3219 Evergreen DrCASH RECEIPT
C1TY OF EAGAN
P. 0. BOX 21-199
EAGAN, MINNESOTA 55121
.
. . ( .
DATE 19
RE EI EO
OM
AMOUNT $ I?
OOLLARS
J A .I 32 , 00
/? GASH tZCHEGK
i . ,? Ly L
FOR
. . . . . ? . . 1 ..? . . ? . . ?
FUND CODE AMOUNT
) J
-714
I
Thank You'"
4 F `,-,3 t,
'7". .5'o
?
z7.y?
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
2006 RESIDENTIAL BUILDING rExMIT arrLrcnTiorr Ck ?. S?-Y3
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
New ConsWCfion RaQuirements RemodeUFieoair Reauiremenls ORceLse'.Ohlv
3 registered site surveys showing sq, h. of IoC sq. ft. of house; and all roofed areas 2 copies of plan shovnng footings, beams, joists Cert of SurJey ReaJ '-_ Y--- N
(20% maximum bt coverage allowed) 1 set of Energy Calculafions (or heated additions Tree Pres Plap Recd Y_ N.
2 copies of plan stwwing beam & window sizes; poured found design, efc. 7 site survey for addi6ons & decks Trce Pres Reqwred Y_ N
lsetofEnergyCalculations Addifion - indicateif rn-s8esepficsystem On-sifeSepficSystem '_Y _N
3 copies of Tree Pmservation Plan if loi pbtted after 711/93
Rim Jolst Detaii Options selection sheet (buildings with 3 or less uniLS) .
Minnegasm mechanical ven6lation foim
Date L_ % U? Construction Cost -P Zo ? M
Site Address ?i 213 321S 3 Z 17, ;Z 1 y 3 2 Z I 3 Z 2 3 Unitlste #
r 'v?2?n_ ?r
T
?
DescriptionoCWork NC1'w1[r1I ?In ?@+aS
Multi-Family Bldg ? y _ N Fireplace(s) _ 0 _ 1 _ 2
PropertyOwner ?oAf_HmA? I4hW TP1+dr??omtS Telephone D Ir
0 5 ?006
Contractor
Address 7351 ?ifQkilloo
cQ tyi ? 13c? ?p /
City /?IqnIL 6110vC
State Zip 5531-q Telephone {! ( 'Y?3 ) (L3' DS?/y
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilatlon Category 1 Worksheet • New Energy Code Worksheet
(dsubmissiontype) Submitted Submitted
• Energy Envelope CalalaGOns Submitted
In the last 12 monihs, has the CiTy of Eagan issued a permit for a similar plon based on a master plan8
_ Y _ N If yes, date and address of master plan:
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone #( )
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 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.
Applicant's Printed Name Applicant's Signature
PLUMBING (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permiu are required for each unit
Date--7- /?o /D3
Site Address 3a 19 ?v era reen ?1' :
J Unit #
Property pwner ,_y ?e ?'?' Telephone # ( (Cs/ ) _ 7US' I9a?
Contractor
G
48
Address 12725 N"? tingale St. NW
66eM RAI??B3? wnr5s4 City.
State Zip Telephone # ('?'? - 755F- (p(hp ?
The Appticant is _ Owner Conlractor Other
Septic System New Refur'bished Su6mit 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional cansultant feas may apply.
Alterations To Existing Dwelting Unit, Including $ 50
00
_ Adding fxtures to lower Ievels or room additions, excluding water so ftener and water heater .
_ Abandonment of septic system
_ Water tumaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigafion system
Water softener ?Water heater
_ $ 15.00
J,,-`ieplacement _ additional
State Surcharge $ 50
SEP 2 9 2003 ?il.
