4441 Slater Rd
CITY a-F EAGAN WATER SERVICE'PERMI
3830 Pilot Knab Road T
P. O, Box 21159
Eagan. MN 5511 ~~IT NO.: % 0
D11TE: '
Zoninp: No. of Unlts:
Owntr: ac A OIIIEe
/~ddnss:
Site Add'°w LA L BCinnamon Ri ge 3rd
Plumber Wcstduk8 P
Meftr No.: jjrill~
Stza: Connection Chorg,; pd
Reoder No.: Account Devoalr: 15 . p d
Pennit Fee: p
OrdIM~p~,~NI wMl~ Nw Ci~~r ef G~n Surcharps: p
Misc. Cho?pes: P L,etar
B Total:
Y
Dots of In Dah PoFd:
sp.:
lnap,;
WAtER SERVICE P 6E~t
G1TY O° EAGAN PERMIT ?`l0.' 8-29-84
3830 Pi1ot Knob aold pATE: 1
P. O. Box 21199 No. o{ Units:
Ea98~, MN 55 Rl
zonirg. Zachman KomeS Rid e 3td
o~L12 B2 Cinnamon
Nddross' 4441 SLATER R0AD 470•00 a
Sie. Nddrcss: Westonka Plb ~~~ion CF?aroe- 15.00 d
Plumber ACCO,nt oevoI 10.00 d
M°ter r Pemnit . 50 d
Surcl+aroe63.00 d mete
rtmooe M~~o oe~Vf? ~ N~ ~ ~ ?,Aisc
Totol:
Or~iM°O~' pWe Potd:
Insp•~ ~
8y Date of Insp.: r
I
CITY OF EAGAN
3830 Pilot Knob Road sivm SERVICE P
P. O. Box 21198 118 !
Eagan, MN 55121 PE~~T NO.:
Zonlnp: R1 ~'?7'E: -
No. of Unih:
Ownwr. ZaChma~l fjp~pss
/1ddrosm ~
Srts Addms,; Slater Road L B Ciana~uou Ri
es o $
Plumber: ge r
~N~MI! whA Ni. C~,,f yp. ~i~ 425. 00 pd
Aa+aw+t aepo.k; p3"-
PwmM FN: p
; gy Surdorpe; p
! 00% of Intp.; Mlsc. ChorM
Irup,; Tofol:
04% Pald:
- .
- .
-
-CITY *j= EANAN WATER SERVICE PERMR
3830 Pilot K nab fioad i; 81
P. O. 5ox 213,99 PERMIT NO.:
Eagan, MN 551?1 D/1TE: ` "
Zoninp: 1 . ` No, of Un9ts:
~r. aC uaa.n
Address: WAKSIMU
'
.4h Add~~ , > Lt.7 F' ' C nnamon Ridge rd MFFI'
umbar.
`~Aeterjo.: ion Charpa: ' 0 pd
peposit: 15 . 00 pd
Reotbr No.: Permit fee: 0. 0 p
1 yrN re oompy wilb eM Gh of lyrm Surcharge: pd
Or~~,f b.~ - Mist. Choryes: p me t e r
Totcl:
By Darte Paid:
DoM of Insp.: In:p.:
33q9~~~~
IPe
II
~I
.
. ,
, CASH RECEIPT ~
,CITY OF EAGAN
P. O. BOX 21-199
EAGAN, MINNESOTA 55121
DATE - ~ 19
RKCKIVtD -
RI~OM
AMOUNT $ 1
~
6 DOLLARS
~oo
? CASH [3-CHECK
f
wOR
FUNO CODi AMOUNT
Thank You
BY
, ,
Vlfhite-Payers Copy
Yeilow-Posting Copy
Pink-File CopY
Raceipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
, Fse
r Fill in numbered spaces S/C
Type or Print legiWy Tot.
1. Date 2. Installation Cost
3. Job Addreu'f ~ J~, 1 ~ . , , . i' ;s
~ ~ Lot Blk. Tract ;
4. Owner
-r
Phone ~4.- '
6. Contractor f~ 'c ~ ~ ' •
6. Address ! --7v/
7. 'State Zip
8. Building Type: Residential 0 Commercial O Institutional ?
9. Work Description: New Z Add ? Alter ? Repair O
10. Describe ~tMi • ` ,
11. No. Fixtures No. Fixtures
Water Closet Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower ~fi
Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
Slop Sink
Gas Pipin9 Outlets
12. I hereby oertify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date tnsp. Date tnsp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
~ CASH RECEIPT ~
CITY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
i DATE
~
w~csivu
FwaM
C-AMOUNT $ ~
: ~ ~j
Ae DOLLARS
~ ~s•
? CASH CHECK
yy
/ -
FUNO CODfi AMOUNT
4 / ,.i S c +
• l
.
