4282 Valley Forge Pl
. . cirr oF FAaAN 8572
-•37lS Pila~ Kweb Rwa bgen, MN 551=1
PHONEi 454-8100
sU1LDING PERMIT Rece+pt 7
~
~ SF DWG/GAR $67,~)OQn October 12 A3
i Te M wnd Mr Est. Value Date 19
Si~ Ad2~u g ey o~Jorthview Meadowe Erect Occuponq R-3
LOt 61otk $eC/Sub. Alter Q Zoninp
Pa~~ # Repoir ? Fire Zone
Enlorpe ? Type of Const.
99 Nan" Jeff & riary Goblirach Mova ? * Srories
~ Addron 1501 E. Burnsville Pkwy. pQmoush ? Length 50
-
G tiurnsville p~,o,,,~ 890-7030 Grode ? Depth Sq. Ft.
Nome .ran a s Deve opment Co. Approvals F...
Addrets 7623 Uppe-r 167th Assessment Permit
v~ Cit Lakeville p~b 432-6561 Woter 3 5ew. Surchorpe 33. SO
Poliu Plon check 167.00
G W Nome Fin SI~C 595 . UO
i~ /lddress Erq. Water Conn. 0. 00 .
<W Ci pFwrw Plonner Woter Metor
Countil RoBd Unit 50. 0
I hercby ocknowledfle thot I how read this opplicotion ond state thot gidg, pff,
fhe intormafion is correct and o9ree to comply with oll opplicuble . 50
Stote of Minnesoto Stotutes and Ciry of Eoflon Ordinonces. Total
Slpnoture of Pertnittee t Co.
A Buildiny Permlt is issued to: on the express conditlon thni
oll worfc sholl be done in occordonce wtth all opplicable State of Minnesoto Stotutes.ond Gry of Eaqan Ordinances.
~ Buildinp Offlciol ` `
,
PNmit No. Vwmit Holder Misc. Pe?mit No. Holder
Plumbinp 38-72s' A-,cDdvta1d.~ a
H.v.aa y,0 7-l w~ ~~l b2`{-~"3
rwu
w
Dap.
Sevver
Elecate ~1L`~l ~(A.°~f'~~-C• I(`~~i-3
Impection W" Intp• Other
Footirys -
~
Foundation
Fnminq ~
Roug+ PlbY.
Rouph HVA ~ 1 8
Insulatlon
Final Plba id
Final HVAC
Final
Waur Dheribe Loeation: Y
IMdI
Smtr - ' ,
Pr. DMP• !
CITY OF EAGAN Remarks
Additfon NORTHVIEW MEADOWS Lot 21 Rlk 4 Parcel
owner Street 4282 VALLEY FORGE PLACB State EAGAN MN 55123
Improvement Date Amount Annual Years Paymant Receipt Date
STREET SURF. 1984 76.75 7.68 10 6.08 A013314 12-15-83
STREET RESTOR.
GRADING
1 1981 15.89 .79 20 12.73 A013312 12-15-83
SANSEWTRUNK 5,75 1$ 138.48 6.92 20 110.80 of to
SEWERLATERAL 22 18.35 15 256.88 A013314 "
1 1981 22.28 1.11 20 16.36 A013312 "
WATERMAIN y7 1984 70.67 4.71 15 65.96 A013314 "
WATERI.ATERAL 1981 M392.32 .93 ZQ 13.69 A013312
if
WATER AREA -~j7 92 20
110.80
'5-73 1982 1.48 20 23.64 STORMSEW TRK $ 1984 39.23 10 313.86 A013314 STORM SEW LAT
DRATNAGE i 3.40 10 30.58 A013314 12-15-83 -1284 CURB & GUTTER '
SIQEWALK
STREET LIGHT
WATER CONN. 4 q
BUILDING PER. 8572
1t n
SAC 525.00
' PARK
~
~ INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number.
