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