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1572B Clemson DrCITY OF EAGAN 3830 Pilot Knob Road P. O. Box 21199 lagan, NAV 55121 WATER SERVICE PERMIT PERMIT NO.: 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. By Date of Insp.: Misc. Charges. Total Date Paid. Insp • CITY OF EAGAN SEWER SERVICE PERMIT 3830 Pilot Knob Road\ R O Box -21199 PERMIT NO.: Eagan, MIN 55121 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: leli`j OityofEaafl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: 1V‘15 -2C) 0UGDaPermit Fee: (00°2- Date te Received: 1a -13-(z, Staff: 2012 MECHANICAL PERMIT APPLICATION ❑ Please submit two (2) sets of plans with all commercial applications. Site Address: ICJ L CLQ M J o N d Y' Date: Tenant: (.kpi)-1v Suite #: RESIDENT /OWNER,;; , Name: "IP NI�-.1 Phone: (PVL. 123. S315' Address / City / Zip: CONTRACTOR Name: li C F\[) t G 9 uII G t E di 6 tV License #: tVi g°'O 3 i Address: DBP Abi t Ali- City: 13L IA (I\ C � State: MI N Zip: 55-7t Phone: (I L.1q l)' ;1 - - Contact: . 6112 Email: 1, TYPE OF WORK • New Replacement Additional Alteration Demolition Description of work: 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. PERMIT TYPE RESIDENTIAL Furnace COMMERCIAL 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 burned out appliances, ductwork, etc.) (includes Surcharge) $5.00 State Surcharge) _ $ TOTAL FEE $100.00 Fire repair (replace COMMERCIAL FEES: $75.00 Underground tank installation/removal $60.00 Minimum (includes State (includes $5.00 State Surcharge) Surcharge) $10,010, surcharge is $ 5.00 surcharge increases by $.50 for each $1,000 Permit Fee requires a $ 5.50 surcharge) OR Contract Value $ x 1% = $ Permit Fee - If the Permit Fee is less than = $ Surcharge - If the Permit Fee is > $10,010, Fee = $ TOTAL FEE (i.e. a $10,010-$11,010 Permit CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against and round utility damage. CaII 48 hours before you intend to dig to receive locates of underground utilities. www.uopherstateonecall.org I hereby acknowledge that this information is complete and accurate; that the work will be in •nformance ith the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and w• is n• to start witho a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of pl x LINAIkEv (- Applicant's Printed Name FOR OFFICE USE Required Inspections: Underground Rough In Air Test ' ignature Gas Service Test oor Heat Final HVAC Screening Date: 1yofall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit#: II (09 (0 Permit Fee: ' Ot 5 . SO Date Received: `O /14 1 13 Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 81dc . Date: 16 -11- 13 Site Address: leo} , 1.5.7e. 161,28 �,1�tnrs ►r+ unit`#: J .71i Name: -I i) its -To 440 hcsiofS Phone: A42. 721-SYVd Address / City / Zip: Applicant is: Owner ___ Contractor Description of work: RerboF1115. Construction Cost: 4 241 3 00 Multi -Family Building: (Yes / No ) Company: --8 19 COOS Tie UG7/CA/ Contact: ___4_1 C Address: 3 0 3O. M 'i n eh alr_ City: M I n,' etziei :5_ State: in Al Zip: 5$-4/0 G Phone: - ? 24 - C __6z..2 License #: 73 1'/ Z ©6 2- Lead Certificate #: _liar — 2 4/7S? , / 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: _ t sem:;.! s��^ e: tus _ '• 3-` _ A � .&.�e n,`'",t t 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.00pherstateonecall.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 authorised by a building permit issued in accordance with the Minnesota State Building Code must be completed within 180 days of permit issuance. x�lr2a.be-14) �n `� er) Applicant's Printed Name Appiica Signature Page 1 of 3