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3268 Valley Ridge Dr44' City of Eau 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-56!_ Staff: 2011 RESIDENTIAL BUILDING PERMIT APPLICATION Use BLUE or BLACK Ink For office Use Permit #: Permit Fee: 1),3\-7q \-15 Date Receive cl-d/-11 Date: t -i •ao • a0// Site Address: 32f,9 Vat('R; [Dr, Unit #: RESIDENT 1 OWNER Name: Qryliv Man ajem.i;)4-, Ac. Address / City / Zip: Phone: 763 -'iy9 -91o0 Applicant is: Owner X. Contractor TYPE OF WORK CONTRACTOR Description of work: Re - -rro-P Construction Cost: cb02/, 30. ,FS Company:,,Sltn(LIS e-- ke_yrorieleA3) 4c Address: 5976, Ips n Multi -Family Building: (Yes X / No ) Contact: d P L7'-) City: - -. prx.0 State: M N Zip: 55//O Phone: 66/ - 7601 - 9.345 License #: p S /$/ g Lead Certificate #: NA 1 - aa9 73 -0 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 conclude that they are trade secrets- CALL ecrets 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.gopnerstateonecall.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 1 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 app . va x ocl �-0-r✓(svli Applicant's Printed Name A • • cant's Signature Page 1 of 3 , Reosipt ~'r P4UMBING PERMIT Permit No. CITY OF EAGAN A ~ Fee , - FiU in numbered spaces S/C TXpe or Print legib/y Tot. _ 1. Date 2. Installation Cost 3. Job Address Blk. ~ Tract z, r I 4. Owner r r., . r ~ 5. Contractor OFione e, 7G2 E.x~ulsi,r ve. 6. Address f:~il'nZSUtB 55 •±`3 938- i san 7. c?ri state z;p 8. Building Type: Residential ? Commercial ? Institutional ? 9. Work Descxiption: New ? Add ? Alter ? Repair ? 10. Describe 11. No, Fixtures No. Fixtures Water Closet Cesspool/Drainfield Bath tubs Septic Tank Lavatory _L $pftner ShOwer Wel I 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 I agree to comply with all ordinances and codes governing this type of work. Signed : ~ Rough ~ EnFinal , ~ Inspections: Date Insp. Date Insp. I This is your permit when numbered and approved. I Approved . CITY OF EAGAN 454-8100 I • . . . . . , . . Ft..' . . ' . - .Y. . ' . ..~...i:~. . ' ,i,',. ..~,~:~'-':.'~y>.,.~, - ~ . ~ ? . _ p t~~w._I~N • . +~~i:.~.lj~`n.." ~ 1 ~.iL.. l. _ ^ ~,,r ~ , ~~S•i ; ~ .•w n~,. , ~ r,.v..,., k .••..t.r.Kr,..r.:x... ~..,r ;ir-. F ~ S k,:~ . i' .v:~- `~?~':n'.:S-a;:>;.~, i„~.~ xk, d:tn:",r•;-;~.:... , • , ~i~..~ 1. :..:.e.4 ai~-r . . ..`.R......~.w~~_c -n`.~,K..s_'V ..wti':"'tY,~~+ ~:.7X~ ~.e.~~YN'. - _.L.. +yh~«>JSG'i:w ~,.3~LL.J..:.?'~+ai.~.~?~ +.h.'-, • _1._1 _.....~i___a_l.~ - L~.~+.._ M1 EAGAN TOWNSHIP ~ BUILDING PERMIT N° 2916 Ownex ....L.`..`..^.~ Eagan Township Address (Preseat) Town Hall Suilder . ~ Da2e ..~d:.-...:Z7~ 7 _ . Addreaa DESCA2PTION Siorias To Be Used For Fronf Depih Heigh2 Esl. Cos! IPermit Fee Remaske -I ~a _ c~-•~-~- I s e s. c ~ />O /~j -7 i- LOCATION /J~.d7• Slreel, Road os olher Deseriplion oi Locafion I Lo! Block Addilion or Trad /n y/ 3G~ ThL permit does aot aulhorise the uae of atreeL, roads, alleps or sidewallce aor does it give !6e owner or his agsat the sigh! !o ereate aay siluatioa which ia a nuhanes os w61eh presenls e hazeed !o !he healfh, sefelp, eoaveatenae and gsneral weltare !o anyone !n the eommunity. THIS PEAMIT MVST HE /g~E~PyT ~ON- TH PREMISE WHILE THE WORK IS IN PAOGAESS. , This !s !o eeriify, lhet.