4672 Stavern PtSite
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Meter No.: Connection Charge:
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By Date Paid:
Date of insp.:
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City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
r
Use BLUE or BLACK Ink
For Office Use ]
Permit #: 1 144%
/ k �51�'
Permit Fee: 4-1'5. 5°
Date Received: 1 /'t 113
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION 16°
Dater 2 /' 3 Site Address: 4%47/j , ¥G7f , `fes- nitro P ,i r- nit #: S
>
Name: RlO6e.,Lli e ' S't-1 tS UG . Phone:
/ 4/957.5- 61 -14.14e -e, CG,, 5-irfe cCo Girl' a yr
Type of Work
Address / City / Zip:
Applicant is: Owner )( Contractor
Description of work: 170 Te - rd ® f
Construction Cost: $* -Swb Multi -Family Building: (Yes / No )
Company:
Address:
420'1 Home- ,/e -d ekOtrContact: j/ c 15C44,6tti
o$ ae9ee--g (G•�c-'r-.
City:
e
State: f l Zip: r-5-337 Phone:
License #:?'c 33 d G G 67 Lead Certificate #:
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:
Sewer & Water Contractor: Phone:
NOTE: Plans and supporting docunr
the information may be classified a
you s
-public if
onclude that the
are considered to be ;t lic information. Por
ovlde specific reasons tha yould: mit. h
tra+
as
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.aopherstateonecall.org
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.
Appek4V-'1
Printed Da
me
.41"' SaralliW
App icant's Si nature
Page 1 of 3
41,1/*
City of Eaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
i
r
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 1 71 Site Address: 4/7/ ytO5 46774,7, 6 % L, v67 L. 5-kVevu Unit #:
Resident/
Owner
Name: g(g6 e -G L 1 // flidePhone:
Address / City / Zip: E...4.'.0-1
Applicant is: Owner Contractor
Type of Work
Description of work: 5/?,//71/43
Construction Cost: 0 3 d 0Multi-Family Building: (Yes " / No )
Company: 4/4/20n t7 he- ./I?/r Contact: 0;', &-illc4J1'Y 6 -
Address: / 3Z 0S S5c�ekk City: ` "9614-4'///:
Jv
State: /41 Zip: rj> ,3,3 1 Phone: 6/I) — la - 716 7
License #:o2 O 3 fo C.7 Lead Certificate #:
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
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:
_Yes _No
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
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 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.
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.
fit e4e -Di,k
Applicant's Printed Name
x
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA176546
Date Issued:05/20/2022
Permit Category:ePermit
Site Address: 4672 Stavern Pt
Lot:1 Block: 05 Addition: Ridgecliffe 3rd
PID:10-63982-05-010
Use:
Description:
Sub Type:Water Heater
Work Type:Replace
Description:Standard Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Building Code).
Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
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.
Contractor:Owner:- Applicant -
William D Allen
4672 Stavern Pt
Saint Paul MN 55122--263
(651) 454-1539
Champion Plumbing Llc
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature