4545 Hay Lake Rd S(1,°
City of kali
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
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Use BLUE or BLACK Ink
For Office Use
Permit #:
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Permit Feer 0 • 00
Date Received: 5111-11R
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Tenant:
Site Address: «5 {( S f7141 iG lS e
Suite #:
Name: X 14. d 6 L/ KV -IL Phone: ( C IFC3
Address / City / Zip: V-(XS'S Ii 4l X P 6,A4414-/
Name: License #:
Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope)
//Sump Pump Repair
Other:
Description of work:
SEWER & WATER (Outside the building envelope)
Repair
Other:
FEES
$60.00 / Each (includes $5.00 State Surcharge)
TOTAL FEE $
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit 1/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.cityofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. CaII 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 ch requires . '-w and approval of plans.
i�
Applicant's Printed Name
Applicant's Signature
Required Inspections.
CITY OF EAGAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO •
Eagan, MN 55121 DATE.
Zoning: No. of Units -
Owner:
Address.
Site Address:
Plumber
Meter No.: Connection Charge•
Size: Account Deposit•
Reader No.: Permit Fee•
1 agree to comply with the City of Eagan Surcharge -
Ordinances.
Misc. Charges.
Total •
By Date Paid•
Date of Insp.: —lG Insp •
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O. Box 21199 PERMIT NO •
Eagan, MN 55121 DATE.
Zoning: No. of Units.
Owner
Address.
Site Address:
Plumber.
I agree to comply with the City of Eagan Connection Charge.
Ordinances. Account Deposit.
Perrnit Fee.
Surcharge.
By Misc. Charges.
Date of Insp.. Total-
Insp.: Date Paid.
41/11
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
flECEWE
AUG 26 2014
8Y•
Use BLUE or BLACK Ink
1
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: 8/18/14 Site Address: 4545 S Haylake Rd, Eagan, MN 55123
Tenant: Suite #:
Resident/Owrier
Name: Peter Kuhl
Address / City / Zip: same
Phone: 651-405-1963
Name: K&S Heating, Air Conditioning & Plbg LLQicense #: MB5216
Address: 4205 Hwy 14 W
State: MN Zip: 55901
City: Rochester
Phone: 507-282-4328
Contact: Heidi Brown Email: hbrown@ksheating.com
New XX Replacement Additional Alteration
Demolition
Description of work:
NOTE: Roof mounted -and ground mounted mechanical equipment is required to be screened; by
Code_ Please contact the Mechanical inspector for information on permitted screening method
RESIDENTIAL
XX Furnace
XX Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under/Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge)
COMMERCIAL FEES
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
*If contract value is LESS than $10,010, Surcharge = $5.00
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
***If the project valuation is over $1 million, please call for Surcharge
.$ 60.00 TOTAL FEE
Contract Value $ x .01
= $ Permit Fee
= $ Surcharge*
TOTAL FEE
=$
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 Rick Keehn
Applicants Printed Name
Applicant's Signature
FOR OFFICE USE
Required Inspections:
I�ndergrounc
Reviewed By:
Gas Service Test In -floor He
City of Eagan
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA126126
Date Issued: 08/13/2014
Permit Category: ePermit
Site Address: 4545 Hay Lake Rd S
Lot: 042 Block: 02 Addition: Overhill Farm 1st
PID: 10-56150-02-042
Use:
Description:
Sub Type: Reroof
Work Type: Replace
Description:
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
Comments:
Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes.
Jackie Terrell
Fee Summary:
Valuation: 4,000.00
BL - Base Fee $4K
$103.25
Surcharge - Based on Valuation $4K $2.00
0801.4085
9001.2195
Total: $105.25
Contractor:
Walker Roofing Company
2270 Capp Rd
St Paul MN 55114
(651) 251-0910
- Applicant -
Owner:
Peter J Kahl
4545 Hay Lake Rd S
Eagan MN 55123
(651) 485-7607
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature
Issued By: Signature