1743 Meadowlark Rd411''
City of EaQall
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Date Received:
Staff:
011 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: / ?VS Ii 7 y 3 Al /Z%Q f cr('/C Unit #:
RESIDENT /
OWNER
Name: - - ( Mel. �2e T-�� Phone: 6 ? 6l? '6/..5;(::,y/eh) �
/� �%
Address / City / Zip: / >'V /v //✓/c'rC l
Applicant is: Owner V Contractor
OF WORK
Description of work: er -/..r(4.. ZED Cif,/il%r Zi / i.� //14 17TYPE
Y
Construction Cost: S ''� Multi -Family Building: (Yes / No )
CONTRACTOR
Company: (cwt S'T/cici - .\ CbC) Contact: Sc -v-, %0_4
Address: 4/60 " (C)7+ -/\k
W City: C',v."). \�\'\-
State: 1/Zip: J ° Li; Phone: >63 £/2 % --S-t70--
it 6License
License#: /(3 6 Lead Certificate #: g---:1-- I g 5 / S '' ' --OO 70
Does this project require Lead Remediation? ❑ Yes No (see Page 3 for additional information)
If no, please explain: IJG `E33.
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.aonherstateonecall.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 p : n ..
Applicapt's Printed Name
x
Apr ' ant's Signature
Page 1 of 3
r
Date:
City of Egli
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Us,
Permit #:
Permit Fee:
Date Received:
Staff:
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Tenant:
Site Address:
Suite #:
RESIDENT /OWNER
Ly n i) Kt -1.A Phone:G4 1 �-il52 -31t, fl
Name:/
�+
Address / City / Zip: /? q 3 ill 1 l ey do �1 ` a c ^- R e �%,�/
Applicant is: Owner —Contractor
TYPE OF WORK
Description of work: `! W t A dlb (A) `p /0 is m.i f)7s EA .� r� s->�/ A
�
L75 Multi-Family/No
Construction Cost: 3 Building: (Yes)
CONTRACTOR
THD At- Home Services, Inc.
Name: 2690 Cumberland Pkwy, Ste 300 License #:
_
Cumberland Office Park
Address: City:
— Atlanta, GA 30339-3913
State: Lic# 20268257 Ph. 763/ 542-8826 q 5 l31i - G 6 417
Contact:()Ddt c Ef 'tura-Email: 0 e / S cDe t l 0 ,t 0 V
COMPLETE
In the last 12 months, has
If yes,
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
the City of Eagan issued a permit for a similar plan based on a master plan?
date and address of master plan:
_Yes _No
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.ciopherstateonecall.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.
x l pe`_ 14
Applicant's Printed Name
Applicant's Signature
Page 1 of 2
September 30th, 2010
City of Eagan
3830 Pilot Knob Road
Eagan, MN 55122
To: Building Department
I am requesting a cancellation of building permit #EA096209, issued 09/30/2010.
The homeowner cancelled the window replacement installation. The permit was for
replacing windows at the residence of:
Verrall
1714 Woodgate Lane
Eagan, MN 55122
Enclosed is a copy of permit. Since no refund is possible, please swap permit numbers
for the enclosed permit application. If you have any questions or need more information,
please call me at 952-345-6047.
d, _A6 (I--)
Jodi Sletten
Permit Service
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1743 Meadowlark Rd
Lot: 045 Block: 04 Addition: Hillandale 1st
PID:10- 32950- 045 -04
Use:
Description:
Sub Type: e - Furnace
Work Type: New
Description: Furnace
Comments:
Fee Summary:
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881 -7739
Quesetions regarding electrical permit
952- 445 -2840
Mary Kivi
8910 Wentworth Avenue So
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Permit Type:
Permit Number:
Date Issued:
Permit Category:
equirements should be directed to Mark Anderson, State Elec
Owner:
Lynn B Keefer
1743 Meadowlark Rd
Eagan MN 55122
$50.00 0801.4088
$0.50 9001.2195
$50.50
I hereby acknowledge that I have read this application and state that the informa
of Minnesota Statutes and City of Eagan Ordinances.
on is correct and agree to comply
h all applicable State
Issued By: Signature
Mechanical
EA087857
12/24/2008
ePermit
cal Inspector,
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 1743 Meadowlark Rd
Lot: 045 Block: 04 Addition: Hillandale 1st
PID:10- 32950- 045 -04
Use:
Description:
Sub Type: e- Windows/Doors
Work Type: Windows/Doors - New/Replacement
Description: House
Census Code: 434 -
Zoning:
Square Feet: 0
Comments:
Fee Summary:
Valuation: 3,000.00
Contractor:
Crew2 Inc
2650 Minnehaha Ave
Minneapolis MN 55406
(612) 276 -1680
BL - Base Fee $3K
Surcharge - Based on Valuation $3K
Applicant/Permitee: Signature
PERMIT
City of Eaan
- Applicant -
Construction Type:
Occupancy:
Carbon monoxide detectors are required by law in ALL single family homes.
$88.50
$1.50
Total: $90.00
Owner:
Lynn B Keefer
1743 Meadowlark Rd
Eagan MN 55122
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Improvements to the home require smoke detectors in all bedrooms. If altering window openings, call for framing
inspection. Call for final inspection after installation.
0801
9001
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply
of Minnesota Statutes and City of Eagan Ordinances.
h all applicable State
Issued By: Signature
Building
EA090678
08/14/2009
ePermit
'f' IM Sep 14 05:10 PM Sedgwick 952 881 -4491 1/4
1111014 Page 1 of 4
MSDS 0463
M000==
PRODUCT NAME
Metacau1k 835+
Section 1 PRODUCT AND COMPANY IDENTIFICATION
PRODUCT CODES
66012, 66019
CHEMICAL FAMILY:
Organic /Inorganic
USE
Firestopping Sealant
MANUFACTURER'S NAME
The RectorSeal Corporation
2601 Spenwick Drive
Houston, Texas 77055 USA
DATE OF PREPARATION
July 24, 2002
MATERIAL SAFETY DATA SHEET
MMOOMam ccncc
e by WT
3 -7
3 -7 22984 -54 -9
15 -40 1317 -65 -3
If INHALED:
If on SKIN:
Section. 2 COMPOSITION /INFORMATION ON INGREDIENTS
CAS No.
7631 -86 -9
INGREDIENT UNITS
Amorphous Silica
ACGIH TLV N/D ppm
OSHA PEL N/D ppm
Ketoxime Silane
ACGIH TLV N/D ppm
OSHA PEL N/D ppm
Calcium Carbonate
Section 3 HAZARDS IDENTIFICATION
i
1 /3
SUMMARY OF ACUTE HAZARDS
May cause skin irritation.
ROUTE OF EXPOSURE, SIGNS AND SYMPTOMS
INHALATION
Not a respiratory irritant.
EYE CONTACT
Contact may cause eye irritati
SKIN CONTACT
Contact may cause skin irrita
INGESTION
Possible irritation to mucous
SUMMARY OF CHRONIC HAZARDS
None known.
MEDICAL CONDITIONS AGGRAVATED BY
Persons with pre- existing skin
susceptible to contact effects
on.
tion.
Section 4 FIRST AID MEASURES
http://vvww.metacau1k.com/data/msds835.htrn1
HMIS CODES
Health
Flammability
Reactivity
PPI
EMERGENCY TELEPHONE NO.
Chemtrec 24 Hours
(800) 424 -9300
TECHNICAL SERVICE TELEPHONE NO.
(800) 231 -3345
ACGIH TLV 10 mg /m3 0.A) CZ )AJ
OSHA PEL 15 mg /m3
AJJ
1
0
0
y P a6Es
[A) Fen- A)572.
membranes of the mouth, throat, and stomach.
EXPOSURE
conditions or chemical allergies may be more
of the cured elastomer.
Not a respiratory irritant.
Wash with soap and water. If irritation occurs, seek
medical attention.
9/14/2009
PRODUCT DATA SHEET
Metacaulke 835+ Silicone Firestopping Sealant
Classified Through- Penetration Firestop System Numbers C -AJ -1035, C -AJ -1037, C -AJ -1115,
C -AJ -1059, C -AJ -7028, C -AJ -1250, C -AJ -1427, C -AJ -1248, C -AJ -0057, C -AJ -3126, C -AJ -3127,
C -AJ -1261, C -AJ -1263, C -AJ -6031, W -L -1013, W -L -1034, W -L -3028, W -L -3029, W -L -7012, W -L -0008,
W -L -1132, W -L -3104, W -L -4058, W- L- 6015,W -J -1018, W -J -3013, W -J -3014, H -WS -0023, H -WS -0025,
W -WS -1025, F -FS -1021, F -WS -1008, F -FS -1025
1. Product Description
Metacaulk® 835+ is a one component,
fire -rated elastomeric neutral, moisture
cure silicone sealant for use in through
penetration firestops. In the event of a fire,
Metacaulk 835+ will prevent the spread
of flames, smoke, gas and water through
penetration openings. Metacaulk 835+
is a flexible, non slumping sealant with
excellent moisture resistance. For use in
interior or exterior expansion and control
joints and interior or exterior penetrations.
Because Metacaulk 835+ is silicone
based, it can be used in systems where
dynamic movement is expected.
Metacaulk® 835+ is protected in a wet
stage as well as in a dry stage against
mold growth with a combination of
biocides.
Use Metacaulk 835+ for various pen-
etrations:
Wall to Wall Control Joints
Floor to Floor Control Joints
Metacaulk® 835+ Features
A single component penetration seal-
ant system no mixing necessary and
no required additives.
Use in Interior or Exterior Expansion,
Contraction and Control Joints.
Use in Exterior and Interior Penetra-
tions.
Neutral, Moisture Cure
DOT Classification is Not Regulated.
Non -Slump Formula.
Applied with a conventional caulking
gun, trowel or with pumping equip-
ment.
A special purpose firestop sealant.
Metacaulk® 835+
2. Material Properties
EMT, Semi Rigid, and Rigid Conduit Asbestos Fillers None
Steel Pipe
Wall to Decking Transition Joints Application
Wall to Floor Transition Joints
Color
Cure Time
Elongation at
Break (ASTM D412)
Volatile Solvents
Volume Coverage
(cu in/10.15 oz tube)
(cu cm /300 ml)
(cu in /gal)
(cu cm /L)
Working Time
Specific Gravity
Dielectric Strength
2.07
Standard 10.15
oz (300 ml)
Caulking Tubes
5 Gallon
(18.9 L) Pails
Gray
21 Days
600%
None
18
295
231
1000
5 -15 min.
1.33
479 V /mil
1,SSIFj
C ®US
February 2005
r J CharterMember
vv International
FireStop Council
(ASTM D149) (19.0 kV /mm)
ASTM E 84, UL 723 Tunnel Test
Flame Spread Index 3
Smoke Index 22
Service Temp Range -60 °F to 300 F
(ASTM C1299) (-51 to 149 C)
Metacaulk 835+ meets ASTM C920, Type
S, Grade NS, Class 25, Use NT, M, G, A, 0
and Can /CGSB- 19,13 -M87, Class MCG-
2-40-A-L.
STC 55*
`Tested in a UL 4121 wall assembly /section to ASTM E90.
3. Applications
Metacaulk® 835+ is used to seal wall and
floor penetrations for electrical, plumbing,
pipe and telephone communication sys-
tems penetrations. Non -Slump Metacaulk®
835+ formula is used in vertical and hori-
zontal applications. Use Metacaulk 835+
to prevent the spread of fire through fire
rated gypsum wallboard partitions, con-
crete block or concrete walls and concrete
floors.
4. Installation Data (typical)
Install Metacaulk 835+ using standard
caulking techniques or trowel from pails.
TYPICAL GYPSUM WALLBOARD
INSTALLATION
Step 1) Cut opening in floor or wall.
Step 2) Clean penetration opening and
surfaces from loose debris, dirt, oil and
wax.
Step 3) Install wire mesh if required. Form
wire mesh into cylinder to match hole diam-
eter. Slip wire mesh inside wall along pen-
etrating item and allow mesh to spring back
against hole.
Step 4) Install backing material if required.
Step 5) Gun the sealant as required to the
specified depth. Trowel surface flush with
wall.
(Application designs vary, please contact
Metoaoulk Product
i Fire Stopping Seciant
n Wira Meth \Steel Sleeve
1 2 Layers of 5/8"
UL Classified
Gypsum Wallboard
l j
i-- Pipe or Gable
I v
Mineral Waal or
Foam Backer Roo
Backing Material
See Installation Data
CUT AWAY SECTION
The RectorSeal Corporation for exact de-
tails.)
