3450 Highlander DrDate:
City of Eapp
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Tenant:
RECEIVED
JUL 1 11 2011
Use BLUE or BLACK Ink
Permit #: %pa! `y
Permit Fee: .6- £2
0
Date Received:
Staff:
2011 MECHANICAL PERMIT APPLICATION
Site Address: 34a2) km \ O in
Suite #:
RESIDENT / OWNER
CONTRACTOR
Name: yi 1 e r P�rV^ r-�-St-{-qgp
,' -1 c -t-'t \O.c'Cj-Qv- .E or>
Address / C�� � g�
Name: _
Dan Wohlers Southside Htg. & A/C _ # ?—LTL SLA 7 q E7
6950 W. 146th St., #106
Address: _ Apple Valley, MN 55124 __. city:
State: (952) 431-7099
Contact: j..111 \ . C° Email:
TYPE OF WORK
New ✓Replacement
Description of work:
Additional Alteration Demolition
PERMIT TYPE
RESIDENTIAL
Furnace
Air Conditioner
_ Air Exchanger
_ Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Exterior HVAC Unit
Gas
Under / Above ground Tank ( Install / _ Remove)
** When installing/removing tank(s), call for inspection by Fire
Marshal and Plumbing Inspector
RESIDENTIAL FEES:
'$'S5.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)TOTAL FEE
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) $
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x 1%
$55.00 Minimum (includes State Surcharge)
= $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00 Surcharge
- If the Permit Egg is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee =$
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) _ $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaII 48 hours
before you intend to dig to receive locates of underground utilities. www.00pherstateonecall.arq
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.
Applicant's Printed Name
Applicant's Signature
Jun. $, 2011 2:47PM SELA ROOFING
)ThurrCity ofEapo
pate:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
C
No. 6530 P. 26
Use BLUE or BLACK Ink
657.70.1:67.4707
Permit #: 9'4/ f
Permit Fee; f3.3q...e95
Date Received:
Staff.
2011 RESIDENTIAL BUILDING PERMIT APPLICATION/1,,
Site Address:4w� g• �c�g�t� R�
.
RESIDENT 1
OWNER
T f —
Name; _Li 1 1I i / 4 r ! t ) .i i 1L «;,
P1 //__ I r
I (Pi #C
Address 1 City I zip: � �' � � / ' 1 ' 1 � fig. 'f
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: 1- % ..c' 7
/� 01ikiz Le- 1-4(5
1
r UU (J
Construction Cost: fu Multi -Family Building: (Yes i No )
CONTRACTOR
'
Company: AriA or i Ai ' ( j , Contact: LL/l — & —161
Address:4/OQ 1t-LLOe r )tvo. City; CST. 1-6(A-6
State: l & Zip: 6541 l9 Phone: 4914-9)&,,—/ql�
License #: 1 0 D Lead Certificate #: IV %r 4560(.'3q,
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
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 yousubmit are considered. tobe public infor'ritebon. Portions of
theinformation may be classified as non public if you provide specificTeasons 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.gor herstateonecall.orq
I hereby acknowledge that this information is complete and accurate: 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 only an application for a permit, and work is not to start without errnit; that the work Wit be in
accordance with the approved plan in the case of work which requires a review and approv of plans
c
9y4-
Applicant's Printed Name
pplicants Signature
Page 1 of 3
Ne