1533 Clemson Dr CITY" OF EAGAN WATER SERVICE PERMIT
3795 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:
agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
/�f r^� f Total:
By (/ /� l Dote Paid:
Date of Insp.: Insp.:
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: — — —
1 agree to comply with the City of Eagan Connection Charge: —
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: _. - Total:
Insp.: - - Date Paid:
tV2 31 3 t fb 1 633 Pr i t 5 33 Conn Aso Y\. brr
Use BLUE or BLACK Ink
F-----------------
I For Office Use l
I Permit ~
1t3~at
City Eap
I Permit Fee: d i
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I ~1~ I
Fax: (661) 676-5694 1 Staff: 7C 17 I
I I
- - - - - - - - - - - - - - - - J
12013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: G~ I C~ (J
y 1! I~~ V t y i f v t Unit M
Name: 1 C i o m o ~c' 4 f Xi sa ui lmhone: , G,K W c'
Resident/ 1 ~o V ~ f r`l
Owner Address / City / Zip: yy) ~G
r
Applicant is: Owner Contractor
Type of Work Description of work: Q ~ G V16 VI VDr ~y
Construction Cost: 0 D Multi-Family Building: (Yes / 'No
Company: ~S~LA tlocc)~'L~t1c~ KEi71(x~L'~in4 o tact: ~`J e V 1
Contractor Address: gIC)G ~c~lslO~ ~JiUc~ City:, S4. Lock
State: PA 1A Z``ip: 5y ~O Phone: / o~
License a-(L o 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.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 o
i2 f permit issuance. ~j1
x t~ 1-11 S x
Applicant's Printed Name App ' is ig ature
Page 1 of 3
Use BLUE or BLACK Ink
-----------------,
�pv�'�j� � � For Office Use I
l.� \/ � �d�"7����- �
� fn � Permit#:
d� Ol �Q�ll JUN Z 4 2014 � permit Fee: "`0• � I
3830 Pilot Knob Road i /
o� 1�
Eagan MN 55122 sY� � _ i Date Received: CO� �� / ��
Phone: (651) 675-5675 � statf: j
Fax: (651)675-5694 L________________�
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
�ate: 6/19/14 site adaress: 1533 Clemson Drive, Eaqan, MN 55122
Tenant: Suite#:
ResidentTOwn�r Name: Tom Bernier Pnone: 612-868-7307
Address/City/Zip: Same
Name: K&S HeSting, Air Conditioning & Plumbing �icense#: PM059513
Cot�tr�Ctor Address: 4205 Hwy 14 W c;ty: Rochester
State: MN zip:55901 Phone: 507-282-4328
contact: Heidi Brown Ema�i: hbrown(c�ksheatinq.com
� .�.yp��f��r� _New XXReplacement _Repair _Rebuild _Modify Space _Work in R.O.W.
" Description of work:
RESIDENTIAL
! XX Water Heater
Water Softener
' Lawn Irrigation(_RPZ/_PVB)
PermitrT�pe Add Plumbing Fixtures(_Main/_Lower Level)
Septic System
—
New Water Turnaround
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 Turnaround*(includes$5.00 State Surcharge)
'"Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 Septic System New($10.00 per as built)(includes County fee and$5.00 State Surcharge)
TOTAL FEES$ 60.00
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.goqherstateonecall.orq
I hereby acknowledge that this information is complete and accurate;that the work will be in conforrnance 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 wil� be in
accordance with the approved plan in the case of work which requires a review and approval of plans.
X Dave Oftedahl X
ApplicanYs Printed Name ApplicanYs Signature
FUR bFFI���ISE s_ � ' = ' Revi�wed By: f � D�t�:`��_ �
Required Inspections:- � �;Untl�r_Graurttl `= F:�ugh�ln AirTest_ , ��s Tes� ` Final�
Meter Related Items: 1tll�fer.S�ze- Ratlio �ead 5taff: '
Use BLUE or BLACK Ink
-----------------,
� For Office Use �
• E � l�y��p ;
�i� O! ���� ���'�"�" I Permit#: I
� Permit Fee. �
383�0 Pilot Knob Road JUN 2 � Zp�q� i a��/ i
Ea an MN 55122 j Date Received: �
Phone:(651)675-5675 �Y.
Fax:(651)675-5694 � I
� Staff: �
�����������������J
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
�ate: 6/19/14 site Address: 1533 Clemsort Drive, Eagan, MN 55122
Tenant: Suite#:
�Resitl�r�tl�Wr�ew rvame: Tom Bernier Phone:612-868-7307
_
aaaress i c�ty i z�p: same
Name: K&S Heating, Air Conditioning & Plbg LLC�icense#: MB5216
! Contra�tpr Address: 4205 Hwy 14 W c�ty: Rochester
�
state: MN zip: 55901 Phone: 507-282-4328
, contact: Heidi Brown Emaii: hbrown@ksheating.com
New ��Replacement Additional Alteration Demolition
'Type Of WOPk Description of work:
,I�OTE.}.Roof mounted and ground mounted meehanica!equipmen#is req'u'�reci3ta b�e scre�ned�y Cifiy
i Gode_ P1ea�se cofit�ctthe Mechanical Inspecta!r folr infarmatior�c�n��rmPtt�d sGreenirt�m�thocl��=-,
RES/DENTIAL COMMERCIAL
XX Furnace New Construction _Interior Improvement
��,��,�T��� � Air Conditioner _Install Piping _Processed
Air Exchanger Gas Exterior HVAC Unit
_Heat Pump Under/Above ground Tank (_Instau/_Remove)
Other
RES/DENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$100.00 Residential New(includes$5.00 State Surcharge) _$ 60.00 TOTAL FEE
COMMERCIAL FEES Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
"`If contract value is LESS than$10,010,Surcharge=$5.00 =$ Surcharge'
*"If contract value is GREATER than$10,010, Surcharge=Contract Value x$0.0005
***If the project valuation is over$1 million, please cal�for Surcharge =$ 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 Rick Keehn � _
ApplicanYs Printed Name Applicant� 's Sig�ure
FOI�fJ��ICE USE , -
�tequi�eii lnspections: T,�, ;p , Rewiewed,By: p �., .. ' Date: �
Undarground ! Raugh In Air T�st i -�as=Servic;e Test ' ln-fltr�r 1=1��t T�irt�f .: 'fi�/i��Scre�ning ;