4426 Lakeshore Ter
Use BLUE or BLACK Ink
For Office Use i
j Permit / U) 1
City of Eap
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122
j Date Received:
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff: j
2011 MECHANIC/AL PERMIT APPLICATION
Date: 11fla Site Address: qqdb Ll1~~Z4s holu- e-rr
Tenant: Suite
RESIDENT / OWNER Name: F RaseoAa-l Phone: b,57 - `Z-OU - -73q~
Address/ City /Zip: a- OJDL EQ=a 0-4111
CONTRACTOR Name: P114 4" License
Address: 640 Cerra-r7G1 JC / City: l 1 FLzi
State: 1V ~Z,iip: Phone: ts✓~~ 73 a/ Qj ® 1
Contact:& ~ 1 Q°f'Z-"~YLGL- Email:
TYPE OF WORK New V Replacement Additional Alteration Demolition
Description of work: Cam.
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.
RESIDENTIAL COMMERCIAL
PERMIT TYPE VFurnace New Construction _ Interior Improvement
Air Conditioner Install Piping _ Processed
_ Air Exchanger Gas _ Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / _ Remove)
When When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$55.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) O® TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $ x1%
$55.00 Minimum (includes State Surcharge)
= $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00
- If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee = $ Surcharge
(i.e. a $10,010411,010 Permit Fee requires a $ 5.50 surcharge)
= $ TOTAL FEE
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 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 ork is not to start without a permit; that the work will be in accordance
with the approved plan in the case of work hich requires a review and approval of pla
x-'~e?~~ 4q44i-a- Applicant's Printed Name A licant's ignature
FOR OFFICE USE Reviewed By: Date.
Required Inspections: -Under Ground Rough In _Air Test -Gas Service Test in-floor Neat Final
E>aerior HVAC Screening Inspection
Oct 07 2014 0827AM HP Fax page 16
Use BLUE or BLACK Ink
�-----------------
� For Office Use �
� j Pertnit#� ���lY� I
C�ty of Ea�a� ; /���;
i Pertn�t Fee: ��[ �
3830 PIIOt Knob Road
Eagan MN 55122 � Date Received: �
Phone:(651)675-5675 I I
Fax:(651) 675�b694 I Staff: I
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2014 RESIDENTIAL BUILDING PERMIT APPLICATION
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Date: J� � � � SiteAddress: �Z� �`�Z(�° `�yL� `f�3C� �`������
Name: ��°��� � �Z��u:� /� /,f, �- Phone:
Resident/
Owner Address�city�zip: ' S�t—
Applicant is: Owner �"��Contractor
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Description of work: �� - s' .�' r 'x;,•� °`''�.
Type of Work ,.
l,
Constructipn Cost� ����S�y Z" ��✓��` Multi-Family Building: (Yes ��No_�
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Company�s" �'a,�,r°°sv.-.�.`�,c.�,�,��?�''�-���� Contaci: � ;�"�a�,,��.,�:�_..
COr1�1^BCtOf Address`� '-'L� �.±'�•''�;r���r,�,tl� t�-sJ' 5.���'��•, ;;?��� City: ri�tif`d.���'>��
State���� Zip: .�- �;� Phone: �r �� ��%�' ? ��J Email: :��'E.r� °�!'e.��`:� °GS.�:���' -
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�icense t�� ���D�°�'P�/,;� �ead CeNiticaie#: .���'!��'"��� ' �
If the project is exempt from lead certlficaiion, please explain why: (see Page 3 for additional information)
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 mo�ha,has the Clty of Eagan Issued a permit for a similar plan based o�a master plan?
_Yes _No If yes,date and address of master plan:
Llcensed Plumber: Phone:
Mechanlcal Contractor: Phone:
Sewer&WaEer ContraCtor: Phone:
NOTE:P/ans and supporting documents that you submit are consldered to be public information, Portlons of
the/nformatlon may be c/assifled as non-�ubl/c!f you provlde specific r�asons that would permlt!`he City to
conclude that the are trade secrets.
CAL� BEFORE YOU DIG. Call Gopher State One Call at�651)454-0002 for rotection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. wwn�v.4opherstatvnnecall.o�a
I hereby acknowledge that this intormation is complete and accurate;fhat the work will be in conformance with the ordinances and codes of the City o(
Eagan; lhat I undersland this is not a permit, but only an application fo� a perrnii, and work is not to start without a permit that the work will be in
accordance with the approved plan in the case of woric which requires a review and approval of plans.
Extertor qthortzed by a bullding permlt issued In accordance wlfh the Minnesota State Bulldlna Code must e completed wlthln 1 Bp
day perml�'(gsuance. �s°^^'.-'�"'�
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Applicant's Printed Name ApplicanYs Slgnelure �
Page 1 oi 3