4678 Traverse PtRESIDENT / OWNER
Name: `C -' f7%v(. L (7
yL, Phone: ,,��/
Address / City / Zip: 3 V3 ' , 14. 0 1 o� i f / t C / e� " M
CONTRACTOR
Name: V / l' ` d/7/4V, . -;G ✓ " E License #:
Address: 78"Y6 /qL./ / L City: --771A 't- R Co J /7
State /4 ' " Zip: -55 77 Phone: 6,5 7 - .7, 7 - l V 3
Contact: X417/(€ // 1Z• Email:
TYPE OF WORK
New Replacement >. Additional Alteration Demolition
Description of work:
NOTE: Roof mounted and grround mounted mechanical equipment is required to be screened by City
Code. " Please contact the Mechanical Inspec for i nformation on permitted screening methods
PERMIT TYPE
/ RESIDENTIAL
Furnace
COMMERCIAL
New Construction Interior Improvement
r 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
burned 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
4 11P CityatBagau
x
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
Applicant's Printed Name
Applicant's Signature
Use BLUE or BLACK Ink
Permit #: e767
Permit Fee:
Date Received:
Staff:
2011 MECHANICAL PERMIT APPLICATION
Date: K--a ?- 2 Site Address: / tv 7e' 7 9 & 5t / /e-c-e
Tenant: Suite #:
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.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 start without a permit; that the work will be in accordance
with the approv plan in the case of work which requires a review and approval of plans.
R eviewed By Date:
Under Ground Rough In A ir Test Gas ,Service Test ri -floor Heat ` Final
Exterior HVAC Screening Inspection -'
FOR OFFICE USE
Required Inspections
No of .Units.
xtiomp fl liolueg,
` x
. : , 467P. 'Y're.verse Polzft id ecliff 4 h
Sall plu Benz Ryan Gonr►ecrion OOS9e: 305'•
tt�'F pd
Siete: , u Account Deposit: 10 • 00 Permit Fee: 1 50 (1
bedew ' .. S" "' 60. tit? 'pd e
::111100111.61101s. Totof
.
DqM of -lrup --^^ ire .:
cant ow BAGAN ' + - SERVICE. PERMIT
3755 joss it PERMIT NO.:
ice, MN 55122 DATE: L -
Zoning: 2ITT No. pi units: 1 'unit trhse-
owner , t>
rr Ez 1(T %t�j(�i? i C?TwE S
Address:
site Address. 4 f 7 Traverse Point TA P2 'tier fe 4 tl�
plumber f'e'z P pn
10 /2 /SC 21167 1GO. pd ..
t *lam tertesepty with idle t r et Eo, a Connection Charge. 4 25•00
Oed eertees. - • I Account Deposit:
Permit Fee: .i;(1 Prl
Surcharge: 50 pd
By
Date / / . / 1 � � � U Misc. Charges
iwsp`YS�f'gs
some Paid: