1983 Gold Tr41111'City otkan
For Offrce'vse t!E atBLA* K 1t
Permit #: l 6� �7; °� _ .
Permit Fee: V 6
Date Received:
Staff
— ____
/ 2011 MECHANICAL PERMIT APPLICATION
�(
Date: fir _:. _! _ Site Address: 9 (1 3._ _ (roll
l
Tenant:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
rcid/e A/4L
Suite #: /
RESIDENT I OWNER
Name: .... _...... Phone:
Address / City / Zip:
CONTRACTOR
Name: /4 / C h A IS # ALI / ^- c License #:
Address: / /� g o�, k-- r/ City: 4 /1/ar K A lni A-
�.. �.,
State: r+-Zip: 63--303-c2 J/ Phone: 76 ? 7..?5/" 9� %,t
Contact A/4, /-fA',so— Email: /.itf/r,ai%ilc.ii Is' IAA ,Co/t-i.
TYPE OF WORK
New Additional Alteration Demolition
nReplacement
Description of work: /Q - /9 i 4c .,_. F i.. c,„-<
NOTE: Roof mounted and ground mounted mechanical equipment is requir i to be screened by City
Code. Please contact the Mechanical inspector for information on permittesi screening me#ratfs,
PERMIT TYPE
RESIDENTIAL
){Fumace
COMMERCIAL
New Construction Interior Improvement
.,-_-. Air Conditioner
Install Piping Processed
Air Exchanger
—
Gas Exterior HVAC Unit
Heat Pump
Under / Above ground Tank ( Install / Remove)
T Other
,
RESIDENTIAL FEES:
$55.00 Minimum Add -on or
alteration to an existing unit (includes $5.00 State
out appliances, ductwork, etc.) (includes $5.00
Surcharge)
State Surcharge) _ $ TOTAL FEE
$95.00 Fire repair (replace burned
COMMERCIAL FEES:
$75.00 Underground tank installation/removal
$55,00 Minimum (includes State.
Surcharge)
$10,010, surcharge is $ 5.00
surcharge increases by $.50 for each $1,000 Permit
Fee requires a $ 5.50 surcharge)
OR Contract Value $ x 1%
= $ Permit Fee
- If the Permit Fee, is less than
= $ Surcharge
- if the Permit Fee is > $10,010,
Fee
= $ TOTAL FEE
(i.e. a $10,010-$11,010 Permit
CALL. BEFORE YOU DIG. Cali Gopher State One Cali at (851) 454.0002 for protection against underground utility damage. Call 48 hours before
you intend to dig to receive locates of underground utilities. www.croaherstateonecall.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 - appro d la in t71e case of work which requires a review and approval of plans.
x
Applicant's Printed Name
FOR OFFICE USE
Required inspect-t
Underground Rough In
x
Applicant's
CITY OF, EAGAN WATER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
Eagorn, MN 55122 DATE.
Zoning: No. of Units.
Owner:
Address:
Site Address.
Plumber:
Meter No • Connection Charge.
Size: Account Deposit•
Reader No.: Permit Fee•
I agree to comply with the City of Eagan Surcharge• r)
Ordinances. Misc. Charges. �`b 50
B ��6� Total
Y 7 ��� Date Paid
•
Date of Insp.: t � Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO •
Eagan, MN 55122 DATE -
Zoning: No. of Units•
Owner:
Address:
Site Address•
Plumber•
1 agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit•
Permit Fee•
Surcharge•
By Misc. Charges•
Dote of Insp.: Total•
Insp.: Date Paid•
Use BLUE or BLACK Ink
City otEaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: _1
For Office Use
Permit #: I H173
z
Permit Fee: G r
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION of $ r A- qp s
Site Address:
Name:
Address / City / Zip: 3 g 13 Gold. / 9
Applicant is: Owner >6 Contractor
19 $3 A—Q B
-EL Unit #:
fres, Gwer te-s. Phone: fog
Description of work: _ RP ., ' ( 'e'
Construction Cost:
kc(4uY\)
Multi -Family Building: (Yes / No )
companytiVAL.e. RiVt& CfrhilYIACII M Contact: FIVIA.A 1 1/`a
Address: � (5x, �ct A City: 2O Y)
State: M% Zip: S 5 _ 1 Lkti Phone: L71 • (OD-1
License #: C A cYb
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:
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.gooherstateonecall.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 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 Building Code must be completed within 180
days of permit issuance.
x /44/1- / fihfr f'G
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 I TDD: (651) 454-8535 I FAX: (651) 675-5694
b uildi nginspectionsAcitvofeaq an.com
Date:
„
JUL 15 2020
For Office Use
Permit #: 62 4 lei
Permit Fee: Le 3 .
Date Received:
Staff:
2020 RESIDENTIAL BUILDING PERMIT APPLICATION
®2® Site Address: ,4$3fr Geld Tirb7I, I?e.'oq,../.1J Sri Va. Unit#: ti1% A
Residentl.
Owner
Name: 3c c CD e 4-1 k Phone: 6 Si - ZSS— o s 33
Address / City / Zip: 1 183 A., 66 14 T r.. i( e B 4 9 4 rt j M Jam? , TS f 2 2
Applicant is: Owner i� Contractor d
Type of Work '
iZeP\u.e. 6 'Poor 4 i t. t-e.1s.► Door 't•A trtMINI o`e.w.tA
Description of work:.,R-soot. s.
1�1
Construction Cost: /%i C)OO '� Multi -Family Building: (Yes %Q / No )
Contractor
Company: 134 ry +re orS Contact: Z®h.A. 21-4>2f®f p
Address: 3 I CIS S4r a e. li Str a 4- SKe$ 1 City: hi a e t e Pig. 4.
State: 00 Zip: SS 3 S`I Phone: —i to 3 - 21 G, - Email: J O Kew. "& Q oe r3 e wire ere rs . cord
License #: se-32'4 Z.11 Lead Certificate #:
If the project is exempt from lead certification, please explain why:
In the last 12 months,
Yes No
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?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be
classified as nen-public if you provide specific reasons that would permit the City to conclude that they are trade secrets.
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cltvofeagan.com/subscribe.
Exterior work authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit Issuance.
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.
x JO)' ✓l zA4ziD
Applicant's Printed Name