3223 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
City of Eagan
3830 Pilot Knob Rd
Eagan, MN 55122
(651) 675 -5675
www.ci.eagan.mn.us
Site Address: 3223 Evergreen Dr
Lot: 30 Block: 01 Addition: Coachman Highlands
PID:10- 18075- 300 -01
Use:
Description:
Sub Type: e - Furnace & Air Conditioner
Work Type: New
Description: Fumace & Air Conditioner
PERMIT
City of Eaan
Permit Type:
Permit Number:
Date Issued:
Permit Category:
Comments: Permit closed without required inspection(s). Letter sent to applicant on 9/29/09. (pf)
Fee Summary:
Contractor:
Sedgwick Heating & Air
8910 Wentworth Ave S
Minneapolis MN 55420
(952) 881 -7739
Quesetions regarding electrical permit requirements should be directed to Mark Anderson, State Elec
445 -2840
ME - Permit Fee (Replacements)
Surcharge -Fixed
Total:
Applicant/Permitee: Signature
- Applicant -
$50.00 0801.4088
$0.50 9001.2195
$50.50
Owner:
Gloria A Johnson
3223 Evergreen Dr
Eagan MN 55121
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
EA088974
05/01/2009
ePermit
cal Inspector, (952)
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
_ i
?. {
?
2/84
? CITY OF EAGAN
f ?
A PPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTIODT
(PLEASE PRIHT)
1) PaoPERTYADDRess:
T-FyaL DESCi2i°TZC:I:
(Lot/31ock/SubdLVision or Tax Parcel I.D. VLUNber)
ir E{IS':'=_:G ST".?UCP'RE, DrITE v_° ORIGi 1AL .=:JIir^,L;G FZF,:•ST ISS???=:
' ,•?=--' --= ,
? P?LSr?_,- ::L. ?•T-Lr,/FRC.°OSE) U5E: ? R-1 SLNCZE r^pm=Y
?
R-2 DUPr.?t,.'?". ('T-h0 Wi ITS)
?., ?
w x-3 TGLQt?HCI1SE (TfSRF^ + LNITS) ( UNITS)
? R-4 ApART`ENT/CCDIDa%L7?iIIU:`,I ( LNITS)
Q COMMERCIAI./RETAIL,/OFFICE
? INDusTRIaL
? INSTITUTIONAI,/G0V'F.PNMIINT
z) pppl,IC?V'•P (PLEASE PRINT)
NPME: ?1r? ??, (`? C
ADDRESS:
CTTY, STATE, ZIr :??
?
PHONIE:
3) pjl,??Eq VLEASE,PRI4T) FOR CITY USE OHLY
ruvME: ? b
ADDRESS: (?q0 n w PLUHBERS LICENSE:
pctive
CITY, STATE, ZIP: Expired
?f
?7
PHOi4E:, tM
`a` '?
? Q Not uf Record
7d
/ l
? PLf1M8ER LICENSE #
ari nitia
lNLtpJt-YHINIJ
AUDRESS:
CITY, STATE, ZIP:
PHONE:
5) INDICA'PC WItICH PERr1IT IS BEIIv'G REQL7ESTID:
/CC ION TO CITY S?r7ER
r
CO.,nQECI'IO.I 'IC) CITY LVATER
? CITIF',R (PLFASE DESCRIBE)
6) LVDIG=IL C:E:
? PL„1SE F?OID APP?2GVID PERMIT FOR PICiC-UP BY ONE OF ABOVE
? PLFASE ?TAIL APPFtOVED PER`ffT 'Iq 1, 2. 6?)qAgpVE
(Circle one)
7) SI??:Am.RE: J // DATE: r?
PERMIT# J S LI
2002 MIDEPTIAL PLUM$INfi PEiMIT APPLICATION
crrY oF EAsM
3830 fll.OT KFOB iiD
EABAN, M1V 551EE
651-881,4675
Please complete for:
SITE ADDRESS:
OWNER NAME:
INSTALLER NAME:
STREET ADDRESS.
RECEIPT DATE:
single family dwellings, townhomes and condos when permits are required for
backFlow preventer for irripation svstem
°%'PR 1 1 2002
?
TELEPHONE #:
(AREA CODE)
JOHNSON AA, GLORIA
3223 EVERGREEN DRIVE
EAGAN, MN 55121
(651) 687-0959
TELEPHONE #:
NE)FOLOM . (.4REF. CODE)
CITY: 2905 ?'?ARFIELDAVE SO STATE: ZIP:
MINNEAPOLIS, MN 55408
_ SEPTIC SYSTEM, new/refurbished (requires two sets of plans and MPC license) $ 100.00
includes $40.00 County fee
Note: Additional consultant fees may apply
• MODIFICATIONfALTERATION TO EXISTING DWELLING UNIT, INCLUDING:
_ Adding fixtures to lower levels or room additions, excluding water softeners and water heaters. $ 50.00
_ Abandonment of septic system.
