3855 Heather DrRESIDENT / OWNER
Name: Pal 1 eti Phone: (a ci - 06 - q as
Address / City / Zip:
CONTRACTOR
Name: e,R( LA Ai A 2 License #:
_Aim
Address: 1101C 7 0 4't /l/ City: c le. I? Ili t✓Z.
State: ,M..A/ Zip: Cs Phone: 60 - ; 8) - - 7F& U
Contact: -- To RAI Email: ` (jLv., d 0` // M.ltitlrti @ A4 i/v- (ova.
TYPE OF WORK
)4 - New Replacement Additional Alteration Demolition
Description of work: Iti s 1 N et, #,JLNM„ E / 47(, s
NOTE: Roof mounted and ground mounted mechanical eq is required to b screened by City {
Cede:_ Please contact the Mechanical Inspector for;information permitted screening
PERMIT TYPE
RESIDENTIAL
Furnace
COMMERCIAL
New Construction Interior Improvement
/-- Air Conditioner
Install Piping Processed
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
Under / Above ground Tank ( Install / Remove)
Other
** When installing /removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add -on
or alteration to an existing unit (includes
bumed out appliances, ductwork, etc.) (includes
$5.00 State Surcharge)
$5.00 State Surcharge) $ TOTAL FEE
$95.00 Fire repair (replace
COMMERCIAL FEES:
$75.00 Underground tank
$55.00 Minimum (includes
installation /removal OR
State Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
Contract Value $ x 1%
_ $ Permit Fee
- If the Permit Fee is less than
Fee = $ Surcharge
- If the Permit Fee is > $10,010,
(i.e. a $10,010- $11,010 Permit
= $ TOTAL FEE
C!tyofaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
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Applicant's Printed Name Appli -ant's Signature
Permit Fee:
Use BLUE or BLACK Ink
1
cx)
Date Received:
Staff:
r� 2011 MECHANICAL PERMIT APPLICATION
/
Date: ' J /( Site Address: TcS [le AA 2 ft Oit v2
Tenant: Suite #:
1
J
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.gogherstateonecall.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.
Under Ground Rough In _ Air Test , =Gas = S ervice Test
Exterior HVA
Obi' ea `_Finn
FOR OFFICE US
Required inspections
S creening inspection
WATER SERVICE PERMIT
i4S nob Rood P ERMIT NO.: t�
Eoi an, iwlN 35122 DATE: 5
Zoning: PIV ; - No. of Units:j 1, unit 't n h s0 .
Owner: To llefson Builders
Address:
Site Address: 3855 11 then Drive L 3 B1 Briar Hill 4
Plumb nobnz..a'R•an •,, ''t
Meter No.: Connect)on.Charge: 4 pd
Size: Account I3eit• 1 +• ) l`
Reader No.: Permit Fee: ^1 ' led
i ogre* to comply with the City of Rogan Surcharge: • 5t) pd
Ordnonces. Misc. Charges: 60.00 pd met 4:
Total: s
By Dote Paid:
Date of Insp.. L/ Insp.- cr
CITE - iit ' EAG...
SEWER SERVICE 4.
c ; Knob Road PERMIT
Egon, MN 55122 ATE:
Zoning: PERMIT NO.: S 77I
. 1IEi DATE: '^-- _._.�__
Address:
ddress:
Site Address: 385 $ @,3t i
Plumber: Genz R an ive L Bit 'fa
i
i agree to comply with the City of Ea : ► : "
Ordinances. — Eagan Connect C r & 5(t 0 - ,d
Account Deposit:
7
Permit Fee: 10 • f
BY / " Surcharge: rn d • Dote o ' '�' Misc. Charges:
Insp.. S Total:
ti. y Dote Paid:
the BLUE or BLACK Ink
I , for OF" U"
i C-1
ties to I
PVTM
of latan I Z,5~ -1,77'
bill
ragan 100 Received
Phone: 6651) STS-Wra
FM (661) mom
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
13pte: 10-ILl- 1.3, 3bAddrm: ~8y4, 38s~, aF~s3; 38.rS- H6f77/014-tZ DR• 'Unit#;
Narne: ~~o A G 7" AV r4 A3 A 4 ~ /4 L AJ -r e- Phone: -7" -.sr9 3 0
Address! City I Dp~Sb ~j i4'---v e 19 gaE.S U101,
Applicant la: -owner K Contrawr
`7r'ER,2 O (QE - IMF
Construction Cost Mull-Fam4 Building: (yes -K I No
Company: E 1 ~a~ 7-L2ro~ Alt h,,~ eAap Contact- b^i/ A %a (?Jo S
Addr //oS 6D S~ , Gp, JylQG 5
State: )FYAI zip: Irryi Phone: !o'z - r'~ G Z y
LJoense *t 8 C A q1J 3 / Lead Coriiflcats rk
If the project is exempt from lead cmdficadw, phase explain why: (see Page 3 for addldonal Information)
RL~ws tJ::e~.' r Post 1 p7 Sr
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NIRN I&DING
In ehe t 12ma+Mq. has the qq o/ Eagan fastrsd a permit for a slmUar plan lased on a ntwar plan?
