2113 Viburnum Tr
CITY OF EAGAN ~,f - ~
3830 Pibt Knob Road, P.O. Box 21-199, Eagan, MN 55121 ' y 13002
PHONE: 454-8100
BUILDING PERMIT Receipt M
To be used ror 'r' FD4;G/CAR Est value $97' 000 Date DECEMBER 22 186
2113 VIBURNUr, ~1'rtAIL R3
Site Address Erect Occupancy
Lot 21 Block Secisub. VIENNA +dOOUu Remodel ? Zoning R1
Parcel No. Repair ? Type of Const V
Addition ? No. Stories
W ?uame TILLGES COt1ST Move O Length
0 9 6 HOLYOK E AVE Demolish O Depth 54
o Address Int Impr. ? Sq. Ff
Ciry LAKEVIAk4 469- 4 Install ?
Name :iAhtE Q~ n/? ~ S APP?ovals FNs
$ Q Address Assessment Permit $ 4 2 4. 00
I" Ciry Phone Water & 5ew. Surcharge 48•50
~ Q Police Plan Review 212. 00
Name Fire SAC 575.00
~a Address Eng. WaterConn. 500.00
lW City Phone Planner Water Meter 63.50
Council Road Unit 290.00
I hereby acknowledge that I have read this epplication and state thatthe gldg. Off. 12 /17/8 Tr. PI. 156.00
information is correct and agree to comply with all applicable State of
Minnesota Statutes and City oi Eagan Ordinances. APC P9rk3
Signature of Permittee Var. Date TOt81 Copie ,26Y. 0
A Building Permit is issued to: TILLGES CONST on the express condition that
all work shall be done in accordance with all applicable State ot Minnesota Statutes and City of Eagan Ordinances.
i -
Building Official - • - - -
PMmIt No. PwmN IioWu DMw TNphoM li
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. , PERMIT M J
. , PLUMBINCi PEHMIT CJ j 7 J
CITY OF E/1(iAN RECEIPT #
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE PHONE: 451-3100
Site Address BLDG. TYPE WORK DESCRIPTION
lot ~2. 1 Block __2__ SeciSub Res. New
f " - Mult. Add-on
m Name C Comm. Repair
~ Address Other
c Ciy G.w ko Phone RES. PLBG. ONLY - COMPLETE THE FOLLOWING:
- NO. FIXTURES TOTAL
Name ' Water Closet -$3.00 ~ 3. G' c•
` Bath Tubs - $3.00 '3. o ~
3 Address I_Lavatory - $3.00 -4, OO
p Ciy j_ a lc o,.. 1 I a Phone ~jL.L,'t - T~ y U Shower -$3.00
_1__K0chen Sink - $3.00 3. G C
FEES Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE -J_Laundry Tray -$3.00 7, OG
APT. BLDGS - COMM RATE APPLIES --l-Floor Drains -$1.50 i. 5 ~
TOWNHOUSE & CONDO - RES. RATE APPLIES -/-Water Heater -$1 50 i. 5 G
MINIMUM - RESIDENTIAL FEE - $12.00 Whirlpool - $3.00
MINIMUM - COMM/IND FEE - $20.00 -4--Gas Piping Outlets - $1.50
STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMIn
(ADD $.50 S/C IF PERMIT PRICE GOES Softener -$5.00
BEYOND $1.000.00) Well - $10.00
Private Disp. - $10.00
Rough Openings - $1.50 ~ G
J
SIGNATURE OF ERMITTEE FEE:
STATE S/C: 5 G
FOR: CITY OF EAGAN GRAND TOTAL• a~ 9~ Oa
rvlr)" r'41:*'3-..?~a~'FS~~.•t'l:.
. . . PERMIT N
• • . MECHANICAL PERMR 7'L~GSS
CIT1f OF EAGAN RECEIPT M - ,
3830 PILOT KNOB ROAD, EAGIAN, MN 55121 DATE Q'' J~
CONTRACT PRICE PHONE 454-8100
Site Address BLDG. TYPE WORK DESCRIPTION
Lot Block Sec/Sub
- Res. New t _
L Name } Mult Add-on
m
~ Address ComrrL qepair
c City Phone' pther
Name . ~ .r • . • FEES
~C Address RES. HVAC 0-100 M BTU - $24.00
p City Phone ADDITIONAL 50 M BTU - 6.00
ADD-ON AIR COND. 0-24 BTU - 12.00
TYPE OF WORK ADDITIONAL 6 M BTU - 6.00
GAS OUTLETS - 1.50 EA.
Forced Alr I' M BTU COMM/IND FEE - 1% OF CONTRACT FEE
Boiler M BTU MINIMUM - RESIDENTIAL FEE - 10.00
Unit Hester M BTU MINIMUM - CQMM/IND FEE - 20.00
Air Cond. M BTU STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Vent CFM gE1rOND $1,000.00)
Gas Piping Outleb # 1
Other
FEE -
g/C: SIGNATURE OF PERMITTEE ,
TOTAL:
FOR CITY OF EAGAN
-0
4
~~rftfir~fr uf (~rru~~nr~
Citp of tagan
lorprbnrnY a# Edlbt" iwprttati
This Certificate issued pursuant to the requiremena of Section 306 ojthe Uniforrn Buifding
Code cerrifying that at the time of issuance this structure w+as in compliance with the various
ordinrmces ojthe City regulating building coxslruction or use. For the followtng.•
use a.mifinuon ~S+I~=; ~~t.:= 61ft. tlnait No.
y
p-pNnc,7' Tra Zonins p;qnd R~M T3've rrnN
t _ I~U+i'. •
Ureerd C0N1'.7,-j'I1M1.:.t•'''.4 Addr=
Z i i 3 VZRL~lt3~~ ~ry `..21, B3, vIW;A = r;
~.:;1. _
p~: • i ~
Buddied Officiv
POST IN A CONSPICUOUS PUCE
CITY OF EAGAN Remarks
Addition VIENNA WOODS Lot 21 elk 3 Parcel 10 81950 210 03
oWner screec-2113 Viburnum Trail stte Eagan, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.~~', jmP. 1981 283 • 5 3. 5 10
STREET RESTOR.
GRADING 4/~-7 128 1 -5$7..73 $8, 77 -
SAN SEW TRUNK 1973 129.78 8.65
* SEWER LATERAL ~
*
WATERMAIN
* WATER LATERAL 1981
* WATER AREA iggi
* STORM SEW TRK 1981
* STORM SEW LAT 1981 10
CURB & GUTTER
SIDEWALK
STFiEET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
^ ^ INSPECTIUN RECORD~^
CITY OF EAGAN PERMIT TYPE:
3830 Pflot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued: ~
(612) 681-4675
SITE ADDRESS: APPUCANT:
~ ~ i~ ~ r„~~ ? i; ,
! NNA 1..1„~i~i•, , . ~ . ~ . . .
PERMIT SUBTYPE: TYPE OF WORK:
, Ir
INSPECTION .A .
; iri~:
s
F-
J
L
Permll No. PermR Holdsr [iuc@ • Telephone i
S/1N
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspectlon Date kap. ComnNnts
Foo[irge I
FoixxisfiDn
Framing
Rodft
Rough PIb9.
Raigh Htp.
~ Isul.
Fireplace
Fnal Htg. Orsai Tesl
Final Plbg. Plbg. Irmpector - NotilY Plumbar
Const. Meter
Engc/Plan
Bldg. FYiel
Deck Fig•
Deck Final
Well
Pr. Disp.