5. Test Data
Metacaulk 835+ is Classified by Under-
writers Laboratories Inc. as a Fill, Void, or
Cavity Material. For specific test criteria
see UL Fire Resistance Directory or call
RECTORSEAL.
Metacaulk 835+ was tested at a minimum
0.01 inches (2.5 Pa) water, positive pres-
sure, in accordance with UL 1479 and
ASTM E 814 test standards.
Through- Penetration Firestop, UL System
Numbers W -J -1018, W -J -3013, W -J -3014,
W -L -1013, W -L -1034, W -L -3028, W -L-
3029 W -L -7012 are for use in gypsum
wallboard with steel or wood studs and for
use in concrete block construction. UL
System Numbers C -AJ -1115, C -AJ -1035,
C -AJ -1037, C -AJ -1059 C -AJ -7028 are
for use in concrete or concrete block wall
and concrete floor construction.
10. LIMITED WARRANTY
6. Storage Handling
Metacaulk® 835+ is not to be stored in
areas where the temperatures exceed
90° F (32° C) or drop below 40° F (4° C).
Keep products stored under protective
cover, in their original containers. Products
have a minimum shelf life of 1 year subject
to re- inspection thereafter. A stock rotation
program is recommended.
7. Availability
Metacaulk® 835+ is available in:
10.15 oz. (300 ML) standard caulking tubes
and 5 gallon (18.9 L) pails
8. Limitations
Do not use Metacaulk 835+ in computer
rooms without first consulting RectorSeal
9. CAUTIONS
FOR CHEMICAL EMERGENCY, SPILL,
LEAK, FIRE, EXPOSURE OR ACCIDENT,
CALL CHEMTREC -DAY OR NIGHT 1 -800-
424 -9300.
CONTAINS: Silicones. PRECAUTIONS:
Do not take internally. May cause eye,
skin, and respiratory tract irritation. Wear
gloves and safety glasses. Wash after han-
dling. FIRSTAID: For any overexposure or
if skin irritation develops, get immediate
medical attention after first aid is given.
EYES Flush for 15 minutes with clean
water. SKIN Wash with soap and water.
Do not use solvents to remove from skin.
INHALATION Remove to fresh air. IN-
GESTION- DO NOT INDUCE VOMITING.
SPILLS-Clean up immediately with scrap-
ers and mineral spirits. STORAGE AND
HANDLING Keep container upright and
tightly closed. Do not reuse container.
KEEP OUT OF REACH OF CHILDREN.
For additional information, refer to Material Safety Data Sheet
For additional technical service, call:
713 263 -8001 or 1-800-231-3345
Fax: 713-263-7577 or 1-800-452-2824
RectorSeal makes the Limited Express Warranty that when the instructions for storage and handling of our products are followed we warrant our products to be free from defects. THIS LIMITED EXPRESS
WARRANTY IS EXPRESSLY IN LIEU OF ANY OTHER EXPRESS OR IMPLIED WARRANTIES, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FORA PARTICULAR
PURPOSE, AND OF ANY OTHER OBLIGATION ON THE PART OF RECTORSEAL The sole remedy for breach of the Limited Express Warranty shall be the refund of the purchase price. All other
liability is negated and disclaimed, and RectorSeal shall not be liable for incidental or consequential damages.
Suggestions and recommendations covering the use of our products are based on our past experience and laboratory findings. However, as we have no control as to the methods and conditions of
application, we only assume responsibility for the uniformity of our products within manufacturing tolerances.
2.07a
METACAULK® 835+
RECTORSEAL
2601 Spenwick Drive, Houston, Texas 77055
www.rectorseal.com
www.metacaulk.com
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Ve�:.AGE "OF EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address: fi
Plumber:
Meter No.• Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
I agree to comply with the Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By , Date Paid:
Date of Insp.: r 7' / nsp.:
VILLAGE * OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
�
Use BLUE or BLACK Ink
�___--_--____.__--^.
