4702 Lenore LaneOwner:
WATER SE
b Rood ' MIT NO.:
55122 DATE:
F.IV No. of Units
Mims*
q�:(ress: 9 4702 Lenore Lan e L2 B14 Ridgeclif f e IV
Site
plr. GenzRyan
umbe
Meter No.: Connection Charge.
Size:Account Deposit:
Reader No • Permit Fee:
I epee to comply with the City Surcharge:
Misc. Charges: 60.00 pd mete
Ordinances.Total.
By` Dote Paid -
Dail of Insp.: i Insp.:
Orrin Thompson Homes
39 4 1
S/25/i<1
1 unit tnhse
335.00 pd
10.00 pd
.50 pd
01/07/2016 THU 15:13 FAX 651 437 9745 HALEY COMFORT SYSTEMS
Date:
'Ham au( )r (I( -C1!+ Car -ti
lc)s
City of Eaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
0001/002
Use BLUE or BLACK Ink
1
For Office Use
I
Permit #: ( 3
Permit Fee:
Date Received:
Staff:
0
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Resident/
Owner
Type of Work
Contractor
Site Address: Unit #:
Name: VI cig-i Go' 1i -ifs
& /1L l ;, . Phone:nLaS -( f(U
/�05512_2-.
Address / City / Zip: `t 7(trio 0 Ke,Gctiit / CJCtrj NI V 55/ Z2 -
Applicant is: Owner Contractor
Description of work: i TOC -Ow t 9 C+ (j Cc S
�7 co
Construction Cost: kikf ,
Multi -Family Building: (Yes / No
Company: ‘A61 t\) r (n* g' + X17) Contact: N 1.0)(e- tla
Address: 122 V i City: I-1c4S-h t19 J
State: IV1+Zip: C30'} 3Phone:LI5I-1)7 O3 -Email; e IialeLJ(a4 /) •(D
License #: I v 12j _3 Lead Certificate #:
If the project is exempt from lead certification, please explain why:
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:
Fire Suppression Contractor: 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 aretrade secrets.__.�...�Y�
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.00pherstateonecali.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.
x NifAle, ;'iG1i
'CA)X
Applicant's Printed Name Applicant's Signature
Page 1 of 3
x I,
C
37 Kiiob Rood
Rc aon, 'MN 55122
Z4nin : I RIV
Owner: Orr
Addre
Site Address: 47
Plumber:
PERMIT NO.: `' 4855
Th
DATE:
No. of Units: - i unit nhae
son Homes
L " • a Lane L2 ?3I4 Rid ecliffe IV
8/14/81 26296
I ogres to comply #vhh the City of Eagan
Ordinances.
100.00 pd
Connection Charge: —.42.242.4k_
Account Deposit;
Permit Fee: 10.00 d
Surcharge:
Misc. Charges:
Total:
Dote Paid:
City of Eat
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
For Office Use
Permit #: /,7) L1 5s, 7
Permit Fee: (�{,1, (T(
Date Received:
Staff:
2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: Site Address:
Tenant:
Suite #:
Name: \ ICi 1 "c"' Phone:4 5 1
Address / City / Zip: L 10 UkOrq C'Lni(_.
Name: (3 vie blur Q, -1-j `y "f �_ y' License #: Cl �'1 0 b Le S 'j
Address: I �� eJ I '� � o S+City:
Hp S-� S
State: t V f V) Zip: s�b .›) Phone: 1.,S1— (437 _ Li! 7
Contact: (6�S i' Email: C/gSi e. fait 41(te171b Va,/r,COvir-t
New y Replacement Additional Alteration Demolition
Description of work:
`lt;.. bra oaItf(-ii-1'd!3iuit�i�gr i\
tag -44,11( 71r IRAitea dt 1) 1'Yt 7
RESIDENTIAL
XFurnace
Air Conditioner
Air Exchanger
Heat Pump
Other
a silll le i 01)4,!,,9
01,441(03
k-1141411-tricir�r�atJ!.
COMMERCIAL
New Construction Interior Improvement
Install Piping Processed
Gas Exterior HVAC Unit
Under/Above ground Tank (_ Install /_ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge)
=$ \Q
TOTAL FEE
COMMERCIAL FEES
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
*If contract value is LESS than $10,010, Surcharge = $5.00
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
***If the project valuation is over $1 million, please call for Surcharge
Contract Value $ x .01
_$
_$
=$
Permit Fee
Surcharge*
TOTAL FEE
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 . VOMJA
Applicant's Printed Name
x No\A-ut)
Applicant's Signature
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