900 Wescott Square
CfT'.' aF EAGAN WAfER SERVICE PERMIT _
3833 Pilr.t Knob Road
P. O. Box 21199 PERMiT NO.: 5862
Eagan, RiN 55121 p^TE; 11-30-84
2onino: R4 _ No. of Unlts: 4 plex
:
FML
~
Inc
Addresx L
: S~~; 900 Wescott Square ~3 B1 Wescott Hills Revised
_ Masters' Plbsz
yA.t.r N,.: 3 3 8' ? 1,/( 9~' Co.,necryon Choge: 1504 . ao a
Size: t ' a
~ r~a.. r~ a t- 7~' a ~ Po~~ ~.,°o~n` 10.00 pa
. I NM to w rhr wa eM Cihr ef Eqpn Surcho.qs: .50 vd
O,~~tw~ ktm Cha,om 252.00 pd mete
Total:
By Dat. Paid:
Date of Insp.: ~ Insp,.
CITY OF EAGAN SEWER SERVICE PERMIT
3834 Pilot Knob Road
P. O. Box 21199 PERMIT NO.: 7051
Eagan, MN 55121 pATE; 11-30-~','.
Zonirg: 114 No. of UNts: . 4 nlex
Owrier:
Address: _
Site Address: 900 Weacott S uare j,5 31 ;'escott ?;fll :tevised
Plumber: " r ` s r1 U .
11-14-311. !:766`~ , p
I"n. ro eaupyr wleu d. Clti of B.'e. Connoctton Charos: 1360. 00 pd
Ordlmnea. llctount Depodt:
Permit Fae: 10. 00 r-.i
Surcharpa: .5) n;!
BY Misc. Cha?qes:
Date of Insp.: Totol:
I nsp.: DcM Pald:
, . CITY OF EAGAN 97i ,8
3$30 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121
PHOM E: 454-87 00
BUILDING PERMIT ReceiPC #
_ To be i..e_fo. 1 or 4 PLEx Est. Walue $48_, 000 Date NOVEMBER 13 19 84
Sitef?ddress 900 WESCOTT SQ (UNIT 103) F~ ~ RI
Occupancy
lot ~j361ock 1 sec/sub. WESCOTT HILLS RE~je;del ? zonin9 R4
Parcel No. Repair ? Type of Const. V 1 HR
Enlarge ? No. Stories
~ Name FrIL INC Move ? Length 3
~ 885 - 12TH ST Demolish ? Depth 36
Address
City ~~WPORT phone 459-4089 Grade ? Sq. Ft.
SAME ApProvals Fees
o Name ~
Address Assessment Permit 24.00
~ City Phone Woter 8 Sew. 5urchorge Potice Plan check 137.00
bW Name MCCOt1H8-KNUTSON ASSOC INC Fire SAC 420.00
i~ Address 12800 INDUSTRIAL PARK BLVD Enq. WaterCor~n. 376.00
~W City PLYMOUThone 559-3700 plan~r WoterMeter 63.00
Councfl Rood Unit 208.00
i hereby acknawtedge thaf I have read this epplication end state thot 81dg. Off.11/13/84 Parks
the informafion is correct ond ogree to comply with oll applicable APC Total • ~ Q
5tate of Minnesoto Statutes-,ond City of Eo9nn Ordinances.
Var. Date
Sipnature of Perrnittee
ll Building Permit is issued to: _ FI4-L I iIC on the express condiNon itw+
nll work sholl be done in uccordonte, rvith q11 aRplicoble Stote jof Minnesota Statutes ond City of Eaqan Ordinontes.
Buildinp Officiol
' ?1
Permit No, Permit Holdar Data
Plumbing y~ GJ ~t) Gc v~ ~U,- ~ 1( (~j 'C 3-)- 9 (
H.VA.C. ~ I C, ~J I I' I `L
Elactric
soRener
Infpection Date Insp- Other
Footings ! &.$y
Foundation
.
Framing
Rough Plbg.
Rough HVAC
Insulation ov91w
Final PI6g.
Final HVAC ~
Finel
Cert/Occ.
Water Describe Lotation:
Well
Sewer
Pr. Disp.
.
' CITY OF EAGAN y~ 97a+4
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100 Rece+pt # (-/l7~ ~
Ts be wed fer 1 OF 4 PLEX Est yolue $48i000 Dare NOVErIBER 13 , 1984
Site Ad ess 900 WESCOTT SQ (UNIT 104) Ere~ 6 Occupancy R1
Lot~Block Sec/Sub. WESCOTT HILLS REWerloiel ? Zoning
Parcel No. Repair ? Type of Const. V HrZ
Enlarge ? No. Storie; FML W Name _
INC Move ? Length
~ Addres Demolish ? Depth --6-
City Phone 459-4089 Grade ? Sq. Ft.
SMlE Approvob Feas
Name
a Address Assessment Permit • O
u~ City Phone Wate? b Sew. Surchor9e 24.00
Police Plon check 137.00
WW Name MCCOMBS-KNUTSON ASSOC INC Firo SAC 420.00
i~ Addres PARK ~ Er?p. Water Conn. 376.00
u
~W City Phone Planne? Woter Meter 63 . 00
Council Road Unit 208. 0 0
I hereby ocknowtadge thot I haw reod this applicotion ond state that gldg. Off11 13 84 parks
the inlormetion is Corred and agree to tomply with oll applicoble APC Tota) i
State of Minnesota Stotutes end City of Eogon Qrdinances.
, Var. Date
Slpnoture of Permittee
A Bullding Permit Is issued to: on the axpmas tondition fhar
oll work shell be done in accordonca witli oll appliaoble Stote of Minnesota Statutes and City of Eopon Ordinonces.
BuRdinp Offidol
T~
! 1/
PKmit No. Pormk Holdw Date
Plumbiny
H.V.A.C. '1 / l'-1 ~'i~`zLtv.~-c.1 I/ - I •I I
Electric
~ ~~j~ ~ 5 ~ i ?~;G~?~ ~a~,ol~ y -
soft.n..
Inspeetion Date Insp. Other
Footings $ib -v
Foundation
Freming .l
Rough Plbg.
-77-
Rough HVAC .
Inwlstion
Final P16g.
Final HVAC
Final
Cat/Occ.
Water Describe Location:
YVell .
Sewer
Pr. Disp. .
. CITY OF EAGAN ~ 9710
.
3830 Pilot Knob Road, P.O. Box 21-199, Esgao, MN 55121
PHONE: 454-8100
BUILDING PERMIT Receipt #
Te be wed for 1 OF 4 PLFX Est. Value $ 4 8,0 0 0 Date NOVEI4Bh`~t 13 , 1 4 84
Site Ad ~ 900 WESCOT'', ( UN I T 2 O 1) ErecY, L~ ocaupancy
~f Jc.:; T HILLS-REIVemKd ? Zonin j
Lot ~ Block SeclSub. e~ 9
Parcel No. Repeir ? Type of Const. t
Enlarge ? No. Stories
W Neme FML INC Move ? Length 30 885 ; Addr~ss - 12TH ST Demolish ? Depth
b
City Phone Grade ? Sq. Ft.
o Name Approvals Foet t~ Assessment Permit 7747 ou Address .O
~ Woter 8 Sew. Surcho?pa
F City Phone ~
G -~WN ~8W I~ Police Plon check 0
WW Neme Fire SAC ~
Address - Enp. Water Conn.
PLYMOM ~ W City Phone Planner Woter Meter O
Council ~4 Rood Unit •
I hereby ocknowtedge thct I hove reod this application ond state that Bldg. Off. Parks
the informotion is correct and agree fo comply, with oll opplicoble
Stcte of Minnesata Stofute;, nd Cif~r of Eogan^Ordinonces. APC Total I +
1~~(i l4 f i" C( ~j Var. Date
Siqnotum of Permittee
N Building Permif Is issued to: - FNL ZNC on the express wnditlon tha+
oll work sholl be done in xcordo e llth all applioobie SIxWe Minnewta Stntutes o-d City of Eayan Ordinonces.
Bufldirp Officiol ~L "
Psrmit No. Permit Holder psts
Plumbing 'l b 56 j l,J A-~?yfyr-~ 11-04A4
H.V.A.C.
