EA183184 - Plumbing - Fixtures - Issued Date 06/01/2023 PERMIT
City of Eagan ® ® Permit Type: Plumbing
3830 Pilot Knob Rd ®®®® ® ® ®®®® Permit Number: EA183184
Eagan, MN 55122 EAGAN
(651)675-5675 111111111111 IN 11111111111111111111111111111111
www.cityofeagan.com * E A 1 8 3 1 8 4 *
Date Issued: 6/1/2023
Site Address: 4676 Cambridge Dr
Lot: 8 Block: 5 Addition: Beacon Hill
PID:10-13500-05-080 11111111111111111111111111111111111111111111111111111111111111111111111 11M
Use: * 1 0 — 1 3 5 0 0 — 0 5 — 0 8 0
Description:
Sub Type: Fixtures
Work Type: Replace
Description: Direct replacement of existing shower wet space,
wall surround,and plumbing fixtures.
Meter Size Meter Tyne Manufacturer Serial Number Remote Number Line Size
Comments:
Fee Summary: PL-Plumbing Permit Fee $64.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
Total: $65.00
Contractor: - Applicant - Owner:
Minnesota Rusco Mark&Karen Taverna
5010 Hwy 169N 4676 Cambridge Dr
Brooklyn Park MN 55428 Saint Paul MN 55122--278
(952)935-9669
This permit shall be null and void if work does not start within 180 days of issuance, or if work is suspended for 180 days or more after
started.
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature ssued B : Signature
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ECE® ® ® ® ® ® I : r For Office Use
PAm
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Permit... 183184 I
EAUAN
Permit Fee: I
6y: I
Date Received: 5/26/23
3830 PILOT KNOB ROAD i EAGAN, MN 55122-1810 I I
(651)675-5675 i FAX: (651)675-5694 Staff:
buildinginspectionsOcityofeagan.com —————————————————J
RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 5/26/23 Site Address: 4676 Cambridge Dr Eagan, MN 55122 Unit#:
Applicant is: ❑ Owner 0 Contractor
Name: Karen Taverna
Homeowner Address: 4676 Cambridge Dr Cit,: Eagan
State: MN Zip. 55122 phone: 651-452-323C Email: tavbball@COmcast.net
01
Type of Work —New Replacement —Repair —Rebuild —Modify Space —Work in R.O.W.
Description of work: Direct replacement of existing shower wet space,wall surround,and plumbing fixtures.
Tankless Water Heater
Standard Water HeaterLawn Irrigation (—RPZ/ PVB)
V( Add Plumbing Fixtures(—Main/ Lower Level)
DesCrlptlOn Water Softener
Septic System Description: replace bathtub, sink
Connection to City Water from Well
New Abandonment
Company: MN Rusco contact: Kelli Gugisberg
Plumbing Address: 5010 Hwy 169 N City: New Hope
Contractor' MN 55122 952-935-966
State: Zip: Phone: Email: I(elll@mIM2SOtaruSCO.COm
PC805612 12/31/23
License#: Expiration Date:
RESIDENTIAL FEES
$150.00 New Residential or Connection to City Water(includes State Surcharge)
$65.00 Water Heater,Water Softener, or Water Heater and Softener(includes State Surcharge)
$65.00 Lawn Irrigation(includes State Surcharge)
$65.00 New fixtures,adding,altering,or removing piping (includes State Surcharge)
$65.00 Septic System Abandonment(includes State Surcharge)
TOTAL FEES$
CALL BEFORE YOU DIG. Contact Gopher State One Call at(651)454-0002 or www.aopherstateonecall.orp for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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 Kelli Gugisberg X ,fid& 04e4&e
Applicant's Printed Name Applicant's Si at e
FOR OFFICE USE°
Reviewed ey: Date,
Meter Slze(if applicable):
Required Inspections: Under Ground Rou,gh-In Air Test Manometer
Final