_ Water tumaround - existing dwelling unit (+ 5/8" meter if needed -$118)
Other:
_ RPZ: new installation/repair/rebuild $ 30.00
_ lawn irrigation system
Replacement/additional: _ watersoftener ? waterheater $ 15.00
cqtz?d a-fcr w-tr
State Surcharge $ 50
5-0
I5
Total $ ,
I herebyacknowledge that I have read this application, state thatfhe informatlon is correct, and agree to mmplywith all applirable Cityof Eagan ordinances. It
is the applicanPS responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the City during its normal
operetional and maintenance acfivities to the facilitles constructed under this permit within City property/right-of-wayleasement.
SIGNATU E PERMITTEE 1/02
CITY OF EAGAN ?
I . " 3630 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 1N . 9156
PHONE: 454•8100
BUILDING PERMIT Receipt #
Te ba umd Fer 1 OF 6 PLEX Est. Volue $72,000 Date TIiNF. 1]
SiteAddress 3223 EVERGREEN DR Erect Occuponty Rl
Lot 30 Block 1 Sec/Sub. COACHMAN HT('HT^p ? Zonin9 R3
Parcel No. 10-18075-300-01 Repair ? Fire Zone N/A
Neme BRUTGER COMPANIES INC
nddress 1 SUNWOOD DR., P.O. BOX 399
City ST CLOUD phone 252-6262
O Name SAME
?Y Address
i- City Phone
WwlName BLUMENTALS ARCHITECTURE INC
tz 00 SUMMIT DR NO
x? Address
?W cty $RKLYN CTRPhane 571-5550
I hereby ockrwwledge thot 1 hove read this application ond state thot
the inlormation is correct and ogree to comply with ull opplicoble
Slate of Minnesota Stotutes and City of Eagon Ordinonces.
SiOnoture of Permittee
A Building Permif is issued fo: i3KU7'li j CUMYI
all work shall be done in accordance with all o " ble State
Buildin0 OFfic(ol A
Enlorge ? Tvce of Const. V
Move ? # Stories
?
Demolish ? Length I r,y
Grade ? Depth aV_Sq. Ft.-
ADOrovals Fees
Assessment Permit y5 349-00
Woter&$ew. $urchurge -IF+-00
Police Plan check 174.50
Fire SAC 525.00
Eng. Water Conn. 470.00
Plonner WaterMerer 63.00
Council Rood Unit 260.00
81dg. Off.
APC Total S1.877..50
%- on the express condition thm
Statutes ond City of Eogan Ordinances.
?jl11LDINL-r AZ
CITY OF EAGAN
BUILDING PERMIT APPLICATION
Include 2 sets of plans,
1 Site Plan w/eleVation5 &
1 set of_ er.ergy cal.culations.
Tb Be Used For Townhouse Valuation ?? $-7Z,G00.°= Date
F",ay 24, 1984
Site Pddress: 3223 ?ewflake ?' e?VERCaRCC-N DR. OFFICE USE ONLY
IAt 30 B10Ck 1 S2C./Sub. Coachman
Highlands
Parcel U? - 6 /
Owner: Brutger Companies, Inc.
Addresg: One Sunwood Drive, P.O. Box 399
r.TECt X_ OCCUjJZC1CY
Alter zoning R 3
Repair Fire Zone N /A
Enlarge _ Type of Const.
Nbve # Stories
ieTmlish Front ft.
Grade D th ft
•
City/Zip Code: St. Cloud, MN 56302 ep
.
Phone #:
(612) 252-6262 APPROVAL6 FT:ES
Contractor: =^,tg=- unpanies, Inc.
AC1dr255: C:e st:nwooc Drive, P.O. Box 399
City/Zip Code: St. C1cud, MN 56302
Phone #: (612) 252-6262
Arch./II1g.: Blumentals Architecture, Inc.
Pddse55: 6100 Summit Drive North
Assesstrents PeLmit
WatQr/Sewer - ?'-: Surcharge 36 °°
Police ; Plan Check I^I
Fire SAC 525 "-°
Eng. Water Conn.
planner Water.Meter
Council Road Unit 2(00. W
Bldg. Off.
APC
City/Zip Code: arooklyn Center, MN 55430
?? O 7 7 S ?
