4287 Valley Forge Pl
cirr oF EAGAN S 5
3830 Pilot Knob Road, P.O. Box 21•199, Espan, MN 55121
PHONE: 4548100
eUiLDING ~ERMIT R~ipt ~
To M wW fer Ar. Esf. Value Date . 19
Sita l:ddreu Erect 0 Occupsncv I
Ramodsl ? Zoning
Lot Block Sec/Sub. , ' - . , 1 ~ '
Repsir ? Type of Const.
Prcel No. Entarqe ? No. Stories
Move ? Lenyth
Name r, . psmoHsh ? Depth
I Addresa 173R~ Grade ? Sq. Ft.
cicY JORD71M Phone 492-6646 in:t.ll ?
SAM! 435-3323 App.oveM F«.
Name
Addreu Assessment Pertnit •
~
City Phone Woter & Sew. Surcho?p 27.50
Polite P1sn Review 149•00
~W Name Hl?LIoQQIa'P •A8aOC Fin 5/?C 525.00
iz Add-- goo '1'E OFpICE PL11Z11 Em. Water Conn. 500 . 00
"
~ Z. City Phone Plonner Water Mtter 63.00
Council Rood Unit 280.00
1 hereby xknowledp thot 1 how rood this cpplicotion and stote Hwt Bldy. Off. 3/20/85 •P• 132.00
tM informction Is correct ond ogree fo comply wirh oll opplicoble
A~ Total ? •
State of MinnesoM Statutts end City of Ea9on Ordi?anps.
Var. Date
Sipnoturo of Pem+itbt , A Bulldinp Permif Is issutd to: KEYLAND 8Q!!ZS ~~expron cpdition thai
all work sholt be done In oooordonte with cll, opplicablo State of Mlnnesofa Statutat ond Uty of Eopon O?dinontes.
9uildirq Off{ciol ,
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Reaeipt PLUMBING PERMIT Permit No. _
CITY OF EAGAN FN
~ fill in numbered 4wcea .S/C
Type or Prini /egidy TOIL .
1. Date 5^ Z~` y y 2. Irutallation Cost
YL ;-i¢!c ~"Jr e
3. Job Address ~ Lot /~Blk. ~ Tract /t-l -,'l+ e~- ~.r,~
4. Owner
5. Contrector_ ~ ~%E' L hA/Cp ,L Phone
6. Address ~7C 9".' 7. citv C C state - zip
8. Building Type: Residential ~ Commercial ? Institutional ?
9. Work Description: New Add ? Alter 0 Repair O
10. Descxibe
11. No, Fixtures No. Fixtures
? Water Closet Cesspool/Drainfield
/ Bath tubs Septic Tank
Lavatory Softner
~ Shower Well
~ Kitchen Sink
Urinal/Bidet Other
~ Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and 1 agree to
comply with aU ordinances and codes go)jerning this type of work.
i
Si gned
for
Rough F insl
Inspections: Date Insp. Oete Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITY OF EAGAN Remarks
nddition _ NORTHVIEW MEADOWS Lot 18 sik 4 Parcel WAR110-180-04
Qwner Street 4287 VALLEY FORGE pIACE State EAGAN NIIV 55123
Improvement Date Amount Annual Years Payment Receipt Date
STREETSUFiF. 1 76.7$ -T•6-~ ~B ld
STREET RESTOR.
