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1651 Donald CtCITY OF EAGAN 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. 1 agree to comply with the City of Eagan Surcharge. Ordinances. Misc. Charges: By // Total /( // 7 Date Paid: Date of Ins .: lnsp • WATER SERVICE PERMIT CITY OF EAGAN 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: — Owner• Address• SEWER SERVICE PERMIT 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: Date: City of Eaaafl 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2012 RESIDENTIAL P/LU7M�BING_PPERMIT APPLICATION 70-0,77- Site Address: / 65! % O/V4`/G� (i-)` Tenant: Suite #: RESIDENT / OWNER ` Name: Phone: Address / C/ Ziip::� CONTRACTOR tCipitt'y 1`C.t 41 -9 Name: Vd /el& , License #: 76 2 p 9/ / Address: 0a WeetaiAiti AO City: 6r97. State: in* Zip: 53/02.1 Phone: 6/ d0/ 66'/9 Contact: CA 41 ,5 Email: C,va4wlt S r 2 Jf )U• CGS TYPE OF WORK New Replacement Repair Rebuild Modify SpaceL Work in R.O.W. — _ _ _ Description of work: r5 aj R Z `- okm, 94, -7-a---.6 7-'-S TioLG PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation ( RPZ / PVB) Add Plumbing Fixtures ( Main / / Lower Level) Septic System Water Tumaround New _ Abandonment RESIDENTIAL FEES: $60.00 Minimum Water Heater, Water Softener, or Water Heater (includes $5.00 State Surcharge) Fixtures, Septic System Abandonment Water and Softener (includes $5.00 State Surcharge) $60.00 Lawn Irrigation $60.00 Add Plumbing *Water Tumaround $105.00 Septic System Turnaround* (includes $5.00 State Surcharge) and $5.00 State Surcharge) TOTAL FEES $ (add $189.00 if a 5/8" meter is required) New ($10.00 per as built) (includes County fee CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; that I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans (22/$ M` o -s Applicant's Printed Name x Applicant's Signature FOR OFFICE USE Required Inspections: Under Ground _Rough -In _Air Test Gas Test Final 4111 City of Eaall 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 #: Permit Fee: Date Received: Staff: i 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 1) )-) 1 2-- Site Address: 1(051 ao-Y-414 Unit #: Name: 13)e -Rete tit1ic-c- Address / City / Zip: J(oSj ari.n.et10( C4 - Phone: S is —Zq ie—MS)9 SS] 2-1 Applicant is: X Owner Contractor Description of work: Actellvt. C{ S ZS-tx) er- `z) $� Construction Cost: $(5- • Multi -Family Building: (Yes / No X ) �. t F vt 6,)--1 , Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain wh : (see Page 3 for addi • nal information) ��((k / - — 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: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: Phone: 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.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. 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. d kC i 1 )1'< - Applicant's Printea Name Applicant's Signat Page 1 of 3 DO NOT WRITE BELOW THIS LINE SUB TYPES Foundation Single Family Multi 01 of Plex Accessory Building WORK TYPES New Addition yAlteration Replace Repair Retaining Wall DESCRIPTION J� �,E/ �1 Valuation {6 O r Plan Review Fireplace Garage Deck y_ Lower Level Porch (3 -Season) Porch (4 -Season) Porch (Screen/Gazebo/Pergola) Pool 60-7-1/11(A4An9c Interior Improvement Move Building Fire Repair (25% 100%) Census Code # of Units # of Buildings Type of Construction REQUIRED INSPECTIONS Footings (New Building) Occupancy Code Edition Zoning Stories Square Feet Length Width Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: Ice & Water Final (, Framing Fireplace: Rough In Air Test _Final Insulation Sheathing Sheetrock Reviewed By: Siding Reroof Windows Egress Window %D$ 12-3 /6S/ (e.a. Cot C Storm Damage Exterior Alteration (Single Family) Exterior Alteration (Multi) Miscellaneous Demolish Building* Demolish Interior Demolish Foundation Water Damage *Demolition of entire building - give PCA handout to applicant MCES System SAC Units City Water Booster Pump PRV Fire Sprinklers Meter Size: Final / C.O. Required Final / No C.O. Required HVAC Gas Service Test Gas Line Air Test Other: Pool: Footings _Air/Gas Tests Final Siding: _Stucco Lath _Stone Lath _Brick Windows Retaining Wall: Footings _ Backfill Final Radon Control Erosion Control , Building Inspector RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL 744picizr" Page 2 of 3 RETURN FORM TO Regulatory Services, Inspection Services Housing Inspector or Fire Inspector Return to the Inspector by mail or fax (612) 673-2110 250 S. 4th Street — Room 300, Minneapolis, MN 55415 311 or (612) 673-3000 TTY (612) 673-3300 HEATING, VENTILATION AND COOLING PERFORMANCE SAFETY CHECK for RENTAL PROPERTIES PROPERTY ADDRESS ^�r� 7 �1.1C'r%Gt ` . c.