Phone #: (612) 571-5550 'IUTAL
CITY OF EAGAN Remarks i )I U ,?' i ' ' _ ' 1,? ', _
Addition COACMMAN HIGHLANU3 Lot 30 Rlk i Parcel 10-18075-300-01
Owner Street 3223 EVERGRBFN DRIVB State ?GAN MN SS121
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF. j
STREET RESTOR. it it of
GRADING 1007 86 354.14 35.41 10 ,4 /072-5 16 -/5- XS
SAN SEW TRUNK 10,
SEWER LATERAL 1994 t? of of
• WATERMAIN ? 1972 p - 3
WATER LATERAL 1975 t? n I I
* WATER AREA 1972 tt to tt
L92 1975
11
It
11
STORM SEW TRK 1975
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
ROAD UNIT $260.00 #44004 6-12-84
WATER CONN. 470.00 11 11
BUILDING PER. #9151
sa,c 25.00 " "
PAR K
CITY OF EAGAN
3830 Pilot Knob Road
P. ai Bax ?."! 199
Eagan, MN 55121
Zoning: L -
Brai ,r
\Pwner:
reas: ?
S e Address• 322 ;
.
??lumber: ?'d D'111?h?? ?OC
`? yYletar i-- _?;t• , --?i
Slze: .
? o
Reode No.: IL?
I ayrse fo wmYh wif6 Ila Ciryr ef Ee
Ordinanam ?? i?-??
CITY OF EAGAN
3830 Pilot Knob Road
P. O. Box 21199
Eagan, MN 55721
Zoninp; '•'U;)
Owner. Brutk
/Wdress:
Site Addi
Plumber:
WATER SERVICE PERMIT CITY OF EAGAN
3830 Pilot Knob Roac1
PERMIT NO.: P. O. Box 21199
DATE: Eagan, MN 55121
- No, of Units: Z?ing: '>i: I?
??£dw?rsction Charye: ±70. 00 od
?t ?eposir: _ 15.00 nd
?
9an
!r?t Fes: - 10.0
Surcharge:
insp..
5E1NER SERVICE PERMIT
PERMIT NO.: DATE:
No. of Units:
0 Dd
50 ?d
Mist. Cho rfles: ?- 0 0 p m P t r ?
Total:
Date Paid.
•
?? ? ? ? ? Eegon
Ordinenqs
By -
Date of Insp.;
Connection Cha?ye: 4 2 5.00 d
Accourn Deposit: 1S. JO pca
Pem,it Fee: I'.) . ??!1 ;? d
Surcharge: Miac. Chqrpes;
Total:
eo eomplr wiA Hw Ghr of Eayen
Nos. # 15, C'YI
or CITY OF EAl3AN
3830 Pilot Kno6 Raad
P. O. Bax 21199
Eagan, MIU 551 a-
Zonirg: ?Lrl
puvrer; rutgt[
IWdress:
Sire Address: srgreen
Plumber: Ral hi e Plb
? yne to
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No, of Units:
-31-84
of b
awn Charpe: _ 4/ U. U U p d
unt DeposJh I 510 0 r rI
Permit Fee: _ 1 •'1 Oo
Surcharge: , S(11
n ?
Miac. Chorfler. (:? r)p G•' ta3
Totol:
Dots Poid:
SEWER SERVICE PERMIT
PERMIT NO.: • DATE: % -3 -
_ No. of Unirs: d
--+vy w, Ni. Cih, o! Ro*o¦
O?alMlllM. Connecrion G+orpe: 42 .99 ci
ACOOURt DQ posit:
Permk Faa:
BY Surcharge:
• p
Date of Insp,; Misc. Chorpes;
?nsp.: Totoi:
-----------
? Dah Pald:
Permit
Raceipt PLUMBING PERMIT • No.
CITY OF EAGAN Fee
Fill in numbered spaces S/C
Type or Print /egibly Tot. 1. Date 2. Installation Cost
3. Job Address rCrfi, Lot Blk. ' Tract
4. Owner
5. Contractor ? r = ; t Ci C-f Phone -: ? f-l - ; ` % _•,' ?
6. Address ; .C?
7. City " , x v c? State ? y ? t- Zip •-- ?'- ?' ?
.
8. Building Type: Residential-Z Commercial ? Institutional O
9. Work Description: New'6 Add O Alter ? Repair ?
1 10. Describe
1 11.
No, Fixtures
Water Closet No. Fixtures
Cesspool/Orainfield
Bath tubs Septic Tank
? Lavatory Softner
? Shower Well
/ Kitchen 5ink
Urinal/Bidet Other
? Laundry Tray
? Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. 1 hereby certify that the above information is true and correct, and I agree to
comply wiLh all ordinances and codes governing this type of work.
Signed . for
Rough Finel
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Receipt
61,)t/? ?
Permit No.
Fee ? ly d
s/c s "
Tot
1. Date - z Y- S? 2. Installation Cost '
i
3. Job Add ?
ress ? '?- ?- LdtBlk.
J
4. Owner
A G-5 v
5. Contractor !-?4- Phone "' 2
617
6. Address
7. City
State Zip
8. Building Type: Residential Q' Commercial ? Institutional O
9. Work Description: New -f?'/ Add O Alter ? Repair 0
10. Describe
11.