GRApING
1981 15.89 .79 20 11.94 "
SAN SEW TRUNK Wli 1981 138.48 6.92 20 lo ff t
SEWERLATERAL RK 1984 275.22 19-r" 15 238.54 11
7 1981 22.28 2'& s 14.88 " "
WATERMAIN $ 1984 70.67 4.71 15 61.2 11 "t-
WATER LATERAL ~ 19$1 1$.6s 124 .9'~J' MIt 12.45
WATER AREA 19$1 138.48 6.92 20 103.88
1952 29.52 1 .4'i 1-.48 20 22.1 "
STORM SEW TRK 1984 392.32 78.44 1$S 2 . 0 it
STORM SEW LAT
DRAINAGE 1984 33.97 7.39 3-r46 10 2.1 "
CURB & GUTTER
SIOEWALK
STREET LIGHT
WATER CONN. 500-00 ii Tr
9UILDING PER. 9985 if If
SAC
PARK
3830 Pilot Knob IRoad 6007
P. O. 6ox 21199 PERMIT NO.: 3- 2 7- 8 5
Epan, MN 56121 D/ETE: 1
Zoninp: No. of Units:
Owrnr: KUlgmd iiagftammik
~
re~
tits llddrou: 110 V Mea~!o~as
ixr+ber 1"('
r No.: .3 4 9 Q F C«+nectfon Cho?w: 500.00 pd
15.00 pd
Size: I
Ee..d.. o.: wrr„ir Fee: i o. oa pa
i.,m t. a..,h? wuh O. aUr .f w.. surcharo•: . 5 0pa
~„o„M,, M~sc. Choroesc 63.00 nd mete
Totol: 09_pi _ 1-C
By ooc. Poid:
Date of Insp.: I^sp.' i
I€%TY OF EAGAN `qwiw6oKom SEWER SERVICE PERMIT
3830 Pilot Knob Rosd pERMiT NO.: 3 71 n(,
P. O. Box 21199 3-27-85
Eagan, MN 55121 DATL
Zoning: ~Z Na of Unfts:
OwMr. ~'e lsnd Fiomes
/lddron:
Sin llddrox: 4287 V811 ev Fo r e I.1 F R 4`;oV Mea oW s
Plurnber llC mechanical
3J'1/~'S 50295 •
1 .gw h«mrb w11r tb CRy of B.wm Conrneeia, e]aop.: ![~t 425.00 pd
15.00 pd
Aooount Depait: -
Parnit Fw: 10.00 pd
Surchorw: .50 vd
gY Mim Chorqm
Dalr of Irop.: Total:
Deh Poid:
CITY OF EACaAN No 9985
3630 Pilot Knob Road, P.O. Box 21•199, Eagan, MN 55121
BUILDINC PERMIT PHONE: 4548100 Receiot #
To M aw6 fer SF DWG/GAR Est. Volue $55.000 Dote MARCH 97 , l9_Z5
Site Address 4287 VALLEY FORGE Erect CK Ocapency R3
? Zoning RI
S Remodel ? T
"i$ Block 4 sec/Sub. NORTHVTF.W MF.Al1
Lot ype of Const. V
~ Repair
Parcel No.
Enlerge ? No. Stories
KEYLAND HOMES Move ? Langth 41
W Neme Demolish ? Depth 4$
= Address 7 W 173R~ Grade ? Sq. Ft.
~ City JO'_2DAN phane 492-6646 instaii ?
rc SF,M3 435-3323 Aov'°v°l+ Fees
=F Name Asussment Permit $ 298.00
Addreu
u~ CitV Phone Water 8 Sew. $urcfwrpe 27.50
- 149.00
Police Plan Review
GW Name HP.LLOUIST & ASSOC Firo SAC 525.00
q~ress 900 SOUTHGATE OFFICE PLAZA Erp, warer Conn. 500 _(l0
~uZi City BLMTN phone Plonner WoterMetar~--~0
Council Rood Unit 28n n Q
I hereby ockrwwledge ihot I have reod lhis opDlicotian ond stote that Bldg. Off. 3 20 85 T. P_ 132 . 00
the inlormation is wrrect ond ogree to comply with all opplicoble
Sfate of Minnewm Srorute d Ciryv! Eeqo ~rdirwnc VarC. Date Total $ 7 974 _ 50
Sipnoturo of Permitt
A Building Permir Is issued to: KEYLF.D]D I-iOMF on fhs axprem conditlon thal
all work sholl be done in accor ance wilh all liwbla St o innewta Statutes and City of Eapun Ordinontes.
Buildinp Ofticiol
. . . .