-.--------- has permisslon !o arect the above deseribed psemiae subjeM fo the provisions ot ffie Butlding Ordinance for Eagan Yownship adopled April 11, 1955. 1 ....................._..~.........:C:.....-.-.-,-,par .--..-.--.,c~.~..w.e.;(--_.-.--Q...-----.---.::,---.....~...........-------..- Chei r8sasd Bulldin Ins aefor ' MASTER CARD LOCATION , . OWNER STRUC7URE AND ^ IAND USED AS ~QLJ.C rr Issued To Permii No. Issued Coniracior Owner BWLDING 29a PLUMBING 3~ CESSPOOL - SEPTIC TANK WELL ELKTRICAL HEATING ~ yd GAS INSTALLING SANITARY SEWER OTHER OTHER Approved Items (Initial) Date Remarks Distance From Well FOOTING SEPTIC FOUNDATION CESSPOOL FRAMING TILE FIELD PT. FINAL ELECTRICAL DEPTH HE.4TING OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUMBING WELL SANITARY SEWER Violations Nofed on Back COMMENTS ~ COMPLIANCE INSPECTTON REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS . PERMIT NO. DATE OF INSPECTION CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE Of NON{OMPLIANCE ? NON-COMPLIANCE. BUILDER DOE$ NOT OBSERVED. INTEND TO COMPLY. El ACCEPTABLE SUBSTITUTIONS OR DEVIATIONS. COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DEL4YED BY CONDITIONS BEYOND CONTROL. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. ITEMIZED AND DESCRIBED AS fOlLOWS: ? REINSPECTION REQUIRED DATE OF REINSPECTION REINSPECTION REVEALED CERTI FICATION -1 cenify chac I have carefully inspected the a6we in which I have no interest present or prospective, end tha[ I have reported herein all significant conditions observed to 6e at variance wi[h ordinances of the Town of Eagan, approved plans and specifications, and any specific requira- ments for off-site imprwements relating [o the propeny inspected. ? ALL IMPROVEMENTS ACCEPTABLY COMPLETED BUILDING INSPECTOR DATE COMMENTS: 23 EAGl3N TOWNSHIP . e5)1 3795 Pilot Knob Road St. Yaul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION DATE:12/29/72 (4/25/73) NOMBER 1328 OWNER:Rivergate Villa -B1dg•14 Address3268-70-72-74-76-78 Valleyridge Drive PWMBER Berghorst Plumbing Co. TYPE OF PIPE heav,y cast iron DFSCRIPTION OF BUIIDING Industrial Commercial Residential Multiple Dwelling No, of units }oc 6 - townhouses Location of Connections: Connection Charge 11 0.00 billed 4/25/73 Permit Fee 10. pd 12/ 6/ 2 • Street Repairs Total Inspected bq: DaYe Remarks• By Chief Inspector In consideration of the issue and delivery to me of the above permit, I hereby agree to do the proposed work in accordance with the rules and regulations of Sagan Towmship, Dalcota County, Minneaota By. Berghorst Plwnbing Co. Please notifq when ready for inspection and connection and before any portion of the work is covered. EAGFN TOWNSHIP 3795 Pilot Knob Road St. Pau1, Minneaota 55111 Telephone 454-5242 PERNIIT FOR WATER SERVICE CONNECTION Date:4/25/73 (12/29/72) Number: 1184 Billing Name: Rivergate 4illa-Bldg. 14 Site Address3268-70-72-74-76-78 Valleyridge Dr. Owner: Billing Address Plumber: Bexghorst Plumbing Co. Location of Connection Meter Size lh" Comection Chg. 1 lda 4/25/73 338251 ?