-Z%J A4 Ail Date of Inspection I z ****Contractor must have the proper Minneapolis Mechanical or Gas se in order to perform the Performance Safety Check**** Equipment Description: (use a separate form for each unit) Type NA416e, Location , 6 em e -' -f- Serial # Aso El 1 (' L% 7/g Ct Make fel 5 Model 1— Vm Ph/ 7 Ft' 1144j 4j Type of Fuel 11�f., CS .fo, � G 5 Equipment Venting Type: Atmospheric Induced Fan Other Total BTU input of all vented gas appliances per chimney: Type of Chimney: Masonry Class B Other Type of Liner: None Metal Flex -liner B -vent Combustion Air Supply, with air trap: Yes Properly sized Safety & Ooerating Control Tests: Pilot/Flame Safeguard Operating Properly Li mit(s) Operating Properly Operator(s) Operating Properly Low Water Cut -Off Operating Properly All Controls Operating Properly Fuel Piping System -Okay B urner Lights Smoothly Connector, Vent, Chimney — Okay Heat ing Unit — Okay Pass K— Flue Gas Analvsisl Stack Temperature Oxygen Carbon Dioxide Steady State efficiency Inl�la! final F/Net 218. F/Net % t'I• 1 % Visual Inspection folenums, supplies, returns. etc): Pass % Does the heating system operate safely and properly ? Combustion Chamber/Smoke Bomb Test Yes Vents Properly Without Spillage Flame Stays Inside/Doesn't Roll Out Carbon Monoxide %.jpjj�(J'rL Comments (List of all repairs made to the system. All necessary permits need to be obtained): No If the heating system does not operate safely and properly, the system needs to be repaired or replaced, with the proper permits. Name of Licensed Contractor: /,(/! Address: y/2 Ves"1L 4a4— l Phone 672— - 21 ° /2.2 Name of Master: Master License #: Person Performing Test: Signature A licensed journeyman/master heating installer employed by this firm has inspected the heating system(s) of the dwe//ing listed above. The inspection revealed that the entire heating system(s) is consistent with Mn. Mechanical Code Sec. 103, 104, & 107 and Mn. Fuel Gas Code, Chapter 8 for adequate heat supply, chimney vent liner, manual gas shut-off, draft hood, venting, cleaning and servicing. As a representative of the firm, I am authorized to sign this certification on behalf of the Master Heating Installer. Retain a copy for your records. Give a copy of the form to either the Housing Inspector or Fire Inspector assigned to the Housing rental licensing case. The certificate is valid for two years. Send a copy to Truth -in -Housing, if required. Revised 2/2013 4/1' City of Eaaall Date: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651 - :94 Use BLUE or BLACK Ink For Office Use G� Permit #: 1 3 l Permit Fee: Date Received: Staff: SIDENTIAL PLUMBING PERMIT APPLICATION 1 Ma -Address: 1 G'51 4)&11\44-1�r, �,y� Al la' Tenant: Suite #: J I Phone: ei 98-1e of 1 Address / City / Zip: ss C�1L1� e<<r License #: WC( -4 \ t$ -V City r\VPi1 (Dike q -in Phone: <ew _ Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater _ Lawn Irrigation ( RPZ / _ PVB) _ Septic System New Abandonment ater Softener Add Plumbing Fixtures ( Main / _ Lower Level) Water Turnaround RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener (includes State Surcharge) $60.00 Lawn Irrigation (includes State Surcharge) $60,00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes State Surcharge) *Water Turnaround (add $280.00 if a 3/4" meter Is required) $115.00 Septic System New (Includes County fee and State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Cali 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.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 hich requires a review and approval of plans. r � t cth Ap icant's Printed Name Applicant's Signature 'Req re o pe 106....•t :Under Grout r r :Mete o.Related teats, Me et Size' °f