~ ALL CONTRA RS MU BE LICENSED WITH THE CITY OF EAGAN
~ INCLUDE Q SETS OF PLANS,
Q CERTIFICATES OF SURVEY
Q SET OF ENERGY CALCULATIONS
G
To Be Used For: Valuation: ~ Date: -3 'o S
Site A!d/dress: CJ/~qA.~ o C-~ e •
Lot:/1( B1ock:~Sect/Sub:/(/a2Tr( vtc'.c3 Erect: ~ Occupancy: R.3
Parcel 1+7e/f000j S Remodel: Zoning: R-I
Repair: Type Of Const: Q
Enlarge: $ Stories:
Move: Length: ~
Address: :3 7.7 Demolish: Depth: ^ 48
City/Zip Code: T~i2 j~R~? /niIv~v Grade: Sq. Ft.:
Phone b: S/9d-GNy~ ut v3S-339)3
Contractor: (f ,lo'XiD 141 ' •
o/W e-5 ~
Address: sf~- I I Assessments: Permit: 29g.~
Water/Sewer: Surcharge: s--
City/Zip Code: Police: Plan Rev.: 145,=
Phone A Fire: SAC: 525.°'
" Engr.: Water Conn: Sco.SO
Arch./Eng: ' ui ° fi S oC' . Planner: Water Meter (03.-
Address: '`~/ea .$-~Ni.- %e oFr;cc- 6/~y~9Council: r iROad Unit: 2&0.~
Bldg. Off.: Par4E-s: 7Pc. 132.-
City/2ip Code: /15x an9i~g.o o n~yAPC: / ~
I py~~~p$, Variance: ~ /J ~ $0
' ~ ~
• - „
X
X cn
- ~
~l a
. ~
N
c~e 0 (7~
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_
i : r O~ce~lls ~
Clty Ol EaIIQII j Permit#:
~ i , i
3830 Pilot Knob Road ~ Permit Fee:
I
Eagan MN 55122 ~ Date Received:
Phone: (651) 675-5675 ~
Fax: (651) 675-5694 ~ gtag:
`-----------------I
2008 RESIDENTIAL PLUMBING PERMIT.APPLICATION
Date: ~ Qo Slte Address: Tenant: Mary Tollefsrud Sutte
4287 Valley Forge Place
RESIDENT 1 OWNER Name: _ Eagan, MN 55123 Phone:
6514936738
Address /
CONTRACTOR Name: License lJt1/ l 52~
Address: _2205 67 L.1.A TI l1 V J 7S(J
CitY: ( State:ryw Zip: ~ D
PhoneAW M qT7' TD %13 Contact Person; ~eS S
TYPE OF WORK _ New _ Replacement , Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Descrfption of work: '
PERMIT TYPE RESlDEN71AL
K Water Heater Water Softener
Lawn Irrigation Add Plumbing FiMures
~ RPZ PVB) Main _ Lower Level)
Septic System Water Turnaround
New
Abandonment '
RESlDENTlAL FEES: $50.50 Minimum Water Heater, Water Softener, or.Water Heater and Softener (includes $.50 state Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge) °
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround' (includes $.50 State Surcharge)
'Water Turnaround (add $136.00 if a 5/8" meter Is re(juired)
$100.50 SeptiC System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) . .
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) 50
TOTAL FEES $ SO,
I hereby acknowledge ihat thls information is complete and accurafe; that the work will be in confortnance with the ordin
Eagan; thaf I understand [his is not a permit, but only an application for a permit, d rk is not to stad without p i; a e r~~illy ~ D
. accordance with the approved plan in the case of work whlch require~, a review an ppro I f a s. LI
X l~2~Y?.lil LI~OYbl6YYL X p-2QQ$-
Applicant s Printed me Appli gnatu Liu
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" h^',FOR- g, ,~~i r,•sa 3~'',:~ '9'~ `M~~~ " a t:~«.,
OFF GE-l~ E: i'~ ~•'~Si,a,t s
~.F.., ~.ns:~..;~5.,.
