921 Oakwood Heights Cir CITY OF EAGAN WATER SERVICE PERMIT
37!5 Pilot Knob Rood PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: — - - - --
Address:
Site Address:
Plumber:
Meter No.: — Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
D. of Insp.: — � - Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
37M Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zoning: No. of Units:
Owner: _
Address:
Site Address:
Plumber:
I agree to comply with the City of Eagan Connection Charge: —.
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Dote of Insp.: Total:
Insp.: Date Paid:
C!ty of Eapn
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 #: final 151
Permit Fee: (n0 . OD
Date Received: . 13/ 13
Staff:
L
2013 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: Site Address:
Tenant:
Suite #:
Name: /fin/ jai 108'46 I' , / Phone: 5 s7 -Z2' X667
Address / City / Zip: 5'2- 1 04-1 4600/
/7/ 5' //5 C,2 .Sala/ /to, 5-5-723
) �'j( j
Name: L(?lkvl,' S 4-IeG-`t oh) k( e License #:
Address: U`7'5C' Jrvu 35 City: Al-eF c.7 f-1
State: 1A.- Zip: 5-4 o / `/ Phone: Z/2_-75-6— /75
Contact: &VIn ^e LVA d Email:
New X Replacement
Description of work:
Additional Alteration Demolition
6 tAvA 2 /2tc, .) f ka c
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
Air Conditioner Install Piping Processed
Air Exchanger Gas Exterior HVAC Unit
Heat Pump Under / Above ground Tank ( Install / Remove)
Other
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) =
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge)
$60.00 Minimum (includes State Surcharge)
*If the project valuation is over $1 million, please call for Surcharge
OR Contract Value $
=$
= $ 5.00 Surcharge*
$ TOTAL FEE
TOTAL FEE
Permit Fee
x1%
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.
4n4, L ni`� , L'
x
Applicant's Printed Name
x
Applicant's Signature
FOR OFFICE USE
Required Inspections:
Reviewed By: Date:
Underground Rough In Air Test Gas Service Test In -floor Heat Final HVAC Screening
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA109038
Date Issued:02/01/2013
Permit Category:ePermit
Site Address: 921 Oakwood Heights Cir
Lot:108 Block: 02 Addition: Oakwood Heights
PID:10-53800-02-108
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:dean Kamrath
13791 jonquil ln n
dayton, mn 55327
612-205-6060
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
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 -
BRIAN A LUBINSKI
921 Oakwood Heights Cir
Eagan MN 55123
Adam's On Time Plumbing & Water Heaters LLC
13791 Jonquil Lane N
Dayton MN 55327
(612) 205-6060
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
-For Of-RceUse
j Permit
City of Eqan I ~ oat
I Permit Fee: I
3830 Pilot Knob Road
Eagan MN 55122 Date Received: j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff: I
I I
~.----------------J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
04ALW* 4e
Date: ltiZ Site Address: D
Name: 4''Atrtnus (CQ/U+JkSj- e_C&h hone: o ~ c..
Resident/
Owner Address / City / Zip:
Applicant Is: Owner Contractor
Type of Work Description of work: re --k=24
Construction Cost: 1 , Mufti-Family Building: (Yes ! No
Company: tiJV*: Contact: VoyeL
Contractor Address: 7,0 ,u_ city:
State: a r J Zip: o ~r 1,3 Phone: 2,10 -1
License 3Q_ 5 q S -7 4 9 Lead Certificate AJJ*N-
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 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 (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gopherstatoonecall.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.
X_ k)t-~ 1-C ?Jv~cati+ -iSr-f x 044 Applicant's Printed N Applicants ignature V 'V_
Page 1 of 3
Use BLUE or BLACK Ink
r-----------------+
I For Office Use �
' � Permit#: �� j
Clty of ����� � � �
� Permit Fee: ��� � � � �
3830 Pilot Knob Road � �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 i Staff: i
-----------------�
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: rJ S Zo_L�Site Address:_ _ . �,�- C/f7 I-�C'.1 ��1^ Unit#:
— --- ���,,,� L,�r��v�S
� ' ` Name:_�Z�A/Qo � �IE`��'� C�nK]orn�N�� �S . Phone: �1 _ t� �c�'�21 �
{"Resrdent/
,OWner ` Address/City/Zip: �Z 4 d f��'CW bo� -�ia �i r t�l�: E 1.�i4f�/�tN
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' Applicant is: Owner' �Contractor
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�� � � `` Description of work: �f N 0 Gc� �2e r�..��mPn.�'�
Type of Work
,. Construction Cost: �� Q � Multi-Family Building:(Yes�!No )
Company:�- ��U"'� "��biE �Sc" �C Contact: 1�)nu c Rc r�ir�rr"��
�
�COt1t1'1CtOP � Address: Z U� � City: �z �t(�a�1r�J
` � /�-� N �.C'
State:�Zip:�Z� Phone: (a�Z—ZI O—((p���ail: �V'i tn �-`'�bav V���l�O�,... �.
License#:__�� () 5�� 7�8 Lead Certifcate#: �1�'—�, ��(��(' �
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 8 Water Contractor: Phone:
NOTE Plans and supporting tlocuments fhat you subm�#are cons�deretl tp be pubbc�nformafron �Qort►ons of �:
#he mformat�on may`be class�fied`as non-publ��if you prov�d�spec��c reasons that wou/d Qerm�t fhe�ity to
; � „ : �_ � �. �
` � ' �; concl"uale,that the`areutrade,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. vwvw.qopherstateonecall.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.
Exteriorwork authorized by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x L„yt}.��L�S �� v��n �,r-�� x �/pn,� ,�
Applic anYs�'�nted Nam�� ApplicanY Signa ur
Page 1 of 3