To?? l5•s b
I hereby apply for a Residenrial Plumbing Pemut and aclnowledge that the info rion is complete and.accurate; that the work will
be in conformance with the ordinances and codes of the City of Eagan and with ?Pluinbiug'Codes; that I understand this is not a
permit, but only an applicarion for a pemut, and wark is not to start without a pernut; that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
?U--( GQViL
Applicant's Printed Name Applic ts Signature
MeRa?il:alf?lJlJ?i1laE?:??l1tf.?i ' . . . ??- : . •
. .. . .... ... .. .. m
F 0 R C I T Y U S E O N L Y
PERMIT °- ISSUED
F°ES: $ io,S 1
$ /e So
$
$
$ ?-s a--e
$
$ 4/ 7 e. o--o
$
$
$
S
S
$ ,
SF':°E? DaA41Ty (71TL.r........ JU1?.CT
WATE? PERf1IT (INCLUDE SURCEARGE)
WAT°R METER/COPPERHORN/OUTSIDE READER
WATE? TAP (INCLUDv- COR?ORATICN STOP)
SELJEB TAo
ACCOUNT DEPOSIT - SEi4ER
ACCOUNT DEPOSIT - WATER
wac
SAC
TRUNK WATE° ASSESSi4ENT
TRUNK SE6+TER ASSESS.IENT
LATERAL BENEFIT/TRUNK SEWER
LATERAL BENEFIT/TRUNK WATER
OTHER
$ TOTAL
5 0. .s-d / c./ C; S?
$ 989. ??d AMOUNT PAID/RECEIPT
DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGEiT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN
? PU$LIC ROADWAY" MUST BE ISSUED SY THE
NO ENGZNEERING DIVISION. LIST AS A CONDI-
TION.
SUBJECT TO TFIE FOLLO;dING CONDITIONSc
APPROVED BY: oy??
TITLE: --c.! 46 ?Ll?
DATE: 7 •,e7 i -?F LP
r
-? i
! 1
2/84
? CITY OF EAGAN
- /
?
APPLICATION FOR PERMIT
- - SEWER AND/OR WATER CONNECTIODI
(PLEASE P9INT)
i) PuoPERTY ADDREss: .?a 1 q c?er r-ee-to
LEC•r1L DESCi2I°TI^v:1:
(I0t/Bl0ck/Subdivision or Tas P cei I.D. NLmber)
iE•{IS='= :G STRUCP.,T.'<E, DaT G^ ORIGi JAL ,=:uiILL'IING F? ?ST
? PREJ,-?': ? R-1 SINGZE r^PM=WY
? R-2 PUPLE.Y (?S+,O iNITS)
O'R-3 2'GTivNHCT-'SE (TFLRFE + UDTITS) ( UiQITS)
C1 R-4 ApART"^.EvT/CGrIDQ%LNILnl ( UDIITS)
Q CGYvIMERCIAL/RETAII,/OFFICE
? MML'STRSA_L
? INSTINPIDNAL/G0-v'EE2NMENT
2.) pppLlC-7_y^I+ (PLEASE PRINi)
NAIfE: _ ? Su
"?C7..er? S
,
ADDRESS: ?- S 4 ? t. QO? ?(`•
CITY. STATE. ZI?:
PHO'\1E:
3) pu,rMER P EASE rrkME: PPINT)
A?n1?•? ?lha FOR CITY USE ONLY
?
ADDRESS:
. PLUHBERS LICENSE:
p?i? Active
CITY, STATE, ZIP: Ezpired
^ ?t'?
PHOiVE: 4 d
4 " ??I ? PLUMBER LICENSE N 0 Not of Record
+
ari nitia
4) (X-[_;UF'ANj`/Cri%it.TEP. (YL[x]C' YnlN 1 J
?lF'. _
ADDRE55: v ? - y
CITY, STATE, ZIP:
PHONE:
5) INDICATE WHZCII PEPNLiT IS BEZIvY; RDQUESTEp:
E?-CCDINELTION TO CITY SEYdER
"Erm.^]NECTICV 'IO CITY WATER
? C7Pf'.EFt (PLE7ISE DESC:iSBE)
6) mDIC; i 0`z:
? PLE`,SE F?OID APPRWID PER+IIT FOR PICI:-UP BY ONE OF ABOVE
°LEASE bTAIL APPROVED PER%lIT 'IO 1. 2,6? 4 11E9%7E
(Circle one)
7) SI?*1Ti.'RE: DATE: ? ?T•
v
2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City OfEagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for. single family dwellings & townhomeslcondos when permits are required for each unit
,SD
30.
