1528 Clemson Dr CITY OF r-AGAN WATER SERVICE PERMIT
379f Pilot Knob Road 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:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By
Date Paid:
Dat of Insp.: 72 nsp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3795 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:
B Surcharge:
Y Misc. Charges:
Date of Insp.: Total:
Insp.: Date Paid:
Use BLUE or BLACK Ink
For Office Use
j Permit 1
City of Eap
Permit Fee: 3830 Pilot Knob Road
Eagan MN 55122 Date Received: 13 j
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff. I
I I
W113 2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:15a6 0Jefi-) scil b k- Unit M
Name: t~Y~aS Lu.t_& 1-6ryLe- 60-41"s Phone a"-70Y-7`y,
Resident! & /''1C)JV~t)~
( r
Owner Address /City /Zip: i QhaQ S~ C~ E.~
Applicant is: Owner 7- `Contractor
Type of Work Description of work: -ems-L~ ,t v"02 C C Si 4111 ii
Construction Cost: Multi-Family Building: (Yes No )
Company: ~~t Q P)OCC)►`-cl 0_,J Qe01a-1 trt4 tact: 1?r-L" ri 6,_
r
Contractor Address: ~f joD x) e_Ck:lov- p3tud city:, S4, L oLJ A 1C1'L
State: h Zip: Phone: , a off--
License ~CC> j U 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 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.-gooherstateonecall.ora
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.
Applicant's Printed Name Applicants Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE
SUB TYPES
Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
_ Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
_ 01 of Plex _ Lower Level _ Pool Miscellaneous
Accessory Building
WORK TYPES
New _ Interior Improvement _ Siding _ Demolish Building"
Addition _ Move Building _ Reroof _ Demolish Interior
_ Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall Vemolition of entire building - give PCA handout to applicant
DESCRIPTION
Valuation Occupancy MCES System
Plan Review Code Edition SAC Units
(25%_ 100%__) Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: -Footings Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough In Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: , Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3
t52Ce 115-t~ C3, ~52~314, ~5 2g 8 CkQ'vNs'or1 b' T_
Use BLUE or BLACK Ink
I For Office Use 1
j Permit
City of Eakan I Permit Fee: C 7 1
3830 Pilot Knob Road I 5 S I
Eagan MN 55122 Date Received: 13
Phone: (651) 675-5675
I I
Fax: (651) 675-5694 1 Staff: I
I I
- - - - - - - - - - - - - -
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: tr 1 I Site Address: 1 GZ `-P C6 elwv1 V NV t Unit
Name: 11~t11~ ~v4~ Phone:
Resident/ - ~o V) a - 1 ~
Owner Address / City / Zip:
f
Applicant is: Owner L Contractor
Type of Work Description of work: 2 u9 W R ~'~L OKI
Construction Cost: J ~200 - 0 ® Multi-Family Building: (Yes X / No
Company: ~c~ l a ~QQk-'I Qci an ,l K 21'1 VX L' I trt~ 14kontact: ' J , V 1
Contractor Address: city: _S4. LoLL C'ctr ~L
State: OA k , Z`ip: Phone: Q-- 1 ~/'S- -7,20
License n-,Loo 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 pen-nit 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 (651) 454-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.gooherstateonecall.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 V1 iAA d 5.~ x
Applicant's Printed Name App ' is ig ature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA157716
Date Issued:09/05/2019
Permit Category:ePermit
Site Address: 1528 Clemson Dr
Lot:9 Block: 02 Addition: Thomas Lake Heights
PID:10-75950-02-090
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Standard 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.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
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 -
Roberta J Elliott
1528 Clemson Dr
Eagan MN 55122
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature