3778 Golden Hill Ter VILLAGE OF EAGAN WATER SERVICE PERMIT
3795` Pilot Knob Road PERMIT NO.:
Eaoon, MN 55122 DATE:
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.• Permit Fee:
I agree to comply with the Village of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By Date Paid:
Date of Insp.. Insp.:
VILLAGE OF EAGAN SEWER SERVICE PERMIT
3795 pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zr*ning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the Village of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
B y : Misc. Charges:
Date of Insp.• Total:
Insp.: Date Paid:
(Q - ~'11co, 3~1$ gto Cdl~ 4' kt "ear
Use BLUE or BLACK Ink
-For Office Use
I
city o~ Permit#: I Permit Fee: 1
3830 Pilot Knob Road i I
I Date Received: 2-1 I
Eagan MN 55122 i I
Phone: (651) 675-5675 i I
Fax: (651) 675-5694 18'
1------------------
2013 RESIDENTIAL. BUILDING PERMIT APPLICATION
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Date: 13 Site Address: 'r7U4 377$ 37$y} Ylai Unit
Phone.
Name:
I Resident!
Owner Address / City / Zip:
I 1
Applicant is: Owner Contractor
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Type of Work Description of work: C~Co rtiti
- i
Construction C Mufti-Family Building: (Yes I No
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Company: '~o taia j, Contact: 1 t d r✓~~y
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Address: ~C) o~ i~.~ ;rctJ~ rr . City:
9 Contractor q
i OYZ~! State: Zip: ~)<53`4S Phone:
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License `4 5 Lead Certificate#: N lq cgoop - f
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. Calf 48 hours
before you intend to dig to receive locates of underground utilities.
I hereby acknowledge that this information is complete and accurate-; that the work will be in conformance withthe 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 ctr I C k P
Applicant's Printed Name Applicant's Signature
Page 1-of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA121846
Date Issued:04/16/2014
Permit Category:ePermit
Site Address: 3778 Golden Hill Ter
Lot:2 Block: 09 Addition: Town View 1st
PID:10-77100-09-020
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description: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.
Tony Boerner
2090 County Road 42 W
Burnsville, MN 55337
Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087
Surcharge-Fixed $5.00 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 -
Thomas Saalborn
3778 Golden Hill Ter
Eagan MN 55122--112
Tony's Appliance
2090 County Road 42 West
Burnsville MN 55337
(952) 435-2442
Applicant/Permitee: Signature Issued By: Signature