DateoSite Address LWAQ/) /IIJ Unit #
PropectyOwner Telephone #*7)
Con[ractor
Street Address City
State
Bond #: '
Zip 69?1a Telephone# (41?
Expires: /?
The Applicant is _ Owner ? Contractor _ Other
Add-on or alteration to existing dwelling unit $ i0.00
X furnace _Additional _ Repiacement
' air exchanger
? airconditioner _New _Replacement
other
State Surcharge $ 50
Total JI?
$?r-?
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; 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 he in accordance with the
ap roved plan in the case of work which requires a review and approval o
??P.t>f4'/
Applican Printed Name
CITY OF EAGAN ?
. 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 l?l? 9154
' PHONE: 454-8700
BUILDING PERMIT Receipt g OU
T. 6e utad hr 1 OF 6 PLEX Est. Volue $58,000 pate JUNE 11 lq 84
SiteAddress 3219 EVERGREEN DR Er"t g a?upancY Rl
Lot 32 slock 1 ?ec/Sub. COACHMAN HIGHLAWq ? Zoning R-T--
Parcel No. 10-18075-320-01 Repair ? Fire Zone N A
Enlarge ? Type of Const. V
rc Name BRUTGER COMPANIES INC Move
i 1 SUNWOOD DR., P.O. BOX 399 ? # Stories
Address Demolish [I Length ??
? City ST. CLOUD phone 252-6262 Gmde ? Depth?!{' Sq. Ft.-
rc N SAME APDrorals Faea
o ame
?U Address ?
Assessment
Permit 307 • 00
City Phane Woter 8$ew. Surchorge 29.00
k-1 5-T. 5 0
Pl
h
BLUMENTALS ARCHITECTURE INC
m
Gw N Police on c
ec
525.00
a
e
tz 6100 SUMMIT DR NO Fira SAC
470
00
xo Address Eng. .
Woter Conn.
u
BRKLYN CTR 571-5550
Wz Phone
City
Plonner
63.00
Water MeYer
Council Road Unit 260.00
I hereby acknowledge thot 1 hove reod this applicotion ond state thaf gldg. Off. -
the inlormation is correct and a9ree to tomply with all applicobla APC Totol +S1• 8?7.5?
Stote of Minnewta 5latutes and City of Eo9an Ordirwnces.
Signafure of Permittea
A Building Permit Is issued to: BRUTGER COMPANIES INC on the express conditian Ihnt
oll work sholl be done in cccordonte wit oll p iwble 5 te o Minnesota Stotutes and Ciry of Eapan Ordirwnces.
Building OfFldal -C --E? 2.
Dt11 L PI N C. AZ
CITY OF EAC'?AN Include 2 sets of plans,
? 1 site plan w/elevdtiOns &
BUILDING PERNLiT APPLICATION 1 set of_ er.ergy cal.culations.
To Be Used For Townhouse Valuation Date P1ay 24, 1984
site ndctress: 3219 qnm;x4i QiE2 ^ariee MJtJ26(2? I, OFFICE USE ONLY
Lot 32 Bloclc 1 Sec./Sub. Coachman Erect k CcauPancY ?-1
Parcel #: / D -/
? -
Y
3
? xighl nds A1ter
2 (
- o? Zoning ?-3
,
o
,
, )
Repair Fire Zone
Enlarge Type Of COnSt. 3z:
OWn2r: Brutqer Companies, znc. _
Move # Stories
PdC1T'e55: One Sunwood Drive, P.O. Box 399 DPl[lOllsh FTOnt ft.