.
°J
Tha ou'' =y1 ~~o,~ ~
White-Payers Copy
Yellow-Postinp Copy
Pink-File Copy
CITY OF EAGAN
3830 Pilot Knob Rosd, P.O. Box 21-199, Eapan, MN 55121
QUILDING rERMIT PHONE: 454-8100 Receivr t V'/
It- T e w w1 fa Sr'' DijG/GA.2 Est. Volue 5L' : 000 . 00 pae L"Y 13 ~q ti4
SiteAddress 4491 SLATER KOAD erect L~ occuPency K3
Lot lZ Block 2 Sc/Sub. CII4N RIllGE 3RD Remodel ? Zoning 12
Parcel No. 10 17402 120 02 Repair ? Type of Const. V
Enlarge ? No. Stories
IM Name ZACIiI•lAN HOI+IES, INC. Move ? Length 3f;
Z Addrecs 4620 W 77TI1 ST SUITL 104 Dernolish ? Depth
~ City ED I Nt1 Phone 893 0755 Grade ? Sq. Ft.
ApProvah F*68
Name .Sj~i•1E
Address I~ssessment Pe?rnit -3 U 7_(i U
1- City Phone Wote? & Sew. Surchorye a~ q
Police Plan check 15 3_ 5 U
~iW Neme Fire $AC ri 2 5_ 0 0
U~ Address Enp. Water Conn. 4711- ~ U
~ W City Pnone Plonner Woter Mete? -«U
Council Road Unit 2w-Lf) t ? U
1 hercby ocknowledye that I how ?eod this opplicotion ond stote that Bldg. Off. Parla
the inlormotion is correct ond ogree to oomply with oll opplicable
5tote of Minnesoto Stotutes and City of Eagnn Ordinonces. APC Total 1. 807 U
Var. Date
Sipnoture of Permiftee
A Buildfny Permit Is iuued to: i;+C . ~~express conditlon thoi
all work sholl be done in xcordonca with oll oppliaobl• State of Minnesota Statutes and Gry of Eapan Ordinonces.
Buildinp Offlcial
Pamit No. ftmit Haldw Ekb
wumWng ~(03 -DD ,-,so- t
H.vr?.c. ~{'1$ a t~ 6- I Y-E ~
ENctric
SoherMr
Irqpection Dm Insp. Other
Footinys ~
Foundation
Framinp
Rouqh Plbq.
Rouqh HVA
Insubtioa
Final PIb4
Final HVAC
Final
CMt/OoC.
Waur Oyaibe Lotstion:
YbII
Swor
Pr. DhP.
-
Reoeipt MECHANICAL PERMIT Permit No. ~
CITY OF EAGAN
Fsa
fill in numbered spaces S/C
Type or Print legib/y Tot.
1. Date l v y 2. Installation Cost c C
r
3. JobAddress Lot Blk.Tract
.J
4. Owner ,
5. Contractor Phone
,
6. Address
7. City State y Zip ri
8. Building Type: Residential ? Commercial ? Institutional ?
9. Work Description: New 0 Add ? Alter ? Repair ?
10. Describe ( - Fuel Type ' !
11. No. EauiQment BTU - M. Ea. No. Eauipment CFM
Forced Air Air Handling:
Mfg.
Boilers Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other
~ Air Cond. • "'V/ •
Mfg.
~ Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
oomply witts ell ordinances and codes gcverning this type of work.
Signed : , r;~ for
, Rough Flnel
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
Receipt ~ PLUMBING PERMIT • Parmit No. J
CITY OF EAGAN Fee .
Pi1l in numbered spaces S/C
Type or Print JegiWY Tot. =j
1. Date r y 2. Installation Cost
, .
3. Job Address Lot " Bik. Tract
4. Owner
~
5. Conuactor- Phone
6. Address
7. City ~ ` ~ State Zip
8. Building Type: Fiesidential ~ Commercial ? Institutional ?
~ 9. Work Oescription: New U Add ? Alter ? Repair O
10. Describe
11. No, Fixtures No. Fixtures
l Water Closet Cesspool/Drainfield
Bath tubs Septic Tank
- Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains
Drinking Ftn.