~ ?D ~ ,F~ ~~xas,~~
+3.&~~1tz= i~; •n' - . i,.." 9~
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a
~~~~'r ~ۥ.-F~a "'ftW,e..,;u.q;,'~
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SURVEYOR S CERTIFICATE KEYLAND HOMES
~ L
C~ssG ~ 3 '~O,q~
SO6~~G'Fc~J-
,1
\60'
~ tia_ o
Q 43 ~
20Z %
s~ ~ ti~' ? ~4~ ' ~ M ~ ~ ~ I •
/ yoq 33 ~ ' l),
J 33 titr O
/ j (9'u 36 0 \
o
~ 4c ~
~ 97 y 4/4,
4c~
G \ \~~~}F4SF 8 ' ~
sb•/os \\Nl~~ . \
~
9 h
(J) ` O
ROPOSED GRADES WERE TAKEN
' FROM THE DEVELOPP1ENT PLAN
FOR PlORTHVIEW MEAD04JS l3Y
SUBUP,BAN ENGINEERING, LAST
DATED 9-29-83.
DENOTES PROPOSED SURFACE DRAIPlAGE
O DENOTES IRON MONUMENT SET SCALE: 1 INCH = 30 FEET
• DENOTES IRON MONUMENT FOUND PROPOSED 6ARAGE FLOOR = FEET
X000.0 DENOTES EXISTING ELEVATION PROPOSED L04JEST FLOOR = cj1 S•I FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK = 91g.3 FEET
I HEREBY CERTIfY TO KEYLAND HOMES THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF
A SURVEY OF THE BOUNDARIES OF:
Lot 18, Block 4, NORTHVIEW MEAD04lS, accordina to the recorded plat thereof,
Dakota County, Minnesota. • PND OF THE LOCATION OF A PROPOSED BUILDING. IT DOES NOT PURPORT TO SHOW IMPROVEMENTS
OR ENCROACHMENTS, IF ANY, THEREON. AS SURVEYED BY ME, OR UNDER MY DIRECT SUPERVISION,
' THIS 6TH DAY OF MARCH , 1985.
APPROVED FOR SIENNA
CORPORATION SIGNED: JAM . HILL, INC.
~ n
L/
BY: ~
' BY:
DATED THIS • DAY OF AROLD C. PETERSON, LAND SURVEYOR
19 OTA LICENSE N 12294
PROJECT NO. BOOK / PAGE JpMES R. HILL, INC.
' 85472 -
Planners / Engineers / Surveyors
FILE NO. 8200 Humboldt Avenue South
FOLOER Bloominyton, Ma asast ets-eea-soso
_ y, . ~
EXTERIOR ENVELOPE AVERAGE "U" COMPUTATION re ~
OWNER:~,~-~-~-.~ DATF :
SITE ADDRESS:_ PHONE:
CONTRACTOR:~q,~rj Gont`I.
Determine Working square footage of each
1. Total exposed wall area..... 1, B2,(o„4(p sq. ft. x .11 =_,?,Op• Bb97
2. Total roof/ceiling area..... 7.11( sq. ft. x .026 = p,2. 611L
Total exposed wall area above floor= ii y~ -or)_
a. Total Nall window erea //4,
b. Total door area.................................................. .3 7•7'b
' c. Total sliding glass door area.................:.................., .39. 99G
d.- Total firepiace wall area 214-
e. Total wall framing area (average l0A) ~7 ~„q• i$;y
f. Total rim joist area i,Z.p ~ /,otr
g. net wall area above floor i7 ~~.d 7 5
h. wa11 area above floor
i. wa11_area a6ove floor
j. frame wall area at foi:ndaticn
Total exposed foundation area= ,r&
k. Total foundation window area.........