¢"~7 =5, Meter N0.22841406 Permlt FeeTO 00 dp 12/26/72 Meter Reading Meter Dep. •50 pd 12/26/72 5/c Meter Sealed: Yea Add'1 Chg. NO Total Chg. Inspected by Date Building is a: Remarks: Residence i4ultiple x No. Unita6 owngouses Commercial Industrial gy; Other Chief Inspector In conaideration of the issue and delivery to me of the above permit, I hereby agree to do the proposed work ia accordance with the rules and regulations of Eagan Townahip, Dakota County, Minaesota. By: aclz~ `Lvl- Berghorst Plumbing Co. Please notify the abwe office when ready for inepection and connection. ~ EAGFN TOWNSHIP 3795 Pilot Rnob Road St. Paul, Mianesota 55111 Telephone 454-5242 PERPIIT FOR WATER SBRVICE CONNECTION Date:4/25/73 (12/29/72) Number: 1185 Billing Name: Rivergate 4illa-Bldg. 15 Site Address:3267-691g1-73-']5-77 Palleyridge Dr. Owner: Billiag F.ddress Plumber: Berghorst Plumbing Co. Location of Connection Meter Size/ ` - Connection Chg • i ed 4/25/73 Meter No,~_~ Permit Feel0-00 pd 12/26/72 pd 2 2 ~2 s/c Meter Readiag~~ Meter Dep. ~ Meter Sealed: Yes Add'1 Chg:--*4 NO Total Chg. 7 Inspected by Date Building is a: Remarks: Residence Idultiple xc Ho. Units 6 Townhouses Commercial Industrial By; Other Chief Iaspector In consideration of the iaeue and delivery to me of the above permit, I hereby agree to do the proposed work in accordance with the rules and regulatioas of Eagan Townahip, Dakota County, Minnesota. By:~ Rerphorst Plnmhine P.o- Please notify the above office when ready for inspection and connection. ~ 75 2007 COV1MEftCIAL BUILDING rERVHT arPLIcATIoN City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 ounfid. . e . . . mprove-men • SWCtural Plans (2) sets . Archdectural Pians • (2) sets • Architectural Plans (2) sets • Civd Plans " (2) • Structural Plans (2) • Code Analysis (t) " • Certifcate of Survey (1) • Qvil Plans (2) • Project Specs (1) • Code Analysis (1) " • Landscaping Plans (2) • Key Plan (1) • Project Specs (1) • Code Analysis (1) " • Master Exit Plan (1) • Spec. Insp. 8 Teshng Schedule " • Certificate of Survey (1) • Energy Calculations (1) not always" • Soils Report (t) . Spec. Insp. 8 Testing Schedule (1) ^ • Elec. Power 8 Lighting Form (1) not always" . Meter size must 6e established . Meter size must be estab6shed • Meter size must be established-d applicable ! • Project Specs (1) l • EnergyCalculations (1) " l 1 • Electric Power 8 Lighting Form '(1) 1 • Master Exit Plan (1) 1 1 • Emergency Response Site Plan (1)'"' ! ! • SoilsReport (7) 1 • SAC determinahon - call 651-602-1000 • SAC determina0on - call 651-602-1000 • SAC determination - call 651-602-1000 • Fue Stopping Su6mittals . Fire Sup ressionlAlarm Form Call N4\' Dept olHcalth at 651-201-4500 for dctails regarding food & beverage or lodging (acifities Contact Building lnspeccions for sample and if reqmred Pemii[ for new buildin~ or addition will not be processed without Emergency Response Si[e Plan. Date 07 Construc[ion Cost ~~a SiteAddress VAL~v V (Z ~Jy z 0Q,, U--IL UniUS[e # ~ 'fenant Name Formcr Tenant Name ,-?