City/Zip Code: st. cloud, Mrr 56302 Grade Depth ft.
Phone #: (612) 252-6262 APPROVALS FEES
CAritSaCtAr: Brutger Companies, Inc.
AddT2S5: One Sunwood Drive, P.O. Box 399
City/Zip Code: st. Cloud, MN 56302
PhORe #: (612) 252-6262
Arch./Ehg.: Blumentals Architecture, Inc.
Pddres5: 6100 Summit Drive North
Gity/Zip Code: Brocklyn Center, MN 55430
Phorle #: (612 ) 571-5550
Assess7nents Pernut 3D1 . `?'
Water/Savqer :. Surcharge
Police ? Plan Check ? 53 • 5D
Fire SAC
Eng. Water Conn.
Plannes Water Meter
Council Road Unit (,p.oo
Bldg. Off.
APC _---
ROPAL J ? ? ? 7 ' SO
CITY OF EAGAN Remarks v'
Addition- • COACtW NIGHI.ANDS Lot 32 Blk i Parcel 10-18075-320-01
owrner screet 3219 EVFRGREFN DRIVE scate BAGAr1 14M 55121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. 2-10 1975 p d e 7 - 1-
STREET RESTOR. 1974 tl o1 to
GRADING 1007 1986 354.14 35.41 10 35 /Q
SAN SEW TRUNK qr) 1968 Fiid anei 10 2750 -010-03
SEWER LATERAL 1984 tt
t 11 n
• WATERMAIN 1972 Paid r STCO1 1 Z750 -010-03
WATER LATERAL 175 tv iI o1
+? WATER AREA 1972 tt H
M ,o „
STORM SEW TRK &$ 1975
STORM SEW LAT
CURB & GUTTER
51DEWALK
STREET LIGHT
ROAD UNIT $260.00 44004 6-12-84
WATER CONN. 470.00 " "
BUILDING PER. 11 rT
sa,c 525.00 " "
PARK
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P.O. Box'21199 PERMIT NO.:
Eagan, MN 55121 D/?TE: 7- 11 -''
Zonin9: p„ `, .+ ?. • No. of Units:
?
OMI/1lf: 13 ???I
1ggrM !o oomPly with tba City of Easan
o.rtscoe... Yn?-L # 0-n ?,, -,-?, _
CITY
3830
P. O.
'Posit: 1.5 AOpd
lII no Pd
2es; 61 _ nn Fj
OF EAGAN SEWER SERVICE PERMIT
Pilot Knob Road .3r. F,?'):) u
Box 21199 PERMIT NO.:
7-31 MN 551'? DATE: ' "
Zonfnp; ru ger No. of Units: ?
Owrwr:
Address:
.5219 ergreen vttve oac man g i-irxc 9
Site Address:
!'-
Plumber: ? Iph 9 P b?
(1-127-64 W714 •
1 yres to eanvh? whb t`e G1p of Eaonm Connection aorge: 425.00 pd .00 Ordtnenea. AccourK Deposlt: p
Permit Ae: 10.00 p
Surcharye: _ ' P
By Misc. Chot'pes:
Date of Insp.: Totol:
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Roed ' 5615
P. O. 60:: 21159 PERMIT NO.: 7_ 31- S4
EurZoning: n, MN 55121 DNTE:
?a"U J No. of Units: o f F'
gwner: BT.'llt??GS3: lllk ?7 S I Addrcss: ?r: -rRi??? R ?- C.
'
-? 470.0o vd
r No.: R`. u?cri?, aor?: 15 00 1 -) a
Stze: " ?'c''? •r " --
Reade No.: Q.1 L 8' D 1 y ----
1 nyne eo eawpll? willi Nw Ciry of Eagow
Ordi"nees.
