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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