Eagan, Minnesota 55122-1897 Date Issued: ~ ! ! ~
(612) 681-4675
SITE ADDRESS• f APPLICANT•
' 1 ilf ; 11 t~l-ut h '
rtil.l EY F'nrRr rl t 1:;s1 E1 N vi i rA I
PERMIT SUBTYPE: TYPE OF WORK:
D • DA
I1I+if
~ J
L- - - - -
PermR No. PNmk Holdw DaM TNkphant #
ELECTRIC
PLUMBIN(3
HVAC
insp.onon n.e. In.p. comm.na
FOOTINOS
FOUND
FFlAMIN(i
ROOFING
ROUGH
PLUMBINd
PLB(3
AIR TEST
ROUGH I
HEATING ~
GAS SVC
TEST
I
INSUL
GYP BOARD
FlREPL/1CE
FIREPLACE
AIFi TEST
FINAL PLB(3
FlNAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSAAT FINAL
DECK FTG
DECK FINAL
' CiTY OF EAGAN SEWER SERVICE PERMIT y 1
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: ~303 ~
Eagan, MN 5512 p^TE; , 12-2-83 ~
Zoninp: Ri ~
No. of Units; 1
I Own.r ----&rMd Oaks nev ;
I Addrcss: ~
sice Addmss: _ 282 Yall y ForQe L21 Bd `7orthii w~.{eadpKs i
; Plumber: McDou,ald' o Plb ;
' 1Q-12-o3 39217 100.00 pd ~slme bowe* wNb Nw Cihr oi y~n Connoctton Qhoqs; Q?"
o.~le.eo... ~ nn I-0___,_ I
Ikaount DepoWt; ~
P.m,it F«: - 10.00 gd ~
su?charge: .50 nd ~
By Misc. Chorpy;
Date of Irup.: Totol:
Insp.: Date Paid: ~
_ - - - - • - ~
rITY OF EAGAN I
3830 Pilot Knob Road WATER SERVICE PERMfT ~ I
P. O. Box 21199 PERMIT NO.: St.14 ~
Eagan, MN 55121 DATE: 12-2-$3 ' I
zoninp: Gran i pak~eY I
I
Owner: No. of Units: I
~
Addrow- - a A7 Vs7 1 e~_ t
1!4 Nor~hvi.,.. Mesdev~ ~ I
. Site Addreu, Mc!
~
Plumber: ~ I
Meter No.: I
51ze: C«+necr+on Chc.pe: .~Q 00 pd
' Reader No.: Acoounf Deposit: I
Permit Fee: 10. QO d j
I ~sme re amolp wlele tiN Clfp «B"sn Surcfiarpa: . SO vd
~"now Mlsc. Cho
; "gn: 6_Qpd ~ae er
ey Tafal:
; Dote Poid: ~
Date of Insp.:
Insp.:
- - - - - - - - -
CITY OF EAGAN N~ 8572
3793 Pllot Knob Road Eegan, MN 55121
PHONEs 454-8100
BUILDING PERMIT ReceiPt #
To be u"d for SF DWG/GAR Est. Volue $67,000m Date October 12 19 83-
Site Address 4282 Valley Forge R-3
Erect ~ Occuponcy
Lot 21 Block 4 Sec/Sub. NoYthvl.eW Meadows qlter ? Zoning R-1
Parcel # Repoir ? Fire Zone NA '
Enlorge ? Type of Const. V
ac Name Jeff & Marv Goblirsch Move ? # Stories
Z Address 1501 E. Burnsville Pkwy. Demolish ? Length 50
9 Ci Burn~vi l 1 e phone 890-7040 Gmde ? Depth 48 Sq. Ft.-
o Name Grand Oaks Development Co. Avvro.als Feos
iii~ Address 7623 UppeT' 167th Assessment Permit 334.00
u
1' Cit LdIceV1110 Vhone 432-6561 Water 8 Sew. Surcharge 33.50
Police Plon check 167.00
~W Name Fire SAC 525.00
Address Enp. Water Conn. *50. 00
iW Ci Phorx Planner WaterMeter 60.00
Countil Road Unit 250.00
1 hereby acknowledge that I hove read this application ond stote that Bldg, Off.
the inbrmotion is correct and agree to comply wrth all upplicable $1819.50
State of Minnesoto Sfotutes and City of Eagan Ordinances. APC Total
Sipnofure of Permittee
Gran Oaks Development Co.