BY
Dote of I nsp.:
nt Deposit: lo. oo ,: _
Permit Fee: 5U po
Surcharge:
Misc. Cha,ges: 63 00 pd mecer
Toto1:
Date Paid: -
MN 55121 DATE:
? No. of Units:
Conrnttlon Clwrpe:
Account Deposit: _
Sur+chorpe: -
M(sc. Cho?yes:
By
Date of Insp.: Total:
Insp.: Date PoW:
Receipt
Permit No.
Fee
S/C
Tot.
PLUMBING PERMIT.
CITY OF EAGAN
fill in numbered spaces
Type or Prini /egiMy
1. Date -• ? '" `? 2. Installation Cost
3. Job Address '? i_ ,? Cf{ r' r l.ot Blk. ' TraCt '•
4. Owner
?---=r
5. Contractor ? C- i ; T, Phone
6. Address
7. City i i?J State Zip
8. Building Type: Residential. ET` Commercial ? Institutional El
9. Work Description: New,,E3_ Add ? Alter ? Repair ?
10. Descri be
11.
No. Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
Bath tubs Septic Tank
i Lavatory Softner
Shower Well
?
r Kitchen Sink
Urinal/Bidet
Laundry Tray
Gther
i
L_
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certitY that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : A I ? . • , ' , ? e. %for
Rough F inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt L-( h5? ?5 / MECHAAIICAL PERMIT Permit No. `'f K. ? 1
CITY'OF EAGAN
Fee
FiU rn numbered spaces S/C
Type or Print legibly • ti ?
Tot.
1. Date 2. Installation Cost '
l
3. Job Address --,`-t. ( ??P[_
?Ldo?t?,?.,. Blk. Tct
4. Owner
,? ? v
5. Contractor Phone ,?/ 2- 7-
6. Address
7. City State
Zip
8. Building Type: Residential Er Commercial ? Institutional 0
9. Work Description: New 0"- Add ? Alter ? Repair ?
10. Describe
11.
Ty pe
No.
? Eauinment 8TU - M. Ea.
Forced Air No. Equipment CFM
Air H
dli
:
Mfg. an
ng
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg.
Other
Air Cand.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and carrsct, and I agree to
comply with all ordinances and codes gaverning this type of work.
Signed : ': ? for
e Rough Final
Inspections: Date Insp. Date Insp.
This is your permit vsrhen numbered and approved.
Approved CITY OF EAGAN 454-8100
BUILDING PERMIT
?w su -al sw. 1 \/C
Lot -' '
Parcel No.
CITY OF EAGAN ?T
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 l? Q 9154
PHONE: 454-8100
Receipt # _ '/ (,'( < </
6 PLEX $58, Q00 r„*e 3UNE 11 ,0 84
ec Name Ll\V i VLl\ t.Vi'1C!3411 iL O JL a.%,
Z Address 1 SUNWOOD DR., P. O. BOX 39S
9 City ST. CLUUD phone 252-6262
C bE?1?1L'
Zo Name
?? Addresa
? City Phone
Name
City
I hereby atknowledge fhof I have reod this applicotion and state thof
fhe information ?Is correct ond agree fo comply wfth all cpplicoble
Stote of Minnealoto Stotutes and Ciry of Eogan Ordinances.
t
A Bullding Permir fs
oll work sholl be do,
Buildlnp Offlcial -
Permit 4 • 00
Surchorpe 29.00
Plan check 15-3.50
? SAC 5.25:00
Water Conn. - 00
Woter Meter -63.00
Rood Unit 260.00
Total ' • 0
INC
on the axpress conditlon tF+oi
a Statutes ond City of Eapan Ordinancea.
Erect ? Occuponcy xl
zoni.w
Repoir ? Fire Zone
Enlurya p Type of Const.
Move ? # Stories
Demolish p Length
Grode ? DeptFt,3 `? Sq, Ft.
