EA190034 - Sewer & Water - Commercial - Issued Date 04/09/2024 PERMIT
City of Eagan Permit Type: Sewer& Water
3830 Pilot Knob Rd Permit Number: EA190034
Eagan, MN 55122 EAGAN
(65 1)675-5675
www.cityofeagan.com * E R 1 9 0 0 3 4
Date Issued: 4/9/2024
Site Address: 4355 Nicols Rd
Lot: 3 Block: 1 Addition: Cedar Ridge 1 st
PID:10-16820-01-030 111111111111
Use: Wood Park Dental * 1 0 — 1 6 8 2 0 — 0 1 — 0 3 0
Description:
Sub Type: Commercial
Work Type: Sewer Only
Description: Repair
Meter Size Meter Dpe 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(65 1)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:
A Z Underground Tle Investments LLC
5718 International Pkwy 4355 Nicols Rd
Brooklyn Park MN 55428 Eagan MN 55122
(612)238-9701
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
o e For Office Use (� 2 4 1
Permit#:
EAGAN
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Permit Fee:1 ' I
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Date Received:
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2024 SANITARY SEWER & WATER PERMIT
Date: 4/2/2024 Site Address: 4355 Nicols Rd, Eagan, MN 55122
TLE Investments LLC
Property Name: Phone:
Owner Address/City/Zip: 4355 Nicols Rd, Eagan, MN 55122
Name: Grant Acquisitions LLC DBA A-Z Undergro License#: PC772192
Contractor
Address/City/Zip: 5718 International Parkway, New Hope, MN 55428
Phone: 612-413-6958 Email: service@a-zunderground.com
Pipelayer Training Certification#: or Master Plumber License#: PC772192
Property Use: Type of Service: Type of Work:
❑ Residential ❑ Sanitary Sewer&Water ❑ New ,
Commercial Sanitary Only Repair, Description:Sewer Replacing 30' of pipe
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❑ 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.
x Daniel Gamayunov X aa4-e-w ZA`
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE ONLY
Fees: Required Inspections: Sanitary Sewer Only
Sanitary Sewer Permit($80:00) Sanitary Sewer Air Test
Water Permit($80.00) Mandrel Test
S&W Repair/Disconnect($80.00) Sanitary Lines Televised
Sanitary Sewer lateral Verify Meter Configuration
Sanitary Sewer trunk Water Only
Water supply&storage Conductivity Test
Water lateral Hydrostatic Test
Water trunk Bacteria Test
City SAC($142.50/SAC unit) Stand Pipe Inspection
Met Council SAC($2,485/SAC unit) Wet Tap
Treatment Plant($1,154.70/SAC unit)
State Surcharge $1.00 Additional Requirements:
Total: City R-O-W Permit
County R-O-W Permit
Plumbing Permit
PRV Required
3830 PILOT KNOB ROAD I EAGAN, MN 55122
(651)675-5675 1 FAX: (651)675-5694 buildinginspections cDcityofeagan.com
If you have a hearing or speech disability, contact us through your preferred telecommunications relay service.