Ekctric r~ 0
,A`l`13~~ i31,ulc Y
Softensr
Inspection Date Insp. Other
Footings ~y
Foundation
Framing
Rough Plbg.
. !ed'
Rough HVAC
Inwlation
Final Plbg. . .4r mxog.,., 7
Final HVAC
Final ~
Ce.t/occ.
Watsr Describe Location:
VYell
Sewer
Pr. Disp.
T----~-
, CITY OF EAGAN 9711
' 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
BUILDING PERMIT Re«ivt #
Te be wed ior ~ OF 4 PLEX EO. Value $48,000 pO1e NOVEMBER ]j3 , 19-U-
Site 900 WESCOTT SQ (UNIT 202) E occupancy R1
A ress r
Lot elock 1 Sec/Sub. WESCOTT HILLS REWel O Zoniny R4
Parcel No. Repair ? Type of Const. V 1 HI~t
Enlarge ? No. Storiea
W Name F~ INC Move ? Length 3
Z 585 - , Demolish ? Depth 36
g Addres 459-4089 Grade ? Sq. Ft.
City SAME Phone
Approvals Fees
, o Name
Z~" Assessment Permit • o
o~ Address
UF Pha~e Woter 8 Sew. Surchorge 24.00
Police Plon check 13 O 0
~W N~e . S-KNUTSON ASSOC INC Fire SI~C 420.00
IND PARK BLVD 376.00
x~ Address F.np. Woter Conn.
~W City F'LYMOUTH Phane 559-3700 plan~r WoterMeter 63.00
Councii Road Unit 208.00
I hereby acknowledye thot I have reod this npplication and stote that gldy, p{f,11/13/84 parks
fhe information is torrect and ogree to comply with oll appliccbl• APC Total -'~I !3 L) 2
Stote of Minnesoto Statutes,and Ciry of Eagan. Ordinonces. ~
Var. Date
5lpnoture of Permiftea 7 ~ ''2 ~ ~'~~=~~•''F~- ~ i k~ L~( _ %
FML INC
A Building Permit is iuued to: ~ on the expreu conditbn thot
oll work sholl be done in occordorxe with all licable State Of 1~ipnesoto_Statutes ond City o4 Eoycn Ordinances.
Buildinp Offkial
Permit Na. Permit Holder Date
Plumbinp l{ $ y 5~.~1 S o 1 t- ~ 4-$'1
H.V.A.C. ~ I ~ 1 -/~c •2~.
ei.cc.ic o-litl~~f f~o. o0
SoRernr
Inspection Date Insp. Other
Footings ~ bY U.Jw
Foundation
Framinq
Roueh Plb9.
-dRough HVAC 1000,
Inwlation ~y_s5
Final Plbg. ~
Final HVAC
Final
Cart/Occ.
Water Describe loeation:
Well
Sewer
Pr. Di~p. ,
CITY OF EAGAN Remarks
Addition Lot 13 -131k I Parcel in 9361! !3n n-1 X-1
Owner Street State F-qga,Tl, MN 551.23
Imp ment Date Amount Annual Years Payment Receipt Date
STREET SURF. 22.68 lO
STREET RESTOR.
GRADING
• SAN SEW TRUNK ~ -
• SEWER LATERAL
WATERMAIN
• WATER LATERAL
WATER AREA
* STORM SEW TRK 1985
* STORM SEW LAT 1985
CURB & GUTTER
SIOEWAIK
STREET LIGHT
WATER CONM.
BUILDING PER.
SAC
PARK
a ' . CITY OF EAGAN N? 9708
` 3830 Pilot Knob Road; P.O. Box 21-199, Eagan, MN 55121
~
BUILDING PERMIT PHON E: 454-8100 eeceipt C/~ G~
# T
Te M uud for 1 OF 4 PLEX E# yalm $48, 000 Date NOVEMSER 13 ly 84
SiteAddress 900 WESCOTT SQ (UNIT 103) Er Rl
er~ L"J Occupancy
Lot elock 1 Sec/Sub. WESCOTT HILLS RFMrr~el ? Zoninq R4
Parcel No. Repair ? Type of Const, V 1 HR
Enlerge ? No. Stories
W Name FML INC Move ? Lenqth 3~-
Z Addrest $$5 - 12TH ST Demolish 0 Depth 36
~ City NEWPORT phone 459-4089 Grade ? Sq.Ft.
o Neme Sp'ME AvOrovals Faes
Address Assessment Permit 27 •00
~ City ' Phone Worer85ew. Surcharge 24.00
Police Plon check 137.00
FW Neme MCCOMBS-P.NUTSON ASSOC INC Fire SAC 420.00
4~ Address 12800 INDUSTRIAL PARK BLVD Enp. WoterConn. 376.00
,W City PLYMOUTFj+hone 559-3700 plpnmr WaterMeter~~~
Council Rood Unit 208_00
I hereby ocknowledge thot I have reod this opplicotion and state thof gldg. Off.11/13IS4 Parks
the inlormofion is Mrrecf ard ogree fo comply wlth oll opplicoble APC Total $1, rJ02.0C
Srote of Minrresota Storutes~p d Citpn ~rdippnces.
Var. Date
Sipnoture of PermiMea ~rU l~t~C/
A Building Permif Is luued to: FML INC on tha expreas conditlon thal
ali work shall be dona in cccordnnce I lieable ah f Mi newta Statutes ond City of Eapan Ordirwncea
Buildinp Oflicial
~ ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
. • O~ INCLUDE 19 SETS OF PLANS,
~ CERTIFICATES OP SURVEY
. Q SET OF ENERGY CALCULATIONS
To Be Used For: _ Valuation:$,~~j.= Date:_ 9-19-84
Site Address: ~q 4048~ ~ •
Lot: 5 Block: 1 Sect/Sub: Erect: Occupancy:
Parcel W sc otc Hiils Revision Remodel: Zoning: -7-
Repair: Type Of Const:
Owner: FML. Inc. Enlarge- # Stories:
Move: Length:
Address: 885 12th St.. _Demolish: Depth: 3l0
City/Zip Code: Newport,MN 55055 Grade: Sq. Ft.:
Phone 459-4089
Contractor: FML, Inc. ~ Address: 885 12th St. Assessments: Permit: City/Zip Code: Newport, MN 55055 Water/Sewer: Surcharge: ~
Police: Plan Rev.:
Phone 459-4089 Fire: SAC: 4zp,°-°
Engr.: Water Conn:
)8Mk}FXjEn9: _McGombs-Knutson Assoc. Inc. Planner: Water Meter (03.=
Address: 12800 Zndustrial Park Blvd. Council: Road Unit: Zpg.`"
Bldg. Off.: ~?'Parks:
City/Zip Code: plymouth. MN 55441 APC:
Phone#: 559-3700 Variance: ~
CITYOFEAGAN M 9709
' 3830 Pilot Knob Road, P.O. Box 27•199, Eagan, MN 55121
~ PHONE: 454810D
BUILDING PERMIT Receiar #
T. M ~Md ier 1 OF 4 PLEX ,Eat Value +548, 000 pafe NOVEMBER 13 lq 84
SiteAddress 900 WESCOTT SQ (UNIT 104) ErCN Occupency Rl
Lot6 1 elock 1 ce<:/sub. WESCOTT HILLS RDMrtrdtlel ? 2oning
Peroel No. Repair ? Type W Conat. V 1 HR
Eniarge ? No. Stori
FMI, INC Move ? Lenyth ~
~ Name
Z Addrm$ - Demolish ? Depth 36
~ city NEWPORT pnone 459-4089 crade ? sq. Ft.
SAME AvproraH Fee.
o Name
o" Address Assessment Permit +S 274.00
~ WoterESew. Surchnrpa 24.00
t- City Phone
Police Plan check 137.00
GW Name MCCOMBS-KNUTSON ASSOC INC Fira S,qC 420.00
~z 12800 IND PARK BLVD
x~ Address Eng. Wnter Conn. 376,
iW City PLYMOUTH phone 559-3700 piunner WoterMeter~90
Council Road Unit 20R _ (10
I hereby otkrqwledge thot I have read this apDlication and stote }hat gld9, pff.l]./13/H4 parks
• fhe informotion is correct and agree to comply ith all opplicable APC Total $1, 502.0
0
Stato of Minnewta Statutes n d City f Eogon rdi nces.