ApProvah Fees
Assessment _
Water 8 Sew.
Police
Fire
Enp.
Planne?
Council
Bldg. Off. _
/1PC
Permit No. Permit Holder Misc. Permit No. Holder
Plumbinq
H.V.A.C. y? ?? 1?-?, b. ?
Well
Water
Disp.
Sewer
Elect.ic q 3 5o t ?3 q o. o ?
Inspsction Date insp. Other
Footinps
Foundation
Fnminp ?
Rough Plby.
Rouph HVA
Inwlation
Find Plb¢
Finsl HVAC ?
Final
Water Dasaibs Loeation:
VYsll
Sower .
Pr. D'up.
RESIDENT / OWNER
Name: -DA -1 t 4t 1161 -1 LA-tub _5 7G/ ° f(/ 1 C:Phone:
Address / City / Zip: _ 5 A- L 3 FL4 ( t Dia—
Applicant is: Owner Y Contractor
TYPE OF WORK
Description of work: RF (200 i
Construction Cost: // S' Multi - Family Building: (Yes x / No )
CONTRACTOR
Name: Rco 3 /-t/ 4J/ 1)4 -ANC. . License #: 02 ° 1 r 7a i 53
Address: S Q (JAM /44 NE City: ST M /C. f,4- - L
State: MX Zip: 53 ( Phone: 76 3 - 5- - C y c /CV
Contact: R- (Z / Email: )D • /' _ +w L7 r0 0 '- co iii / . Coo\
COMPLETE
In the last 12 months, has
Yes No 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:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
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.
** City of Evan
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
2010 RESIDENTIAL BUILDING PERMIT APPLICATION
Applicant's Signature
Staff:
Use BLUE or BLACK Ink
Qr1e -'/
Permit #: /4(0
Permit Fee: 221 2s
Date Received: l2 2 /a
Date: Co /U Site Address: 32 I 1 El/ (,,BEEN N, go/l_6(A) 6 L
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.gopherstateonecall.orq
VIG.l 1 I? 17 '2-11 3223 Suite #:
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 wit be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
Page 1 of 2
. - - , �� � 3� :3 aI Sj 3:�- 17j � � ►�� ��-�1 , ���.3
Use BLUE or BLACK Ink
------------------
� For Office Use �
' j Permit#: '1 �W ��� j
Cit� of ����Il a�
� Permit Fee: ���• I
3830Pilot Knob Road
Eagan MN 55122 j Date Received: j
Phone:(651)675-5675 I Staff: I
Fax:(651)675-5694 � �
�..���� ���-�_�����J
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: cJ �"1, �� t Site Addr�s: ���' �o��" J �U�.����� VF-LIJ� Unit#: �3"3�-3
Name: Phone:
Residenti °� ^� �����1 J �
�Wtt@1' Address/City/Zip: J��3 ^ �d��3 � � l✓�
Applicant is: OHmer 1� Contractor
�.������� Description of work: ����
Construction Cost: � `� � � Multi-Family Building: (Yes�/No�
' Campany: i�V b'F �- 1�,� • l�� . Corrtact:�t�'�� 1��1����
C011#C'dC��l Address: ��j0� �Ilf�� ��1/� • �L.. City: �� I��lG-Nl��.L
' st�te:�� z�p: �537b Phone:�D1.2-"1���"IP13� EmaiL��{�lr.l►'1C.FL��I'n1a1��CD
' License#: ������ J Lead Certificate#:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 moMhs,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 8 Water Contractor. Phone:
NOTE:Plans and supporting docurr�ents that yau submit ar�e cot►sider�tl to be�ubltc�nfomratiart. Por�ns of
#he ir�farmation may be ctassified'�s rwrr publtc if yc�u prQV�iale speci�c reasons#ha#wcruld�errre#t fhe Gity�cr
cw»cJuc#e ti+at fhe are tr�ate secr�s,
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.c�opherstateonecalf.org
I hereby acknowledge that this information is complete and aca�rate;that the work will be in conforrnance with the ordinances and codes of the City of
Eagan;that I understand this is not a permit, but onty an application fior a permit, and work is not to start without a pertnit; that the wro�ic will be in
accordance with the approved plan in the case of work which requires a review and approval of plaru.
