4082 Durham CtCity of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
I
For Office Use 4/23
Permit #:
Permit Fee:
Date Received: 0 -1b -
Staff:
> I Y
Staff:
2012 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: ID
Tenant:
RESIDENT / OWNER
CONTRACTOR
TYPE OF WORK
Site Address:
1,.r ha1v�
Name: 4 nfl N.,(56-(1
Address / City / Zip: ` {u 1)V,
Suite #:
Name: Kline Corp.
DBA: Practical Systems
Address: _ 4342B Shady Oak Road
State: Hopkins, MN 55343
952-933-1868 X ‘2,03—
Contact:
License #:
City:
_ New i< Replacement Additional Alteration Demolition
Description of work: Cr'.a)1h 6 t •(L: 0rl0 (e 4-- 1::\C--'
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by Cityy
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RESIDENTIAL
Furnace
i
A Air Conditioner
Air Exchanger
Heat Pump
Other
COMMERCIAL
_ New Construction _ Interior Improvement
Install Piping _ Processed
Gas Exterior HVAC Unit
Under / Above ground Tank (_ Install / Remove)
RESIDENTIAL FEES:
$60.00 Minimum Add-on or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) = $ V TOTAL FEE
COMMERCIAL FEES:
$75.00 Underground tank installation/removal (includes $5.00 State Surcharge)
$60.00 Minimum (includes State Surcharge)
*If the project valuation is over $1 million, please call for Surcharge
OR Contract Value $ x 1%
$
_$
_$
Permit Fee
5.00 Surcharge'
TOTAL 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.
x u Ct../Ln.
Applicant's Printed Name
x 4 /,t( 0/A
Applida is Sigature
c
FOR OFFICE USE
Required Inspections: Reviewed By: Date:
_ Underground _Rough In _ Air Test _ Gas Service Test In -floor Heat _ Final _ HVAC Screening
e/ e e lOZ-90-O l 90 bb 81
6981££6296
46 City of Eapil
Date:
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:
io-7LiTzA
Zps(5 Vi27q
Date Received:
Staff:
2012 RESIDENTIAL PLUMBING PERMIT APPLICATION
Site Address:
9, 6- .2-, 3trIo
Tenant:Suite #:
RESIDENT / OWNER I Name: liC),Nrs 'f -N"
Address / City / Zip: 'c)r.a.
CONTRACTOR
Name: 4-r—. d 12,; v-vr-vt
rso CL
State: \frl r•— Zip: ‘6,...5//0 Phone: ‘i 2- - 37
Phone:
6, 42 -' L/a3
(4t• t
License #: 6 5 (")-‘•
City:
TYPE OF WORK
PERMIT TYPE
RESIDENTIAL FEES:
$60.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge)
$60.00 Lawn Irrigation (includes $5.00 State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
"Water Turnaround (add $189.00 if a 5/8" meter is required)
$105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge)
TOTAL FEES $
New K. Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work:
RESIDENTIAL
I Water Heater
Lawn Irrigation ( RPZ / PVB)
Septic System
New
Abandonment
Water Softener
Add Plumbing Fixtures ( Main / Lower Level)
Water Turnaround
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
is011iiiiir
I hereby acknowledge that this information is complete and accurate; that the work will be in conforma c- with ',4,. • :. 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 n ta mit; that the k will be in
accordance with the approved plan in the case of work which requires a review and approval of • . diele'
x C r .:g,....,....) x
Applicant's Printed Narhe Applicant's Signature
FOR OFFICE USE
Required Inspections:
Reviewed By:
Da
Under Ground Rough -In Air Test _Gas Test _Final
06/17/2014 15:07 Les Jones Roofing, Inc. TAX)9528817009 P.015/020
41/111' City of Eaaali
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (661) 676-8694 .
