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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$2.-134Yy 6reer>;tabbci Ci-. S Untt#; -4 J RESIDENT / OWNER Name: 5uYYt'�/ N-c\l n��i C( CG Phone: ()S -?3l1-3$ / 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