-70 3:,)-7 3a~7 3~7~ Descrip[ion of Work N L? GA C: z/n N~e w Sh"I(" U p c CK'- Pruperty Owner .Telephone # ( ) G/~ 2 J/ 1-/4 2TKF_ Applicant is: _ Own)er ~Con[ractor I Contact ( G/Z. ) 9 I 9- ~ 78~ Contractor ,°d,,,~.S j LJ c`ti7ao/<„J CO / - Address ,i ~7:3 S" I c_ City / 7/ G S State M/•i Zip S S`7`0 Telephone 6(~ 7,;) Arch/Engr Registrution # Address City State Zip Telephone # ( ) Licensed plumber installing new sewerlwater service: Phone I hereby appty for a Commercial Building Pernvt and acknowledge [hat the information is complete and accurate; tha[ 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 pemvt; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. ~ GIq 2 V kd AnolicanYs Printed Name Annlic c Ci atnre I 0428i2008 14:01 EHC'daN ErG+COM DEV + %57J101A1 N0.541 001 . . . . City af EaQan 20d6v ~35D1v 3830 Pilot Knob Road ~ v Fee: Eagan MN 56/22 ' Rem;,,,p: /'9 Phone:(651) 675-5875 ~ n I Faz: 166116754694 i ~ 2ooe RESIDENTIAL PLUMBING pERnnir aPPUCATI N ~ s~,~~: g2 TenaM: fl 17-fz'i'G- ILr,Su1teC: RESIDENT/OWNER Nema: 17~~l~?1 ~~,[~l~YJI'9/'(I/{I Pnona; Addran ,Cd,,,Zip: CONTRACTOR Name: ILL/~~446 I"/aYIz!5/~,(,~o T.(.(-Ccense tk ~SI / P~ v 1 ,waress: Q-EO DX2`CGiZr:-g/U /~!/E /i/ ciry: slate: r~Zip: ~ Phona:65,- I y3657&1 contec,Pers,,,: ~D 13n~~~~ TYPE OF WORK _ New Repacement , Repair _ Reaalo _ Mo6y spaoe _work in a.O.w. Desui don of work: PERMITTYPE RENT1Al 7ater Heater Water SoMner TLawn Iflig9lion _Add Poumbing Fxlums C_ RPZI_PVB) ~Main_LOxerLeveq _ Septic System _ Wew TumarwaM Neri _ AbanEonmeM RESlOENT7AL FEES: fi0.50 Nlnlmum Water Neater, Water Softener, or Water }leater antl SoRener (InGudes 5.50 State Surcherge) $30.60 Lawn Irrigation (u,etuees E so Srata Surrnerge) $50.50 Add P4anEing Fixhues, Septic System Abandonment, Water Tumaround` (includes $.SO State Swcnarge) 1Maler Tumaround (ede $138.00 if a 5111' meter is repu'ved) $100.50 Sephc Sysfem New (S10.00 par es euiln (hduoas County tee arW f.50 State Surcharge) 590.50 Fire Repair (reolaca burrre0 out appliences, aucMOrk, etc.) (indudes $.50 State Surcherge) TOTALfEE9S I hereby acknoaEdpe tnat mis IMprmatbn a oompb[a oM acNrate: Mel tne waM wN Oe in coniwmance wth me oralnanem antl cotles d tne Gry W Eapan: ihat i uneercqrb tnb 9 nd a permn. W onN en ppyice4on Ior d Oerni an0 woAc is not m sYh wilhoW a permM; " the werk wdl ps in aceordanm witn tle approvaA Plen In tM ceea of woh wnucn rcpvlros a revim and apPmid ofPkm x &&wwbJ AppllcanYs PriMeO Name Applicant'c Slgt t re FOR OFFICE USE Revievred By: Date: Requlrod Inspeclions: _Under Ground TRough-In ,Air 7est _Gas 7esc _Final ! ~ ~ Fo`r Office Use I Clty of Ea~aIl I Pemit # Pertnit Fee' ~ 3830 Pilot Knob Road I Eagan MN 55122 ~ Date R vea: MAY 0 2009; Phone: (651) 675-5675 I 11 ~ Fax: (651) 675-5694 I Staff: : i 2009 RESIDENTIAL BUILDING PERMIT APPLICATION ~-I__ l Date: S"T'0`/ SiteAddress: _3G-,U •L6~PS eids,~?_ s)rn,i 5312l ~ ~ J Tenant: Suite RESIDENT/OWNER Name ('Pf(srw Phone: ~3~'3Y0-6~35 Address / City / Zip. 3Z70 Ua flp 44~, C 1~ cA 33 /ZI ~ Apphcant is: d Owner Contractor TYPE OF WORK Description of work. Construction Cost. MWti-Family Building: (Yes No 0,~) CONTRACTOR Name: License # Address: City. State: Zip: Phone: Contact Person: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672 Energy Code . Residential Ventilahon Category 1 Worksheet • New Energy Code Worksheet C0t¢90ry Submitted Submitted (4 submission type) • Energy Envelope Calculations Submrtted 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 Contrector: ' Phone: NOTE: Plans and suppoRing documertts that you submit are considered to be public information. Portions of the informafion may be classified as non-public if you provide specific reasons that wou/d permit the City to conclude that the are bade secrets. I hereby acknowledge that this information is complete and accurate; that the work will be in confortnance wilh the ordinances antl cotles of the City of Eagan; that I understand this is not a permit, bW only an applicahon for a permd, and work is not to staA without a permiL that ihe work vnll be in accordance with the approved plan in the case of work which requires a revtew and approval of plans. e144~~ X X.