A Building Permil is issued fo: on fhe express condifion Ihni
oll work sholl be done in atcordonce with all applimble State of ' newta Statu ond City of Eagon Ordinances.
Building Official ~-P-Q
.L-
d^~Y :9' ::a~ a^' -vt~ v' -xr ~ 1-°' ' a° 1 ~ ' ~ ?
~,;•~y~-~, 4 "~~,r ~rp"
C~rr#ifirttte uf (19rrupttnrlj
Citp of Cagan
~ aP}1F1TI111PI1I Df B1it1D[Y[1J -N8}1PtltilYi
'
Tbit CMifitatt ittutJ Purtuant ro tbe rrquiremenu of Sraiars 306 of the Unr(orm Building Ir
Coda tat'ng Jbat at tix timt af ifsuana rbir rtruaurr war in romPlianre with the variout
~dinoruet of t!x City ngulotmg building ronn+rution or atr. For the fa!louang:
SF DWG/GAR 9~d~hme~No 8572
A-L;, .f omv~'roa R3 ryP,~ V Fnz NA z„wswwn R1
Grand Oaks Dev. 7623 Upper 167th,Lakeville
o.>,aamaw
~~~~t! MM 4282 Vallev For eL21,B4,Northview Meadows
I
t ~~l
By
December 9, 1983
Xm,vs,$~ - - '~.`~F~' • ` . . , w~'
. A,~r-----------
i
h
. l ~ CI'1'l' OP !_~~r;~1D1)IRQ'Cj~~ltr.3e 2:;ets C~E p]ans,
• ' l~'lo~'~.~ ~ ~ ' c p7c~n ~.•%r~l~~vat.ions &
L'UTI,I~T^v; PI'RALC'P 7+f'YI,I'_A'ff~P~ 1,et Of e:ir~r.c{; calailation5.
C ri 'PO t 3c Used Por lizt.i.on Dntc
SiCe lu~cl-i=ss: ---prL'1C13 USi
J~~ s
L,~C B]oc::c y_ Sec:./Suh- .r.~ ~
~t. ittcupinc?,
^arcc•1 Y. idtor i;on incj _<I-~'3
I'irc 'l,or.c
' ~q '~i
Gmcr: ~ ~~~~c qf Cot. -
`tories
--~50._~
Li.t,;/zip Ccx7c: L^«~ Gradc n,•pGh _-_~/~---it.
c•n<~:,~ e: _~9b-7~o
A:PT~i,UVAi S' -r•~r:r•s
Contractor: Pci:llut
Surchn:-( c Ss-
r~L3r.es_.: _70~3 P) L.icc Pl.;ui Chuck~~~> ~
Cit_y/'/,i.p r'.'tr.o $,C `cS--
.r ~ ..b-
~r lda tCL (:oM. f Plannrr ldatcr ••!-•~-v~
Counc.i.]. - Ikoc_i UniL
70dress: MC
Cityj'l,ip Coc'.e: ~
Phone tf : - 'IC71'.~I, ~C ~ g
~
,
~
iry~.~.w~-•~.:aa;e - - - - _
ri
CnLcT
22. Area of [Ciling unAer vented iool o: L.
unconnitioncrlsn;ic!' . ~
10 or sq. It II 0 liem 23 N A)
J u p
73 7hicknc,50f In5uinti0n . . .
(0. J. 6. 72 or 16" ol 6uurglas or R valu~:s
Ex~ A30)
24 AreaolllOOr50'+Cr UnGO1HhItunCdSp.ICC
C~ C n
(0 0! $Q. ? 11 0 lIC19 ZJ IJ /1.)
