3834 Heather Dr410/' City of Eatail
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 6754675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
lows
For Office Use
Permk;r
Permit Foe:5
Date Received: 1j 1 0 y
Staff
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: II -9s- Site Address: 3 0 5 5/ He4 7 W /Z r♦)I
Resident/
Owner
Type.of;Work,
Unit #:
Name: e/o 4e _ dv.i 4btixE..; i ,mow C. phone: 763 - P*3" 9770
Address / City / Zip: 8S0 [j E s4 r OZ. 4v, AL 14 Gocos,t/ ,cs r /nA)
Applicant is: Owner 2cContractOr
Description of work: R EP L,4 C l'1 ty r u�G_ l.►�, ra d c.) 5
Construction Cost: Multi -Family Building: (Yee / No _ J
Cont actor
Company: fa £ Ex- r E.// 0 2 ink . Ca RP. Contact ✓ t 4,/2 -/Li s
Address: 41‘13- L 40b/1- 17: City: _ /37 PL S
state: SAS zip: sr4//
Phone: lo/ .L • b' (o / - Lo 24/3
Lienee ati: 'a t - 2A//, 1 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional Information)
tIL44.S_ Posy /s7 r
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: , _ Phone:
Mechanical Contractor:
Phone:
Sewer & Water Contractor: Phone:
CALL BEFORE YOU DIG. Cap 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.aopherstateonecall.oro
1 hereby admowtedge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City a
Eagan: that I understand thio Is not a permit but only an application for a pain*. and work Is not to sten without a °e►mit: that the work will be In
accornance wan the approved plan In the case of work which requires a review and approval of plans.
Exterior work euthoraed by a building permit Issued in accordance with the Minnesota State Build ngCode must be oompbbd within 180
days of pens* Issuance.
x 4" 0 at"2�,S
tc
Applicants Printed Name Applicants Signature
EZ/0Z 39vd
Page 1 of 3
1NItiW IX3 I3S L9Z9T98Z19 LZ:UT PTOZ/TT/U0
City of aan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date:IV / 1 1
Tenant:
4-) ECEIVED
DEC U 61011
Use BLUE or BLACK Ink
For 40.U6e
Permit # C%' S
Permit Fee:
oD
Date Received:
Staff:
2011 MECHANICAL PERMIT APj/Q� iLIICATION
Site Address: 3n4 h! �1 1 t1 e
RESIDENT / OWNER
CONTRACTOR
Name:
t"4040,� 9)_ a
Address / City / Zip: 3_1- Nur.
Name:
Ph ne:
I-1 VP
Suite #:
e -cur tea � q/tsflp License #:
( t�v
Address: 1'404- v�.1 ee±City::1 GLS r 1
State: 1 f 1(n Zip: 0 / � Phone(:: (0S) --1-1-31-s 411 �n r�y�
Contact: JO r� e H ,,1 t f IC 1 Email: VSA l� ( a c c our r �L%� r 1
TYPE OF WORK
New „/1 Replacement
Description of work:
Additional
!TE:; Roofmounted'and gran
Alteration Demolition
mounted mechanical eguipmen
ode Please contact the ;Mechanical Inspector for information'
* 1tYrzc.e
u to be screened tty
fitted screening metho
PERMIT TYPE
�j� RESIDENTIAL
Furnace
J.Air Conditioner
Air Exchanger
Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under / Above ground Tank (_ Install / Remove)
**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 $5.00 State Surcharge)
$95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
COMMERCIAL FEES:
$75.00 Underground tank installation/removal OR Contract Value $
$55.00 Minimum (includes State Surcharge)
- 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
(i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge)
TOTAL FEE
x 1%
= $ Permit Fee
= $ Surcharge
_ $ TOTAL FEE
CALL BEFORE YOU DIG. CaII Gopher State One CaII 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 is no to start without a permit; that the work will be in accordance
with theroved in th case of work which requires a review and approval of plans.
Q ()VIM\A
x
Pnnt�Name
1
App -cant
FOR OFFICE USE
Required Inspectionsl
Rough In Air Test
Exterior HVAC;Screening Inspect
GAN
nab Road
rx 21199
1N> 5512211
Tolle ofl Bidz
38 a Dra L56 Bi . Briar Hiii 4'
;42378 a lye}. QU
BfF of Began Connection Charge:- 742G 5•i7i0l0
Account Deposits liy.lyll pd
Permit Fee
Surchorre • � r
Z;
Owner; re
Site Address:3834 Heesthar give
Plumber: Cent: Ryan i
Meter No.: }
Size:,
Reader No.:
1 eeoo to tom* with
L36 B1 '3
Hill 4th,
[�
Connection Charge: � �F % [i' 00 pdr.
