1886 Southpointe Ter.City of Ekon
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
JUL_262012
6)609F 19 52(
Uset°°'°6
E or BLACK Ink
For Office Use
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Permit #:
Permit Fee:
Date Received:
Staff:
2012 MECHANICAL PERMIT APPLICATION
❑ Please-�submit two (2) sets of plans with all �commercial applications.�ti
tV
Date: I I 12— Site Address: t (� i�LQ OW y ►"- 1 Pc 1 V1+ :t% 1 D C
Tenant: Ncknc, L L' (k leV1 e. (TerSuite #:
Phone: 1X5 "Z `OS�
Address / City / Zip: 1$ LQ 1,t -W10 {� T-�1/- CO .
Name: Oat t-1-0-10 l-- 1y License #: ' 2 2-02-65)
Address V (r� j (f Or? s) --City: ( S �J yZ
State: VL& Y Zip: 55 0-3 7D Phone: 1CS) , "TJ")S1 K 2-t o
RESIDENT I ;OWNEF
CONTRACTOR
Name: KlAvi C ! Lutc / fv L LA
Contact: _{Q__V/hJ
TYPE OF WORK
PERMIT T"YPE'.
Email:
O a.
New • Replacement Additional Alteration
Demolition
Description of work: f
NOTE: Roof mounted and ground mounted mechanical equipment,):
Code. Please contact the Mechanical Inspector for information on
RESIDENTIAL
Furnace
Air Conditioner
Air Exchanger
Heat Pump
Other
quired to be screened by City
mnitted;screening methods.
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under / Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge)
_ $ Leo °TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge) OR Contract Value $ x 1%
$60.00 Minimum (includes State Surcharge) = $ Permit Fee
- If the Permit Fee is less than $10,010, surcharge is $ 5.00 = $ Surcharge
- 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
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.uopherstateonecall.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.
x
Applicant's Printe• Name
FOR OFFICE USE
Required Inspections
Underground R
x
Applicant's Sign
Cn-•
41' City of Eta]]
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 6754594
Use BLUE or BLACK Ink
For OMce Use �
Penn t * 12:31%
Permit Fee: S( o
Date Received:
Staff.
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ir
S- -J�i% Site Address: it o"9A,Cv"vb� B if o Spony pe, " 7-d .r,Z2
Unit
Rte,
Owner
Name;'/ f1 G 7' /4 ,4, )4 r,1/1.1 8U % .X":4)
Address / City I Zip: VS -0 hr. e- 4 ru R AV L .7g14 r2 A Goi.h z,,1
mvu s v 7
Phone: 7& -.. f 3 - 9 7 )O
Applicant is: Owner x Contractor
Type,o wlin{c• Description of work: -7-C•41-2 F
Construction Cos13 x 7 85. GQ Multi -Family Building: (Yes %C / No
Cir
Company: E,r r CR l o de /%i..l :. p Contact k44,-1/ CI" RR t 5
Address: Or W D S? . City: /h PL—S .
State:1"1 Zip: .5 -s -V1 9 Phone: - ra Z'/3 -
License it: C .i' 1I 3 / Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
tIa-h/os l.)f_aL R.>, -i r. Posr J
COMPLtTE THIS AREA ONLY IF CONSTRUCTING A ?IEW 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:
tfte
Nor
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(.•, .. ,�� ,� • veep",- ':z �yc u<R",h`,hfa►JD�k'G!iVK�. r F . !r..r,'. Zu ., k ,�' y
,BALL BEFORE YOU DIG Cali Gopher State One Call at (651) 4644002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utillues. »ww,apoherstateonecad.oro
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 worn win be in
accordance with the approved pan in mho case of work which raqulaes a review and approval Of plans.
Exterior work authorized by a building _. _
ssued in accordance with the Minnesota State Solidi Code mint be completed within 180
days of permit ieauance.
I a 2lZ l3
Applicants Printed Name
ZO/T0 39vd
x
Appllcante Signature
Page 1 of 3
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*City 0Ibin
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
PA -r
V
Use BLUE or BLACK Ink
For Office Use
Permit* I 2 -
Permit
Permit Fee:
FLP
LCt1
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
-1 l/% >atie,,sz,IN, re,a�
Date: Site Address: /1'7ov 9X , Fy, 1/e, 7t, r gam Sor:srf/P6 •••)7." 7.7-Z Unit #:
J
Res'e/. ,
OOAfner :
Name: % ACT /y104 n.3 �4 6 E /11 8 AA.l T .T•} C Phone: 74 - .S-9 3 - 9 7 7°
` �f/
Address / City / Zip: 'S> lis e, r4 "—Li A, /91/ N 'ter ,2 4 boil E -3
m•As-53-17,1,
Applicant is: Owner X Contractor
7
Type O.WOrk
Description of work: A 1- o d E 4 2 CPL /t r. E .5;4/0.)4:0
CPO
Construction Cost 2 9 to cI° - Multi -Family Building: (Yes %C / No ._...j
Coa
-
Company: il£ I £, rf2 0 0147.s -r. P Contact 2kAv Q tZR r S
Address: 'i/ t3 6 ty ‘7. . City Ai PG $ ,
State: M" ci Zip: .5-S-1// 9 Phone: lo',t - S96 / - 6 A i/3
License #: a C Pi ! / 3 / Lead Certificate #:
If the project is exempt
Qin-Dios i.)E.2i;
from lead certification, please explain why: (see Page 3 for additional information)
riv1L Po.s J 9'7 i?
In the last 12 months,
_Yes No If
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:
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
NOTE: i s iR ''•
the . i.i ' r y r ! 7J 5 ^ 'd c iii
.^it - _•-. .-, i. .... t ' AiA,„,:' ,mDh:#a1¢:s!.ta]..... f... _ :•jW^.
Y �0 ,f AML& K•'J inT 4 wr SS t i
SQA
s ti
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.000herstateonecall.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 or 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.
x b,AV/N qv(Zt ,S
Applicant's Printed Name
x
Applicant's Signature
Page 1 of 3