~
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 N2 13002
PFIONE: 454-8100
BIjILDING PERMIT aeceiptq
7obeusedfor SF DWG/GAR Estvalue $97'000 pate DECEMBER 22 86
Srte Atldress 2113 VIBURNOM TRAIL Erect Ocw pancy R3
~
Lot 21 slock 3 SecrSub. VIENiNA 4400DS Remodel ? Zoning R1
Parcel No. Repair ? Type of Const. V
Addi6on ? No Stories
TILLGES CONST Move ? Length 69
= Name Demolish ? Depth 54
o Adtlress 20936 HOLYOKE AVE Int.lmpr ? Sq Ft.
Ciry LAKEVITpkF,., 469-2144 Instau ?
i o Name SAME Approvais Feea
Address Assessment Permit $ 424.00
~ City Phone Water&Sew. Surcharge 48.50
~ Q Police Plan Review 212 . 00
~i Name Fire SAC 575.00
~i Address Eng. WaterCOnn. 500.00
aw Ciry phone Planner waterMeter 63.50
Council Road Unit 290.00
Iherebyacknowledgethatlhavereadthisapplicationandstatethatthe gldg.OH.'lZ/l7/$ Tr.PI. 156.00
information is correct and agree to comply with all applicable State oi
Minnesota Statutes and City of Eagan Ortlinances. APC Parks
~f~1 Var. Date Copies
Signature of Permittee 1`~f7 /14 4/5~- Total ' Z. b 0
A Builtling Permit is issued to: TILLGES CONST on the express condition that
all work shall be done in accordance with all applicable St~g of Mi~ ta~tqs and C~ iry ot Eagan Ordinances.
Building OfOaal i1~~ ~-G( C~C~~?
19
~ PERMIT
CITIf OF IEAGAN
3830 Pilot Knob Road PERMITTYPE: aur~dr1Number: 024751
Eagan, Minnesota 55123 Permit
(612) 681-4675 Date Issued: 10 / 21 / 9 4
SITE ADDRESS:
2113 VIBURNUM TR
LOT: 21 BLOCK: 3
VIENNA WOOD3
P.I.N,: 10-81950-210-03
DESCRIPTION:
Bu"ilding'Permit Type DECK
Building Work Type NEW
1 1
(
~
• i -
L: Jf~7~~f J C--J\~] L' L; \J
L .
REMARKS:
FEE SUMMARY:
Base Fee $30.00
Surcharge $.50
Total Fee $30.50
CONTRACTOR: OWNER: - Applicant -
FICK BARRY
2113 VIBURNUM TR
EAGAN MN 55122
(612)223-3042
I hereby acknowledge that I have read this application and state that the
infiormation is correct and agree to comply with a11 applicable State of Mn.
Statutes and City ofi Eagan Ordinances.
- ~
-Arw.n.
' A PLICANT/P R -SIGNATURE ISSUEDB SIG ATURE-~
INSPECTION RECORD
CtTY OF EAGAN PERMIT TYPE: B U I L D I N G
3830 Pilot Knob Road Permit Number: 024751
Eagan, Minnesota 55123 Date Issued: 10 /21 /94
(612) 681-4675
SITE ADDRESS: Lo T: 21 B L 0 C K: 3 APPLICANT:
2113 VIBURNUM TR FICK BARRY
VIENNA WOOD3 (612) 223-3042
PERMIT SUBTYPE: TYPE OF WORK:
DECK NEW
INSPECTION .
FOOTINGS FINAL
F
L
~
° CIIY OF EAGAN ~
40 1 1994 BUILDING PERMIT APPLICATION n
~ 681-4675
SINGLE & MULTI-fAMILY 2 sets of plans, 3 registered sit surveys, 1 c o energy
calcs. ~)CT 19 1994
COMMERCIAL 2 sets of architectural & struct -l-ant,_1_set o
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date 0<_610Pf /11 / 9~ Valuation of work
Site Address: 2113 VbUYY1lAm TYuI~
STREET SUITE !i
Tenant Name: (commercial only) N lA
LOT I BLOCK 3 SUBD. y i PnY\G, INODdS P. I. D. # IQ 'gi q S o 2l0 03
Descri tion of work: O(G1J1D\A 14 lus Gk
The applicant is: I& Owner ? Contractor ? Other (Describe)
Name 17i c.k szvrAe Phone 68Y•YZ6S f{
Property LasT FiRSr 22,3-3"v - W
Owner qddress .1-113 V;61c(Aum '[-Ia
STREET STE p
City 5tate mM1) ZiP 5S122
Company N/A Phone
Contractor Address License # Exp.