51op Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ardinances and codes governing this type of work.
Signed : -
for
Rouyh Final
Inspections: Oate Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8700
I
I
CITY OF EAGAN Remarks
Addition CINNAMON RIDGE 3RD ADDN Lot 12 Blk 2 Parcel 10-17402-120-02
Owner Street 4441 SLATER ROAD gtate EAGAN NIIV 55122
ImprOVement Date Amount Annual Years Payment Receipt Dete
STREETSURF. 1012,20. 202-44 5 1012.20 C009602 10-2-$4
STREET RESTOR.
GRADING
SAN 5EW TRUNK 9 1973 102 . 22 6.81 15 20.50 C009603 10-2-84
SEWERLATERAL x 1985 724.53 144.91 5 724-53 02 10-2-84
WATERMAIN
WATERLATERAL ~ 1985 617.30 123.46 5 617.30 C009602 10-2-84
WATER AREA 1AL 1973 131.44 8.76 IS 26.32 00-9603 10-2-$4
Services x 1985 393.87 78.77 S 393.87 C009602 10-2-84
STORM 5EW TRK a 1979 381.69 19.08 20 267.21 C009603 10-2-84
570RM5EWLAT ~ 1985 1098.83 219.77 5 1098.83 C009602 10-2-84
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 260 '
WATER CONN. 470.00 11 "
BUILDING PER, if ;
sac 525.00 "
PARK
w~d y 55,~ r
his threaus es fr[om
mon
~77565 LI2 go a- C<r R~~ ~ 3 Va.S o
Renaesl DFire No. Rouph-in Inspectio ~
qwreAt ReaAy Noi11 Nolity, insoec-
M 1571 wp~7 W es ?Nu ~ ~ ~ar When ReadV
~(p~ Lmensed Eleci mai Contractor I hereby request inepection ol ebove
/u Owner electncel work instelled eL
Sirem Atldr~~ ox oLROe No. City
S ia r A aat,
ecbon o. Township Namo or No. ange o. Counly
L hk
OccupxnifPqlNT Phona No.
Q
Power Supplier Atlaress -
O 4 El ~
Electral ontractor (Company Nam 1 Conhactor's Lmense No.
_ o yo ~
MaihnB AAJress (ConVactor or Owner Meking Ins[ailatmn)
~a
Autho' ed Sienat re (CoMrecmr Owner Makmq InstalWIinnl Phona Number
~0- 3555~
MINNESOTA STAT 90APD OF ELECTHICITY THIS INSPECTION REUUEST WILL NOT
GriOgs-Midwev Bldg. - Hoom N-191 BE ACCEPTED BV THE STATE BOAqD
1821 UnivarsitV Ave., St. Peul, MN 65104 UNLESS PflOVEN INSPECTION FEE IS
Phone 18121 297-2111 ENCLOSED.
~ 55 y ~ REQUEST FOR ELECTRICAL INSPECTION ee-ooooi.a
' SBe instructions tor camOletinp thia form on bock oi Vellow copy.
0~7 5 ~ 11 X" Relow Work Cou:;: ed by.ihis Request l
Atl NeP. Type of BuiIEinO APGiloncea Wved Equipmenl Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electric Heaun
Cortxnercial Bldg. Fumace Silo Unloader
Industrial BIAg. Air Conditioner BWk Milk Tank
Farm t r peu v 17v(S0e11 ly)
mar uou y the, Othw
Compute lnspectron Fee Below
M fee ServlceEntrenceSize d Fee Feedere/Subfeedera p Foa Circuitn
/ig U to 200 qm s 0 to 30 Am s 22 0 tn 30 Am
Above 2_Am>s 31 to 100 Amps 'j G 31 to 700 Am
Swimmin Pool Above 100-/am s Above 100_.4m s
Transtormers Irrigation &ooms d Partial,'Other Fee
Signs SpeciallnspeCtion
Remrrks S 3% TOTAL FEE ~
y ?