Exterior work authorized by a building permit issued in accordance with the tabe Bui in Code must be completed within 180
days of permit issuance.
x ^�� ������ x
ApplicanY Printed Name Applicant' ign ure
Page 1 of 3
Use BLUE or BLACK Ink
For Office Use
0fPermit: )4e/0
Eaiail
Permit Fee: _J.5, 1q
3830 Pilot Knob Road
Eagan MN55122 kLC .i :
�' Date Received:
Phone:(851)875-5875
buildinaInspectionsecitvofeagmt.com SEP 1 9 1017 Staff:
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit tiff
ti , fSvs (�i►Y
Name: Y. i` Phone: g ca 4..-Xt") _. 3'S-4..te
Resident/
Owner Address/City/Zip: a i � v�v-etr ,�, rti\J2) Gn 1 .1
Applicant is: Owner X Contractor
TYPO Of Work
Description of worker '� "� '��-" u- lc'
Construction Cost Multi-Family Building:(Yes lit /No )
Company: ' a cAQ_ vt��.-_l,1�,r c . Contact Ecv.\(- `-zb:a
Contractor
Address:7 -.""t c' 45 `� ;« 4 city: lr--)211G't
State:i`+`,,t zip: SS Phone:te t 2—35 3:L.3 Email: 5-3\:)--e4"s s. Ieli ..'11`a>
License#: 6C-1 'I 1`t Lead Certificate#: 1=1 Pt
If the project is exempt from lead certification,please explain why: -y
:1-�i"3 V a: � G Zj�i G�''� ws— Ztf� l { <4J
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 we considered to be public lnf mrauon. Pis ofd
information,may be classifterfas nonpublic If you provide speciffc masons that would
are tradesecret� _ permit-the City to conclude that they
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.citvofeagan.condsubscribe.
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(851)454-0002 for protection against underground utility damage. Call 48 hours before
you intend to dig to receive locates of underground aildies. www.gopherstateonecaii.org
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 perm#,and work is not to start without a permk;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 1 2 . 57415"3-.,
Applicants Printed Name Applicants Signatu
Page 1 of 3
bit /1--`
1 i DO NOT WRITE BELOW THIS LINE /1/500 5 /
SUB TYPES
_ Foundation _ Fireplace — Porch(3-Season) _ Exterior Alteration(Single Family)
Single Family _ Garage — Porch(4-Season) _ Exterior Alteration(Multi)
Multi X Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous
01 of_Plex _ Lower Level _ Pool _ Accessory Building
WORK TYPES
New — Interior Improvement — Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace Repair Egress Window Water Damage
Retaining Wall *Demolition of entire building-give PCA handout to applicant
DESCRIPTION
Valuation 0 Occupancy MCES System
Plan Review Code Edition f 1 A „ l SAC Units
(25% 100% ) Zoning City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction ,f Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
" Footings(Deck) Final/C.O. Required
f - Footings (Addition) X Final/No C.O. Required
Foundation Foundation Before Backfill ! HVAC_Gas Service Test Gas Line Air Test
Roof:_Ice&Water _Final Pool:_Footings _Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_Rough In Air Test _Final Siding:_Stucco Lath _Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:_Footings_Backfill_Final
Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan Other:
Reviewed By: , Building Inspector
RESIDENTIAL FEES
A /a
Base Fee P ci 1 .-i
Surcharge `
Plan Review
MCES SAC
City SAC
Utility Connection Charge �j�
S&W Permit&Surcharge V Pvi
Treatment Plant (-7-172, 2 0 (-2-'
Copies
TOTAL
Page 2 of 3