1. Total net foundation area above grade
Determine "u" value of each wall segment
(e.g. window, door, each separate wall section)
a. X ..U„ . ~9 ,51~•f~4
b 37.7L,_ X U„
c. _39.994, x "Ul.
d. /UA. ~
,
e. i7&..6 y, ,lull .DB = 1-1o1 44 /
f. /.31.03 x ,Pu,l , D 4
9• I2G.5 - L'1 k 'lUll .-O = 1n3.2B
h
If item #3 is the same
as, or less than ttem
/1, you have met the
1. 18 X"U"_ 114, ° . B/L intent of SBC 6006 (c)i
3 . .................................Total = (2n, 842.
, ,
~prioz Envclopc Average "U" CWt.-,;t;:eicn pa9c 2 of 4 •
Total exyosed roof/ceiling area = y 7B .~j ¢
m. Tbtal skylight area
, n. Tbtal roof/ccilin; franing arca (.i•:cro,,o• lOZ)... 87.89 "
o. Total net ins•,:lated roof/cciling azea........... 791.0~
Uetermine "U" valne fo[ cach cvut/cclliny segnicnt
M. _ lU ~4 x.1U.. =
n. R1.89 x "U" ,OZ¢--
o. 7Si.n~ x ,.U„ .D2. _ /5•f3z~
a . zbui = ~'7,93
~
If total of 04 is the same as, or less than #2,; you have met the intent of
SbC 6006 (c) 1. ,
Alternste Building Envel.ope D=s3 n
4b utilize the total envelope 'systun IIP.L}lUCI, the values established by tlle s;um of
items q3 and #9 shall not be greater than the sum of items #1 and li2.
1. a~oo•ea~'7 + 2. zt.3.7~-
s. 17C~.F34~__ + a: i79~ _ lB8.77.2._
'{ias ~~.~~•a:
_ -•a. -
M
PLAU *.P,
L i xiEA L FT. Expo5F-p WAL L
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3LocrC1, K , S = ~ e
4,,EE : x s = sBa
w o IF . x~ =
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PU l. L. I; /3z. cz~ )C S= 4-
)L Q
- ~
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w ovu5 ih . O D oo~.s ~
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t ~ r 36 > ' ?5 ?AT1 O DRS . .
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Construction . R-Valuc
: ~ .
Intcrlor air ftlm , .0.61
2 D
i`}~~(~ 3. 4 0
Extcr:c:_ ,;i t:.r, (5t'11) I.
~ , ~11 i,i~il4: 2 58
¢ ~ Y~ , • ' ~ ' ' V= OZ ~
. . . FtiA+" 6;
Hea[ flov Inrcrinr r.ir fiim 0.61
mCed 2_
up ~ •
. 3•
' • 4.
• ~ . . - :,~tat 2 . qo.iS
~ ~ ~ . . v=.oz4.
- _ • . _ . Caq.~s~?cri .r,,_ ? '
t=~1.~=' •/{P. =nJ-~~JM1~L~~41 0.61
Inside iir filin
? • - r----r 3: . , .
. 4_
.
ir, fiLn 0.17
y ~1~5. cstsidc
l„~~~~~ Totaz.
_ .
~.~n•-. E
• ~-'O L@ LO G • ~ ~ 1. Znsldc aiz film 0.61 • .
2.
8eat Ilov up • , ~ ~•vented 3- ~
. . 4.
, ' • ' S. Outside aiz film 0.17
• • , .1SG. 16' . _ . . . ? , Total ~
- ' .
• 3 4 Inside air film 0.61 ~
. .1..t•.! : . . .
' ,.~•yr----. 3. •
a. ;
. . ..r.', . / /
~'s~-~?j•..-..,.~.` ~ j' ~ - 5. QuLidc air fil:n 0.17 i
Total
~ '
1
. ~..L-.T. • : trotc: V-;e idditional sheets it morc 'pacn 1: ~
~ ' • ycede.t for details and ealeulatians. ~
$eat ' . .