25 Thickness olin5ula!ion .
(0. 3 or G' lihcrqlas. or Ft vaWesl
26 Frea ol Ilaors over open or vrnle(I space ~u
o,jaro,e
~
(o w sa n ii o n~:m ai N n.)
27 ThiCkne55of in5Walion
10. 3 or fi" ol 11hcryla5 or R vatues)
20 Basemenlr.rca ~ .
(0 or;q.ll 11llem 151e Oekip thle enlry._) I I ~
- ~ °
25 To;aIhC01cC ared
ISr, II )
. a C~ u
30 Penmcleroltonc,eIcslTp _
(0 0: bnear Ii ) (11 0?em 31 N.A.)
k ~ / J N
31 lhic'.nr;sof slahinsula11011..... .
10. 1 Or 2")
37 Desurd summnr md00: lemperolu.e --1 ay
{Valu.'_ brtween I antl 6 fnclusilc
35 UesrtCtlwMlrrinsitlelCmpelatura
3•: Duf,l I?)cnlion
(Al allic. l3A Uasr,tnenl. Sl ' slah..
Cf7 ° r.rav,l snar.., CO = Contltlioned
spaci;) (If BA SL, or CO. Ilr.rn 15 N A)
n p P
35 1 hiCFnC55Ufinsulabon . .
10. I O, 2" lJsr. 2!or 1"' :ig-tl ~
..REVEATOATA? . ~ I~~ rta pa
YOr N ~
"CONRECTIONS?" .
II Ih11ic :u.: 110 Cuin:CliOn} rcqui.ud rirt0i : n
II Ih.:rC tI:u CU~,rr_hOnS In Ih, d.l1:l I-nhli
r,uf-~siron numb,:r. " Ihc nc:a tlnid. :inU :n: q Mn
F.Y; ISPWFn
~u-1 uu ~ kn
II n0 tUr;hw COnCCpons. i`uIVi Only ~
COOLING B.T U H. / ~ 7 '
EOUALS~~ -f r/AT Y G °r ~ o.i.u H._l, AT ~ C)"F O.T.U.H _AT °F
\ HEATING B.T.U.N.
' • EOUALS C14AT - 'J -F O.T.U.N. ~J i ~~•JAT_/ F 13.T.U.H. AT °F
"RF.PEATTHEANSWtqS^(YOl t:)
C~ ~n O
"SAVE YOURDaTA?"
Y or tJ. o, YRve n01 Save yl~,-r tlata an0 1;0'5~
10 begmning (Ot ncrv Andlp1ds, or 4H-11 rvill
noi ST%C dala bul 90C5 bBLk lU hr9immuq Iqi ~
ne, Fnalysis ~
JOBNUMBEN . . . . .
II vou v.nnt to sa•:q vou, t101a CI.IC dsvcns
.lOh tJUlnllq,
"STRUCTURE GMANGE57" .
II IhWe mC n0 Ch]nqe5 n:QnuCf1 Cnln,r pn .
IIlhr~u:u~.ch:~nt:~•~~o1OeCdle Oniri
f111~:5:1711ltI1fl~~~:f Illi'fln..j(lillil.illlfl~~~~ h Ltl I~ bv ~
25GP70-^ f~ C~ O
II no Iurthcf ehnnrns, en;c: ONy L
OPf'0171UNIlY HOtAE ?-;9 rnnicn ~n U S n v~ 836-039
`S.~ _ . _ _ , _ _ ~
C/~ ~ ~-d,~~ h~ .5 N I C~ ?J G' L C~
EL E 1 Summcrar,sign(lr.qrce5 ....[~I C' ~ 17, `
(90.95. 100, 105. 1 10or 1 15)
III 90. 105. 110 or 1 15. ID_m,2 NA 1 ----1u~
2 Dadyfan3e(0°-35°)
7 \Vmleraesiqnde9n_Y
(PrnCl'UC o mmos numh^_: with h1)..