Account De osit: ^ C' r V
0
Permit Fee: pd
Sart/large: pd
s� 63.06ifil
It S pta :�K rY i
cflyofR
3830 Piot Knob Road
Eagan MN 85122
Phone: (651) 6754875
Fax: (651) 6784
•
Use BLUE or BLACK Ink
for office Use
Pool* 1 1 a t
Pamit F
Oete Received:
SurK'
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
/3 sitsAddmso:37..Z.1143y, s%36, 38'Ig
Name; ifo A C r /fr9 Ai* A L m L L T" .7:•) a phone: 74,3�- 3- 9'7 70
Address / City 4'ti`•' �/ i4 God Emil L' 44-1-E4`'
p1 is s!441.7
Applicant is; Owner 2‘.. Contractor
oeb« on of work '7"S.1, Z Ori a• 2 z - (I �
Construction Cost / 3A 7 vo : vt3
Multi -Family Building: (Yes )C 1 No
Company: g L 1 Epr> z'o, !!1(rtzwi C . /4 Contact • •1:1Avr
Ate: Vos 61,1xt, C; mP[. 5 ,
state:/)'!ic! zip: SSV' 9 Phone: 6'A - rbc - (a Z 4,'3
License # 'Q C gill / t.oad Cerdfloats d:
If the Project is woarnpt from Lead certification, please explain why: (sem Page 3 for additional infom ation)
is 4,4 L4Liat- Etozr Post' / 97Ir
,AMY.
COMPLETE THIS AREA ONLY IF CONSTRUCTING A PIEW BUILDING
In the haft 12 menthe. has the City of Caw Issued a pennIt fora similar plan based on a mater plan?
_Yes No If yes, dant and address of master plan:
Licensed Plumber: phone:
Mechanical Contactor:
Sewer A Water Contractor:
CALL Cell eophsrStel a one Call et (051) 454.0002 for pr *eaIon against underemund i4Wty damage. Call 48 hours
before you leo 1 Drs Wats otundo,ipund
thereby acknowledge that this inionnahep IS complete and aconite; that the work WI be in cardamum with tho adnsnoes and codes of Ito Qty of
WM; that l understand atruarderteo with the eitareuen this is nota Pon* but only sn a,.qulr ion fora pennant. and work is not to start tsehout a penult: that the work 41be
planrequire
In
w+ to the arose Owens +mush ° s rs,A.w mina approval ar p.na
atelier work authorized
days of penult issuance.
bye balding norma l:mead In accordance with the Idliawdols Stale BuildCode must be completed within 180
Plane:
•
'.,'.• r�wr•s—^�,�e:;�an�Nc':iv��W -i :�'.Gr.�7 A ! tiFe �„". _'�f� ,'
6 �a``; t's-='+tyy's c=151 r. �'.�'�.�'y^Tr'• --�
i i'C.+ -�i7!��t#.'�'�Ji11�'N�i",..+4$�-' 'w -� �f-�`af 1' '*� •G,;Loi r
&� .:�.,.a_..._ �..�_,.,._„_�i�"'il1.�t:1Mt.:tLM{►7,e�9CY�'� a1a'+i�rtbVi.
�Jlv�l, {��fi.tt1s
APPtieatnt'a PrIntIld Nem.
170/b0 39Vd
ApplcsnCs Signature
Page 1 of
1NIt7W 1X3 I3g L9Z9T98ZT9 ZO:bT £TOZ/90/TT
City of Earl
3830 Pilot Knob Road
Eagan MN 66122
Phone: (651) 675.5675
Fax: (651) 676-6694
RECEIVED
MAR 2 a 2014
Use BLUE or BLACK Ink
For Office Uoe aI j (�
Permit a: 1 l3°I `^ 1
Permit Fee:
Date Received: 3
Staff.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Data; 3-X6Site Address; 34732, 383 CI, 3 34,35235 NSAri/412 isQ
Unit*:
Resident/
Owner
Name: eh) 4. /) 4 6 Z Ix E al•j+ C. Phone: 74 3- S-73, •- g 7 7 0
Address / City / Zip: APS -0 b E C 14•ru 2 4v, A), ,till 60e.640. i.44 -as Y ft )
X7Contractor v'z 7
Applicant is: Owner /\ Contractor
•
.
Type.of�INork..
Description of work: RSA o f., (� a £ PL et -f; 4 d / ..J 6 a Fill c. r rd M L' 7-4 L
Construction Cost / 4 Yat • crO , Multi -Family Building: (Yes, / No __r_)
•
COpitla4or
Company: a£ l & r I c 2 )2 4 i .i' -r . Ce alt Contact ba Lit e as., /LA, S
Address: VP W 4,0*A 17"- City: I)/ PL 5
State: 1.11 Zip: 575'4r// 9 Phone: 10/1- e to / - 62 r/3
License*: 'a C 24/// 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
t.447S- 13,Jrt,.2- Pos.r /F7r
In the last 12 months,
_Yes _No If
Licensed Plumber:
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?
yes, date and address of master plan:
_ Phone:
Mechanical Contractor
Sewer S Water Contractor:
Phone;
Phone;
NOTE: Mails dna.. •j subl+o t,/� oonq�jr�/ : Cf,
triemfOrmaflof ,.z: 'w)., •.. '
:, clasogf i too k. fi y> , .
CALL, BEFORE YOU DIG. Call Gopher State One CaII 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•g42oherstalconecall.Qrq,
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the Gay of
Eagan; that 1 understand thla is not a permit, but only en application for a permit, and work is not to start without a permit; that the work will be in
accordance with the approved pion in the case of work which requires a review and approval of plans.
Exterior work authorized by a building permit iriaued In accordance with the Minnesota State Build' Code massa be completed within 180
days of permit issuance.
4 ✓' 124✓2i2.i
Applicant's Printed Name
VO/V0 30 d
Applicant's Signature
7 �G
Page 1 of 3
iNIVW 1X3 I3E LsZ9I983t9 0060 VTOZ/8Z/60