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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: a.ry 1 Applicant's'Printed Name City of Eaan Phone: x % � App icant's Signature r For Office Use d) Permit #: /0 C Permit Fee: Use BLUE or BLACK Ink Date Received: Staff: 2012 RESIDENTIAL BUILDING PERMIT APPLICATION 3Oc,Q Sh;eks £r \Jt Unit #: /6/ /hc1,r3E 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 h s &-Qit C as ICI.Se,rf 6qs Z- 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 08/26/2013 09:46 6516464532 BOEHM HEATING CO PAGE 02/02 Ute_BLUE _or BLACK Ink For office Use j Pe!mhtt 0: Z 1 Of Evan I ( ' 1 Permit Fee.. I 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: - -'a 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 55 tate: -zip: Phone S 15A* E Conte ors ~nm Email: 14t& Q boe~~ Demolition r ' New Replacement Additional Alteration R i 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