4288 Meghan LaneDate:
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Tenant:
c rat 3
Use BLUE or BLACK 1r,
Permit #:
Permit Fee:
Date Received:
Staff:
2011 RESIDENTIAL PLUMBING PERMIT APPLICATION
Site Address: y Cr 0rLa-i-L-0---
G ` Suite #:
RESIDENT I OWNER
Name: 4 t / -I2. t a 4V it' / Phone: g111413 «216
Address / City / Zip: 42. a ine_q^_ V
CONTRACTOR
Name:MILBERT COMPANY INC.dba CULLIG1AN WATER
Address: 1801 50114ST EAST City: INVER GROVE HGTS.
State: MN Zip: 55077 Phone: 651 :.451-2241
Contact: BILL.MILBERT t Email:
TYPE OF WORK
_ Nein Replacement Repair Rebuild Modify Space Work in.R.O.W.
_ _ _ _
Description ofwork:
PERMIT TYPE
RESIDENTIAL
Fater Softener
Water Heater
Add Plumbing Fixtures ( Main / Lower Level)
Lawn Irrigation RPZ / PVB) _
Septic System Water Turnaround
New
_
Abandonment
RESIDENTIAL FEES:
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$35.00 Lawn Irrigation
$55.00 Add Plumbing
"Water Turnaround
$105.00 Septic System
$95.00 Fire Repair (replace
(includes $5.00 State Surcharge)
Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
(add $166.00 if a 5/8" meter is required)
New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
bumed out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
TOTAL FEES $ a QG
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage.
if Call 48 hours before you intend to dig to receive locates of underground utilities.- www.aooherstateonecaliorq
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance h = • •• finances and codes of the City of
Eagan; that I understand this is not a permit, but only an application for a permit, and work= not to ; • it; that the work will be in
accordance with the approved plan in the case of work which requires a review and ap • •tans
13, ti PLIL2(45t---
Applicants Printed Name
equ red 1 spec o s �E `, d r •I r- ou
All111111.
Applican s Signature
City of Eagan
Eagan,
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA102718
Date Issued: 01/11/2012
Permit Category: ePermit
Site Address: 4288 Meghan Lane
Lot: 204 Block: 03 Addition: Meghans
PID: 10-48250-03-204
Use:
Description:
Sub Type: e - Water Heater
Work Type: New
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Kris Oien
3670 Dodd Rd
Eagan, mn 55123
651-365-1340
Fee Summary:
PL - Permit Fee (WS &/or WH) $55.00
Surcharge -Fixed $5.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
- Applicant -
Owner:
Akis Hatzipavlidis
4288 Meghan Lane
Eagan MN 55122
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature
I*)
City of Eaall
Date:
3830 Pilot Knob Road
Eagan
Phone: MN(651) 55122675-5675 RECEIVED
Fax: (651) 675-5694 JAN 2 4 2012
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
/oaz?37
2011 RESIDENTIAL BUIL()IING PERMIT APPLICATION
/,:-=77-7.:= Site Address: u/ (-7-,CaV1 (1 -pi, L,4-16
Name: CASSb1tP,00(M 1;i) 11. l_0/ 5..> Phone:
RESIDENT
OWNER'.
TYPE OF -W
Unit #:
J
Address / City / Zip:
Applicant is: Owner Contractor
Description of work: RQ ,- Gr 1 iN1Lt SI CAI/2(43/4,0 / f ,v't s E�C
Construction Cost: 00 Q Multi -Family Building: (Yes Y / No )
Company: IVITP �t t 1-U► Y I S -tom r� ;
Address: l `I5) S (Ou04 rLct
State: .Yy\.), Zip: Phone:
ContactTT .Fr t*Cc.\i`i /__
City: )00('t/0b0
tra q moi. l % 4-0
License #: S�_Wag. (0355o3 1 Lead Certificate #:
If the project is exempt from lead certific tion, please explain why: (see Page 3 for additional information)
U(/ /9
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:
NOTE(Plans ;and supporting documents -that you submit are considered to be public information.
the information maybe class!fred as non public rf you provide specific reasons that would perm)
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.gopherstateonecall.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.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Buil ina ' ode , st be completed within 180
days of permit issuance. !�
frytAsi J.
Applicant's Printed Name pp icaan ?.ture
Phone:
Phone:
Phone:
Page 1 of 3
9 /IA L�
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation Fireplace
Single Family
Multi
01 of Plex
Accessory Building
WORK TYPES
New
Addition
Alteration
Replace
Retaining Wall
Garage
Deck
Lower Level
Porch (3 -Season)
Porch (4 -Season)
Porch (Screen/Gazebo/Pergola)
Pool
Interior Improvement
Move Building
Fire Repair
Repair
DESCRIPTION
Valuation Occupancy
Plan Review !/J Code Edition
(25%_ 100% '() Zoning
Census Code Stories
# of Units Square Feet
# of Buildings Length
Type of Construction VO Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
Roof: Ice & Water Final
Framing
Fireplace: _Rough In _Air Test _Final
Insulation
Sheathing
Sheetrock
Reviewed By:
Siding
Reroof
Windows
Egress Window
1O-72-37
_ Storm Damage
Exterior Alteration (Single Family)
Exterior Alteration (Multi)
_ Miscellaneous
_ Demolish Building*
Demolish Interior
Demolish Foundation
Water Damage
*Demolition of entire building - give PCA handout to applicant
t-kt
MCES System
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Meter Size:
Final / C.O. Required
Final / No C.O. Required
HVAC Gas eve Telt__Gas Line Air Test
Other: G'C't (L l
Pool: _Footings _Air/Gas Tests _Final
Siding: _Stucco Lath _Stone Lath _Brick
Windows
Retaining Wall: _ Footings _ Backfill Final
Radon Control
Erosion Control
, Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
��0
Page 2 of 3