:
Name: C.& V b n ✓�e S '�I i1"GLi� ��-� awl s~ L LS -Cense #: '206 3 951515—
Address:
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State: /1/N Zip: 557 2 3
Contact: eCiYM'n.e�'�
Phone: iD -s ( 2 Z —
Email:
PLUMBING (Within the building envelope)
Sump Pump Repair
X Other: t2eo(,1ve.-'4- SJ44 f c I(SGLila
Description of work:
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SEWER & WATER (Outside the building envelope)
Repair
C Other:
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FEES
$60.00 / Each (includes $5.00 State Surcharge)
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TOTAL FEE $
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*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. CaII Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call
48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a
permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans.
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Applicant's Printed Name
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Applicant's Signature
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OFFICE.1
Required Inspection