&/ Applicant's Printed Name ApplicanYs ignature Page 1 of 3 . 01i" DO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation _ Fireplace _ Porch (3-Season) _ Stortn Damage _ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family) _ Multi _ Deck _ Porch (ScreenlGazebo/Pergola) _ Exterior Alteration (Multi) _ 01 of _ Plex ; X Lower Level _ Pool _ Miscellaneous Accessory Building WORK TYPES New Interior Improvement Siding Demolish Building' Addition _ Move Building _ Reroof _ Demoiish Interior ~GAlteration _ Fire Repair _ Windows _ Demolish Foundation _ Replace _ Repair _ Egress Window _ Water Damage Retaining Wall 'Demolition of entire building - give PCA handout to applicant DESCRIPTION Valuation ~ J Occupancy pv&l MCES System Plan Review Code Edition ~v7 SAC Units (25%_ 100%~] Zoning Ciry Water Census Code ~ Stories Booster Pump # of Units Square Feet PRV # of Buildings Length Fire Sprinklers Type of Construction IM_ Width REQUIRED INSPECTIONS Footings (New Building) _ Sheetrock _ Footings (Deck) _ Final / C.O. Required _ Footings (Addition) Final / No C.O. Required Foundation Se HVAC Drain Tile Other: Roof: _Ice 8 Water _Final Pool: _Footings _Air/Gas Tests _Final ~ Framing _ Siding: _Stucco Lath _Stone Lath _Brick Fireplace: _Rough In _Air Test _Final _ Windows ~ Insulation _ Retaining Wall Meter Size: Erosion Control Reviewed By: I~i . Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Pertnit 8 Surcharge Treatment Plant Copies o , TOTAL Page 2 of 3 Aug 18 1510:58a Sunrise Remodelers 651-762-9395 p.10 Use BL1�E r�r BLACK ink l EorOfflcslise --------� a �` ��a�� Permit## � ��t� �� I Pemnit Fee: �(�'�� 3830 Pilof 6�nob Road � � Eagan MN 55122 � Date Received: _ i Phcne:(657)675-5675 . � j 5tafi: � Fax:(651)675-5694 � ------� ",'�'I�t{{ � �+ �. -��L��'� Lri"'f G° �4C..�G:d�1 •C a:ry' ---------- 201g ��SILIENI'�A� ��1�LDIN� P�ER�If1T APPL.�C�4T�Ohl C�e d��Y' t3L��= Tc 4�n �►,:�c S-c s' Date:$'1�'� '—�� Si4e Add�ess: �-�(,�� 1.�� :�+F' �'.V2 '`'�'�!31 linit#: �� -- --.--_.r.,�.:�--,__�.,,�v;c.i-�ci��;�.`..�,"3 a-"i G, 3 a-�� ,'3��1`�-1 ,3�--�t.c, 3�-j 8 . Name: Phone: �@S�tlB�ttO Owner �ddress r c�ty�zip: . � : : . . � ` APP�icant�s: Owner �Contractor _ , ._..�>.�,,.��,..,�:.� __ `; ` ..-.�...�._.:..:.. .._...._,.._�• i��escription o€work: �� C�� 11�� ; '�ype of�Vork `' f I No_) F `. Cons#�uction Cost: � ��;�C��•�.. _Multi_Fami�y Building: (Yes ?,,..:,,..._:.._..�..._..,.:..:....__._,.:.° ::�...._,�_�....,�._..__.._,._,____,......,_�.�...�..__.,4..._...........�y_.�_ ....__,.��r..�� , Company:�4�.� �: 1-e ��M cx�...l--� �S Contad_ �t3t'..� ��.�(' �:..�1 ,. ; � i � : Aaaress:� �� (�^ •t-�L�l�-� L-�i �n-e c�ry: �t , ��-� E �or�tract�r ' � State: r V"Zip: � �� U Phor3e: Email:j Y�� . S—e Y�r� ��`��—=�rs. ;tcw _._...,....:__.._....._--.,...,..�..License#��+,_��-I�-� �--�ead Certiflcate#:��-.