1731 Bluebill DrCityofEaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
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Use BLUE or BLACK Ink
Permit #: /
Permit Fee: 0
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Date Received: F 1/
Staff:
2011 MECHANICAL PERMIT APPLICATION
Date: 7/7_V,Ji 1 Site Address: /7 3 / 6�GL `e. 1( 12'
Tenant: ri i_/`%'e 77
1-1
Suite #:
1
RESIDENT / OWNER
hv /"5� 7 - S -s77- I%
Name: D73 ' /
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(et -Phone:
Address / City / Zip: 17 2 A) (AJ ��`���7. 1(e A'�1_. L49 tfe�' TZQ..('', .M/
CONTRACTOR
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Name: �u Q� Z -Z� f/ .! i�` �1i� License #:
Address: 1 1 Li C a L-0 S•7 �� ii,�: City: E -b.._
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Phone: ' Ci -- 9 -Ct
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State: Zip: SZ
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Contact. t �i ��1J.Agmail: {Lv\ Q L C @_vie,.„ -:e. Iry&c. ca
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TYPE OF WORK
New `v Replacement Additional Alteration Demolition
Description of work:
' ti�rorand mounted mechanicalequip ene °fir City
NOTE Roof mounte °r
Code.: Please co } tete Mechanical ins pe c. • nfo mGtaiio ° :$ " a c t • ds.
PERMIT TYPE
RESIDENTIAL
F ce
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) $ STh 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 a • ainst undergrou:d utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www. • o • herstateonecall • r
I hereby acknedge that this information is complete and accurate; that the work will be
Eagan; that I . nderstand this is not a permit, but only an application for a permit, and work is
with the p oved plan in the ca wprk which requires a reviiw and approval of plans.
x r, Printed Name
rdinances and cod-- •f the City of
t; that the worbe in accordance
7 -
FOR OFFICE US
Required Inspections:
Reviewed'
it Test
or HVAC Screening lnspecto'
Use BLUE or BLACK Ink'
"IIP -,
,.....,
C!ty of Eaujll
G
Permit Fee: . ., ` w
3830 Pilot Knob Road RECEIVED
Eagan MN 55122
Date Received:
Phone: (651) 675-5675 JUL1 8 2011
Staff:
Fax: (651) 675-5694 I
,2010 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 11 q 1 I 1 Site Address: 13 s I t) KthilI 13r Caja.,
�J o.
S� o
Tenant: 6r t tr1� Jrni l `/ Suite #:
RESIDENT / OWNER
Name: P 64-i-nQ,t,i Sill tin-, Phone: (a5 I 5D -5 5'foci
Address / City / Zip: (361i1k�I I
!
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CONTRACTOR
Name 5f, Cit) iy Va.-1 r t4 License #: (i. 'MCI 7
Address: 3 d0 r• City:
State: wI Zip: "fU
l Phone: IIS 38L0 ebW
Contaet: Email:
I ber I
TYPE OF WORK
_ New Replacement Repair _ Rebuild Modify Space _ Work in R.O.W.
Description of work: (Y,. t tt bf Wafer heater
PERMIT TYPE
RESIDENTIAL Water Soften er
IWater Heater i
i
Add Plumbing Fixtures ( Main / _Lower Level)
Lawn Irrigation (_ RPZ / _ PVB)
Water Turnaround
Septic System
New
_ Abandonment 1
RESIDENTIAL FEES:
i
$55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
I
$35.00 Lawn Irrigation (includes $5.00 State Surcharge)
$55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnarund"
*Water Turnaround (add $166.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00
(includes $5.00 State Surcharge)
State Surcharge)
$95.00 Fire Repeir (replace burned out appliances, ductwork, etc.) (includes $5.00
State Surcharge) 65
TOTAL FEES $ r
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
Eagan; that I understand this is not a permit,
accordance with the ap roved plan in the case of
x
and accurate; that the work will be in
but only an application for permit, and wor
work which requires a review and approval o
Z - X
onformance with the ordinances and codes of the City of
is not to start without a permit; that the work will be in
plans"
.o/ id Alf, 1i. ,.
Applic nt's Printed Name Applica
t' I.�Rte,
I '
FOR OFFICE USE Reviewed
Required Inspections:nden GroundT-Rough-In , ,-�,, .gin Telt
_ _Gds Test Ftnal
I i
1
\IR -1 raot
Clyof Eapri
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
1,13t fl ii:kus) LI D -r --
Use BLUE or BLACK tnk
For Office Use
Permit #: I 31 a
Permit Fee: 1 • -I
Date Received; Received: O I 1.9.)
Staff: 56
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Site Address: --1-2 t'ZS 33
Date:
Unit #:
Name:
Phone:
Address / City / Zip
Applicant is: Owner
Contractor
Description of work: C-Crra c 4
Construction Cost: 51 00
Multi -Family Budding: (Yes >0 / No )
C -Nn
Company: CO. ?*44°- CCA
Address: 6P0
State: M A) Zip:
License #:3C- (-Si& ,4 5
Cont *-
city:
Phone: 3'4 9.900
Lead Certificate #: A)1:1 -r - (
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
Leapt
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: Phone:
Sewer & Water Contractor: Phone:
Phone:
GALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility dam e. Gall 48 hours
before you intend to dig to receive locates of underground utilities. w,vw,qopherstaieortecali.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 1 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.
fixterior work authorized by a building permit issued In accordance wlth the Minnesota State Building Code must be completed within 180
days of permit issuance.
L1 —eel-ie.-tr.
Applicant's Printed Name
k'Fh!
Applicant's Signature
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