Use BLUE or BLACK Ink
For Office Use �%
Permit #: I a3 `f �1. (p
Permit Fee:
Date Received:
Staff:
a
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
6/(7 y Site Address: 4/Do-V(62407a- £/Q7 y076-i/07b'-1/0k0- r/D8,2. bags -M -/f CDU. .%
9/10V -4f146 -¥/0F Y//U Unit#:
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Name: yo P2oP T`' G'4.f I. NC.. Phone: /A57- .524-2/- f94//,?°'R
,/
Address / City / Zip: 'P.O. Bp k 212 5- /N1� n. ✓,1 4itah Ai 6570 74
Applicant is: Owner X Contractor
�'�r• •y ������y' ��'���'' -° �% iii`
' : ''i: > ! "'>' % '`
Description of work: F /Wig/NO
190
Construction Cost ' 27, 5Lf7 , Multi -Family Building: (Yee X I No )
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Company: Ars r?2M/6 Rcat-wiz-f Ave_ Contact: CNa+ s r Jag -sod
Address: 95t l 14/. d'D TN S7"/LE%' City: lie '4 d to A/
State: .4W Zip: frieze) Phone: 9S2 - 74 7 - 428/9
License #: 6561) Lead Certificate #: 4/4r `f o . 9 R -
If the project Is exempt
from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes _No if
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDER
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Phone:
Phone;
Phone:
,NOT ,�Pl ,r o .<;. b ,t .dt _; tali•„ "It a .' oo:..a derdd',-to ,,db o info17%ibr`tl ':ifr:';pr'.of
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CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 464-0002 for protection against underground utility damage. Call 48 hours
before you Intend to dig to receive locates of underground utilities. www.gooherstateonecall.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 wilt be In
accordance with the approved plan In the case of work which requires a review and approval of plans.
Exterior work authorized bye building permit Issued In accordance with the Minnesota State Building Code must be completed within 180
days of permit issuance.
x CIPS IS 4I40072s-04/
Applicant's Printed Name
de -
Applicant's Signature
Page 1 of 3
0211912014 12:36 Les Jones Roofing, Inc. (FAK)9528817009 P.0151020
Date:
City of Eaaall
3830 Pilot Knob Road
Eagan MN 56122
Phone: (661) 678-6676
Fax: (661) 675-5694
RECEIVED
FEB 1 9 2014
Use BLUE or BLACK Ink
For Office Use 7
Permit #: -L SY(;
Permit Fee: c'1) 0 11
Date Received:
Staff:
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
J
i 9 b % Site Address: L/7:/l 0YzO7 -/Y0 f'1O7/
4:4 go7S, go8'O,C %OJ28. 2- Unit
#:
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7I. 1,tl� !°
;
`'�'!'�;'�1(�':�t;'� ,`;,;
&.-•-4,,N,., M" • a '
Name: yo PeoPWI'Y G AizE LNG-• Phone: /57— 5-3-1/- VI Lill
Address
Applicant
/ City I Zip: Bo. Bo K 2t 2 5 /Nva Co -wit l M' 61S20 24
is: Owner X Contractor
e,. •;. ''up' '4"''''' 7. � .'' , : f
� � ?�
�:Multi-Family
u %,�;. �
Descriptlon
Construction
444,491/1 Q /egg £,oF LrA 9°.:14-5
of work: R'N
Cost k � 2i fig, Building: ....._j(Yes x ! No
_
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a i �x s,� . �s k
tre„„:)4`�y '! , I :4A-.-1-1-020'' '
.�' t �: "° 'rgy,
Company:
Address:
State-
AES �TaNES CtOfifiVir /.VG Contact CAI/at s �wLSO /
9 Y 1 W. 8a m i"/ City:P__4 uL.ylrre2.✓
MA/ Zip: Phone: 9SA 7' 0? /
License #: 6.5-64 Lead Certificate #: ,g4r 4`C 3 VR- /
If the project is exempt
from lead certification, please explain why: (see Page 3 for additional Information)
In the last 12 months,
Yes No If
COMPLETE
has the
yes, date
THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
City of Eagan issued a permit for a similar plan based on a master plan?
and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
®"frgt,�c ag lhp :
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, C � 1'� �� - ..,. , =� : , �.
CALL BEFORE YOU PIG. Call Gopher State One Call at (661) 464-0002 for protection against underground utility damage. Call 48 hours
before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.ora
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 penult, but only an application for a permit, end 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�i -Rts 110072s0AI
Applicant's Printed Name
Applicant's Signature
Page 1 of 3