/ Var. Date
Sipnature of Permittee
Ll ildingPermil is iuued M: FML INC on tha express conditlon thot
ork shall be done in cccordarxe wit a vlicoble St o --i-n~newta Stmutes ord City of Eapon Ordirwnces.
irp OHlciol Q ~
Qb
ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE E] SETS OF PLANS,
0 CERTIFICATES OP SURVEY
~ SET OF ENERGY CALCULATIONS
TO Be Used Foi: 4 Plex ~ Valuation: g+~.,~ Date: 9-19-84
Site Address: 96a 48.aro. OM
Lot: 5 Block: I Sect/Sub: J Erect: Occupancy:
Parcel Remodel: Zoning: 2-4
w ~ o xiil Revision Repair: Type Of Const: , IhR.
Owner: FML. Inc. Enlarge: # Stories:
Move: Length: 30
Address:_gg5 12th St.. _ Demolish: Depth: ~
City/Zip Code: NewDOrt, MN 55055 Grade: Sq. Ft.:
Phone 459-4089
Contractor: FML. Inc. ~
~
Address: 885 12th St. Assessments: Permit: Z~
City/Zip Code: Newporc, MN 55055 Water/Sewer: Surcharge: Z.~
Police: Plan Rev. :
Phone R: 459-4089 Fire: SAC: 420 ,9R
Engr.: Water Conn: 37 /0.'=
36g,Vb3FYJEn9: 1lcCombs-Knutson Assoc. Inc. Planner: Water Meter (n3.=
Addiess: 12800 Industrial Park Blvd. Council: Road Unit: 2pg_°
Bldg. Off.: Parks:
City/2ip Code: plvmouth. MN 55441_ APC:
Phone#: 559-3700 Variance: ~
CITY OF EAGAN N? 9710
3830 Pilot Kmb Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8700 Recelpt # 4a io)-
Ts M wed for1 OF 4 PLEX Est.Value $48,000 pate NOVEMBER 13 1 q 84
SiteAddress 900 WESCOTT _GQ (UNIT 201) Er t C~ Ocwpancy Rl
Lot~Block 1 ~/Sub. WESCOTT HILLS RF~eI ? Zoning
Pareel No. Repair ? 7ype of Const. V 1 HR
Enlarge El No. Stories
W Name FML INC Move ? Length 30
Z ddrms $$5 - IZTH $T Dem0lish ? Depth 36
ciNEWPORT Pnone 459-4089 Grede ? sq.Ft.
Name SAME Avorovob Fees
~O ~~O
~ Address Asussment Permif
City Phone Woter & Sew. Surchorge 24. 00
Police Plan check 137. 0 0
G°`+ Name MCCOMBS-KNUTSON ASSOC INC Fire SAC 420.00
12800 IND PARK BLVD 376.00
I~ Address Enp. Wafer Conn.
~W City PLYMOUTH phane 559-3700 planmr WaterMeter 63,.00
Council Road Unit 208.00
I hereby acknowledge thot I have reod this avVlicotion and stcte that gldg. Off. 11 13 $ parks
fhe informofion is correcf and agree to wmply with oll opplicable APC Total ~~..SO?.04
Stafa of Minnesota Stotute nd Ci of Eogan P" nces.
Var. Date
Siprwturc of Permittee '
A 8uflding Permlt Is issued ro: ML INC on the exprcss wndiNon thm
oll work sholl be done in xcordo e th II app iwb St Minnesoto Statutes ond Ciry of Euyan Ordinancea.
Bufldinp Officiol
ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE El SETS OF PLANS,
CERTIFICATES OP SURVEY
SET OF ENERGY CALCULATIONS
To Be Used For: 4 P aluation:uai.,T9fie: Date: 9-19-84
Site Address: - /'64Q~Q&COO ~Y• .
Lot: 5 Block: I Sect/Sub: Erect: X Occupancy: R-1
(Z-
Parcel R: wercotr x=11s Revision Remodel: Zoning:
Repair: Type Of Const: '7- -1 HR,
Owner: FML. Inc. Enlarge: # Stories:
Move: Length: 30
Address: 885 12th St.. _ Demolish: Depth: 3!p
City/Zip Code: Newport,MN 55055 Grade: Sq. Ft.:
Phone 459-4089
Contractor: FML„ inc. ~ Address: 885 12th St. Assessments: Permit: 2~4•~
City/Zip Code: Newport, MN 55055 Water/Sewer: Surcharge:
Police: Plan Rev.: .
Phone 459-4089 Fire: SAC_ 42p.=
Engr.: Water Conn: 3-%,70
lbglkrANign4=_McCombs-Knutson Assoc. Inc. Planner: Water Meter /03.°-
Address: 12800 Industrial Park Blvd, Council: Road Unit: 208.S!
Bldg. Off.: Parks:
City/Zip Code: plvmouth. MN 5544 L_ APC:
Phone # : 559-37 00 Variance : ~
" CITY OF EAGAN M 9711
, 3630 PiIM Krro6 Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 4548100 /
BUILDING PERMIT Receipt # ~o
Ts M wad hr 1 OF 4 PLEX Est,yalue $48,000 Dore NOVEMBER 13 , iy-BA-
Site dre 900 WESCOTT SQ (UNIT 202) Ere~t~ Occupancy Rl
Adr' e
Lot ~slock 1 cec/Sub. WESCOTT HILLS RBFkrrOel ? Zoning R4
Parcel No. Repair ? Type of Const. V 1 HR
Enlarge ? No. Stories
W Neme F~' INC Move ? Length 30
~ 5- 12TH ST Demolish ? Depth
A res
dds Grade ? Sq. Ft.
city NEWPORT phone 459-4089
g SAME Approrala Faea
Name
E~
Addresc Asseument Permit 274.00
City Phone Woter 8 Sew. Surchnrge 24 . 00
Gz MCCOMBS-KNUTSON ASSOC INC POlice plan check 137.00
~W Name Fire SAC 420.00
4Z Address 12800 IND PARK BLVD Erg. WaterConn..7 ..90
~W City PLYMOUTH phone 559-3700 Plonner WaterMeter~90
Council Rood Unir 20 R_ 0 Q
1 hereby acknowledge tFwt I hove reod this application and store that Bidg. Off. l 1 13 8 4 Parks
fhe inlormation Is corred and ogree to tAmply with oll ovvlicabie APC Total $1,502.00
State of Minnewta Stat tes City f Eagon rdi nces.
Var. Date
Siqnoture of Permittea W~
A Bulldirg Permit Is issued to: FML INC on tha expreaa condltlon thos
oll work sholl be done in xmrdence with oll li ble S ate i nes Statutes ord City of Eaqan Ordinances.
Buildino Official
4z>
ALL CaNTRACTORS MUST SE LICENSED WITH THE CITY OF EAGAN
INCLUDE E2 SETS OF PLANS,
7 Q CERTIFICATES OP SURVEY
~ SET OF ENERGY CALCULATZONS
To Be Used For: V uation: Date:
a{-'flQ~ 9-19-84
Site Address: - 46,000. . ~
Lot:-Al Block: I Sect/Sub: Erect: x Occupancy: (Z-~
Parcel WPSro Hi11w RevisiOn Remodel: Zoning: R-4
Repair: Type Of Const: ~-IHR.
Owner: FML. Inc. Enlarge: # Stories:
Move: Length: 3p
Address: gg5 12th St., Demolish: ?epth:
City/Zip Code: Newport, MN 55055 Grade: Sq. Ft.:
Phone 459-4089
Contractor: FML„ Inc.
Address: 885 12th St. Assessments: Permit:
City/Zip Code: Newport, MN 55055 Water/Sewer: Surcharge: 24.°~
Police: Plan Rev.: ~'j'j.%'
Phone 459-4089 Fire: SAC-
Engr.: water Conn:
7bffSk}F}~En4=_McCombs-Knutson Assoc. Inc. Planner: Water Meter (03.°-=
Address: 12800 Industrial Park Blvd. Council: Road Unit: 2pg =
Bldg. Off.: ~ Parks:
City/Zip Code: plvmouth. MN 55441_ APC:
Phone#: 559-3700 Variance_ ~
C+` ~y HOUSE HEATING TEST RECORD 13
AODRESSI~~ 2!`" -~EeAO,"P- A7TZRZ Fl00R CITY SUBURB
OCCUPANT ONTIER
HEAT LO55 DATE NTG INST.
