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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�� CD 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 #: `l (_ C\ (1.--,� City: �. --r-A Address: 0 C.:,`-\ tee: v-.., _ 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 ) t � ontr, ° 07 w.. \ JC 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