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Suite 742 Use BLUE or BLACK Ink r________________i ° I For O�ce Use � ' � Permit#: �� J� � Clty Of��Il � Permit Fee: �� j 3830 Pilot Knob Road � � Eagan MN 55122 j Date Received: I Phone: (651)675-5675 I � Fax: (651)675-5694 I Staff: �-----------------� 2015 COMMERCIAL PLUMBING PERMIT APPLICATION ❑ Please submit two(2)sets of pians with all commercial applications. Date: ( ~°�� ite Address: �( �� 7 �u/ `�(�✓� ��1 '"'`�'"" Tenant: / � � �`� Suite#: � Name: N� � ��f� �� ( �� " ��4 f' �b��,�r- Phone: Name: � Q ��'�/1�� i U�9 <<R Lice se#: / (/ �U �� Address: f�Z F City: e�'�c� State:�Zip: S�l Phone: ��d�� L � //EmaiL �`�`�j-��. �C ��C�� _New _Replacement _Repair _Rebuild _Modify Space •_Work in R.O.W. ��Y. ,�-/ �"� ` � Description ofwork: /�4 W� GCI`l - :� COMMERCIAL New Construction Modify Space ��- Irrigation System�yes/_no)�RPZ/_PVB) � �- �� _ • Rain sensors required on irrigation systems • Avg.GPM (2"turbo required unless smaller size allowed by Public Works) �� Meters Call(651)675-5646 to verity that tests passed prior to aicking up meter. � � ,� � w.-� ° � � ' Domestic:Size&Type Fire: 1 ��_ _�. Avg.GPM High demand devices? Yes No Flushometers_Yes No COMMERCIAL FEES Contract Value$_��_� x.01 $55.00 Permit Fee Minimum _$ 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 Following fees apply when installing a new lawn irrigation system $ Water Permit Contact the City's Engineering Department,(651)675-5646,for required fee amounts. $ Treatment Plant $ Water Supply&Storage $ State Surcharge _$ TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at(651)454-0002 for protection against underground utility damage. \ 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 wo ' 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 ans. X �6�c��J� ��' �'c��' X G✓G ApplicanYs Printed Name licant's Signature . . .. _ : }�.._. , _ �. _.� ..- LLF�E�� #E }= �` _£ - - � ��:. . _ _ v .-- - �� _ :� � �. _ _ -_ . _ . _- r - � :. � _� _ - - _�� : @. � _ _ _ _ �. . _ .� _ _ _ _� ._ . _ � . __ . � ��p �/� � Page 1 of 3 �fK-- 1" ` l �'`. C�' . , , Use BLUE or BLACK Ink � For Office Use ---------j • � (� � � Permit#:_� ��`�p I C�t of �� a ; . 3� ; � � � Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 i �3"�'- � � Date Received:� 1 Phone: (651) 675-5675 � � � Fax: (651)675-5694 � staff: � ---------------��S� 2015 GOMMERCIAL BUILDING PERMIT APPLICATION ,�� Date: � ��-� Site Address:_��S �rja�L1'1 �U7LK c�LY1�l�V2-�/ -- � �'� �-r J 7— Tenant Name:�� l�'i'U 1=�7-_�S �C __ (Tenant is:x New/__Existing) Suite#:_�� 1� k Former Tenant: `� V�"�' - — i/� Name:TLt;l�vi �r�eS_�Uf��e'lS. ;01�✓1�C_ Phone: (Q l�'"��7 ��_ .'�� 1 Property Qwner � �� Address i Ciry l Zip: J�g�'��,i'1 �(��5 ��J�I�Ic�� Applicant is: Owner �Contractor TYpe of WO�'k Description of woric:��Xi� .��f�l.2F'�el �� IY� CQ d't//�_(��/� //� � � Construction Cost: `7��D� Name:_��__��V�_�u-' _______ License#: __ _ COCttI'aCx01' �ddress: / �_�(l Gl� l�0 YK� �2�__ City: �l�c VG�l/� --�' / ---- - —�----^ State: 1�Z►p:��a� Phone: ��_�>_�'U( ��.3 S _ Contact:-- ----- Y Email:��Q��D ��s re• C� � /� //�� S tti.fGt l�/ S Q Name:��L�I�IS-��G�1/7��fGC,f'i,�egistration#:��O� A�CIt1��GUEt7�117eBC Address:_I�1� S'�L�6�__C��'VP ��___ c�ry: �.�1.LY�l�IQ��— / /' f State:.�_Zip:_��__ Phone: �Y t� ��_� Contact Person:�� "1� .� v�L_!dY�� EmaiL L I.l A(�d+��'Vl Licensed plumber installing new sewer/water service: _ ____ Phone#:_______`_ _, Nt3TE:Plans and supporting daeuments'that you submit are e�nsidered to b,�public informatian. Forfians of ' the informatian may be classi�ed as non publec if you provide specr�c reasorrs tha#wouitl perrrtit fhe Gity#o co�clude thaf the are�rade secrets.' 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.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 will be in accordance with the approved plan in the case of work whic equires a review and approval of plans. x � t � h�� ` ---- - X- -- - ApplicanYs Printed Name Ap IicanYs Si nature Page 1 of 3 � - • �/ � �� ' (�J �4 �,� (�Jf��f5 ! � DO NOT�ITE BELOW THIS LINE ��C� �3 SUB TYPES Foundation _ Public Facility _ Euteriar Alteration-Apartments ✓ Commercial/Industrial _ Accessory Building _ E�cterior Aiteration-Commercial Apartments Greenhouse 1 Tent Exterior Alteration-Public Facility Miscellaneous Mtennae WORK TYPES , _ New ✓ Interior improvement _ Siding _ Demolish Building* _ Addition _ Exterior Improvement _ Reroof _ Demolish Interior Alteration Repair Windows Demolish Foundation _ Replace _ Water Damage _ Fire Repair _ Retaining Wall _ Salon Owner Change *Demolition of entire building-give PCA handout to applicant DESCRIPTION �, Yaluation 006 Occupancy M MCES System ✓ Plan Review ✓ Code Edition Zbb7M5L3G SAC Units /'� OR"�D (25%_100%� Zoning --�� City Water ✓ Census Code Stories 1 Booster Pump #of Units v Square Feet ,3i�� PRV #of Buildings �— Length Fire Sprinklers � Type of Construction .�' � Width REQUIRED INSPECTIONS Footings{New Building) Sheetrock Footings(Deck} ✓Final/C.O.Required Footings(Addition) Final/No C.O.Required Foundation Other: Drain Tile Pool:__Footings _AirlGas Tests __Finaf Roof:__Decking _Insulation _Ice&Water �Final Siding:_Stucco Lath �Stone Lath _Brick Framing Windows Fireplace:_Rough In V_Air Test _Final Retaining Wall Insulation Erosion Control Meter Size:__�_� Concrete Entrance Apran Finai C/O inspection: Schedule Fire Marshal to be present:✓Yes �_No Reviewed By:_�"1� , Building Inspector Reviewed By: , Planning COMMERCIAL FEES Base Fee �03 �Z� Water Quality Surcharge 2-'° ° Water Sampling Fee Plan Review 61•<! Water Supply 8�Storage(WAC) MCES SAC Storm Sewer Trunk City SAC Sewer Trunk S&W Permit&Surcharge Water Trunk Treatment Plant Street Lateral Treatment Plant(Irrigation) Street Park Dedication Water Lateral Trail Dedication Other: Water Quality TOTAL �7Z•3�' Page 2 of 3