~ • ' ilov up . •
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' ~ • _ _ - . . ~'•1qr •;~:n _
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~ Ei U:r of cli-0yua wall ercn for
~ - .(inlM: con[71 rvCt 1un - - ~Cc,n[:tr.ncl iMi
~Y ___-1J 1• 11115~':'i'_ 11 1 i~ai l1 <H
_____~j ~ • ~ ~ ~r.?~'~~' ' ' ' ~
im.-hi': :.:Af
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SIC . 6. t:r.lcrii,r air ti',m U. 17
1LL ° -
9'~.~ia 27
eic. e1 101'viEi4 oe INSut-• .
• F1WtE IIALI. - 1. Iutrrinr air '11m.---_------- D:G~I
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. -~s ~`--!~`-s - -~3.0
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' ._..--'---._a 5• -'tv.~r~?b_._--~----._~._......_...~i.L
G. Extcrior air 1iL, 0.17
FI"G. 12 7bt:a1 ZQ,1
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1, )nt_ei ior nir f ilm 0.~~!1
2. IrISt~L
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4' --~~~-~~------------G-'-Qt
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~ r--~ 6. F:xtrrfor nir IiJm 0.77
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2/84
~4~J 1 CITY OF EAG?N
~ ~~'rC•~ \ /
APPLICATION EOR PEP.MIT
SEWER AND/OR WATER CONNECTION
- (PLEASE PfliHi)
i) PRoDERTY ADDR: ss qQ67 lJ?r/k y Fo rc4 e
rFr,L DE..Z?TIC.`I: 2?ar~-
(LotBlock/S ~~ivisicn or Ta:•; cel I.D. NL;,..-er)
I =r ~•:IS~_:G ST?.[:CI? ME, Da' 0° C2T_G^7;+L EuIT. 7r:G :-=_ST
P.---~SE.'?' :'::Ti:X:/p?0?CS:I) i'c'• S-:GI.c :;~.+rr•~ '
• ? R-2 l'Jii.7i (T.:'J L^IITS)
? '-3 TCi:-~=vrcr (`1'!__°^. ~ L"1ITS) ~ U:II'_'S1
L] .,-4 r;?: ~~-rz-.^r/CC:~i;r;I~~•l ~ LiiZ?':i
Q CCi~"•TF'?Ci-iL/f2~,':T,~I,/GF?'I~.~
? T" ~ Du s?~ --.7z
? r.sTZ=zo.iAL/ccv=- n=-,r
2) (7LE;.Sc rRiNr)
MV.!E: tc f/V+ll,~. I
ADoIRESs: _ 17040 S(1nRi"Se 14vt
c=z, sr:=, zzP: Prr~or 1 k~ m.~. Ss37~
PFoNE: Yy7- SGo l
j) pu.E= ~ly~- - ~~rnC ACASE ~R tiT~ FOR CITY USE 0NLY
ALU!!BERS LIC.45E:
PDDRF.SS: `I Active
CZiL, STATE, ZIP: ~ E:pired
Not of Record
PHODIE: PLU96ER LICENSE #
S~~~ni;lil
4) ~'[J_°?1PT/C['~i]E.i'2 kL ~~11s+/~ (PLF~ASE PRI4I)
NAt+1E: ynrrt tS
ADDRESS: 3y7/ n I73'`-
CI:^!, ST,TE, ZIP: JO/'tXh/i /I ,
PFiMrE: q G6 w
5} INpiCATE ;;yICEI PER;-LIT IS BEIP:C RECCJESTf:D:
[&Ca,NF.C.TION 'Io CITY Saic.~i
M CO`INECI'ZC:I 'Ib CZTY S•IATL'!?
El Oi[E2 (PISi,SE D°.SC12It3E)
6) P,:DIG,-= C:.%: .
~ PLz'7~-QE E?OID APPP.OVID pER,++ST FOR PZCi:-L'c BY O:v'E OF aFGVE
:S `•'.aIL i1PP??Wm PER,'1IT TYJ 1, 2. 3. 4 AE+QJE
(Circle cne)
7) SZC.:,T~~^.: W DATE: 3-(3?-'9Y-
w e~alra}~.JSS i el~a~ra: ~ r+~sasra a~ s~s~aa:~ ~~e rd~rw~a ~ a s~zacsar .