A NurnbCr ol viinO~.H fuines .
Ii.2or3 II ^ 0:9. RemSNA). ~
i-~ S-S'nr^..inUOwSl(YOtFJ)
6 VlintlOV:s wPnihCr5lrfppCOl (YOf NI
7, FOw wm0ow arr.as slarting wilh N Ui
NEoneniation (1i
(E+ Na25u30^?On25ne.~h:;~a pe, Sitlu
s99.Q :1)
71 N Or N[
72 E or $E
73 Sor5tY
L~
74 wo, nlw
B ShanetlwinAOw.rea .
(0 0f s9 1; Entr,r 0 rt nol appliCablc
Ma. 9?9 sn tt i
. - .e
9 OCOrdrea
(ooIsn u;da. 9995(1 n 110. ~
Ilcros 10 L l1 N A 1
t0 DoorweathcrsirippcA7iYOrt4) L V 41 C~ ~
!_J
tt Stormhoors>(YorN) . ~l ak / p" nP
12 iu51510r'i Pfnmete. ~ • % n ° ~
13 SeCOnUS:OrypenmetCr
14 Tluchnessolwailmsulation........ .
(4 24 oi 6" liberglas ENer FdA loi
masonry. H v.lue,t, enter R. Ihr.n vaAnr
E. F119)
15 E3asemeni Penmcir.r . . . . Z=- ~
(0or tinear it I10.licros 16. 17 8 26 tl.a.)
16 Basement nr.ated? IYOi NJ
III N. IICm 17 N A ~ . .
17 Perrenlaboic9raUe(E~ 5%=5) U U J ° r p
ie Area ol rool wnn e.nosca nc,ms o,
$tUd10CC1l1l1g
(o or sq : f I I I ero. Items ts, 2o R T N n ~
M
19 WoDUO1),bcr. ~
(':V for woo4Florhbc, IIP7,Item20
It F. IIem 21 I! A)
20 ihickncs50tliDci
11 5. 2 or J" or R values)
21. InsulaliOn
` (V. Id or R values. V assumes 1 5"1
1
Alp: i
SURVEYOR'S CERTIFICATE ' GRAND OAKS DEVELOPMENT CONPANY
\ / .
/1 -
1 i
~ M1~
5 'Y 8B0QO/OO/Iw
V(?O~•M~ s~o ' --2az~///.qg \ lo r,
0~, ~ ~ • n
(V /0ry 0,_~
5
~26>
1 ~s> Oy~y
h\ Q
O O O~ rh ' 2 Oi
~ • 9 ~M ~D Qe ~ ~ a• ~o: ~ I O i
seo ` \a\\
\ ~ 2~op W I ~ \ J
N ~
\LOT
CS
5
19
a
~
~
~
,..t._ DENOTES PROPOSED SURFACE DRAINAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INCH = 30 FEET
• DENOTES IRON MONUMENT FOUND PROPOSED GARA6E FLOOR = FEET
X000.0 DENOTES EXISTING ELEVATION °ROPOSED LOWEST FLOOR = 5• o FEET
(000.0) DENOTES PROPOSED ELEVATInN PROPOSED TOP OF BLOCK =°-7~.5 FEET
I HEREBY CERTIFY TO GRAND OAKS DEVELOPMENT CODIPANY THAT THIS IS A TRUE AND CORRECT
REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF:
Lot 21, Block 4, NORTHVIEb! MEADOWS, according to the recorded plat thereof,
Dakota County, Piinnesota.
(THIS LEGAL DESCRIPTION WILL BE VALID UPON THE FILING OF THE PLAT, NORTHVIEW MEADOWS.)
AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, TNEREON, AND ALL VISIBLE ENCROACHMENTS,
IF ANY, FROM OR 0N SAID LAtdD. AS SUP,VEYED BY NE THIS 19TH DAY OF SEPTEMBER,1983.
