1700 Four Oaks Rd - Unit 331411,11
C!tyofEagali
Date:
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Tenant:
Use BLUE or BLACK Ink
For Office Use /II��
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Permit#: ,Le
Permit Fee: r!
Date Received:
Staff:
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
4., Site Address: 0
7\2, c) SS- \-\\
Suite#: T3\
ReSll e;
Name: \< S C a S -�� . Phone:
Address / City / Zip:
Con e C
Name: ,.....,-.-s- -_,----.--\ - License #:
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(1.--,� City: �. --r-A
Address: 0 C.:,`-\ tee: v-..,
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State: \---A. \----1 Zi ��� i�� Phone: C �-" ‘ ` 3--3C 'S
Contact: -,-+--) (-7---C Email:
V
New Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work: \ J� /(SC.'—y�
i
VJ 4\ .' '- C "� '"e
# Y
RESIDENTIAL \S-,` \- -----,
Water Heater
\`� ,,,_\— _-- \
-�----• c
Water Softener
Lawn Irrigation (— RPZ / PVB)
Add Plumbing Fixtures ( Main / Lower Level)
—
Septic System
—
Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,
$60.00 Lawn Irrigation
$60.00 Add Plumbing
*Water Turnaround
$115.00 Septic System
Water Softener, or Water Heater and Softener
(includes State Surcharge)
Turnaround* (includes State Surcharge)
TOTAL FEES $
(includes State Surcharge)
Fixtures, Septic System Abandonment, Water
(add $280.00 if a 3/4" meter is required)
New (includes County fee and State Surcharge)
CALL BEFORE YOU DIG. CaII 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; tha nderstand 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 approved.plan in the case of work which requires a review and approvaLa plans.
x
Applicant's Printed"Name
x
Applicant's Signature
City of Eaaau
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651)675-5694 Y 1 3 2016
Go Mclgc l'
2016 RESIDENT AL BUILDING
Date: /6' Site Address:
r
Use BLUE or BLACK Ink
For Office Use
Permit #:�
/L/
Date Received:r
JEW
Permit Fee:
Staff:
PERMIT APPLICATION
4`165 fr, Z I# 33 /
,ii
Name: - 55 41,W5 — 4-1 Phone: :C1 5:78; cFaRS"
Address / City / Zip:Uc J �� C
Applicant is: X. Owner Contractor 6 p. ` M 0/9-tc. Cel)(6...0
y x:
Description of work: i 4/C 6 6,4:5„-... or -c() G'( W l i c -
Construction Cost: Qq 0 0 Multi -Family Building: (Yes YN, / No )
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ontr, ° 07
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Company: '91.1.,•-.4-0i.,•-. C-I/1jt €_ I.C,-?w c&v1 1-1C--Contact:,)DIA.-vL e „9____
Address:/0 B'
Y- Gt-14-*at .. City: 1.0, 51 *-(,
State:in/it/Zip: l' Phone: 6402 f7`'/6gmail: '?%�.5c tcR(9!./ryt-c.)1a.c0 1-11..
License #: a 5 �pZ 3 —72,,Lead Certificate #:A 1a41 4
If the project is exempt from lead certification, please explain why: "'—/-4 `a -if 7
r,1/4,2e..
In the last 12 months,
Yes No
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
If yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Fire Suppression Contractor:
Phone:
Phone:
Phone:
Phone:
1110 lani# supporting d - rn its
theinformation ay be ciao cif d a non a ®lic if a ern %at wou i pew #oto
cora hat,1a
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 errd 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.
Applicant's Printed Name
x
Applicaiff s Signature
Page 1 of 3
. 17co
lis&.„/
DO NOT WRITE BELOW THIS LINE
/
SUB TYPES
Foundation
Commercial / Industrial
V Apartments
Miscellaneous
WORK TYPES
New
Addition
Alteration
Replace
Salon Owner Change
Public Facility
Accessory Building
Greenhouse / Tent
Antennae
✓ Interior Improvement
_ Exterior Improvement
Repair
Water Damage
DESCRIPTION
Valuation 7409.64) Occupancy
Plan Review ✓ Code Edition
(25% 100% V) Zoning
Census Code Stories
# of Units 1 Square Feet
# of Buildings 1 Length
Type of Construction V t Width
REQUIRED INSPECTIONS
Footings (New Building)
Footings (Deck)
Footings (Addition)
Foundation
Drain Tile
_ Roof: _Decking Insulation _Ice & Water Final
/% Framing 30 Minutes 1 Hour
Fireplace: Rough In _Air Test Final
Insulation
Meter Size:
Exterior Alteration -Apartments
Exterior Alteration -Commercial
Exterior Alteration -Public Facility
Siding
Reroof
Windows
Fire Repair
Demolish Building*
Demolish Interior
Demolish Foundation
Retaining Wall
*Demolition of entire building - give PCA handout to applicant
11 2- MCES System A/A-
20 !s /tf BG
SAC Units
City Water
Booster Pump
PRV
Fire Sprinklers
Sheetrock
Final / C.O. Required
r/ Final / No C.O. Required
Other:
Pool: _Footings Air/Gas Tests _Final
Siding: _Stucco Lath _Stone Lath Brick
Windows
Retaining Wall
Erosion Control
Concrete Entrance Apron
Final CIO Inspection: Schedule Fire Marshal to be present: Yes ✓ No
Reviewed By: 014-14' , Building Inspector
Reviewed By: , Planning
COMMERCIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC
City SAC
S&W Permit & Surcharge
Treatment Plant
Treatment Plant (Irrigation)
Park Dedication
Trail Dedication
Water Quality
88, S6
1 . So
57. S3
Storm Sewer Trunk
Sewer Trunk
Water Trunk
Street Lateral
Street
Water Lateral
Other:
TOTAL: g / 1/7* $3
Page 2 of 3