Type
No.
' Equioment BTU - M. Ea.
Forced Air No. EQUipment CFM
Air Handlin
:
Mfg. g
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
? Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codeuo this type of work.
Signed :
oll ? ?(?n?.% for
Rough F inal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Esgan, MN 55121
PHONE: 454-8100
BUILDING PERMIT
Te he wmd fer 1 C I' fi
N° 9156
? c
Receipt # - -
SiteAddress JZZJ LVERGREEN DR Erect
? R1
Occuponq
Lot Block 1 Sec/sub. CQACHNiAfJ H:CGALA [" ? Zo?ing R3
Parcel No. 10-18 O 7 5- 3 0 0-(} 1 Repoir [] Fl re Zone NA
Enlorye Q
Type of Const. V
m Name
z
i T3RUTCF.,? CONPANIES IP1C
1 SUNWOOD DR
P
O
BOX 399 ?
? ? # Storie
?
- -/
Addres .
.,
.
s Demolish Q Length I
-
city
t --T CLOUD Phone 252-6262 Grode ? Depth
juT Sa. Ft.
rvame
Addres8.
Li: t + -
City Phone
Sipncture of Permittee
A Buildiny Pennit is issued to: BRU7
all work shall be done in occordonte with oll
8u{IQirp Official
Assessmenf
Woter 3 Sew.
Pol ice
Firo
Eny.
Plnnner
Counti I
Bldp. Off.
APC
?
Permit Y 34?9-. oo
Surchorye 36.00
Plan chetk50
SAC a25.00
Woter Conn. 470.00
Water Meter ?? ' ?O
Road Unit Totol r .50
i
I?1C
on the expross conditlon thni
Dto Statutes ond City of Eopon Qrdinances.
1 hereby ocknowledge thot 1 have read this opplicction ond store that
the intormotion Is correct and agree to comply with oll applicoble
Stcte of Minnesoto Sfotutes and City of Eagon Ordinonces.
Permit No. Permit Holder Misc. Permit No. Holder
Plum6ing
H.V.A.C.
Well
w
r
Disp.
I
S?
Ekctric
t!?
? Z
? .'?
A5a !a ?•r s 1?/ (/a • o 0
Intpsction Date Insp. Other
Footings
Foundation
Framinp ?
Rouph Plbp.
Rouph HVAC /
Inwlation ?
Finel Plby.
Final HVAC ? ?ZZ
Final J
Waftr Wacribs Location: G? b C?--? , f •
vvsu
sewe?
l/ `•
Pr. Disp.
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
Cityof Eu Pemhk#: ass
Permit Fee: q�' 1
3830 Pilot Knob Road
Eagan MN 55122 tate Received:
Phone:(651)675-5675
buiidinainspections@citvoteacian.com Staff'
SEP 191017
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
{mac,- t-las-e +�
Name: Phone: `i 3n �
Resident/
Owner Address I City/Zip:. )4.3 lav-12-v--11cr, r) 4-e-1 Gni .1
Applicant is: Owner X Contractor
Type of Work
Description of work i2�rvv� 1xYaa.�t uj_ti L 1t.
Construction Cost Multi-Family Building:(Yes )4 f No )
Company: " :r1,- r.�L ;1 ly r,G Contact VII: S`ab:a
ContraCtor =
Address.
7- '
AddWi't r - city: tr-:3�. ra-1 .v-
state:;.,i°,,,0 Zip: 'S Phone: t 2-353--03).3 Email: ` -s\a .o,: -44-..x.e.= ,,,r? a'>
Ucense#: 6C-1-3 3j }cZ Lead Certificate#: t= I i}
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 8 Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE Plans and supporting documents that you submit we considered-to bepubliainfomiation. .i ons ofthe'
informationmay be classified as non-
�_p`pntf_provtde isttsthat'i�EttctpermlCtJie E:�ytpconcltrtlettttey
are tradesect s
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.cityofeagan.comisubscribe.
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 utilities. wwwanopherstateonecatt.ora
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.
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Applicant's Printed Name Applicants Signature
Page 1 of 3
,t66".._ LiQ--`
5
,? 9 3 DO NOT WRITE BELOW THIS LINE N 0
SUB TYPES
_ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family)
_ Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi)
Multi / 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 1) Q Occupancy MCES System
Plan Review Code Edition /Art., f` SAC Units
(25%y. 100% ) Zoning � City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction775—
Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
X" Footings(Deck) Final/C.O. Required
' `y 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
Base Fee 0 6f IC
Surcharge ( 14;
rz 6 Pv
Plan Review
MCES SAC
City SAC
Utility Connection Charge /�
S&W Permit&Surcharge V 1
Treatment Plant
Copies
(al
21
TOTAL
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