SIGNED: J41ES~. ILL, INC.
BY:
HAROLD C. PETERSON, LAND SURVEYOR
DSINNESOTA LICENSE N0. 12294
PROJECT NO. BOOK / PAGE JpMES R. HILL, INC.
83386
Planners / Engineers / Surveyors
FILE NO. 8200 Humboldt Avsnue South '
FOLDER Bbomington, Mn, 55431 812-ee4-3029
CITY OF EAGAN PERMIT mo"T.9551
3830 Pilot Knob Road PERMIT TYPE: B u i L D i N G
Eagan, Minnesota 55122-1897 Permit Number: 026991
(612) 681-4675 Date Issued: 01 / 2 6/ 9 6
SITE ADDRESS:
4282 VALLEY FORGE PL
LOT: 21 BLOCK: 4
NORTHVIEW MEADOWS
P.I.N.: 10-52100-210-04
DESCRIPTION:
(SIDING/STORM DOOR)
B.uildi g--permit Type~ SF (MISC.)
;Building Wo.r._k Type REPAIR
,Census Code ~1 . 434 ALT. RESIDENTIAL
./f
.~A60~
Utr;-~~, ~.71 REMARKS:
FEE SUMMARY: .
VALUATION $9,000
Base Fee $149.75
Surcharge $4.50
Total Fee $154.25
CONTRACTOR: - Applicant - sT. Lzc OWNER:
PANELCRAFT OF MN INC 17216628 0002179 GOBLIRSCH MARY
3118 SNELLING AVE S 4282 VALLEY FOR6E PL
MINNEAPOLIS MN 55406 EAGAN MN 55123
(612) 721-6628 i (612)954-8734
Z hereby acknowledge that I have read this applzaation and state that the
information is correct and agree toifiaomply with all applicable State of Mn.
~ Statutes and City of Eagan Ord3nancgs. ~
~~{1Q~ ~
11
APPLICANTlPERMITEESIGNATUFE ' ISSUEDB%S TUR
[:ITY c)r~ r-..AGAM
ILQQI ~41:~~1 !'ll_(:i}' lt6s()Ct RI.-1 - .ri5122
V!s,,; ~3.011_.l11P,I1, ['rRA'll T A;'PI.,.IC;AT'IQN (FtESIDENTIAL)
U 1-4G7 51
; I^r, rn;lI~n I-:rn1~ircrnan!s R?m~del/$Qpair PQUIr_flf119p15
- , .,i..-., ...r•~; : 2 copies of plan
. r.... f p'..n° -in ,2 nin..d rnn. 't.,Ij~inr ..r.~ . 2 sifc eunoec~ (e.tv.rior asrrytion, R ri^_ck;)
• ,.-~.v ..h'~:n•: • 1 eneray czlculahons iar h^Mr,d ad4ilious
i( tni a4r.f i1i/93
~r,.,i Yra 11;n
GQiFSlitUGTIUPdCOST.,~ ~J 1"J•CO
I 1< <r,l o, VVORI;:._~e~-_r_--..o_EF _r,-~ or re piQc. ~
V_G~:~_S2~_...+:Qr~4~-5.~~ ~
I_01' F31LOCI: Li SU[3U.11P.I.D. I1:.__Ll~~~~y0ia~ 111 fG`17'JJV
rr~4if'[.~rY PJan~e:__~l.I.LSC~._ M Q.~ Phone Ik. `154' 8734
; treel Address:~= UQI~ -l-Or!3Q, plQC:e,
Cily: GOCAa-n State: m2 Zip: SS/ 23
corvTRncTOR Company: 0.rle- I C.r-DI--F+ bF M 11I • Phone -~~2-g
Street Address: 3119 tiS(12//ihq ~S. License 000a/ _79
City: M I Yl n2CLP~~ ~ 5 State: P n Zip: SS~O~
,nRCFnTFCTr Company: Phone
FNGINEER
Name: Registration #StrEB! Addrass
Gity: State: Zip:
Sewer & water licensed plumber: Penalty applies when address change and lut
change are requested once permit is issued.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all
applic:able State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
CertiSaates of Survey Received _ Yes _ Mo
Tree Prc,ervation Plan Received Yes No
Q('FICE USE ONLY
-
w. •
RUILDING PERMIT lYPE i.1 01 Foundation ? 06 Duplex o 11 Apt./Lodging ? 16 Basement Finish