��1� 3�� ; lf the p�oject is exempt from 6emd certific�tion�ptease expla�n why: '��+�T1 T�^'��^^�C�DMPLETE THIS �4REA ONLI'IF f:4RISTRUCTiNG A NE1dVV BUIE.DING Y Ic�the iast 12 montt�s,i�as the City of�agan issued a permit for a sirniEar plan based on a master pian? ; Y�s No ff yes,date and address of master plan: � `•. Licsnsed Riumbec Phone• � l�echanicai Cantractor: Phona: � � 5evy��Waber Contractor: Phone: > s Fire 5uppression Con�actor. Phone; �1�07'E:Plans and s�pporting nlocurs+er�fs tha�yo[�sutionit a�e considered��e public informatron. Partions of � . She in�arma�iv�may be class�ed as eaon pcab/ic if yotr provide speciflc reasons that wouia�permit the Cit�l�e � �oRclude ihat the�r are frade secrets. ` ;._. ..._.:_._..�...,...._.:.,...:�..:�,.:,,.�.�v,�.,..,:..:..:..-�,�:r..�_:�..:_..,.,,.,.,.._..._....�:.,..,.�.:.._..�..�,_._,..... -,..�,. :x_,�,.,.._..�.,-_.b:_.._:_....,,..__L...,._,..___._....�......._.:..._.___..:_,_..w_�.....___,.., �ALI.�EEORE Y8U DIG. Caii C:opAer Statz One Call at(651)464-OOa2for protecGon ayainst tmdetground uli[ity damage. Call 48 houis beto�you 4ntend ta dig to receive locales of underground utliities, www ao�he�stateonecail.ora !hereby acknowledge that fhis i��rtnatlon�is camplete and accurafe;lhat i#�e wo�c will De in confom►ance witt�the ordinances and cedes of the City of �agan; that 1 undersland this is not a permit, buf only an application far a permit, and wak is not to start without a permE� thffi the wo�s will be in accordance wfth the approved plan in the case of work which requires a review and approval oi plans. Exterlorwork autlzorized hy a building permit[ssned In accordance wifh the Minoesota Sfate Suilding Code musE be completedwithin 180 days of pemeit issuanee. --•� x �� L�L.r.� G r'1 ' x � Applicant's Priated Name A 's ignature . Page i of 3 Use BLUE or BLACK Ink r-----------------• ( For Office Use � • � Permit#: �� //�� j C��,� 0� �"�"`� I Permit Fee: / ��` �� 3830 Pilot Knob Road I I Eagan MN 55122 � Date Received: � Phone: (651)675-5675 I I Fax: (651)675-5694 I Staff: I I � 2015 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: ✓� �� L� �� Unit#: � Name: Phone: Re�id��ti .' _-�_ '/ Q�•�� Address/City/Zip:�� Yi4L��H ��D ErE � ��'�� N. .$�$��3 ,�. . ' Applicant is: Owner Contractor Type of 1�1c�rk Description of work: �p�r C�a��e+� w Construction Cost: '� Multi-Family Building: (Yes�/No� Company: l ,AA��t�N�„��_ LLG Contact: S'�Lf3 �t�/tNS�� Address: ��7$b �p� A'bt� City: (_�svn�.� �t�c.s (',Utl'�Cc'1�'�C11' — „ ; State: '!�N Zip:s�,Sn� Phone: �S/-�ys-03/� Email: SJotHvSaNlc�vi�.e��ku,sy��. License#: N� � Lead Certificate#: N�� If the project is exempt from lead certification, please explain why: NU ��4A�f�ti��ti�►''r 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: Fire Suppression Contractor: Phone: ' Nt)T�i F�a�s a�d s�tp�torf�t��cic��e�s t��a�t,�o�t�ub,�'are ca�lde�ec�'�'be p�b��c��rt��p�., Fc�tr��f the infor�at�c�n r�aay f�e class�f��d as n�n-��b�ic�f y��j�ro��s�sci��rea�ota�s t��t�+vou�`tl p�rc�a�t the C1ty t� ca�cJuale f�a#:t� a�e t�ide secr€f�:: 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.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. 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 S"7BVG ��I�1NSor� x ApplicanYs Printed Name Applic t's Signature Page 1 of 3