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1345 Crestridge Lane Use BLUE or BLACK Ink � r----------------i I For Office Use � I Citof �� Il j Permit#: ��3a � I Y � � r� � � Permit Fee: (s7(�. �D I 3830 Pilot Knob Road � � Eagan MN 55122 i Date Received: �(�`��l S � I Phone: (651) 675-5675 � �� i � Staff: Fax: (651) 675-5694 �_________________I 2015 RESIDENTIAL PLUMBING PE MIT APPLICATION �� -� / Date: r D -r- (S Site Address: / /� �r�S� L- Tenant: Suite#: / �� ReSident�0an►nEr Name: �-P.��/ SC/�/''1 e� Phone: Address I City/Zip: `T p i Name: �+n e G� l U✓j'� � �,i! License#: > �Ofl#�C�Oi'. �� : Address: /�� D/1 ��', � �� City: 0'�B/� d�( �� State: /�✓v Zip: SSI�G,v Phone: (9�� - �SG� ��1 � ' ' Contact: Email: New Replacement _Repair _Rebuild �Modify Space Work in R.O.W. �7�Pe�+�1l�(�rk� — — � � — Description of work: �C/'�Vi/P G�h� 1'�C �S�t� aY7�� O��'G.,� f/ �/��c RESIDENTIAL �Water Heater `� � � � �� Water Softener Lawn Irrigation(_RPZ/_PVB) �� Add Plumbing Fixtures�Main/_Lower Level) Septic System New Water Tumaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(includes State Surcharge) $60.00 Lawn Irrigation(includes State Surcharge) $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment, Water Turnaround*(includes State Surcharge) "Water Turnaround(add$210.00 if a 5/8"meter is required) $115.00 Septic System New(includes County fee and State Surcharge) TOTAL FEES$ 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 w t to start without a permit; th t the work will be in accordance with the approved plan in the case of work which requires a review and appro I of plan . X �e �� °� ��., ,,y-�".. ApplicanYs Printed Name Ap cant's S�nature �OR�FFlCE USf Reviewed By: Date;i Required Inspections. Under Ground ` Rough-In Air Test Gas Test Finai ` Meter Related Items: Meter Size Radio Read i�lanorn�eter : S�aff: Use BLUE or BLACK Ink r----------------� I For Office Use � J C.� I Clt of�a a� ; Permit#: `�3� � Y � � �o.�� 3830 Pilot Knob Road � Permit Fee: Eagan MN 55122 � Date Received: ��'�-/-� � Phone: (651)675-5675 � I Fax: (651)675-5694 j Staff: /�'1�... I �-----------------� 2015 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commercial applications. Date: l v � �Site Address: / �L�� '�4�✓�u� � � � Tenant: Suite#: �3�� , � ��cr�� Phone: � ��' Name: ��,��l�l : I'��St#��t��iE��' �� ' �� ' � � ' Address/City/Zip: � � J i ' Name: G✓1 2 �` v m� ,"� License#: ' '�� = Address: � ✓L r�ti. / City: /' '� /C/ � G{�� C a : , �� State:�Zip: SSl.2O Phone: � �� ,G��('L�`c�2 G�� E ��` ��s ��;;� � Contact: Email: ` New Replacement Additional Altera ion Demolition i I Ty[��pf{t�tpt'� Description of work: �ei''`o% �no� ��hS�C�l a�� ;r �"�l� � � ��y` Nt�T��i'4un�;c�and g'raur�d mou�t�:d rn�chan�+�al equ��i��d to be s�� ed by Crt�� .' ��z � : :. . ,, .. :. �ad�..:P��:�e,;c�n#ac�,th�M�+�han��al Insp�ctc�r for ir��c►��.:� �_''��r��r��ri`g��la�ti��cl� �.�, � �b�. .;. RES/DENT/AL COMMERC/AL y �\_Furnace New Construction Interior Improvement T— ��,m��T�� —Air Conditioner Install Piping Processed �,a _Air Exchanger Gas Exterior HVAC Unit ;• � ' � _Heat Pump Under/Above ground Tank (_Install/_Remove) �� — �� , Other RES/DENTIAL FEES $60.00 Minimum Add or alteration to an existing unit, includes State Surcharge $100.00 Residential New, includes State Surcharge =$ TOTAL FEE COMMERCIAL FEES Contract Value$ x.01 $60.00 Permit Fee Minimum, includes State Surcharge $70.00 Underground tank installation/removal =$ Permit Fee "If contract value is GREATER than$2,010, Surcharge=Contract Value x$0.0005 -$ Surcharge" If the project valuation is over$1 million, please call for Surcharge =� TOTA�FEE 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-af' Eagan;that I understand this is not a permit, but only an application for a permit,and work is not to start without a per �;that the work will�eirr a'ccordance with the approved plan in the case of work which requires a review and approval of plans. , _ x V��e� x Applicant's Printed Name icant's Signa e �OR t3FF1��1�� .; ,_ 3 , ,�t��uire�l#m�pe��i�r� g � �� R�v��w�d B� t?�t�� -: tJnd�rg'rc�urrd �"��`�cau�h In ':''' Air:Tes# ` Gas Service"�es� ', !n-flc�€�r Fiea#.... '' �ir�al H�l��r��nirt� Use BLUE or BLACK fnk . • �� . . . . . . . r-^ -----"-------'�. � FOI f�ffiG@ US@ � ' � Permit#:�� l5 �%/' ' C�� Of ��.