x 02 SF Qwelling' 0 07 4-plex ? 12 Multi.Repair/Rem. ? 17 Swim Pool
? 03 5F Addition o 08 8-plex ?13 Garage/Accessory ? 20 Public Facility
ri 04 SF Porcfi ? 09 12-plex ? 14 Fireplace o 21 Miscellaneous
? 05 5F Misc. ? 10 _-plex ? 15 Deck
+INORK TYPC
0 31 New ? 33 Alterations ? 36 Move
? 32 Addition 34 Repair o 37 Demolition •
GrNERAL fNFORMATION
Const. (Actual) Basement sq. ft. MC/WS System
(Allowable) Main level sq. ft. City Water
U6C Occupancy sq. ft. Fire Sprinklered
Zoning sq. ft. PRV
# of Stories sq. ft. Booster Pump
Length sq. ft. Census Code.
Uepth Footprint sq. ft. SAC Code
Census Bldg
Census Unit
APPROV/1LS
Planniny Building Engineering Variance
Permit Fee Valualion: $ 0 3 / 9 OD
Si.irch,arye
Flan Review
I_icensr
MCNVS SAC
City SAC
1A':;ai
.lj:,tm nnota, ------ACCi. f 1enOCil l .
!,P:ff)l(t
^nIJ ;ir,r.h2rae
rfn:1lf'n4:n1
~i,•~arf Llilll
PM! IJnd.
r:iil;; Ili.rl.
~)li1F,[ •
S/`,C Units ~.^T~
i ~6f<#?#iieeS/se i
City of ~apn j Permitlt ~ Q-/? I
I
I ~ j
3830 Pilot Knob Road I Permit Fee:_ ~
'Zi
Eagan MN 55122 ~ Date Received: EL! ~
Phone: (651) 675-5675
i i
Fax: (651) 675-5694 I Stan: ~
I----------------I
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: ~~~BQ VR1 bQ u t p(q L~
Tenant:
Suite
RESIDENT/OWNER Name: "1Q('C.t 01ch1 I f~Ch Phone: (pSl' T5 `t-873V
Address / City / Zip:
Applicant is: _ Owner X Contractor
TYPE OF WORK Description of work:
Construction Cost: ~ o[ / / • ~ Multi-Family Building: (Yes No V
CONTRACTOR Name: License#: ~~~~5~-I[7-I
Address:5C0'41 ~f'(y)CX-iCXA TTVP IV
, City: -SrG I IW~"* e,r State: VN_Zip: S~'J080
Phone: GSI ' 9?S1-"I3,~10 Contact Person: Lic~en
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code • Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
Category Submittetl Su6mifled
(4 su6mission type) • Energy Envelope Calculations Submitted
In the last 72 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 ptan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE:.Plansand suppoiitng:documents that ynu subm~t are consrdered tobe° ubNe rnfor`matrod `Porhdns.ol',
P~
the rriformatron may~6e classil~real astiian piibl c:~# you provrqfe specNia reasads~thaf Wotr~/d p~rmit the City fo
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I hereby acknowledge that this mformation is complete antl accurale; Ihat the work will be in conformance with the ordinances and codes of the City oi
Eagan; that I understand Ihis is not a permi[, but onty an application for a permit, and work is not to start without a permit; that the work wiil be in
accordance with the approved plan m the case of work which requires a review and approval of pl~r~ .
x (~~chQl~e~'lo~~an / .'ic.~
Applicant's Printed Name Appiicant' Signature
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