City _ 5tate Zip
Architect/ Company n) )A Phone
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber AJIA Processing time for
sewer & water permits is two days once area has been approved.
I hereby acknowledge that I have read this apPlication and state that the information is
correct and agree to comply with all applicable State of Minnesota Statutes and City of
Eagan Ordinances.
Signature of Applicant:
OFFICE USE ONLY
, • 4k
t ~
BUILDING PERMIT TYPE
? OI Foundation ? 06 Duplex ? il Apt./Lodging ? 16 Basement Finish
? 02 SF bwg. O 07 4-Plex ? 12 Multi. Misc. ? 17 Swim Pool
? 03 SF Addition ? 08 8-Plex ? 13 Garage/Accessory ? 18 Comm./Ind.
? 04 SF Porch ? 09 12-Plex ? 14 Fireplace ? 19 Comm./Ind. Misc.
? 05 SF Misc. 0 10 Multi. Add'1. 15 Deck ? 20 Public Facility
? 21 Miscellaneous
WORK TYPE
~31 New ? 33 Alterations ? 35 Tenant Finish ? 31 Demolish
32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION Const. (Actual) Basement sq. ft. MWCC System
(Allowable) lst F1. sq. ft. City Water
UBC Occupancy 2nd F1. sq. ft. PRY Required
Zoning Sq. Ft. total Booster Pump
# of Stories Footprint Sq. ft. Fire Sprinkler
Length On-site well Census Code ~/7
Depth On-site sewage SAC Code d
Census Bldg
APPROVALS Census Unit G
Planning 6uilding Assessments
Engineering Variance
REQUIRED INSPECTIONS
O Site ~ Footing 0 Framing ? Insulation
? Wallboard Final 0 Draintile ? Fireplace
Permit Fee vetuac;on: $
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
sac %
SAC Units
brl,
~ ~+P~~NPt.~~ ANO v(II.rTY F~?~"1G'NS~'/ i
~
~
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P I~ o T P l~ A~-1 v"
o-~' 2 I l. o G I~ 3 V I~INA w~i
Fi.A,1•! 8~12/?634
1986 HQILDING PERtiIT APPLICATIOH - CITY OF E6GAN
HOTE: ALL CANTR9CTOES MOST BE LICENSED iiITH THE CITY OF EAGAN
SI27GLE F94IILY DiIELLZNGS
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
MULTIPLE DWELLINGS - RESIDENTIAL RENTAL iRiITS FOR SALE ONITS
INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SORVEY - CHECB WITH HLDG. DEPT.,
1 SET OF BNEAGY CALCULATIONS
COlIlMERCTnr:
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
ENERGY CALCULATIONS,
$2,000 LANDSCAPE BOND
. + 9Z,ao
To Be Used For: Cj~~{1Q ~yyy~`v Valuation: = Date: /
-F
Site Address OFFICE DSE ONLY
Lot Zj Block 93_ Erect ? Occupancy R 3
Remodel Zoning R I
Parcel/Sub Ojej&V(,( Repair _ Type of Const -Z
Addition ll of Stories
OwnerT~7 ( j~V~rU[y''lUN Move _ Length (19
Demolish Depth 54
Address 2 3~ ~ld~alce +~re. ~o.~,c4~s Int.Impr. _ Sq Ft
~ Install
City/Zip Code ~.ti(,~vAQ
j Phone 21 q q APPROVAIS FEFS
Contractorl~~lm.-yDyi Assessments Permit 424.
p Water/Sewer Surcharge 48,
sO
Address ~~j(p~pi i'q~ Police Plan Review ZIZ.