Yes No It Yes. date and address of meftr plan:
Licensed Plumber: Phone:
MschanloW ConpgcW: Phone_
Sewer S Waist contractor: Phone;
Now--- 11 pill
tfre:jfiia
W" you k"'d 1104iEiia~ a Can Goptwr Sbla oft am at (661) 45a0o02 for mvwwon against underground u ft damoga Call 48 hours y
locates of undwWamw LdItiee. %mft
+e n.ora
e hereby adub'*0 d1m On wftrQ6ap Is -
Eagan; ft I w* st&W this is and &=n* that to
VA)* will to in wribramw with to ardkrencas and codes of the Oty of
aaeauaMW wdh Ow not a rppner,.a pl,,, in m bd an. aAD iorl for a Aerml and wont is not to Seam wldmA a oennix ow the work vA bs to
Uqukcs a slew Ow appmw of plan,
&bd*r work ft*-wft*4 by ~ of Pmt lmuarrom a twilling permit Issued in accordance with tM IAtmeeott Stft ftUm Code must be complebd wWn 180
~jiv11J ~u RR rS
Applicant's Printed Warne
Appllcaneg Slgnotum
Pate 1 of s
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Use BLUE or BLACK Ink
_ -
I For OM CO U30 ----I
1
My of ~ Pem,rt ~ I
Ealan I
I PemtiE Fee: I
3830 POot Knob Road j l
Eagan MN 66122 i pate Received:
Phone: (651) 6756676 1
Fax: (651) 67411-6694 S'taQh j
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date; 3 Site Address: 3$y9 3 Ys', 3 95I, 3 fss" &,*7-WeA Unit
Name: alb r✓ In.44 4 & is m x 4 j . ~ ~ r✓ Phone: 76 3 - SrJ 3 ' 9 7 7
Rt i~ertt/ S O QSc~s~-u2 Ate, A) 14 GoGD£u 1/*a'X Y /n.)
Owner Address/ City ~ Zip:, ~
Ss y~ 7
Applicant is: Owner ,Contractor
O71':~Af01'K Description ofwoek: Ps-ou c a, RE Pt .Kt~ S~ d /C, d > ,a-x a ly1 £ r •e L
Typo' .
Construction Cost / y 410D CFO Multi-Family Building: (Yes ~ / No
Company: Q E 1 ~`,r r 6e v 2 IY~*-i .~`r . do 10 Contact: DA tJ 14 I(~~ 22i S
Co>ttacvr address: /o w ~o S~ City: M Pz. S
State: /V-*~ Zip: Phone: log .L - 9 /v Co V/3
License fP: 4 C v p lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
qt-N&S- QIiLr Posy /5'-2,
COMPLETE THIS AREA ONLY I 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 S Water Contractor. Phone;
NOTE: a>nd iAI~Y •sti'br~1['~r 1Ni>t•~e• vamF"
• tlr~:prarr!oins?loni:.~ d~' ~ . t?~ R~;~~. a'P~~ai~tt~, s ° ' ' ji+ ~D::-•: i;'
CALL BEFORE YOU [Me. Coo Gopher State One tail at (631) 434-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to (00010 locates of underground miss. www.goeherstateonecall.om
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 wodt will be in
accordance with the approved plan In the case of work which requires a review and approval of plans.
Exterior work authorkad by a building permit issued In 11=0rd4noe with the Minnesota state, Suildi
daps of permit issuance n Code must be Completed within 180
.
x ~~~r ~ ~u2.JLiS x ~
Applicant's Printed Name Applicant's Signature
Page 1 of 3
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