�� F �i : . � � � �� Permit�ee: �� I 3830 Pilot Knob Road ` F "i'�� Eagan MN 55122 � Date Received: -�� Phone: (651)675-5675 Fax:{651)675-5694 �� o �y�� I Staff: I ��1� �' ! ------- - .-.' 2a�� RES�DEhITIA� BU�La1NG �ERn��T �PPucA�r�on� Date: � '�"�' r�` S'ite Address: f��'"�`-3� � �� .- Ur�it#: '"'�'.,�. � � _ . tJarne;��?�� ^, ��., i� Phone: ��7 j ''�'j� ��t� R,esider�tf � � �VYt�et' AddresslCitylZip: ��,''�� '�.�_S'�°�i'`� �C� �tL.� �,/�'j� Applicant is: �wner �' Contractor � � � �� .._.�..d.,W.._.._..��,.....,.w .,.,.�...�..�..._�.�u.�,. ��... t�:s��"�- �S 1 , � „ C?escriptiQn afwork: ��`'� � �--�--��.�c�.. 4�d" �.a,,�'�l��a�� .'�-z�; t��.s�t�t ��1�'�Pnn � Type ofi itlla�t�k ��i�-�.°�.c�� -..t„�: �'�e�a�,..,� �'�.s�-- `� y� _;„, ; � Construction Gost: �� Multi-Family Buiiding: �Yes � J No ) ;: � �3 ;. Gompany:��"��..,.��.¢-- ��r.t� �""� �.. Contac#: �J��.�� '�`�t � �� .� "�� . � � � ' Address: � ��- ��c� City: ��.�� '-- CQ�tra�ctiir k � � State: Zip: ��j�� PTio�: �-��""'�-`""t,�� Email:��'�� ' � �.�� . R.� � � � � � �� `� License#: �� .S G�Z� � Lead Certificate# � ��-��"" t � �; �...,,�,.,..�,.�.�,._,..�._��,.�. „��..._��,,,�.nW�.�,�� ......._�.�.�,..,.,.Po...,�, m..�.... ...,a...� ,�.�.�.� If the project is exempt from lead certification, piease explain why; , � � � ' COMPLETE'THIS AREA ONLY tF C�NSTRUCTlNG A NEW BUILDlNG in the last 12 manths, has the City af Eagan issued a permit for a similar pian based an a master plan? Yes No If yes,date and address of master plan: � Licensed PlumbEr: Phone: � ' � Mechanicat Gontractor: Phane: � Sewer&Water Contractor: Phone: � ' Fire Suppression Contractor: Phone: � ' �fl��' P3��rti�`s�p�tc�rt�t�g alocurrrerzts th�t,�c�u,�ubfnl�a�e c�nsidered tsz be��i�r��t�t�w �rt�r�.n�af t�eu��ft�rr�'t�.`�€rr� �y��I��ifi�d a�nr�►��ti�l�c i�y�'l��r��:s�re��""��.��#vvou��aert�t�t'�e-,C��`' �� s: ' �t��c��(�+i�� "�„tr�(�e;�ecr�ets. =;:. �,__ � � � �. �.�. _ �. GALL BEFORE Yf�U DlG. Call Gopher State One Cail at(651}454-0002 for protection against underground utility damage. Call 48 hours befare you intend ta dig to receive locates of underground utilities. www.gopherstateonecail.orq I hereby acknowledge that this information is complete and accurate;tMat the wark wiil be in conformance with 4he ardinances and ccrdes of the City of Eagan; that � underStand this is not a permit, but only an appiicatipn far a permit, and work is not to start without a perrniY that the work will be in accordance with the approved plan in the ease vf work whieh requires a review and approval of plans. Exterior work authorized by a buiiding perrnit issued in a�cvrdance with the Minnesota State Bwilding Code must;be compteted within 18Q days a#permit issuance. x h� ��"'�,�� i� j " ; � �.� � • x Applicant's Printed'Name Appiicant's Signature Page 1 of 3 ��•�j ��-�Z� � ��t DO NOT WRITE BELOW THIS LINE � 3�� SUB TYPES Foundation Fireplace Porch(3-Season) Exterior Alteration(Single Family) X,Single Family _ Garage _ Porch(4-Season) _ Exterior Alteration(Multi) �.Multi _ Deck _ Porch(Screen/Gazebo/Pergola) _ Miscellaneous 01 of_Plex Lower Level Pool Accessory Building WORK TYPES _ New _ Interior Improvement _ Siding _ Demolish Building* _ Addition _ Move Building _ Reroof _ Demolish Interior _ Alteration _ Fire Repair _ Windows _ Demolish Foundation _ Replace _ Repair _ Egress Window �Water Damage _ Retaining Wall *Demolition of entire building-give PCA handout to applicant DESCRIPTION Valuation ,�� Occupancy ��' MCES System Plan Review Code Edition �� -� �' SAC Units (25%_100%�) Zoning __�� City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction Width REQUIRED INSPECTIONS Footings (New Building) Meter Size: Footings (Deck) Final/C.O. Required Footings (Addition) � Final/No C.O. Required Foundation HVAC Gas Service Test Gas Line Air Test Roof: _Ice &Water _Final Pool: _Footings Air/Gas Tests _Final � Framing Drain Tile Fireplace:_Rough In Air Test _Final Siding: _Stucco Lath _Stone Lath _Brick � Insulation Windows Sheathing Retaining Wall:_Footings_Backfill_Final Sheetrock Radon Control Fire Walls Fire Suppression:_Rough In_Final Braced Walls Erosion Control � Other: Reviewed By:_ �1 , �" , Building Inspector RESIDENTIAL FEES � Base Fee �� j��t�`� Surcharge V`� ��;�j Plan Review � �� MCES SAC City SAC � Utility Connection Charge �� S8�W Permit 8�Surcharge Treatment Plant � Copies TOTAL Page 2 of 3