Fire SAC 515.
City/Zip Code Engr Water Conn Gop,
Planner Water Meter (o -5,so
Phone l.F/pq- 7jACouncil Road Unit 'No.
Bldg Offj2-11 Treatment P1 IS
Arch./Engr. APC Parks
Varianee Copies
Address TUTAL C/
City/Zip Code
Phone ak
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MDST DESIGNATE AHICH ADDRESS
IS DfiSIRED. NO CH9NGES iiILL HE ALLOTiED ONCE BQILDING PERMIT IS ISSUED.
Z4-x 30 - 7Zo x SY~ = 4 1-7(c~o
14-
14x22 = 30~ x Sg ° i~8~4
23x 3Z ~ 136
9ca0 (2:,
q-
93~~ gGf, ~i
,kp
5~ - - - - -t g.
I .
~ f O'P+AINPl.jE AND V(Il.i'TY 6°?~MG'NTH ;
I
~
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GA1epGE
'TaQ DF GA~, F~¢ ~ ~ i
RETAI~:~ i•V1 HtAU Q 7 10
- -
-•tc2~ Ici- ~ 102L io
I i
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1'7ji CIVEWAY
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9
- -i
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~ zi~'Jpp i 00
Z
vi 6U P~ NuM T~A? L _
P I~ o T F~ l_ A t~l i^_ v„
L o-T' 2 I l. o G K 3 V I~?~INA WCCCW7
F1,.1~IJ 8rol 2 /E'~o 34
EX;cRiOR ENVcLOPE AVERAGEE "U" COVDL'iAT1CN
o,-~:~:.~ T41,~:<:~~~- G~v~~--~v~,?-..-;-~~~~ C'.~~?~~::;•;el ~
, f
Si7~ ADDRESS o:f 4~,i V1 ~Cm?l.y~°'V6.4.xV1h R/'CttE
CO\TRA CTGR""~~.~rF'c5 ~.~I'??~,-~"1^tl~°~~`5~.1 Da;- l'y y~~4~ ?-~C\~ ~~,q °~14
~ . .
G e i. • M.. ~ wo•;.,<~ ; r.g . sqaa,; e ~ H
" roc • ~age o~, eac.~.
; . Toial exposc-d wa l1 u:^::a . . . . . x
2. To'tai roo'/ceilin,g area sq. i t.. x`'~
`;ot-a? exposed wa?l area above flocr
.
d. ?G;:d! 4Jc7l Wl',^uOW c,l^t?c
. il. 10-c:dl G00:^ area . . . . . . . . . . . . . . . • • •
c. To'tu': sl ~dIng g?ass door area .
d.. iocal fireo?ace wa11 a•ree
2. TO-di Wul i F:^dilllY;] d'^e8 (dV2rage IOi')'
. -F. 70 tal net wal 1 area abova f? oor . . . : . . . . . . . . . .
g. Tota: rim jc;st area I i SK
7ota? ezocsed ftur,cation area t;..Toza7 -:ourdatior w;ndow area.....................
Toal ret. fourdat~cr a:ea above grade
. Deter-mine "U" vaiue cf each lYd1l, segmzni:.
G . p~ ~3+ ~ ji ti J ii , 77- e'i7 ~ F,
. ' .-D. w~~9i x iiLi~ 11
, . ~
c: •X lluil S S
d. X IV, _
, -
e. 1 `1 l ~ ~ I a .,u„
X„u„
;
t:~~ X l,ull
h. - x „V1
oo X %11
3 . ...................................7otai
rr 1',`.C'T ir"3 ;S i.`fl2 Sdf;O d5, 6i 12SS tIidI1 ii.c:l ;;l~ y0:1 hdVe ~Tiet `..,ie 7ritent
0',` SBC oOOo(C)Z.
7ota1 er:posed roor/ceilir,y area = Ic.'~~~>1`7 ,
sl;ylignt area..............
