3480 Greenwood Ct SAug 1 2012 12 36P Sela Accounting No 1661 P. 4
City of Eaean
3830 Pilot Knob Road
Eagan MN 55122
Phone; (651) 675-5675
Fax: (651) 676-5694
Use BLUE or BLACK Ink
For Office Use/y
Permit*: �,-)
Permit Fee: * 6 (,)
Date Received:
Staff:
2012 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: I /!1 Site Address: 3y 7$, 60 3N$2.-134Yy 6reer>;tabbci Ci-. S Untt#;
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RESIDENT /
OWNER
Name: 5uYYt'�/ N-c\l n��i C( CG Phone: ()S -?3l1-3$
/ J e l\\L' Ca ;-},CN r
Address / City/Zip: Lill ra- L-k.'hi (,Jt's+ Par-Lca y
g;c\' n c)“,l,r\ ,rnY1 5 5 ',73I)1-1
Applicant is: Owner Contractor
TYPE OF WORK
Description of work: re (t
Construction Cost: 1 chi 091 , DO Multl-Family Building: (Yes X / No, )
CONTRACTOR
Com an nC,U-7 VI k Ke tVY'I t✓>� ���4 i
:
Company: &Ia., d I Contact: k.
n
Address: LU UCU t,XCr-A S► O t'' t61 V CL J City: S , LULR IIS r -k_
•
State: Min Zip: S 5'-I 1 (.0 Phone: CII cJ L— i (`J - D-
License #: __(12. VD) V 5_±(.2_ Lead certificate #: AfA r •-- a J 03 ii — 1
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
Yes 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:
^No
Licensed Plumber: Phone:
Mechanical Contractor:
Sewer & Water Contractor:
Phone;
Phone:
NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of
the information may be classified as non-public if you provide specific reasons that would permit the City to
conclude that they are trade secrets.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call Ale hours
before you Intend to dig to receive locates of underground utIlllles. www.00pherstateonecall.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 he completed within 180
days of permit Issuance.
rkhr�l�r
x
Applicant's Printed Name
Applicant's Signature y j
Page 1of3
TC
411/1°
CityofEaaan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: //1-4( 13
Use BLUE or BLACK Ink
1
For Office Use c
Permit #: 1 I Dd S$
Permit Fee:
0 o�
Date Received:
Staff:
INFLOW & INFILTRATION PERMIT APPLICATION
Plumbing / Sewer & Water
Site Address: • Xi C'Ct - S
Tenant: rV/t CCKt``-�
:'ttit t MN. 5-517.z.
Suite #:
Name: MVt t k<t--? is.Y'-i Phone: ie'2 ` 43t,`'1
Address / City / Zip:N°jt> L' ''S(/')'""l) Ktti1. % 2 -
Name:
Name: M / License #:
Address: City:
State: Zip: Phone:
Contact: Email:
PLUMBING (Within the building envelope)
Sump Pump Repair
Other:5`•hi..r�
SEWER & WATER (Outside the building envelope)
Repair
Other:
Description of work: 9.-A t -6D Bre NWC- 5 e ST [ V -=s1 Act J kis (64V1
\YCe (;.l i '✓ V_t^-V512-,�S [ f1" ` ` �t.711 tZ� 44o'3 f 9 ic, �fT►
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 I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. CaII
48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.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 $1/VnitA41,.3
Applicant's Printed Name
x
Appl.
is Signature
City of Eagan
PERMIT
City of Eaan
Permit Type: Plumbing
Permit Number: EA139423
Date Issued: 10/21/2016
Permit Category: ePermit
Site Address: 3480 Greenwood Ct S
Lot: 3 Block: 09 Addition: Surrey Heights 1st
PID: 10-73000-09-030
Use:
Description:
Sub Type: Residential
Work Type: Replace
Description: Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Fee Summary:
PL - Permit Fee (WS &/or WH) $59.00
Surcharge -Fixed $1.00
0801.4087
9001.2195
Total: $60.00
Contractor:
Appliance Connections Inc
12850 Chestnut Blvd
Shakopee MN 55379
(952) 445-4803
- Applicant -
Owner:
Matthew A Wold
3480 Greenwood Ct S
Eagan MN 55122
(651) 373-9655
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