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EA188010 - Sewer & Water - Commercial - Issued Date 11/13/2023
PERMIT City of Eagan ® , , , Permit Type: Sewer& Water 3830 Pilot Knob Rd E AGAN Permit Number: EA188010 Eagan, MN 55122 (651)675-5675 . 1111111111111 IN 11111111111111111111111111111111� www.cityofeagan.com * E R 1 8 8 0 1 0 Date Issued: 11/13/2023 Site Address: 1800 Yankee Doodle Rd Lot: 1 Block: 1 Addition: BCBSM West PID:10-13350-01-010 11111111111111111111 IN 11111111111111111111111111 Use: Blue Cross Blue Shield * 1 0 — 1 3 3 5 0 — 0 1 - 0 1 0 Description: Sub Type: Commercial Work Type: Sewer Only Description: Repair Meter Size Meter Tyne Manufacturer Serial Number Remote Number Line Size Comments: Please call Utilities at(651)675-5200 for water turn ons, shut offs and meters. Please call Engineering at(651)675-5646 to schedule inspections. Fee Summary: Surcharge-Fixed $1.00 9001.2195 SW-Sewer Permit Fee $80.00 6201.4532 Total: $81.00 Contractor: - Applicant - Owner: Valley Rich Bcbsm Inc 147 Jonathan Blvd N 44 1800 Yankee Doodle Rd Chaska MN 55318 Eagan MN 55121 (952)448-3002 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 Issued By: Signature lY-h -----e---------, I For Office Use Q I e ® • I Permit#: 16 OLD o i I r-- I EAGAN I Permit Fee: I I Date Received: I I I I Staff: I i————————————————— 2023 SANITARY SEWER & WATER PERMIT Date: 11/10/23 Site Address: 1800 Yankee Doodle Road Blue Cross Blue Shield 612-418-0160 Pro a Name: Phone: }3 ftY . owner 3400 Yankee Drive Address/City/Zip: Name: Valley-Rich Co., Inc. License#: PC643697 Contr6ctar Address/city/zip: 147 N Jonathan Blvd, Chaska MN 55318 Phone: 952-448-3002 Email: matt@valleyrich.com .•f cz, y VZ4 dL Pipelayer Training Certification#: or Master Plumber License#: Property Use: Type of Service: Type of Work: ❑ Residential ❑ Sanitary Sewer&Water ❑ New Repair of sanitary sewer that has belly 0 Commercial 0 Sanitary Sewer Only 0 Repair, Description: ❑ Public Facility ❑ Water Only ❑ Disconnect ❑ I understand that new water connections require a separate Plumbing Permit and associated meter fees. 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. -.^Dkjllally slgnetl by Mail Miklya xMatt Miklya x Matt M i k I ya©9t@ 2023.11.10.,Inc.',CN=ftMiklya Applicant's Printed Name Applicant's Signature FOR ME;USEbNLzY Fees: Required Inepections SahitarySewer Only SanitarySewer Permif($80:tl0) l Sanitary Sewer Air Test t Water Perrrtit-($80:00) Mandrel Test, 'S&WRepair/Disconnect($86�0) � Sanitary Lipes Telev�s'ed ;Sariitary� ew rlaterel Uenfy;MeterConfigu�tatibnAr Sanitary Sewer trunk VVaterOnly j Water sdpp�Y storage Gonduct�uity Water[titer Hydrottatic�Tes, ; Water trunk Ir - Baetena1 e at � b ctty`§Ac($f 3 QOJSAO unit) Stand Pipd Inspection Mit CouncEl SAS 46 5/vP, n( , Wet Tap Rz Treafrtent�Plant($1i l26 QO/SAC unit) �' ' 1 .: State tlrnharga � Addttlonal11equirement$ ` �� o#al 7 Gityl FCS 0�W Permit ,1 'WR U �N, r F � �.OuAt) R-0 'Pelfnllt ` Plumbing Pi e,mtb ,. PRV.�Required 3830 PILOT KNOB ROAD I EAGAN, MN 55122 (651)675-5675 I FAX: (651)675-5694 buildinginsaections@cityofeaaan.com If you have a hearing or speech disability,contact us through your preferred telecommunications relay service.