iFor Office Use�� i
� � Permit#: (� �
CltV of �a a� � . . a �
" � � Permit Fee: ���� � �
3 8 3 0 Pi lo t Kno b Roa d � I
Eagan MN 55122 � �
Phone: (651) 675-5675 i Date Received: i
Fax: (651) 675-5694 � �
� Staff: �
�-----------------�
2014 COMMERCIAL BUILDING PERMIT APPLICATION
Date: I ��S � Site Address:
Tenant Name:_ �e���Q v..� \��� 1l�:�g��,� (Tenant is: New/ � Existing) Suite#:
Former Tenant:
Name: {' �-e a.cM��n� X, o'\�� �� � � Phone:
PropertyOwner Address/City/Zip: j7�'3 , ��51, I '>>(�A , �-��}'7 1 ��IS � �`� �(3 . 1 ?�`� ►'�'?q
�`13 7 , � �3�'
Applicant is: Owner �Contractor �� � � k�
o� ��
_Type of Work Description of work:�'I� . •�.��e �r�N� h i��,,,�t.,��
Construction Cost�� S.2� �
Name: C� 1�vr��� i`1�� C o v.��1��c��v� License#: �3�..�� �
Contractor , Address: Z O7'� V�1�����-o,� Q r. City: �/, ��.'.��
State: �1 h Zip: �S 3 �' b Phone: G SZ " � �� �" �� `v b �
Contact: %he �'�'� �.� Email: � .^� v.�- �o L...�i��
Name: Registration#:
Architect/Engineer Address: city:
` State: Zip: Phone:
' Contact Person: EmaiL
Licensed plumber installing new sewer/water service: Phone#:
NOTE:P/ans and supporting documents that you'submit are considered to be public information. Partions of `
the informatiori may be classified as non-public if you provide specific reasons that wou/d permit the City fo
conc/ude that they are traale secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www.qopherstateonecall.orq
I hereby acknowledge that this information is complete and accurate; that the w rk w�I be in conformance with the ordinances and
codes of the City of Eagan; that I understand this is not a permit, but only an ap c tion�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 r whi h requires a review and approval ofplans.
X `✓�4 ��-� g v� � �eY.) X
ApplicanYs Printed Name ApplicanYs Sig
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA129028
Date Issued:12/30/2014
Permit Category:ePermit
Site Address: 1743 Meadowlark Rd
Lot:045 Block: 04 Addition: Hillandale 1st
PID:10-32950-04-045
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Deb Larson
8815 209th St
Lakeville, MN 55044
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Lynn Tstes B Keefer
1743 Meadowlark Rd
Eagan MN 55122
(651) 452-3160
Drain Pro Plumbing
8815 - 209th Street W
Lakeville MN 55044
(952) 469-6999
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA146979
Date Issued:11/29/2017
Permit Category:ePermit
Site Address: 1743 Meadowlark Rd
Lot:045 Block: 04 Addition: Hillandale 1st
PID:10-32950-04-045
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Dryer
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
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 -
Lynn Tstes B Keefer
1743 Meadowlark Rd
Eagan MN 55122
Genz Ryan Plumbing & Heating
2200 West Highway 13
Burnsville MN 55337
(952) 767-1000
Applicant/Permitee: Signature Issued By: Signature
I—For Office Use• �--
i 7 5%a--
• ' • P
ermit% E AG N
).<1 +
Date Received:
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX: (651)675-5694 Staff:
buildinginspections@cityofeagan.com
2019 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 6'771 Site Address: // D 1,4ric p- I G -# Unit#:
Name: Re-001,),--4 k-945-5-6 (477°'\•)
(477°'\•) Phone:
esit ent/
;owner Address/City/Zip: /735, 37 , 37 /`/f / Y 3 ,q5, `l 7 `/? , s/ , 5 3
Applicant is: Owner K Contractor
A
Type of:wor�C.
Description of work: 44-77( ,/ SoN /NS7A-t-L- �� ON G 4 G E S
Construction Cost: ��j�, Multi-Family Building: (Yes /No )
Company:____C---170C-4:-.)77/../G ,CriZto12 5 Contact: .J I^^ 2)41/IV S°'`J
Address: /72/3 /fz t-E y C/lze-e City: // ,1 -5
Contractor 7 /15/
_[State:/Lr" Zip: 5503 3 Phone: 657 Z7�iZ3Email �n-�rer /09 eSier-ierSt'' . c'--
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber:. Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE Plans and:supporting documents that you submit are considered to be public information. Portions of the information may be
classified as non-public ifyouprovide specific reasons that would permit the City to conclude that they are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaoan.com/subscribe.
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.
CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www.aopherstateonecall.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 tart without a permit; that the work will be in
accordance with the approved plan in the case of work which requires a review and app • • • •lans.
JAI' esl
Applicant's Printed Name Applic. Signature