F 0 R C I T Y U S E O N L Y
PEPMIT ISSUED
~
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DOES UTILITY CONNECTZON REQUIP.E EXC.,VaTION IN PU6LIC RIGHT OF WAY?
~ YES IF YES, THE:^7 n"PE:2iSIT FOR :dOR?: S4IT'IIN
PUBLIC ROADWAY" MUST BE ISSUED BY THE
NO ENGZNEERZTIG DiVISZ0N. LIST AS A CONDI-
TION.
SliH3ECT TO TEiE e0LL0:9IiqG COAIDITIOi:S: •
APPROVED BY: aeLp
TI.LE:`~~,~
DAT°_:
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3830 Pilot Knob Road ~ Pertnit Fee:~
Eagan MN 55122 j Date Received: j
Phone: (651) 675•5675 i i
Fex: (651) 675-5694 I Statt: ~
I -
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Z Br
pl
Tenant: Suite
RESIDENT / OWNER Name: Phone:
Address / City / Zip
Applicant is: _ Owner -xContractor
TYPE OF WORK Description of work: U o
Construction CostA ?2. oQ Multi-Family Building: (Yes No)L
License
CONTRACTOR Name: _Co~(1122cd Cxnsha
Address:_ 5rO II IY)P60X-I0.1 1TVe N•
Ciry: r7,H I ~(1.xX7f er State: _MN Zip: 'r' S0p0
Phone:G61 'L1-,M - q 3oJ ContactPerson: koren
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
Categary submined submined
(4 submission type) • Energy Envelope Calcvlations Submitted
In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan?
_Yes _NO If yes, dafe and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: P/ans and supporting docurnebt§:that you submit areconsldered to.be public 1nf6rmati6n. PoKlons ol. _
;_.fhe iriforinatiommay 6e olassified as=nonpu6lic i/ you, provide specifia, reas`on's that would-permit the Cfty to,r~
- - sonclude f%'aYthe are tra8e secrets.
I hereby acknowledge that Ihis information is complete and accurate; thal the work will be in contormance with the ordinances and codes of the Gity ot
Eagan; ihat I underetand this is nol a permit, but only an application for a permit, and work is not b starl without a permit; that the work will be in
accordance with the approved plan in the case ot work which requires a review and approval of plans.
x 1 o /GU k/l x ~
Applican 's Printed ry me ApplicanYs Signature
/
V Page 1 of 3
Use BLUE or BLACK Ink
r-----------------
For Office Use
Eata n Permit City of l ll IPermit Fee: fill (0
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (661)676-5675 I I
Fax: (651) 676-6694 I staff: I
I I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: / Site Address: ti,~oZ87 (J®__ /~-0 ( l'cle Unit fl:
Name: Mclrt ✓ e _ PV Phone:
l~S~"3~/~
Resident/
Owner Address i City / Zip: 107 4 fvrw gzr E-z n iyln / 3
0- 10~
Applicant is. Owner Contractor
Type of Work Description of work: A&¢ Ikee Aheltzow-s in Luce- SJIAr, on ~flb euso tl~
o'i7 Gaya .11 - Construction Cost: A - Multi-Family Building: (Yes No
Company: Mn 11V Me -Z iv/0/'ouc°N►NnContact: ryt 34t02~ S.3/ r
Contractor Address: RaO if,& U »c~ City; S-f
State: J- Zip: -S-L 3 7 Phone: -3v?0 - 313 - !V K
License g: 14C 3 3 3 Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Bar I / f__ I * r ./2 ZB
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes _No If yes, date and address of master plan:
Licensed Plumber: - Phone:
Mechanical Contractor. Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents that you submit are considered to be public Information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
_ conclude that they are trade secrets. _
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. mm goohemlateonecall.ora
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 Minnesota State Building Code must be completed within 180
days of permit issuance.
x L~Ifll ?a -Llee /Z-,
Appllcant's Printed Name A plicant's Signat
Page 1 of 3
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