SOLD B7Z =--dMw/-(- Al- INSTALLEO BTS6fl~lS~~-
Eleehieal Wark Br GasLim Br5"
TYPE OF NEAT GA _ FA HW _STEAM -SPACE MTR. _UNIT NTR. _OTHER ~
GAS OESIGN CONV
MAKE MAKE OF BURNER C~
Med~l a~~ U Mod~l s«iai w.. aTU ae.i,p
INPUT Za n2n MAKE OF FURNACE AMdoI
CONTROIS
TIiERMOSTAT M ot Plu` Vent Si:* y
Velv. KIND Oi° lIN R ~NONE
Limie D~ah Need n Rp~ior ~p ~'£1'Er'G.AQ
Limi/SeMinO ~ Filt«t
Fon Se"inq Gimnh. Leeat{en InSido ov 0ut~id
Piler Trp. l/~'~o^~.vf1 /~O/~~ Ohimn~Y Censrruetion~ ~h~6P.5`?tn.S C. ~SS'~
Pilat Msk~ Sp1118qe ~ Pilse Medol ? Swetii Banh Wirinq 73 Pilel Timi" Dreff Toat 7ag
L.W. Cut Off Dea Prouve Liqhtinq Inst
Pnsaur~ ; Pere"tCOZ.=JA? S~o Don Tooted 4!5,
lwurCEN45_ P«eone OZ i ~n Compenry T~stleq
Sac4 Tomy. Pwanr CO 425,
f7 Nase ei ?oshr - ~ 1Certificate o£ Compentency_ #
. HOUSE NEATING TEST RECORD
ADDRESS~a~ C~GD~ ~~zldre A?T,)i[QF[.OOR_CITY SUBUR9
OCCUPAN• ~OMNER
MEAT LOSS gA , NTG INST.
SOLD BT Z~.AJ~10 IhQ17,INSTALLED ~BY.~d'llLSQ '
El~cnfeel Week Bq.r LCCfY'fC a, LiM gY 'GV.~w.l'TiA/S' T7P8 Of NEAT GA __FA_4-_NM _STEAM -SPACE MTR. _UNIT MTR. _OTNER
~ GAS DESIGN CONVERSION
MAKElL;E2:9¢ MAKE OF BURNHR
Med•I Msdol
S«ial „i0~/~ JSf~tiy Msa. BTU Retfnq
INPUT 1AAKE OF fURNACB
Msdel
CONTROLS ~TNERMOSTAT/~LZ_ Nwr lu` Y•nr Sis• ~
Vah~ ~N+'~ ~ZKIND OF LINER_ SIZE NOME
Limit Drah Maed ~ ~-°5 Rp~ k'
- /
Limif Soniwy 0 Fihws Sis. /~a% MY111~~'q
Fan Stfino ~ QlmnN Lxaefen ~Inside )4f Outside
Pilee Tyye ~•a/~n.o>i Ohim"Y
Pilef Msw ~ i/'y~ Spillsge O~
Pila Me"l Sw,km Banb Wirinq
P;ler Ttminq a~r* T..+ ra, " & c
L.W. Cut oH oear Pr.uw Lfqhrin' In.a ~Yp S
Pn--we ~/C' Psreznl CO? 7~9 p Da» Tested
InputCFM -5-e7 Pweene 0 = Cemyawy Testiny-~t6'[eli '
Srock TemO. Pwpnt CO Nan» e! Taslr CIJO~"~.o 3-1vi LS'!J
Certificate of Compentency_ #
• HOUSE HEATING TEST RECORD
ADDRESS T n~ 4 Z'L Q, APT. / U 1 FLOOR _ CITY fUBUR!
OCCUPANT OMNER
MEAT LOSS DATE NTG. INST. SOLD BY ~~i ~iY9 /`~~f4~'iN[Y INSTALLED BYSv..rwrs'oH/'t•
EI"Meel Wxk Brsu~"a~iYl Gas Lin~ BqScUO I~/r~rrL'/r'~F.~X/)~(
TYPE OF MEAT GA _ FAA_MW -STEAM -SPACE NTR. _l1NiT HTR. _OTMER
GAS DESIGN CONVERSION ~
MAKB MAKE OF BURNHR
M,e.i s S,DSO ,w,d.i
s«;al c~ S3 ?d,. eru s.«ng
INPUT _5512 OOd MAKE OR FURNAGE
L
. MOdd
CONTROlS THERMOSTAT~ ~
Mw1 Pluy Vent Siss
Valre ~/'L'~'-~/y KIND OF IINER NONE
Limit sf !HC'O Drah Meod ~`eS Rpulere.
LimitSeniny Rfltwo 5is*1AX21Jx~ wuwMe
Fan SeMiq ~almnw Lxetlen Ineid~ Outa id0
Ptioe Trp~ Gimmy Conseruefien 443 C S
P+lve Mar. Spillaga
viia. MOe.i 7-!,49, swwW eems Wiriny O•& ~
Pilet Tiininq 1~i Drait -924 Tot Tay~ ?1.~
L.W. Gue OH g De> Pnuun Liqhtin' Inu. y'C-S
Pr•ssw. ~Porc~nt CO2 . ~'13_ Da» Tested ~,?S J-
Input CFM ~d A 0 Pweewt OZ 7~~4 Cewvanr T..nnq ~
Srack T~my. Pwnnt CO ~~0 Nawe ei T~~t~- «-~'•tP. ~CO .
Certificate of Compentency_ #
MOUSE MEATING TEST RECORD
ADDRHSS -APT.'~~FLDOR CITY fU6URB
OCCUPANT OMNER
NEA7 LOSS ;qATE MT INST.
SOLD BY r~S r&44 %v~f~2 /4? INSTALLEO BYS~/QA.YOA/r Io¢6 ir/v
Elecblaal Wxk 9y ~a_/G.14?f`_ •/C Cos LiM By S'uJCwfrnAf~s'~~sr~i.:uc. r 2~ i%~
T7Pfl OF MEAT GA _FA X NW _STEAM _SPACB MTR. _UNIT XTR~OTMER
~ GAS DESIGN ~ ~ I~SION
MAKE f MAKE OF BURNER ~ ~
Moa.i r.~6.~~i/l,~-s~DSO wa.~
5«~ai .f'6~C ?~es. BTU Ranno ~
INPUT r~hUKE Of FURNACB
Msdd '
GONTROLS T1ERM05T T M"r PI Veet Si:.
Velr~ ~ ~ KIND OP LIHER SIZE-~ HONE
Limit fA~CA DroN Xeod ~L~'s
Li~nit SNfiny Filv~rs Si:.6X?OX1I
Fan Sening ~aimnay Leeatien IMOutside
Pclee Trp. Q,ITmy Gn.ervaien ~ L.ve, z Jt'-s-rtS Clas~~L.J
Puer µab Spillage L
Pila Msd~l S~Ite Ban6 'Niriip ~n
Pflo/ Tiininq Draif TeH Tay~~ ~
L.W. Cuf Off 4``& ~ Dea Pwuw~ 4_~ Liaht{nq le~f.
