3060 Shields Dr Unit 101Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675 -5675
Fax: (651) 675 -5694
I 2 — Site Address:
Sewer & Water Contractor:
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Applicant's'Printed Name
City of Eaan
Phone:
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App icant's Signature
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For Office Use d)
Permit #:
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Permit Fee:
Use BLUE or BLACK Ink
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
3Oc,Q Sh;eks £r \Jt Unit #:
/6/
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a Phone: t i r 1S - 7161 - 3y53
Address / City / Zip: 3O(O 5 kl s r. N t gec r�
Applicant is: Owner Contractor
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Description of work:
Construction Cost: Multi- Family Building: (Yes / No )
Company: ( t 7 r l'u S / C6 S Contact: &i a''l C ar Tt r
Address: 32 / Rd. S k Lt M City: n t t / 14
State: r V ` lb Zip: 5S 11 0
License #: 3C CD3 20 (PCP
Phone: ($ - 2- — S2
Lead Certificate #: Q`I 3 '355 11 0
07 5 $
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: Phone:
Mechanical Contractor: 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.qopherstateonecall.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.
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.
Page 1 of 3
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Ute_BLUE _or BLACK Ink
For office Use
j Pe!mhtt 0: Z
1
Of Evan I ( ' 1
Permit Fee..
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3830 Pilot Knob Road
Eagan MN 55122 j Date Received:
Phone- (651) 676.6676 I
Fax: (651)6T5.8664 I
L S-m
2 00 MECHANICAL PERMIT APPLICATION
0 Please submit two (2) sets of plans with all tsommeMIS' appllmtlons.
Date; 3 ),7-1L She Address- 3 OG O Sti t_e t/Y a ~O 1
Tenant; Suits 6: -
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Name: ' . Z ~ YA Phone: 1 ~I .3`6
ResidentlOwner
Address I City / zip: 0(n Zt
9 Name: r'^ oAC7\ License
Address City: 'PNu tl
Contractor
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tate: -zip: Phone
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E Conte ors ~nm Email: 14t& Q boe~~
Demolition
r ' New Replacement Additional Alteration
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Type of Work^ Description of wh3rlc• .
NOTE: Roof mounted and ground mounted mecMalcal equipment ft required to be screened by City
Code. Please contact do Mechanical inspector for information on permitted screening meth0d.-
RESIDEN77AL COMMERCIAL ;
Furnace ~ _New Construction Interior improvement.
Permit Type X Att conailioner Install Piping Processed
Air Exchanger _ Gas Exterior HVAC Unit x
Heat Pump UndeNAbove ground Tank InsMtt / _ Remove)
Other-- ~ M,_..._..., ,r•... a
RESIDENTIAL FEES
$60.00 IN !)[M 1Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge) = $ TOTAL FEE
3
a
COMMERCIAL FEES Contract Value $ X.011
$55.00 Permit fee Minimum ! $ Permit Fee
$70.00 Underground tank Installationframoval p
1 *If contract value is LESS than $10,010, Surcharge $5.00 $ Surcharge*
"*If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge $ TOTAL FEE F
I hereby adm&Medge that this Irtformagon Is conlpleis and nomwoAe; that the wont will be In cw tbtmwm with the m onenons and codes of the City or
Eagan; Mat 1 undamiand this is not a pernft but only an appilmom or a peraft and work Is not to start without a permit: that the work will be In aonordance
with the approved plan in the teas of work which requires a reNew and approval of plans.
+~~Mas 1G. %2!lM Applicanro Printed N
ame A=P!M Ir(jiWw
FOR OFFICE USE
Required Inspections; PrDate.
1-Underground Rough In Air Test Gas SeMoe Test Inaloor Heat Final HVAC Screening