1225 Timbershore Lane
Use BLUE or BLACK Ink
.
I For Office Use i
Permit#:
City of Eapn I Permit Fee: (to U3 i
3830 Pilot Knob Road I i
Eagan MN 55122 I f j
I Date Received:
Phone: (651) 675-5675 I I
Fax: (661) 675-5694 Staff: I
I
2013 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: A1 I _ Site Address: l d• J- 5 -T,..., ate/ S P L
sh /q S C 4 - Suite
Tenant:
j _ _ ~sl- Z~3 -396
Name: ✓ h c vi n lii✓ J G ~Ut _ Phone:
,ResielentlOwner
S. S / a
14 1 Address / City / Zip: W'c',A v✓ /P7 It/
° Name: -uC ontl IAI(` f UAPQMY INC_ License#: `
Address: 1400 CONCORDIA City:
'Contractor. T. PAUL, MN b0i 04
Phone:
State: Zip:
ngl
Contact Email:
New Replacement Additional Alteration Demolition
Type of Work Description of work: A "o / ryt -
h10TE Rootf.rnQUnted _ d ground mountedi echanical equipment.is requireri'To besrreened by City
I Coc#e. 'I? se contae6 thesMetisnical.ins~ctor-for info rmatioii on peimittedscreening.methods.
RESIDENTIAL COMMERCIAL
Fu
mace _ New Construction _ Interior improvement
permit Type - Air Conditioner _ Install Piping _ Processed
- Air Exchanger _ Gas _ Exterior HVAC Unit
_ Heat Pump _ Under/Above ground Tank Install / Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge) _ $ it ® TOTAL FEE
COMMERCIAL FEES Contract Value $ X.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal = $ Permit Fee
*if contract value is LESS than $10,010, Surcharge = $5.00 Surcharge'
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
***If the project valuation is over $1 million, please call for Surcharge . $ TOTAL FEE
I hereby acknowledge that this information is complete and accurate; that the work will be in ance 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 i of to start ;;4 out a permit; that a work Will be in accordance
0
with the approved plan in the case of work which requires a review and approval of plans.
x x
Applicant's Printed Name Applicant's Signatur
F.ORDFFICE.-IJSE .
Requireddnspe~cfions. ~ ReviewedBy: Gate:
Underground Rough In Alt Test was 5 r±rice Test in floor neat Trial ,=i'v'hC',5crsenina W ,
i
Jul 28 2014 09:52AM HP FaxGates G.C. 7634987710 page 23
�
Use 6WE or BLACK Ink
� ForOfficeUse---------�
� � Pertnit#: � � L��� �
Clt of E���� ; . �� � ;
� Pertmt Fee. �
3830 Pilot nob Road �a
Eagan MN 122 � Date Received: o�L� �
Phone:(65 67S-56T5 � �
Fax:(651) 5.5694 I Staff: I
I I
���������.�����r��J
014 RESIDENTIAL BUILDING PERMIT APPLlCATION
Date: � �S �;i Site Address: �Z i, ' 7 z•j �7 7-7 /�+�D� -,✓;�,, `;�,�i�-6rr_ l--l��
� " `' � � �-•L U n it#:
F�,�.,.�...___.. ..__,.,... ,....,..�,�...,..._��.,...._..,�.._.,,,_.,.. _._..._.�.�....,.,.._._
� ��Name: ._r vH�ij i%n.e:i� r-��� �v.!- ==l':i�- �l•y?..:
� Phone: `
Resident! �
� Owner I;Address/City!2ip: �-� � i�.��o�-�-.
� 'Applicant is: Owner � Contractor
�_.,..,..._ _ •-- ....._..,.� —_...�... ._....._.....,.._ _._.�,...,., .�..<,. --, __.__.______
.✓ „r� i
Type cf Work '�escription of work: � p,�' �/�! ��' -��
� , _ � r. �
`Construction Cost: ��� y`°�• �� � Multi-Family Building: (Yes f��I No�
� � � � � .H GT"3y� �._._ . ,.....'rs( �R �
�CompanY'���-� '��' �"� � Contact: � - -
� !Address: jv''?n ��:���i�.'cr'�^ �/�� /� � ��yt�;:c�
Contractor �ry� -
1 � -� , � . �...= .�c :,,,�e:�-� c�;
;State:�Zip: �� 1� ` Phone: (�,!�':'ZS-rf Email� �r• ,c�'��- Gr�::%e����-�' r.�.-:
;License#: Lead Certificate#:
If the pr�ject is exe pt from lead cer6ification, please explain why: (see Page 3 for additional information) �
�COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING �
In the last 12 month ,has the City of Eagan issued a permit for a similar plan based on a master plan?
` _Yes �No I yes,date and address o1 master plan:
Licensed Plumber: : Phone:
Mechanical Contra r: Phone•
Sewer&Water Con ctor: Phone:
; NOTE:P/ans an supporfing documents that yo�submit are considered to be public information. Porbions of
the informatior� ay be class�ed as non-p�b/ic K you provide spec�c reasons that would permif the Cf1y fo
' conclude that!he are trade secrets.
_......._ ._..........._.,_...._._.__,._.�_...�._..�_...._ . ....,...�.._.�..�
CALL BEFORE Y DIG. Call Gopher Sta/e One Call at(651)454-0002 for proteclion apainst underground uliliry damage. Call 48 hours
before you intend to dig receive locates of underground utilities. www.aopherslateonecall.oro
I hereby acknowledge th t this irrformation is complete and accurate;that the work will be in confomiance with the ordinances and codes of the City of
Eagan; thal I underslan this is not a permit, bul only an application for a permit, and woiic is not to staA withari a permit; lhat the work will be in
accardance tne ap 'ved plan in the case of work which requires a review and approval of plans.
Ex rior w rk authoriz ' by a buildln ermit issued in accordance with�e Minnesota S Bu' ng Coda must be c ple d withln 180
days of pe 't isauanc .
x / X
Appli rrt's Printed me Applicanrs Signatura
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