Pr~s~w~ PereMr C0~ 1p Z- q~ Dan T.srod
~
Inyur GFH Pweent 01 co {I miany T•e y Sw121Vrnd ~~.O l~ '/Y~
SD
Seeek Temp. Na" sf Tesr~r ~I., /5 r~'~iL(7~~
P«e~nr CO ~ +~GS~.~s.-
Certificate of Compentency_ #
co nK nK e/,
2000 BUILDING PERMIT APPLICATIOWIVVJMEN-TMILI,
CITY OF EAGAN
3830 PILOT KNOB RD - 55122 ~ S Cf ~ . --7 851-881-4875 1 _ a v
New 6onafiucllon ReauIreRl9Ma RamoAel/Reoalr Reaulremanla
n SI reglstered aite wmeYS ahowing aq. ll. ot lot, aq. H. of houae 2 copiea o( plan
cvntl gU roolad areaa (20% mmdmum loi covamae albwedl 1 sel 01 energy calculatlaa for heated addlllona
> 2 coples ot plana (show beam & wlnqow sizea; poured fntl. design; efcJ 1 alfe aurveY for exfedor addlllons & decks
'v 1 I set ol energy CpiCulatbns
~ 3 coplea o1 ree pres avatbn plan H lot platfed t*er 7/1/93
DATEI: I l~ . o CON5fRUCTION COST: ~7~ (~~Z,
DESCIRIPfION OF WORK: Fl-gi S oez~;- A-6E PE-PA-f RS
STREET ADDRESS: D O Wr7-SCOf'T- IO ¢ Z-1D I
LOT: ~ BLOCK: ~ SUBD./P.I:D. ~~~STf lw P,~T~ YS-G I~S~
Name: PhoneC
Loy{ Ftrsl
PROIIIPERTY
OWNER
Sheet Address:
Cfty State: vp:
II ComPunY ~6 NL=~Z Pc-~S-t-a 2 h-R, o a s P,one n: 2 43 S- l 9 32
(area code)
CO i RACTOR /1
Sfreet Addresse 2 -t-B t0 X2O~`~?~4~- License M ExP.
ph, tTP PLE VA-~Z-EE'Y Swte: h-'t ZiP;
ARCHITECT/
ENGINEER Company: Name:
Telephone ( )
Sheet Address: RegisTM°„o^
Ctiy Stote: Lp:
SeweAwater licensed plumber (ff Installina sewerlwatarPhone
reby ackrawledge Mw11 have read lhis applicafbn, slate lhat Ihe in(omwibn is coeecl, and om wNh aPP~~ State
I h91
of Minnesota Statufes and CHy of Eagan Ordinances.
Signafure of ApplieanY.
OFFICE USE ONLY
Cert~l'ficates of Survey Received _ Yes _ No ~
Tre~e Preservation Plan Received _ Yes _ No _ Not Required
I il
OFFICE USE ONLY
BUILDING PERMIT SUBTYPES
? 01 Foundatfon ? 07 05-plex ? 13 16-plex O 21 Poroh (3-sea.) ? 31 Ext Ait - MuMi
? 02 SF Dwelling ? OS OB-plex ? 77 GBrage ? 22 Porch/Addn. (4sea.) ? 33 Ext. AR - SF
? 03 01 of _ pbax ? 09 07-plex ? 18 Deck ? 23 Porch (screened) ? 36 Mutti
? 04 02-plex ? 10 08-plex ? 19 Lower Level ? 24 Storm Damage
? 05 03-plex ? 11 10-plex Plbg _Y or _ N g 25 Miscellaneous
? 06 04-plex ? 12 72-plex ? 20 Pool ? 30 Accessory Bldg.
WORK TYPE
? 31 New ? 36 Move Bidg. ? 43 Reroof
? 32 Addition ? 37 Demolish (Bldg)" ? 44 5iding
? 33 _ Alteration ? 38 Demolish (Interior) IK 45 Fire Repair
? 34 Repair ? 42 Demolish (Foundation) ? 46 Windows/Doors
" Give PCA handout to appllcant for demolition permit
GENERAL INFORMATIO r
SAC Code # of Stories sq. ft.
No. of Units Length - sq, ft. ~
No. of Buildings Width - Footprint sq. ft. ~
Const. (Actual) Basement sq. ft. ~ Census Code
(Allowable) Main level sq. ft. MC/ES System
UBC Occupancy sq. ft. _ City Water
Zoning sq. ft. Booster Pump
PRV
Fire 5prinklered
MISCELLANEOUS INSPECTIONS
? Stucco/Stone
APPROVALS ~5
Planning Building ' ~ ~Engineering Variance
Permit Fee 5~.~ ~ Valuation: $
Surcharge z. C) c) CITY OF E:AGFlN
Plan Review
License
MC/ES SAC ~ ~:ASHIEti° 7".F~MINAI... NU: []06
DA'il:.. 01/25/00 TTMI: ~ 14:c 3:51.
City SAC ~
Water Conn. n,:
Water Meter NAME:: FONF_I._ I;i =,TnraTtoNs
Acct. Deposit
S/W Permit 3r 1.0 9001 300 41f::iCOTT' S(t K13.75
S/W Surcharge 2i.55 9001 900 PIESCOTi SO 40.00 Treatment PL
Park Ded. r
Trails Ded.
Other
Copies
Total:
,
SAC Units roi;,l Fr,ereil-rt Fart~our3t, n 893. 75
% SAC CR:1.2267.8 tJL?E:I'i :[Dc ::IAN
CITY USE ONLY
LOT ~ BL PERMIT
II SUBD.WQhGo'~ tTi\`, f14AiSP~ RECEIPT#:
RECEII'TDATE:
2000 MECHANICAL PERMIT (RESIDENTIAL)
CITY OF EAGAN
' 3830 PILOT KNOB RD
EAGAN MPI 55122
I Date: 651-681-4675
~ Complete this section onlv if you are installing HVAC in a single family dwelling, townhome or condo under
I construction and not owner/occunied.
il
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets (minimum of one required @$3.00 ea.)
' State Surchazge .50
Total $
~
II
Complete this secrion onlv if you aze remodeline, addine to, or repairine an existing single-family dwelling,
townhome, or condo. Please indicate if it is a new item, alteration, or repair.
New X AlteraUon _ Repair _ Other
~ Fumace 32,3f(A V 01~0 4 ~5 ~ Airconditioning O~Gl
i _ Air exchanger Other
Fee $ 30.00
State Surcharge .50
, Total $ 30.50
Reminder: Call for irtspections
I SITEADDRESS: qO(::) WC.ASTCO4T
OWNER NAME: PHONE
-
(ARE
INSTALLER N~ ?l HONE k:
1 (AREA CODE)
STREET DRESS: I~~~ 1 L ~ UJ I CITY:c w v~.L] l. STA : M n ZIPk553 ~)j
~
SIGNATURE OF PERMIITEE
i
~I
CITY USE ONLY
L BL PERMIT#:
SUBD. RECEIPT#:
APPROVED BY: , INSPECTOR RECEIPT DATE:
2000 MECHANICAI, PERMIT (C0MMERCIAL)
CITY OF EAGAN
3830 PILOT lQdOB RD
EAGAN, DIId 55122
651-681-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
DATE:
WORK TYPE: New construction Install U.G. Tank
_ Ititerior Improvement _ Remove U.G. Tank
_ Processed Piping
When installing/removing underground tank, caU 651-68I-4675 for inspection by fire marshal and
plumbing inspector.
DescripUon of work:
Fees: I% of contract price OR $30.00 minimum fee, whichever is greater.
Underground taok removaVinstallation = minimum fee
Coatract price: $ x 1%= $ (Base Fee)
State surchazge calculate at $.50 for each $1,000 Base Fee
TOTAL $
- -
SITE ADLRESS.
OWNER NAME: PHONE
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS'lI-IERE A PREVIOUS TENANT IN THIS SPACE7 Y N. NAME:
INSTALLER:
ADDRESS: PHONE -
(AREA CODE)
CITY: STATE: ZIP:
SIGNATURE OF PERMITTEE
401MV oF eagcin
January 20, 2004
PAT GEAGAN
Mayot
HOWARD POPKIN
971 SIBLEY MEMORIAL HWY
PEGGY CARLSON LILYDALE MN 55118
CYNDEEFIELDS
~ ~:_9~oar~sCO~T sQu~ i
, MIKE MAGUIRE
MEG TILLFY Dear Mr. Popkin:
Council Members Thank you for the steps you have taken to complete repairs on the aforemenrioned property.
THOMAS HEDGES On January 15, 2004, an inspection was made to verify that repairs requested in our letter were
complete. As of that date, the following items remain non-code compliant and need to be
CiryAdminiscracor repaired:
• A handrai] must be installed on one side of each stairway with a retum to the wall of not less
than 34" nor more than 38" above the nosing of treads. (interior and exterior). See
Municipal Center. aYtlChment 3830 Piloc Knob Road
• Electrical panels must have cover plates on them.
Eagan, MN 55122-1897
Phonc: 651.675.5000 • Exterior light fixMes must be in good condition with working bulbs and covers.