. . O~dl t'OCi/CEi1li.y cm "c"'2d (dVei'dQG ,:~,°w~. ~C"•,"~'.h.~'' .
. ' '70La1 fiEi, i(1SU~SL'CG'
, , JBi.BYfiil,n@ "U" VciUE fC:' 23Gfi 1"GG~lC2~ll,-iy
U
11~v.,~-!• .~,.~.R-
i•1~~=~~.'~::.?~X.,,U"
,ee... -__.~-•~,r.al-~
4 ...7otal = LT.~
1z ~07.cl 0{ 'S,iS„tfl' So~-e ,d5~ 0:' IBSS i.fidf. r2,.you have i~l@L L;eintent of '
53C Sv05(cjl. .
F,lternate Quilcir.g cnvelope Dzsi9r,
io utiiize "hz total enveiope syste,r. methcd, the values estab7isned by tne..
' SWM O,i 146 2.-,. 5 43 and;~4 S,ridl1 lnOi. FJ0 ];^2di.°Y' Ll',8l'i.h2 SUGl Oi 1i.0~T,5 r1..and.::~2.' .
i . 7 L+„ `7 Y 2. ~ Z , Lf ( . .
M
4. .
, .
. ,
. . ,
,
scitVoFeagan
3930 PILOT KNOB ROAD, P.O. BOX 21199 BEn BlOM9UIST
EAGAN, MINNESOTA 55121 nnavor
PHONE: (612) 454$100 THOMAS EGAN
JAMES A SMIiH
JERRV iHOPdFS
DATE: Sept 18, 1985 7HEODORE 4VACHTER
courcn rsemoe,:
THCMAS HEDGES
Gh / dms1,a1«
SPECI.aL ASSESS;fENT SEARCH EUGENEC ACI~y ERBEKE
Requested by: Dakota County Abstract Co RE: Vienna Woods
1250 Highway 55, PO Box 456 Lot 21 Block3
Hastings, MN 55033
Enclosed herein is the search which you requested made on the above described property.
Kind of Imnrovement yPa-; Bzeinnine Original Anount Balance Due
Street Surf. 10 1981 $2834.45 $1417.20
Grading 10 1981 587.73 293.88
San Sew Trunk 15 1973 129.78 17.33
Utilities 10 1981 4232.34 2116.19
I further certify that according to the records of said office, the following improve-
ments are contemplated or pending after having been approved and are now in the process
of planning or completion.
Kind of Improvement Apnroximate Date of Completion Anproximate Cost
NONE
..WAIVER:
Neither the City of Eagan nor its employees guarantees the accuracy of the above infor-
mation which was requested by [he nerson or persons indicated. Nor does the City or its
employees assume any liability for the correctness thereof. In consideration for the
supplying of the indicated information in the above form and for all other consideratio
of any nature whatsoever, any claim against the City or its employees rising therefrom
is hereby expressly waived. Levied assessments to be paid to the CITY OF EAGAN,
3830 Pilot Knob Road, P. 0. Box 21199, Eagan, MN 55121.
Very truly yours,
SPECIAL ASSESSMENT DIVISION
iHE LONE OAK TREE. ..iHE SYMBOL OF STRENGTH AND GROWfH IN OUR COMMUNIiY
. ******#********##Y#**fii#**kif}*~}*q
' C I T Y O F E A A f~f PAYMENf OF FF.E AT TIME pF ;
* Arrisc.aaIoN noFS Nar wKS-riUM *
~ APPLICATION FOR PERMIT *APPRomm OF PERNIIT. *
~ . * INSPDCrION oF SE.WR ADID/OR kIIi'M *
*F tt1g1'TT.TATTONS WIIS. B10iP BE SC1IID- •
SEWER AND/OR WATER CONNECTION +uLED uNm PEPMIT HAS BFEd ;
* APPRaVID. +
* w
w *
r "
. *s**:*t****r+xwew*r*,e~rt,et,tt,tst*ts,tw*
, P ease Print) y-
1) PROPERTY ADDRESS : Z j/ 3 v' b;,i v n
ti 6- . -
LEGAL DESCRIPTION: Z j G /C ~
Lo
. t Block/Subdivision or Tax Parcel ID )
IE' EXISTING STRCCMME, DATE OF ORIGINAL BL'ILDING PERMIT ISSL'ANCE: .