Nouph-i^ ~ te 1, the Elacpr al
X ' 6 - InsOectoq heroby
vi cefbfv tMt the nbove
Final inspeetion Ms Geen
r mada.
fMa requesivol018montlmtrom ~ ~
~ • ' CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100
ReceiPr #
Te M usad for SF DWG/GAR Est. Vol.e 58 ,000 _ 00 pate JULY 13 ~q 84
'SiteAddress 4441 SLATER ROAD Erect IN Occupancy R3
Lot 12 elock 2 Sec/Sub. CINN RIDGE 3RD Remodel ? Zoning RT-
ParcelNo. 10 17402 120 02 ReDair ? TypeofConst. V
Enlarge ? No.Stories
~ Name ZACHMAN HOMES. INC. Move ? LengthI$_
; Address 4620 W 77TH ST SUITE I04 ~emolish ? Depth
Grede ? Sq.Ft.
City F.DINA Phon
b e 893 0755
p Approrolt Fees
o Name SApqE
zu Assessment Permit 307 _ 00
Address
~ City Phone Woter 8 Sew. Surchorge -'2 Q-DO
Polite Plan check 153 _ 5 p
Fw Name Firo SAC 525_O0
Address Erp. Woter Conn. 470 _ OQ
~W City Phone Vlonner WoterMeter ~10
Council Rood Unif n0
I hereby ackrwwledge that I have reod this application and stote that gldg. Off. Parks
iha informotion is correct and agree to comply with oll opplicoble AP~ Total 1 A(17 _ S~
Stofe of Minnesota $lotutes and City of Eagon Ordirwnces. •
Var. Date
Sipnoture of Permittee
A Building Permit Is issued to: ZACHMAN HOMES. INC. on tha exprese conditlon thao
all work shall be done ' accordance wit a"ll' ~aD"G~licable State of Minnewto Statules and Ciry o4 Eoyon Ordirwnces.
Buildirp Ofiiciel ~SSl~_-(Ly~,
~(f-
CITY OF r:?Ga.~I Inc_ude 2 sets oF kllt-~~
1 site plan w/elevations 6
5•F. PIA (l. 6,ARBUILDIVG PEMIT AP°LI('ATION 1 set oi energy calculations_
~b 58 oGb. Cee ~ ~
To Be IIsed For, Am, Valuation Date
Site Pl.'c'sess: ~0~13' OFFICE USF' 0!UY
Lot Block Sec./Sub. ~ I7 n Erect ~ OcciiPaLncY _ -3
Parcel' ' : /D v`~ e 32 ~ Alter Zoning -
Rel.~air Fire Zone
OVmer: z Enlarae 'I
_~rpe oi Const.
r~c m; t n ~IOm PS C- ~b`,e
r Stories
Pddress: A~ 2b 12 } . ] 1!5~ peiTolish Front 8 ft.
City/Zio Code: Ln~ >Y1,n Grau~e DeP~ ft.
Phone ` Q 75 ~ APPFXIVAi: S pEFg
Contractor: Assessrents Permit ?jC)°o
Pddress: ~ water/sewer Surcharge
Polioe Plan Check ! 5 3. SD
City/Zip tE Fire S.i1C 25.~
Phone ~g. F7ater Corn. p
Planner tdater R leter
Arcn_/Enq.: Council Poad Unit 2(oi
Pddress: Bldg. Off. lo
~ ADC
Citv/zin rr-aA-
,
OL
-P - ~ ~
~
o x
x x -x
O
-P
`
J {C7?. 'F~"
~-~t 1 N H. H E D L U N D 7726 Morqan Avenue Soutn
~ e" RlchfleId,Minnesota 55423
~and Surveyor Clvil Enpineer Phone : 866-2323
survalor`s G'ert~,~icate'-
JOB N0. 51 ~
SURVEY FOR: Zachman ]fome-I Inc.
DESGRIBED AS: Lot 12, :ilock 2, CINNAMON RIDCE 3RD ADDITION, City of Eagan,
Dakota County, Minnesota, and reserving easements of record.
914.c~ 588°23 5z E '
9io.o
3<5~ - - ~ 7/. 53
f°W
/ \17~ ~s t
~ Z 9~ - - 19.0 C)i9,p 4-
° O\ 3(0 -/0 Pinewoa./ • \
'g, \ N \c C M
` Z \ -C/GWI I~
~
,ry~
Ap 'h
°'Y \
L-U~ i i ( \\\d- ~ njti \
,
9 i8. I~~ R= 46,
ao i
i
~
? SLAT£R RGAD ~
~
ToP a-F b/ock 9 i9.~ Druinu9e direcfibns
Baseinent f/oor 916.5 Proposed e%t/. (E~o
Ga.a9e -t'ioor 919•3~, 'Ewsf%ny elev• 900
Ocnofes /ot i~on o
CERTIFICATE OF SURVEY
I hereby ceriify ihat on ' /30 /$3 I surveyed the property described above and ihot
the above plat is a correct representation of said survey.