Fax: 65I.675.5012 This letter is to advise you that these repairs must be made by January 31, 2004 or the City rrtay
TDD:G51.454-8535 issue a citation to you. Please call 651-675-5675 to schedule an inspection once repairs aze
complete or if you have any questions regarding this request, please contact me directly at 651-
675-5679.
Maincenance Eacility:
3501 Coachman Point Your efforts to resolve these issues are greatly appreciated.
&gan, MN 55122 Sincerely,
Phon<: 651.675.5300
Fax: 651.675.5360 G
TDD: 651.454.8535 Tetry Zelenka
Building Inspector '
www.cityofeagan.wm TZ/]S
cc: Dale Schoeppner, Chief Building Official
THE LONE OAKTREE
The symbol oEstrengrh
and growth in our
communiry
69 116; 53 ~ 70
2004 RESIDENTIAL BUII.DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCtion Reauirements RemodeVReoair Reauiremenls OFiee tTsaOnN
3 registered site surveys showing sq. R of bt sq. ft of house; and all roofed arees 2 copies of plan Ce(-of 3- -N
(20% manimum lot coverage allowed) 1 set of Energy Cak,uWtions for heated additions T 25 PWn~R~ w
2 mpies of plan shawmg beam & window s¢es; poured found design, etc, i site survey for additions & decks T*fra Requved - Y_ N
1 set of Eneqy Caiwlat~s ABd9Mn - indicate Non~Re sepfic system 0~-site Seppc;~sGei~~,.
3 caples of Tree Preservallon Plan if lol platted afler 711193
Rim Joist Detail OpGOix selection sheet (bldgs witli 3 or less units -
Date cla / 3/ezoo y Construction Cost
Site Address ( 0 Q L(,f-e s cv~~~ UufUSte #
Description of Work ` ~ct -L-C~_
Multi-Family Bldg ~ Y _ N Flreplace(s) _ 0_ 1 _ 2
Proper[y Owner Telephone # ( )
Contractor h~yt ei•e Alil- ~r S/0i( t t kc,--
Address City
State Zip SSU7~ Telep6one#(6L'/) ~/S^7-'/~,010
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Wwksheet • New Energy Code Worksheet
(Jsubmissiontype) Submitted Su6mitted
• Energy Envelope Calculations Submitted
Mave you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone # ( )
Mechanical Contractor Telephone )
Sewer/WaterContractor Telephone )
I hereby apply for a Residential Building Permit and aclrnowledge that the information is complete and accurate;
that 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 pernut, and work is not to start without a
pemut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval of plans.
r ~
i;%~a / _S;
Applicant's Printed Name Applicant's Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OS 06-plex ? 16 Fireplace O 21 Porch (3-sea.) ? 31 EM. AR - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. AR - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building O 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteretion ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
? 34 ReplaCement 'Demolition (Entire Bldg) - Give PCA handout to appllcant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ FinaUC.O.
_ Footings (deck) _ FinaUNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Tce & Water _ Final _ Pool Ftgs _ Air/Gas Tesu Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ AirTest _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
(~~/~5G aa~ ?s'
2004 RESIDENTIAL BUII.DING PERNIIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New ConsW ction Reauire menis RemodeVReoair ReouiremenLS Dlfiom-
3 registe2d site surveys showing sq. R of lot, sq. IL of house; and all roofed areas 2 wpies of plan C~t~ rvegl~di t:~~'-Y =,=A7
(20% manimum lot coverage allowed) 1 set ot Eneqy Calculations for heafed addilions Trex Pre5;P4in^Fk~d Y
2 wpies of plan showng beam & wirWow sizes; poured found design, etc. 1 sfte survey for addNOns & deda TreeFres ReqW Y
1setofEneqyCaiculations AWiOon-lndicetedon-sHesepticsystem
3 copies of Tree Preservation Plan it bt plaGed after 711193
Rim Jolst Defad Options seledion sheet (bldgs wiN 3 or Iess uniLs
Date 4^ Constrcucti-on Cost
SiteAddress , d~ Unit/Ste #
Description ot Wark ~^~r w~
Multi-Family Bldg V`, Y_ N Fireplace(s) _ 0 _ 1 _ 2
Property Owner Telephone # ( )
M1
COntCBCtOi
Address City
State AL Zip SS-?~76 Telephone #((p 5-1)`~~~'
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Ivfinnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 7 WoAcsheet • New Energy Code Wwksheet
(4 submission type) 5ubmitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber Telephone )
Mechanical Contractor Telephone # ( )
Sewer/WaterContractor Telephone )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work wili 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
pemut; that the work will be in accordance with the approved plan in the case of work which requires a review and
approval ofplans. ,
~ r
;g[ N z Z ! ~ ~ (1~
~ApplicanYs Printed Name Apphcant's Signature ~
OFFICE USE ONLY
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex O 11 10-plex ? 79 Lower Level ? 24 Stortn Damage
? 06 04-pleX ? 12 12-plex Plbg_Y or_ N ? 25 Mi5ce11ane0U5
Work Types
O 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building` ? 43 Reroof ? 46 Windows/Doors
O 34 Replacement 'Demolition (Entlre Bldg) • Give PCA handout to applicant
Valuation Occupancy MCES System
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings (new bldg) _ Final/C.O.
_ Footings (deck) _ FinaVNo C.O.
_ Footings (addition) _ Plumbing
Foundation HVAC
Drain Tile Other
Roof _ Ice & Water _ Final _ Pool Ftgs _ Air/Gas Tests Final
_ Framing _ Siding _ Stucco _ Stone _ Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
-
Base Fee
Surcharge
Plan Review
MCIES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies .
Other
Total
0.~~~ ~~)6-D
2005 COMMERCIAL PLUMBIlVG PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Date
Site Address WP g CO'ff Unit #
Tenant Name Former Tenant Name
Property Owner tl-) i M YI7(/L tG Telephone #(W) 3[pR`' eZ45~
Contractor ~ c1- ~e(r/
Address City ~Lt~!
State m f~ Zip ~ Telephone # (f5p~ WD ` 3'7~l
License # ~g /LF' Expires: /a ! D S
The Applicant is _ Owner Conhactor _ Other
Work Type New Bldg _ Modify Tenant Space RPZ PVB New Repair/Rebuild Replace
_ Irrigation system Work within public right o[ way/easement _ Yes _ No
Rain sensors are re uired on irri ation s stems
DeseriptionofWork CgD LUN4C~ke04r,/, I.~Q,~ L1~-s c3/,7
To inqmre if Pressure Reducing Valve is' uired on new service, ca11 6 51-67 5-564 6 ~
Meters - Call 651-675-5300 ta verify that hydrosta[ic, conduc[iviry, and 6acteria tests passed prior to oickine uo mMCr.
Irrigarion Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Puhlic Works
Fire Size & Price 3/4" displacement $161 A0
Doxnes6c Size & Type Avg GPM Includes high demand devices? _ Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No
Permit Fee $50.50 minimum (includes State Surcharge) `0,0 O
7
Conhact Value $ 3~ x 1% PermiY Fee
$ Meter(s)
Required on all new buildings & boulevard irriearion svstems $ Radio Meter Read
If permit fee is $1,000 or less, surcharge is $.50 $ $t3t0 SUTC}18Ige
If permit fee is over $1,000, surcharge is $SO per $1,000 attLe Permit Fee
Following fees apply only when fnstalting new irrigation system $ Water Permit
Call Jerry Wobschall at 651-675-5024 for required fee amounts
$ Treatment Plant
$ Water Supply & Storage
$ State Surcharge
---------------------------S.-Q--
~ Z~
$
n
I hereby apply for a Commercial Alumbing Permit and aclrnowledge that the information is complete and acc~??'a4e; th~dj$h' ~ klJ '1~~ i
con£ormance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand Ehis. is not a pemut, 6ut onl
application for a pernvt, and work is not to s[art withou[ a pertnit; [hat the work wi116e in cordance with the alrovedf ~J3tf i~i t~~Rf d
"which requires a review and approval of plans. ~
ApplicanPs Printed Name ApplicanYs Signature
-
CITY USE ONLY
REQUIRED iNSPECTIONS: _ U.G. _ Air Test _ Cras Test ~Rough In 211~ Final
PLANS SUBMITTED APPROVED BY: 17a BUII.DING INSPECTOR
General Information
• Radio Meter Read (required on all new buildings & boulevazd 'urigarion systems- $141.00
. RPZ's must be tested every yeaz and rebuilt every Five yeazs. Test results sLould be mailed to Paul Heuer at the City of Eagan
• A minimum fee pemut per address is required for the following RPZ's: new, rebuild, reuair, remove.