! FRFSENt 7ANING/pROPOSID C'SE: (~n Yeaz) ? COMMERCIAL/REI'AIL/OFFZCE ~ R-1 SINGLE FAMILY
Q IPIDCTSTRLnd, 0 R-2 DCPLEX (TrA Lfiits)
f-I INSTITL'TIONAL/GpVERNAg,'NT CD g-3 qpWNipUSE (Three + Units) ( C~nits)
. 0 R-4 APARTMENT/COAIDOMINZUM ( Units)
2) T .
N11ME°-
ADDRESS:_
CITY, STATEr ZIP:_ r io r ~.o- ~P ~ h 3~ 37 2-
~
PHONE: !F5?-013 7
• 3) • u r~• For City C~se
Plumbers License:
ADDRESS:
Active
e
~ CITY, STATE, 2IP: Fxpired
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PHONE: [fIf `7- 4 3MASTER LICEN5E#
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NAME:
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CIT7. S"fATE, 2IP:_
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PHONE:_ Z/ L/ y
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~ CONNEGTION TO' CITY SEWII2 ~ CpNAIECTION 'IC) CZTY WATIIt ~ pTHER ' .
' 6) PLF.A,SE HOLD APPROVfD PERMIT FOR PICK-CP BY OI~ OF ABOVE
~
PLF.ASE MAIL APPROVID PERMIT 10 1,2 3. q. pBpVE
/ (Circle one) „
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. FOR CITY USE ONLY .
PERMIT # ISSUED
Pd w/Bldg. Permit FEES:
$ $ 5-6 SEWER PERMIT (INCLUDE SURCHARGE)
$ $ ~O• WATER PERMZT (INCLUDE SC'RCHARGE)
$ ~ 3 'S--b $ WATER METER/COPPERHORN/OC'TSIDE READER
$ $ WATER TAP (ZNCLUDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEPOSIT - SEWER
$ $ ACCOUNT DEPOSIT - WATER
$ ~ C~ • U O $ WAC
- $ S SAC
$ $ TR[}NK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ ' LATERAL BENEFIT/TRC'NK SEWER
$ LATERAL BENEFIT/TRI)NK WATER
$ C) $ WATER TREATMENT PLANT SURCHARGE
$ $ OTHER:
$ A-2- %~Z SZ~ $ d O TOTAL
Z, 7 3 oz ~ ~73
RECEIPT RECEIPT
DOES UTILITY CONNECTION REQOIRE EXCAVATION IN PLBLIC RIGHT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WITHIN PUBLIC
ROADWAY" MUST BE ISSCED BY THE ENGINEERING
~ NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
TITLE:
DATE : ~ / Z ~ 7
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401'
C!tyofEaali
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit#: 1� o 73
10535
Permit Fee:
Date Received: t 12'/ %(
Staff: 92
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
It(o5. Z£
Date: Site Address: Unit #:
all
=I = Ann 1 v 6( q -(oto
Name: Vqn o ;; J`fZ Phone: 2.- 8$9— '7
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Address/City/Zip: 2113 V.lournonn Tra.11,
Applicant is: X Owner Contractor
Il ii�
1
Description of work: �s\-°►11 Ile...)Ile...)w' ^�°-u \`n5.,_, — AbcL
op
Construction Cost: 41 0°C)' Multi -Family Building: (Yes / No )
1 a IFE Company: Contact:
Glx tz} Address: City:
l State: Zip: Phone:
License #: Lead Certificate #:
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?
If yes, date and address of master plan:
_Yes _No
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
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.gooherstateonecall.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
Applicant's Panted Name
2