Z~,IK,1 WdLenl
Calvin H. Hedlund, Minn. Reg. No. 5942
,
~ ~
~
~
. J!
0•Fl
>o7.oc+
29•OC+
153•50+
525•00+
<<7 c•oo+
6 3 • 0 0 +
2 6 0+ 0 0+
1dO7•SC~
r .
2/84
CITY OF EAGAN
t APPLICATION FOR PERMIT
i
- SEWER AND/OR WATER CONNECTIODT
(PLEASE PRIHT)
1) PROPEZPY ADDFtESS: qq`y l S LA~~A e~o ~
r•Frar• DESCRIPTION: ~O~ I i. Bfnrl2 Z (l'~10hM-Gno-4, fe~c dow-
(Lot/Block/Su:xltvision or Tax Parcel I.D. NuTber)
i. F"iS'?'R(;CI'L:c~, DAT CF ORIGINAL 'cliI=L`:G F==:-S':'
` :Z' l
! P?2ESLT ::71I":r;/P??OFt?SED. CSE: q~(R-1 S=!GLE r^a,.iri,Y
? R-2 DUP=? (7,i0 L^:ITS;
? R-3 TCV~iNh30[ISE (TFREE + tJDTZTS) ( [JPIITS)
O R-4 r1PAR1Il`g,T7T/C0DIDC'.iNIN2[M ( UNITS)
? COMA'tEE2CIAL/FtESAIZ,/OFFIC:.'
? .II~USTRIAL
? INSTITUTIONAL/GOVETh'Vi+4QNT
2) APPLIGnNP ~ (PLEASE PFlINT)
NAME : C.a..eST~ k A- ? ,~J Cn .
ADDRESS: ~js0 f eSj a-<I
CITY, STATE, ZIP: y7~fi0 4~c.C4. v?/+jr? , PHOLNE: N7 z
-~-~~-l-
0
3) PLU.,ffiER NALME PLEASE PRINT) FOR CITY USE ONLY
PLUHBERS LICE4SE:
ADDF2ESS: ~ a?5 Active
CITY, STATE, ZIP: Q Expired
MAStER Q Not of Retord
PHONE: PLUMBER LICENSE ~~n
a nt t~
q) OCCTTpjvyZ+/CrqITER (PLEASE PRINT)
n~arE: A~ E-4-c~n.v C ~'1C _
.3 w. - -M ~ ~ .
ADDRESS: tI(0?_C
CITY, STATE. ZIP: 57 (.-1 ?^4- aflti
PFiO^IE: 75 3 O7 s''
5) INDICIITE WFIICH PF1tMIT IS BEINC; RDQUESTID:
[5-'CONNGCPION `IO CITY Sa1ER
Gj-6.'INDCPION 'IO CITY WATER
0 dI'IIII2 (PLFIISE DESCT2IBE)
6) INDIG,TE ONE:
~~LFt'1SE HOLD APPR(7VID PERMIT FOR PICF:-UP BY ONE OF IaBOVE
? PLEASE b*AIL APPROVEp PEF2hLiT TO 1, 2, 3, 4 AEOVE
(Circle one)
7) SIGN41'IURE: . DATE: 0
'
F 0 R C I T Y U S E O N L Y
PERMIT ISSUED
F°ES: $ SEi'IER PEZ:1T_T (I?1CLGD: SUP.CHARGE)
$ / o. S a WATER PERf1IT (INCLUDE SURCHARGE)
$ WATER METER/COPPERHORN/OUTSIDE READER
S WATER TRP (INCLUDE CORPORATION STOP)
S S°WER TAr,
$ ACCOUNT DEPOSIT - SEi>;ER
$ ACCOUNT DEPOSIT - WATER
$ WAC
$ SAC
$ TRUNK WATER ASSESSMENT
$ TRUNK SEWER ASSESSMENT •
$ LATERAL BENEFIT/TRUNK SE[^]ER
$ LATERAL BENEFIT/TRUNK WATER
$ OTHER -
0
$ TOTAL
$ / v AMOUNT PAID/RECEIPT
DOES UTZLITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGi-IT OF WAY?