• Water meters include copper horn/strainer, remote wire, and touch-pad meter.
METERS REOUIRING 4-HOUR ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
1-20 518" residenrial $125.00 4-120 1-1/2" irrigation syst $ 735.00
displacement smcommercial turbine** PublicWorks
niaXiinurn must approve
continuous meter size
10
2-30 3/4" lawn urigation $161.00 4-160 2" turbine lg imgarion syst $ 931.00
maximum displacement residential &
conrinuous sm commercial production lines
15
3-50 1" displacement very lg res $296.00 1/4 to 160 2" compound bldgs over $ 1,849.00
b13g to 24 units 6; units
xnaximum sm commercial &
continuous & Ig comm bldgs
25 uri arion s stems
5-100 1-1/2" bldgs 25-64 units $429.00
maximum displacement &
conrinuous most comm bldgs
50
METERS REOIIII2ING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbine verylgirrigaNon $1,182.00 6-500 4" compound +300 unit bldgs & $3,563.00
syst & production very lg comm bldgs
lines
1/2320 3" compound +200 unit bldgs $2,282.00 10-1000 6" compound +400 unit bldgs $6,076.00
very Ig comm 61dgs very lg comm bldgs
15-1000 4" turbine verylgirrigation $2,226.00
syst
& prodaction lines
Comments
• To schedule inspecrion of the inside water line and backflow preventer, ca11 65 1-675-5 675.
• To azrangefor waterhun-on,call 651-675-5300.
cc: Maintenance Division Clerica] Technician Sanuary 2005
5c)
2006 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: single family dwellings R, townhomes/condos when permits are required for each unit/
nate U 3 106 / o<'
SiteAddress ~/e.$~o-}'•-~- 5 Q v4.r Unit# 020a
~ ~v'^ r y k ra: .llI. t-
Property Owner LeZ7 S P ^ Telephone # V~o / a ;z
Contractor /-/0'4m.xn (?e~~--; ~o.4-%n C\
Street Address /70 9 5 City 5 -~i \ ~ ~ a -~{r
State MtJ Zip .S S vS`.2 Telephone #(6~,5)) y3 9' S?} a
Bond GJ R`-) C'G Sq SS Expires: Y C a 7 1 v~a
The Applicant is _ Owner Contractor _ Other
Add-on or alteration to existing dwelling unit $ 30.00
-7k furnace _AddRional LReplacement / New
air exchanger
~ air conditioner
heat pum/p/ other !J~ ((hG fw /~Otq~-~
StateSurcharge $ .50
Total ~
$ 30' 5o
.
\ \ .^tY /
I hereby apply for a Rasidential Mechanical Permit arid aclrnowledge;ttiat the information is oompleCe and accurate; that the work will
be in conforrnance wi[h the ordinances and codes of~ttie'City of Eag'an and with the Mechanical Codes; that I understand this is not a
permit, hut only an application for a permit, and work is notto start without a permit; that the work will be in accordance with the
approved plan in the case of work which requires a review an8 approval of plans.
Appl ant's Printed Name A Rcant's Signature
2006 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
_ .
_ _
New Consiruction Reauirements RemodeUReoair Requiremenis Otfrce Use Onlv
3 registered sile surveys showing sq. fl, of bt, sq. ft. of house; and all mofed areas 2 copies of plan showing footings, beams, loisis C6rf n#Sun2YRecd _ Y N
(20% muimumlolcoverageallowed) iseto(EnergyCalculationsforheafedadditions Ae2Pmsp6ReCt) _ YT _N,2 copies of plan showing beam & window sizes; poured found design, etc 1 site suNey for additions & decks Tre2Ptes Reqov¢d ,,;~V _N
lsetoFEnergyCalculations Addifbn - indicafeifon-sitesepficsysfem DFrsitesepiic:Sysiem V r.N3 copies of Tree Preservation Plan If lot platted afler 7/1193
Rim Joist Delaii Options selecfion sheet (buildings with 3 or less units)
Minnegasco mechanical ventila[ion form
3 ~0 l N
Date Construction CostQ(~ l f~0.
Site Address W o 1i- 5o~ `'L- v-~vzE ° Unit/5te #
Description of Work J pt -m W-'CCtF'EYJ
Multi-Family Bldg _ YX, N Fireplace(s) ~ 0 _ 1 _ 2
Property Owner ~~v~ Telephone
Contractor l~r~-k,?Z,S ~wc- a~ 'n,~
Address C Ctty y/~-~S.
State Vl Zip Telephone #(~t,)J 'ac)'- j' L'~ 119-_
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 _ Minnesota Rules 7672
Ene~gy Code Category
• Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
(J su6mission type) Submitted Su6mitted
. Energy Envelope Calculations Submitted
In the lasf 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan?
_ Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone )
Mechanical Contractor Telephone )
Sewer/WaterContractor Telephone )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of NiN
Statutes; I understand this is not a permit, but only an application f a permit, and work is not to start without a
permit; that the work will be in accordance with the approve a n E as yg,qrl~~~~~ view and
approval of plans. ~U1
W MAR D 7 2006 ~
Applicant's Printed Name ApplicanYs Signature
DO NOT WRITE BELOW TffiS LINE
Sub Tvpes
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
~7 02 SF Dwelling ? OS 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt-Multi
/ ~
? 03 01 of_plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. A1t-SF
? 04 02-pleac ? 10 OS-plex ? 16 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? OS 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
WorkTvpes. ~/j/Lh/(~(~W ~'UC~~yr~. ~wL~/i6~l•~~'frr
? 31 New ? 35 Int ImprovemeM ? 38 Demallsh Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair y~~7r^$ZP1
x 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 Windows/Doors 4VU20 34Replacement •Demolition(Entire8ldg) - GivePCAhandouttoapplicant 17Fpiv~[i
~ ?
D85CTIqti0lt: WaterDamage_Yes " " fi-lk-N
Valuation Occupancy MCES System
Plan Review 4if,~0001-0r_25%
Census Code 43q Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of 81dgs Length Fire Sprinklered
Type of Const 42 Width
REQUII2ED INSPECTIONS
_ Footings(new bldg) Sheetrock
_ Footings (deck) ~ FinaUC.O.
_ Footings (addition) FinaUNo C.O.
Foundation HVAC
_ Drain Tile Othcr
Roof Ice & Water Final Pool F[gs Air/Gas Tests Final
~ Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
Fireplace _ R.I. _ Air Test _ Final _ Windows
Insulation _ Retaining Wall
Approved By: Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
D
aty sac
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
7~~~~ '52-5t)
2005 C49MBtMtt
UELUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Date3--/ALL-!0 (0
Site Address ~e l,U rC,SI iJ I l JakQ fQ~ Unit # /D02
Tenant Name Former Tenant Name
Property Owner Telephone # ( )
Contractor
Address City r'~j~
State Zip ephone # `-y~~ ~ - '7.-
(
) (2
License # Expires: MT
The Applicant is _ Owner V Contractor _ Other
Work Type New Bldg _ Modify Tenant Space RPZ PVB New Repair/Rebuild _ Replace
_ Irrigation system Work wi[hin puhlic right of-way/easement _ Yes _ No
Rain sensors are re uired on irri arion s tems
Descrip[ion of Work \ a
To inqm i£Aessure Reducin Valve is required on new service, cati 651-675-564
Meters - Ca11 65 1-675-5300 ro verify that hydrostatic, conductiviry, and bacteria tests passed nrior to pieldne uo meter.
Irrigarion Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Puhlic Works
Fire Size & Price 3/4" disolacement $161.00
Domestic Size & T}pe Avg GPM Includes high demand devices? _ Yes _ No
F7ushometers _ Yes _ No PRV Required Yes _ No
Permit Fee $50.50 minimum (includes State Surcharge)
x 1% $ PernntFee
Contract Value $ Q
$ Meter(s)
Required on all new buildings & boulevazd 'urieation svstems $ Radio Meter Read
If permit fee is $1,000 or less, surcharge is $.50 $ ! L~ SY3te $1u'CI1NgC
If permit fee is over $1,000, surcharge is $.50 per $1,000 of the Permit Fee ~
Following fees apply only when installing new inrigation rystem $ ' r Water Permit
Cal] Jerry Wobschall at 651-675-5074 forrequired fee arrwunts .
