1992 Shale LaneCity of Bain
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Date Received:
Staff: (".)
2010 MECHANICAL PERMIT APPLICATION
Date: r a i f i b Site Address: 199 Sha I e, Ln Sarin
Tenant: Suite #:
RESIDENT / OWNER
Name: Phone:
Address / City / Zip:
CONTRACTOR
Name: At (t C'.. r f..1 fia IZi i en . KO_ License #:
Address: Ito 0 (r,1 if.) I h .S1* City: Neu \ Proc OP
State: �t4 Zip: 5 (Doi I Phone: `J
Contact: Email:
TYPE OF WORK
New )(, Replacement Additional Alteration Demolition
Description of work:
NOTE: Roof m nted and ground mounted mechanical equipm ent is r s cl tie sc d`by
Code. Please contact the Mechanical Inspector for information an gree
PERMIT TYPE
RESIDENTIAL
x Furnace
COMMERCIAL
_ New Construction — Interior Improvement
Air Conditioner
Install Piping _ Processed
_
Air Exchanger
Gas Exterior HVAC Unit
Heat Pump
_
Under t Above ground Tank C__ 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
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.goaherstateonecall.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.
x (1 rn (13,1 I
Applicant's Printed Name
x 110,1N
Applicant's
Signatu
FOR OFFICE USE
Required Inspections:
City of Evan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
t e.Usg
Permit#: qq 7Ei
Permit Fee: - CCD
Date Received:
Staff:
ora
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Unit #:
RESIDENT /
OWNER
Name: Z'Av'i d i� d P/ "c5:6 de. Phone: �,42 /b3 7-. 7/
/', ;9C, S a ._ .4..,j a11
Address /City /Zip: � . . (� !
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: S L,,f 1.9
( �--� , d., /--nom_
Construction Cost: `1) Multi -Family Building: (Yes X., / No )
CONTRACTOR
Ce pan Contact:
Address: City:
State: .. Phone:
License #: Lead Certificate #:
Does this project require Lead Remediation? ❑ Yes AVo (see Page 3 for additional information)
If no, please explain:
In the last 12 months,
Yes to 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 you submit are considered to be public information. Portions of
the information maybe classified as' non-public if you provide specific reasons 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.qopherstateonecall.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, a 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 apal of p, ns. �
1(2) ?"-1/7"F
Applicant's Printed Name
licant's Signature
Page 1 of 3
Cu wilArom WA SERVICE PERMIT
3795 ‘Pilo Rood PERMIT NO:
Ecgan ;$5122 DATE:,... 1 / iri
. J
Zoning: ', `T »- No. of Units
`onstruct fort
Owner:
Address:
Site Address:1992 Shale Lane Li P4 °xeadowl
Plumber: !V;17 4 c? E ?` vid (SQut1itcrga )
Meter No.: Connection urge:
Size: Account Deposit
Reader No.: Permit Fee•
I agree to corn • with the City of Eagan Surcharge.
Ordinances. J Misc. Charges:
Total:
By Date Paid:
Date of insp :
Ions
,1
lad
0.00 nd meter
CITY OF ELAN
379L110 knob Road
Eagan, MN 55122
Zoning: RII
Owner: Song
Address:
Site Address:,
Plumber:
•
-_ .. SEViER SEtYICE PERMIT
PERMIT NO.: 537)9
A i \
DATE!
1
,No. of Units:nstruct ion
1992 Sha a Lane Ll E4 Meadowland
Davi
9/27/8
I agree to comply with the City
Ordinances.
i
0,
1
du
•
2
lex
By
Do
Apr -
Imo/
Insp.:
D
id Sout to . - )
100.00 pd
of Eagan Co. ection ChargEl:
• count Deposit:
Permit Fee: — 10.00 Ad
Surcharge: 50 n d
Misc. Charges:
Total:
Dote Paid: _
Date:
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee: / t� S
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address:
Name:
Address / City / Zip:
Applicant is:
Description of work:
/YPZ _sof 2w
Owner
Contractor
Unit #:
Phone:
Construction Cost: %Get,
Multi -Family Building: (Yes / No
Company:
Address:
State:
License #:
Contact:
City:
J7
Zip: .r 77
Phone:
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 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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
rt re considered tob
you provide specific rea;
conclder tl at they are trade secrets.
�.;c information. Portions of
hat would permit the City t
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.oro
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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State rr}digg Code must be completed within 180
days of perssuance.
x �/ L� ✓sG
App cant's Printed Name
x
Applicant's Signature
Page 1 of 3