~ YES IF YES, THEN A"PERMIT FOR WORK WZTHIN
~ PUBLIC ROADWAY" MUST BE ISSUED SY THE
~ NO ENGINEERING DIVISION. LIST AS A CONDI- TION.
SUBJECT TO THE FOLLOS4ING CONDITIONS:
APPROVED BY:
TITLE:_,:~ ~y
DATE:
~
aa m -Fan offs im m Ma ocw wm wn wqpjq wi+ w.a VcaV wWzpg Qiw w.a 04 IT se W" ia sw w~
.
SUBTERRANEAN
ENGINEERING CORP. s+e.e93e
6875 Highway 65 N.E. De~.
RECEIIlEDOC~'..~
Fridley, Minnesota 55432
Job Neme 3J b N S- P/3y
JobLocet;oncxflc-F~~/,~~~,.~J
Eerfhvork
Contreaor Clianr~%/~~ ZR[~SMO
ArriveJo6~1.ySP rorei
DepertJob 1.15'P TravelTime Chergeeble
- Houn ~
Lab. Time
iofel Hours
!
On Job Repor} T;m• y
Summery of Technicel and/or Engineering Servicas performed, including Fie(d Test De4a. Lxetions, Elevefions, end Deplhs ere
astima4ed. THE LIMI7AilON GF LIA6i il' STATEMEFJTS ON THE ReVEStSE SiDE OF THIS nEPORT CONSTITUTe AN IhiTEG-
RAL PART HEREOF. !~i; r n,~, dJ~ ~
l
Lot 12, Block 2, 3rd Addition. Visual inspection of house pad
showed that pad is in its original location. h1easurements showed that
the pad is at the same location, on the lot, as indicated on the grading
plan, used during placement of fill. Last density tests taken on this
pad were on September 26, 1983.
Hence, the house was not moved back, and the rear coall is on the
original compaction pad. Several densitv tests taken during original
earthiaork operations passed our compaction specifications.
DISTRIlVTION
?
Bv ~~y~
ICC SUBTERRr.NEAN ENGINEERING INC.
: jiYrf ~wiil ~~wwJ~~ S~a7 ~i•
yegf-so w- 77,v4.4 rt -j r0/e /es'
~j -
I For Offce U'se ~
City of Ea~aIl ~ Pe~it~ y ~~yo
~'f-~ ;
~ Permit Fee. / v• ~
3830 Pilot Knob Road
Eagan MN 55722 ~ Date Received. ~
Phone: (651) 675-5675
Fax: (657) 675-5694 I Staff: I
I 1
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ite Address: ~l4 /l
Tenant: Suite
RESIDENT / OWNER Name: m 4 rl~j ) Cp ~ K oL". Phone. O I Z 151S I9a$
Address / Ciry ! Zip: Zy lI 1J / SL ec fer k D. Ccr~w n.
Applicant is: _X_ Owner _ Contractor
TYPE OF WORK Description of work: S i D~(J
. Construction Cost: Multi-Famify Building: (Yes No
CONTRACTOR Name: License
Address: 4") S!, i4e1 R D (!A ~ n .
City: State: Zip:
Phone. Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet . New Energy Code Worksheet
CatBgOry Submitted Submitted
(4 SUbmissiOn type) • Energy Envelope Calculations Submitted
In the last 12 months, has the City of Eagan issued a pertnit for a similar plan based on a master plan?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting documents fhat you submif are considered to be public informafion. Portions of
the information may be classified as non-public if you provide specifc reasons that would permit the City to
conclude that the are trade secrets.
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 pertnit, but only an application for a pertnit, and work is not to start without a pertnit- hat the work will 6e in
accordance with the approved plan tn case f work which requires a review and approval of I
x x
ApplicanYs Printed Name Applicant's Signature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA177682
Date Issued:07/13/2022
Permit Category:ePermit
Site Address: 4441 Slater Rd
Lot:12 Block: 2 Addition: Cinnamon Ridge 3rd
PID:10-17402-02-120
Use:
Description:
Sub Type:Air Conditioner
Work Type:Replace
Description:
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507)
210-0754.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
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.
Contractor:Owner:- Applicant -
Gay & Dianne Agustin
4441 Slater Rd
Eagan MN 55122
(651) 334-8377
Majestic Custom Construction Inc
8800 Royal Ct NW
Anoka MN 55303
(612) 419-2173
Applicant/Permitee: Signature Issued By: Signature