$ Treatment Plant
$ Water Supply & Storage
$ Sbte Surcharge
$ ~(J 5- Total Fee
I hereby apply for a Commercial Plumbing Pemvt and aclmowledge that the infortrtarion is complete and accurate; that ffie work will be in
conformance with the ordinances and codes of the Ciry of Eagan and with the Plumbing Codes- that I understand this is not a pemut, but only an
appliradon for a pemut, and work is not to start without a pemut; that the work will be in or ance with the approved plan in [he case of work
which requires a review and a roval of plans.
pa~<~n5
Applican4s Printed Nan& ApplicanYs ignaM'e
CITY USE ONLY
REQUIRED INSPECTIONS: _ U.G. _ Air Test _ Gas Test _ Rough In _ Final
PLANS SUBMITTED APPROVED BY: BUILDING INSPECTOR
General Informa6on
• Radio Meter Read (requued on all new buildings Rc boulevazd iirigation systexns- $141.00
• RPZ's must be tested every yeaz and rehuilt every five years. Test resulu should be mailed to Paul Heuer at the Ciry oF Eagan.
• A minimum fee permit per address is requued for the following RPZ's: new, rebuild, re~air• remove.
• Water meters include copper hom/strainer, remote wire, and touch-pad meter.
METERS REOIIIRING 4-HOUR ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
1-20 5/8" residential $125.00 4-120 1-1/2" irrigation syst $ 735.00
displacement sm commercial turbine** Public Works
maximum must approve
continuous meter size
10
2-30 3/4" lawn irrigation $161.00 4-160 2" turbine lg imgation syst $ 931.00
maximum displacement residential &
continuous sm commercial producuon lines
IS
3-50 1" displacement very lg res $296.00 1/4 to 160 2" compound bldgs over $ 1,849.00
bldg to 24 uniu 65 units
max3mum sm commercial &
continuous & lg comm bldgs
25 irri ation systexns
5-100 1-1l2" bldgs 25-64 units $429.00
marzimum displacement &
continuous most comm Uldgs
50
METERS REOiJIRING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbiue very Ig irrigation $1,182.00 6-500 4" compound +300 unit bldgs & $3,563.00
syst & productian very Ig comm btdgs
lines
112-320 3" compouud +200 unit bldgs $2,282.00 10.1000 6" compound +400 unit bldgs $6,076.00
very Ig comm bldgs very lg comm bldgs
15-1000 4" turbine very Ig irrigation $2,226.00
syst
& production lines
Comments
• To schedule inspecuon of the inside water line and backflow preventer, ca11651-675-5675.
• To anange for water nun-on, ca11651-675-5300.
cc: Maintenance Division Clerical Technician January 2005
RESIDENTIALBUILDINGs *70 100
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New Conshudion Reauirements RemodeN2eoair Reouirements Office~USe (kiN
3 registe2d site surveys showing sq, k of IoL sq, ft. of house; and all roofed a2as 2 mpies of plan showing footings, beams, joisfs CeAOf Survey Recd _ Y_ N
(20qo maximum lotcove2ge allowed) 1 setof Energy Calculations for heated additions Tree Pres Plan Reai :,~„_~Y 'N
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions 8 decks Tree Pres Reqwrea Y-
isetolEnergyCalalaUons Adddion-indicetei(onsifesepticsysfem On-gde5epfieSystem- ..._Y;. 'N
3 copies of Trce Preservation Plan'rf bt pladed after 7/1193
Rim Joist Detail OpGons selecfion sheet (buildings with 3 or less units)
Minnegasco mechanipl venGlatlon form
Date Construction Cost
Site Address .UniUSte # It7J~
Description of Work A~~K- KJ !e- .
Malti-Family Bldg _ YIXN Fireplace(s) ~ 0 _ 1 _ 2
Property Owner }ZCSt~t I l E Telephoue #(L~Sl 3 03a
Contractor
Address AME: City YVI~J~•
State Zip Telep6ooe #
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
(q su6mission type) Submitted Submitted
• Energy Envelope Calculations Submitted
In the lasi 12 monThs, has ihe CiTy of Eagan issued a permit for a similar plan based on a master plan2
_ Y _ N If yes, date and address of master plan:
Licensed Plumber Telephone )
Mechanical Contractor Telephone )
Sewer/Water Contractor Telephone # ( )
I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate;
that 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 permit, and work is not to start without a
permit; that the work will be in accordance with the approved i h of r which requires a review and
approval of plans.
0- ~
Applicant's Printed Name Applicant's Signature
DO NOT WRITE BELOW THIS LINE
Suh Tvpes
? 07 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 01 of _ plex ? 09 07-piex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Tvaes
? 31 New ? 35 int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building* ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement `Demolifion (Entire Bidg) • GWe PCA handout to applicant
D05Criptlon: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
REQUIRED INSPECTIONS
_ Footings(new bldg) _ Sheetrock
_ Footings(deck) _ FinaVC.O.
_ Footings (addition) _ FinaUNo C.O.
Foundation HVAC
Drain Tile Other
Roof _ Ice & V?ater _ Final _ Pool Ftgs Air/Cias Tests Final
_ Framing _ Siding _ Stucco Lath _ Stone Lath _Brick
_ Fireplace _ R.I. _ Air Test _ Final _ Windows
_ Insulation _ Retaining Wall
Approved By: , Building Inspector
-
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
City of Eapn
Mike Maguire
MAVOR
Paul Bakken February 6, 2008 Peggy Cadson
Cyndee Fields
Meg Tilley
COUNCIL MEM6ER5 Chris Awe Construction
4835 281h Avenue South
Minneapoiis, MN 55417
Thomas Hedges ,
CITY AUMINISTRATOR
RE: PERMIT 72586 dated 3-16-06 for a remodel
900 Wescott Square, #102, Eagan
PERMIT 73282 dated 5-9-06 for window replacement
9D0 Wescott Squaire;=#102;~Eagan
MUNICIPAL CENTER
3830 Pilot Knob Road Our records indicate that required inspections have not been completed on the permits
Eagan, MN 55122-1810 listed above. Inspections are necessary to ensure that the work for which the permit
was issued meets all life safety requirements of state and local codes.
651.675.5000 phone
651.675.5072 fax Please call (651) 675-5675 within 30 days of this notice to schedule an inspection. Be
651.454.8535 TDD sure to provide the permit number at the time of scheduling. If, for some reason, your
records indicate that inspections have been completed and approved, please supply us
the date of the inspection, as well as the initials of the inspector who approved the
MAINTENANCE FACILRY inspection.
3501 Coachman Point We want to thank you in advance for your anticipated cooperation in this matter. Please
Eagan, MN 55122 do not hesitate to call if you have any questions or concerns.
651.675.5300 phone
651.675.5360 fax Sincerely, .
651.454.8535 TDD
Inspections Department
www.cityofeagan.com
THE LONE OAK TREE - Tha symbol of
strength and growth
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07/29/2013 13:23 6513447137
4,I1' City of Earn
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
AMANDA HANSON PAGE 02
Use BLUE or BLACK Ink
Imma
For Office Use t�
Permit a: I I 0
Pemtit Fee: 1r
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: % Site Address: 900 lA 1 t ".Gz Unit #:
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Address / C / Zi p: ?� Ii P►t_iiT -1 )g (-D OK .-12-I
Applicant is: Owner X.. Contractor
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Address: 557102 iilieT$0.6,City: B1IM(NU17744
Zip:
State: Mk 31 Phone: 1062 333 --)14Q-----1x.71
License #: &,•1p �� ( ?1 Lead Certificate #: jdi(( ItiA j — (
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If the project is exempt from lead certification, please explain why: (see Page 3 for additi I. formation)
AA - C(Ls-PEA U. Q /f o.CottA. bid bib btl5- ,.CIS!
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:
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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 utilRlee. www.gQQherstate9neCall.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 Avvikrivc kircmSlk l
Applicant's Printed Name
A • • 11 ant's = lgnature
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