3155 Coachman Rd Unit 375 Use BLUE or BLACK Ink
For Office Use
4/111'`
of City Eaaau Permit#: i'LI
Permit Fee: (,�.,,
3830 Pilot Knob Road
Eagan MN 55122 Date Received:
Phone: (651)675-5675 Staff:
buildinginspections(aicitvofeagan.com
2017 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 10-18-2017 Site Address: 3155 Coachman Rd
Tenant: Suite#: 375
Resident/Owner
Name: Joe & Lynda Decker Phone: 612-240-0401
Address/city/zip: 1201 105th St Inver Grove Heights MN 55077
Name: License#:
ConeAddress: City:
r
State: Zip: Phone:
Contact: Email:
New _Replacement XRepair —Rebuild _Modify Space —Work in R.O.W.
Type of Work —
Description of work:
RESIDENTIAL
Water Heater
Water Softener
Lawn IrrigationL�RPZ/ PVB)
Perms Tom Add Plumbing Fixtures L—Main/ _Lower Level)
Septic System
_New Water Turnaround
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 System Abandonment,Water Turnaround*(includes State Surcharge)
*Water Turnaround(add$280.00 if a 3/4"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.gooherstateonecall.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.citvofeaaan.com/subscribe.
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 which requires a review and approval of plans.
x x
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed Bye :
Required Inspections: �_-„Under round-'; =Roug I Test --,Gas Test til
Meter Related Items: Meter Site Radio Read Manometer Staff . .
-Jita
Use BLUE or BLACK Ink 1"
r
For Office Use I. tt cdati
411)01 P
ermit /q6//I& ti,61
City
el� ��� /d -b / -
3830 Pilot Knob Road ?,a-i_/7
Eagan MN 55122 Date Received: 0
Phone:(651)675-5675
buildinainspections(c citvofeaoan.com Staff:
J
2017 RESIDENTIAL BUILDING PERMIT APPLICATION
8-2,1-1 Date: .7 Site Address: J(5 l�Ghi1V\Q I) '\cad Unit#: 3 75
Name: ynd ek U U-E 1 i Phone: (Q/Z—Zio-c1c)1
Resident/Owner Address/City/Zip: 3(S-s— rc(od 1')i ari 2ct ..#"37s- 'T\ 5-37a/
Applicant is: Owner Contractor
. E3f Wt7i lc Descriptio of work: Usk, # (N\ — 91 i: I f 4 tc,t2 I +U i k ,✓ i' �l
y .A5t,ia l\ li5 A y �S
Construction Cost: U ndE- y oou Multi-Family Building:(Yes> /No )
Company:
Contact:
Address: City: '
Contractor ` "
State: Zip: Phone: Email:
License#: Lead Certificate#:
If the project is exempt from lead certification, please explain why:
1.,;-\
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
In the last 12 months,has the City of Eagan issued a permit for a similar plan based on a master plan?
Yes No If yes,date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer&Water Contractor: Phone:
Fire Suppression Contractor: Phone:
NOTE:Plans and supporting documents that you subs MO const to be public of lrtatian: mon of the
information maybe classified as no►n--pobtic `,you provide speak masons,that would the City to dude t rat the
are trade secrets
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on
the City's website at www.citvofeaean.com/subscribe.
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.
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.gooherstateonecall.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 work is not to start without a permit;that the work ;II be in
accordance with the approved plan in the case of wor/k,'wwhhich requires a review and approval of•lans. '
x i._ fido kay 0(eftve-
laPJ2))•&L j #1 '
Applicant's Printed Name Appli-= �- Signature
Page 1 of 3
DO NOT WRITE BELOW THIS LINE 1(Zd.W,6
SUB TYPES
Foundation — Fireplace — Porch(3-Season) _ Exterior Alteration(Single Family)
_ 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 ,o EX ,.-- Occupancy g•-l MCES System
Plan Review Code Edition n*i-X75 0 2C Units
(25%100% ) Zoning cZ. - City Water
Census Code Stories Booster Pump
#of Units Square Feet PRV
#of Buildings Length Fire Suppression Required
Type of Construction \ (3 Width
REQUIRED INSPECTIONS
Footings(New Building) Meter Size:
Footings(Deck) Final/C.O. Required
Footings(Addition) Final/No C.O.Required
Foundation Foundation Before Backfill jd HVAC_Gas Service Test Gas Line Air Test
Roof:_Ice&Water Final Pool:_Footings Air/Gas Tests _Final
Framing 30 Minutes 1 Hour Drain Tile
Fireplace:_^Rough In Air Test _Final Siding: Stucco Lath Stone Lath _Brick_EFIS
Insulation Windows
Sheathing Retaining Wall:4 Footings Backfill Final
14. Sheetrock Radon Control
Fire Walls Fire Suppression:_Rough In_Final
Braced Walls Erosion Control
Shower Pan �' / Other:
Reviewed By: / 'U i"' "i r /y, , Building Inspector
RESIDENTIAL FEES
Base Fee ri 71 i* (77 ti 0'1
Surcharge
Plan Review
MCES SAC
City SAC
Utility Connection Charge
S&W Permit&Surcharge
Treatment Plant
Copies
TOTAL
Page 2 of 3