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Z Use BLUE or BLACK Ink
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I For Office Use I
~ Permit
City of EaEd~ 1 X, s~
Permit Fee:
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: -1 ! I
Phone: (651) 675-5675 I
Fax: (651) 675-5694 I Staff:
I 1
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: 9/1/-13 Site Address: L) IQU W CtVr Unit#:
Name: Al Phone:
Resident/ -
Owner Address / City / Zip: 964 c 1v~ N 2Z,
Applicant is: Owner Contractor
Type of Work Description of work: P,4, - l~~a
Construction Cost: 1 (.9,60 Multi-Family Building: (Yes V /No
)
Company: 6 Contact: c~ Mg tl C~ 3 ~3 _-3
/ ce`t✓ lob 1- ~~°f l~f
Contractor Address: 3 City
State: Zip: t Phone: -9;_d _5C77- 77-7 License C Lead Certificate
If the project is a empt from lead certification, please explain why: (see Page 3 for additional information)
C~ ~j f~~? ~.J~ ~,r in ~~i3 J G~ J'~ ~ + P.~ ✓v~ ~ ~C. O,~`t~-~ , 7 ~ ,
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 documents that you submit are considered to be public information. Portions of '
the information maybe 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.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.
ff r''
X A VV\ t~ , l *App'can' Applicant's P ' ted Name u re
Page 1 of 3
Use BLUE or BLACK Ink
---------,
� For O�ce Use �
' ������ '
�lt� Of���1�Il � Pe�,�t#: o e� �
, �
� �
� Perrnit Fee: I
3830 Pilot Knob Road I �
Eagan MN 55122 I Date Received: �
Phone: (651)675-5675 j �
Fax: (651)675-5694 � Staff:
-----------------�
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
� � y y �I�h o I C� ��
Date: l � ! Site Address: l �
/ � ..
Tenant: �GIiL� ( ,�/'i Suite#: `-'
� ����� � -�, / °�'��' � ��� � �
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ro� Name:� Lc.( �s ✓�/.� Phone: ��� � ���
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�������p "" � � =' Name: �'" /"'� �1 ��la'1 A , °r >��' nse#: � �v �� �
� � � --
���� ��� - �
� �.s�� � Address: � � �� ity: �
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�:: � � r 7�..�� ��� � ����
� ��� � °� �.'� � State: Zip: �� Phone:
�' � �- , , _
�� �:� � � �<
-'�� Contact��"�' EmaiL � �' I� �
�,� �'� �'������"��„�� .�:a� �$ �
�� L'
� �� � �� ����� New UReplacement _Repair _Rebuild _Modify Space ��� Work in R.O.VN.
� �i _
�� � ` —
��'������s�'`� � "�
'r�� ����� ��' ��� � Description of work: �� � �
������ . � RESID NTIAL
�Water Heater
� �� Water Softener
����� ��° Lawn Irrigation(_RPZ/_PVB) � � � �
� � ��`� � Add Plumbing Fixtures�Main/_Lower Level)
� ���
�����'� ��'� � Septic System
� � ��� � �
�§ � 'y' 4 1 � .
+�t�_ {�"p13"5�' £ �}6"P
�`� �° �� ,��� � Water Turnaround
'� `� � �� �� ��� , New �
� ���� �� h�� �� —
�`,�'��"���� �=;;� ��� Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge)
$60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Tumaround*(includes$5.00 State Surcharge)
"Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 Seqtic SYStem New($10.00 per as built)(includes County fee and$5.00 State Surcharge)
TOTAL FEES$ � �- �z'
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.aopherstateonecali.orq
I hereby acknowledge that this information is complete and accurate;that the work wiil 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 J � � - v � � .�c�' ��� �p���1
ApplicanYs Pr nted Name Appli Y ignature
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PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA129356
Date Issued:02/03/2015
Permit Category:ePermit
Site Address: 4166 Knob Cir
Lot:016 Block: 02 Addition: Knob Hill Of Eagan
PID:10-42500-02-016
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Applicant: Diane Moyer
Home Energy Center
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Paul Tillman
4166 Knob Cir
Eagan MN 55122
(612) 803-5937
Home Energy Center
2415 Annapolis Lane N #170
Plymouth MN 55441
(651) 766-6763
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
RECEIVED � ForOfficeUse --^---_T—j
�.i �.335� �
�� QCT 1 9 2015 i Perm�#: �
�� ����� �
� Permit Fee: • �� I
3830 Pilat Knab Road i �
Eagan MN 55122 1 Date Received: � � ,
Phone: (651}675-5&75 j c� i ',
Fax: (651)675-5694 � Staff_
-------------� I
2015 RESIDENTIAL PLUMBIPIG PERMIT APPUCATiC)IV
Date: �� � J � Site Address: "I � �D � �,I(�l'�� ��� 1�_
Tenant: ���"i���t�� �L�� (� � Suibe#:
� � � Name:� f .r � _ �i � � I(���i (� Phone:,� ����� �-l�L��
� ��!1'���€t` � �-- < (,�,-� �
� Address 1 City/Zip: `'C� �D Y ��(.� � L.��- I� ����
� � Name: �� � ��- License#:l Q L l. 1`1�L�� �
� �+E�t't�#'�[�+�!". � Address:�`i 1-[l� City: �lL�D-�j�� �
� > � State:�_Q�� Zip: �-� L t �4 Phone��,� ��4 �Q�Q� �
� e \ . �
� Contac�l�� Email: (���-��l_ �� �� ���--'�"" €
- New �Re{�acement Repair Rebuifd Madify Space Work in R.O.W. `
s ����if'��!'� � — — — — — _
� : Qescription of work:
� RESIDENTIAL � �
� , � Water Heater �
� � �Wa#er Softener �
� Lawn Irrigation(_RPZ/_PVS) —
������' � Add Plumbing Fi�ures�Main/ Lower Level) �
� Septic System �
� � _New � Water Tumaround �
;µ�� Abandonment � �
�
� RESIDENTIAL FEES: �
� $60.00 Water Heater,Water Saftener, or Water Heater and Softener(includes State Surcharge) _
� $60.00 Lawn Irrigation(includes State Surcharge} `
� $60.00 Add Rlumbing Fixtures, Septic Svstem Abandonment,Water Turnaround`{indudes State Surcharge} �
"`Water Turnaround(add$290.00 if a 5/8"meter is required) �
� $115A0 SeDtic SYstem New(includes County fee and State Surcharge) I-�� �
� TOTAL FEES$ �v �
�
��.�.�------ �
CALL BEFORE 1�0U DIG. Call Gopher State One Gall at{651)454-�2 for protection against undergraund utiGty damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. w+�vv.qo�herstateonecail.orc�
I hereby ackrrowledge that this information is complete and acxurate;that the worlc will be in conformance with the orclinances and codes of the City of
Eagan; that I understand this is not a pemait, but only an application for a permit, and uvork is not to start without a permit; that the work witt be in
accordance�rith the approved plan in#he c�ase of work which requires a review and approval of pl .
X_`��c. � l.e b�� � X (..�
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