1498 Woodview Ave WCity of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #:
Permit Fee:
Date Received:
Staff:
q qa 9
2011 MECHANICAL PERMIT APPLICATION
Date: / — / "–t ( Site Address:
Tenant: Suite #:
RESIDENT / OWNER
Name: ,4—i )/ J Y /'1I'' °') Phone: 6rI _ Lj5 _
Address / City / Zip: L -04?(•. --) '-4V ieL,-) PA/G (.ci
/
CONTRACTOR
Name:// d/— dec.:x ' 5 t 2i 1 "(iv License #:
,2
Address:3/6 (-Jc....I4-rt LJ City: ,lliqe L'e--//e`
State: (/) Zip: 5: Jar/ Phone: 6'0 —Cf / — i /
Contact: ci Email: C / lec—li'7SC-ic--kie-ti/4 14ClJ, C'7
TYPE OF WORK
New If Replacement Additional Alteration Demolition
Description of work: ZC'/2/4(C il4'
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
PERMIT TYPE
1 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
burned out appliances, ductwork, etc.) (includes
$5.00 State Surcharge)
$5.00 State Surcharge) $C�% 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)/�l
Contract Value $ x 1%
= $ Permit Fee
- If the Permit Fee is Tess than
Fee = $ Surcharge
- If the Permit Fee is > $10,010,
(i.e. a $10,010-$11,010 Permit
= $ ,J 5- Cw 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.gopherstateonecall.org
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 ingot to start without a permit; that the work will be in accordance
with tpproved plan in the case of work which requires a review and approval of plans,
moi f
x
Applicant's Printed Name
Applicant's Signature
Signature
FOR OFFICE USE
Reviewed By:
Required Inspections Under Ground Rough In Air Test Gas Service Test In -floor Heat Final
Exterior HVAC Screening Inspection
Date:
Cilyof Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit ( /7
Permit Fee: b67 ` Off.)
RECEIVED.
Date Received:
APR 2 3 2011 Lstarr:
J
2011 RESIDENTIAL PLUMBING PERT APPL ATION
Dat.: ' \ L 11 sits Address: kizi% \..A) , 1jI V'
du ' Suite 6:
RESIDENT / OWNER IName: Phone: ‘6) or)4,34
Address / Clty /Zip: 1117 W 000. %J i cit,l) 1"vJ J
CONTRACTOR Nante;MILBERT COMPANY INC.dba CULLIGAN WATER
Address: 1801 50m ST EAST Clb,, : INvER
GROVE 1
6
1
'S
State: MN Zip: 55.077' Phone: 6S.:::45].-2241 •
Contact BiLL.M E �`'�. Email:
Tenant:
TYPE OF WORK
PERMIT TYPE
_ New eptacement _ Repair Rebuild _ Modify Space Work Ih,R.O.W.
•
Descrlptlon of orlt•
RESIDENTIAL
• . Water Heater
' Lawn trrlgatJ n (_ RPZ I PVS)
Septic Systern •
• ,'_New •
_Abandonment
ater Softener
Add Plumbing Fbdures L_ Main / Lower Level)
Water Turnaround
RESIDENTIAL FEES:
555.00 Minimum Water Hdater, Water Softener, or Water Heaternn Softener (includes 55.00 State Surcharge) •
$35.00 Lawn Irrigation (tnchides 55.00 State Surcharge)
555.00 Add Plumbing Flxtutes, Septic System Abandonment. Water Turnaround" (includes 55.00 State•Surcharge)
'Water Tumaround (add 5166.00 If a 5/8' meter Is required) •
5105.00 Septic System lith (510.00 per as built) (includes County fee 'Ind 55.00 Stats Surcharge)
595.00 Fire Repair (replace bumel! out appliances, ductwork, etc.) (includes 55.00 State Surcharge)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (551) 454-0002 for protection agalnat underground utility damage.
Call 48 hours before you Intend to dig to redelvd locates of underground utilities; www.000heratateonecafl.orQ •
I hereby 'dual/ledge that this h4rmatlon 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 N nota permit, but only'en application tor a permit, and • le not to start without a pemtl0 that the wont WI be In
accordance withapproved p1a In th caw d work which requires anyhow and approval /
x i fI,P(flt•
t I6
' Applicant'. Printed Name '
A Meant a.SIQnature