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3828 Country Creek Way
*6 City at Eapil Date: 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Tenant: r /MOH 4i vi Li. Use BLUE or BLACK Ink For Office Use Permit #: n. 4 (00 O (2=– 2— Permit Fee: Date Received: Staff: 2012 MECHANICA L PERMIT APPLICATION Site Address: L-0 (Ie k VI Suite #: Name: Ron's Mechanical Inc License #: Address: 12010 Old Brick Yard Road City: Shakopee State: MN Zip: 55379 Contact: Linda Phone: 952-445-8585 New VReplacement Additional Alteration Demolition Description of work: Air Conditioner Air Exchanger Heat Pump Other New Construction Install Piping Gas COMMERCIAL _ Interior Improvement Processed Exterior HVAC Unit 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) TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installation/removal (includes $5,00 State Surcharge) $60.00 Minimum (includes State Surcharge) - if the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) OR Contract Value $ _$ $ $ Permit Fee Surcharge TOTAL FEE x 1% 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.gopherstateonecail.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 ismot to start without a permit; that the work will be in accordance with the pproved plan in the case of work which requires a review and approval of plans. I. x Applicant's Printed Name Applicant's Signatur City of Evan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink For Office Use Permit #: 1©°I S 9701 Permit Fee: Date Received: 1 `2- 4-1 Staff: 2012�RESIDENTIAL BUILDING PERMIT APPLICATION Date:j3 ISite Address: Unit #: Name: (.I 1 v) 1301,., i) d 1 �v"U Address / City / Zip: (3oced6r"e,/ & re E'kC�tx Applicant is: Owner Contractor Phone: '5/ /087q3q1-1 Description of work: 4e izit 1 1 !ret QEz..,k, NCt\ Construction Cost: Viloo ` Multi -Family Building: (Yes / No Company: Contact: Address: City: State: Zip: Phone: License #: Lead Certificate #: If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 1.) 1 I —11 P.P- 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. x 1dvl 1:9 d(4,5 Applicant's Printed Name x Applicant's Signature Page 1 of 3 SUB TYPES Foundation Single Family Multi 01 of Plex Accessory Building WORK TYPES New \/ Addition 1` Alteration Replace Retaining Wall DESCRIPTION Valuation Pian Review (25% 100% ) Census Code # of Units # of Buildings Type of Construction '58D3 C IDUrr--fi (are �a DO NOT WRITE: LOW THIS LINT Fireplace Garage Deck Lower Level Interior Improvement Move Building Fire Repair Repair REQUIRED INSPECTIONS Footings (New Building) Footings (Deck) Footings (Addition) Foundation Drain Tile Roof: Ice & Water Final Framing Fireplace: Rough In _Air Test Insulation Sheathing Sheetrock Reviewed By: Porch (3 -Season) Storm Damage Porch (4 -Season) Exterior Alteration (Single Family) Porch (Screen/Gazebo/Pergola) Exterior Alteration (Multi) Pool Miscellaneous Occupancy Code Edition Zoning Stories Square Feet Length Width Final 41./ Siding Reroof Windows Egress Window 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 Siding: _Stucco Lath Stone Lath _ Windows Retaining Wall: Footings Backfill Radon Control Erosion Control , Building Inspector Final Brick Final RESIDENTIAL FEES Base Fee Surcharge Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant Copies TOTAL 576' 9'0 Page 2 of 3