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1794 Bluestone Dr E PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA085204 Eagan, MN 55122 . Date Issued: 08/12/2008 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 1794 Bluestone Dr E Lot: 6 Block: 9 Addition: Cedar Grove 7th PID 10-16706-060-09 Use Description: Sub Type: e-Reroof & Windows/Doors Construction Type: Work Type: Reroof & Windows/doors Description: House & Garage Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, you must meet inspector with ladder and flat bar. Pictures are not acceptable in lieu of inspections. Windows/Doors: If altering the opening size, a framing inspection is required. Smoke detectors are required in all sleeping rooms prior to final inspection. When wall studs or ceiling joists are exposed, Fee Summary: BL - Base Fee $6K $132.75 0801.4085 Surcharge - Based on Valuation $6K $3.00 9001.2195 Valuation: 6,000.00 Total: $135.75 Contractor: -Applicant - Owner: Schmidt Roofing Richard L Reynolds 13401 County Road 5 1794 Bluestone Dr E Burnsville MN 55337 Eagan MN 55122 (952) 888-4889 I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Applicant/Permitee: Signature Issued By: Signature Parcel Files Cover Sheet Unique ID: 1854 1794 Bluestone Dr E 101670606009 CITY OF EAGAN Remarks Addition 7 Lot 6 Rik 9 Parcel -CEW 9=31 11 16600 060 09 Owner r i a. Street 1794 E., Bluestone Drive State FAMe M 55122 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, p STREET RESTOR. GRADING SAN SEW TRUNK 1970 58.18 2.08 28' Pai$ *SEWER LATERAL 1971 2 WATERMAIN ~a WATER LATERAL 8 p 1971 1,615.00 80.75 20 Paid WATER AREA STORM SEW TRK 131 1971 20 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 230.00 1769 10-6-69 BUILDING PER. SAC 200.00 1769 _ PARK 5 0 Request Date Fire No. Rough-in Inspection NOTICE: You Must Call Electrical Inspector ®q, / Required? is A Rough-In Inspection (~y ❑ Yes o Is Required. I *censed contractor ❑ owner hereby request inspection of above electrical work at: Job Address (Street, Box or Route No.) City Section No. Township Name or No. Range No. Coun Occupa INT) Phone No. Power Supplier Address Electrical Contractor (Company Name) Contrja I License No. lSo~t Flee Mailing Address (Contractor or Owner Making Installation) Authorized Signal. nt ac ing Installation) Phone Nu ber y 6 L~ MINNESO TATE BOARD OF ELECTRICITY - THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. - Room 5-173 BE ACCEPTED BY THE STATE BOARD 1821 University Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 642-0800 _ ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION E 7 7 ~ See instructions for completing this form on back of yellow copy. } s`$ qq n I"S '-I 5 0 "X4 Below'Work Covered by This Request emu, New New A~)ome Type of Building Appliances Wired Equipment Wired Range Temporary Service Duplex Water Heater Electric Heating Apt. Building Dryer Load Management Comm./Industrial Furnace Other (Specify) Farm Air Conditioner Other (specify) Contractors Remarks: Compute Inspection Fee Below: AlCc # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 Amps Above 100 Amps Signs Inspector's Use Only: TOTAL Irrigation Booms Special Inspection Alarm/Communication THIS INSTALLATION MA BE O RED DISCONNECTED IF NOT Other Fee COMPLETED WITHIN 18 S. I, the Electrical Inspector, hereby Rough-in r Date certify that the above inspection has Final r Date tl { been made. OFFICE USE ONLY This request void 18 months from EAGAN TOWNSHIP BUILDING PERMIT N°• 2125 Owner IJS '-~7'... ht' ~ ....D_.._ ~ Eagan Township Address (present) ._1..3.3.....~~ if Town Hall Builder l--~--~- Date Address DESCRIPTION Stories To Be Used For Front Depth Height Est. Cost Permit Fee Remarks LOCATION Street, Road or other Description of Location II Lot Block Addition or Tract 7 . This permit does not authorize the use of streets, roads, alleys or ( sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEP ON THE PREMISE WHILE THE WORK IS IN PROGRES . This is to certify, that 0--------------- _..,_._._..has permission to erect a-..L......_'. - the above described premise subject to the provisions of the Building Ordinance for Eagan ownship adopted opted April upon ' 11, on 1955. `r'- Per ~ ?Ch81lMan of Town Roag Building Inspector EAGAN TOWNSHIP BUILDING PERMIT N° 2188 Owner -----41A--' Eagan Township Address (present) ..7. Town Hall Builder Date z:I/X y/fir ` - 7 Address DESCRIPTION Stories To Be Used For -Front Depth Height Est. Cost 'Permit Fee Remarks v LOCATION Street, Road or other Description of Location I Lot Block Addition or Tract 6 19 7 This permit does not authorize the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and general welfare to anyone in the community. THIS PERMIT MUST BE KEPT ON THE PREMISE WHILE THE WORK IS IN PROGRESS.- This is to certify, 3haL... .................................has permission to erect a, ...`:.`...:"`:~'"~._.._upon the above described premise subject 3 the provisions of the Building Ordinance f Ea~E agan ownship adopted April 11, 1955. Per i L ChaixmSn of Tnwn Board Building Inspector v?~~ r~;~ j \ ` 2004 RESIDENTIAL BUILDING PERMIT APPLICATION - City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 - - - - - - -Telephone #-.651-675-5675-----,--FAX-#- 651-67-5-5694---- New - - - - New Construction Reguirements 3 registered site surveys showing sq. ft. of lot, sq. ft of house; and all roofed areas 2 opieslofplanr Requirements J (20% maximum lot overage allowed) 1 set of Energy Calculations for heated additions T N 3 i c 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site surve for additions & decks 1 set of Energy Calculations Y F r 4;; 3 copies of Tree Preservation Plan if lot platted after 711/93 Addition'.- indicate if on-site septic system - - Rim Joist Detail Options selection sheet (bldgs with 3 or less units Date L4 r., Construction Cost _ n Site Address x-11 Unit/Ste # Description of Work (-L.~ Multi-Family Bldg - y N Fireplace(s) _ 0 - 1 - 2 Property Owner 1' { Telephone #M1) "l &<7-)0-3 Renewal By Andersen Contractor 1920 County Rd. "C" West Address Roseville, MN 55113 City State 651-264-4777 License # 20130983 Telephone # ( ) COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING 7Enrgy Code Category _ Minnesota Rules 7670 Category 1. _ Minnesota Rules 7672 (4 submission type) • Residential ventilation Category 1 Worksheet Submitted New Energy Coda Worksheet Submitted Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y N If so, 25% plan review fee applies. Licensed Plumber Telephone # ( T Mechanical Contractor - Telephone # ~ Sew er/Water Contractor Telephone I hereby apply, for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; 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. Applicant's Printed Name Ap 4anVs ignatur e tr OFFICE USE ONLY Sub Types 01- Foundation------ ❑-07-05-pfex---❑ -13--16=pfex-- - - ❑.---20--Pool- 30--Accessory Bldg - ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.) ❑ . 31 Ext. Aft - Multi ❑ - 03 01 of plea' ❑ 09 07-pfex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ ` 33 Ext. Alt - SF ❑ 04. 02-plex ❑ 10 08-pfex Cl 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ ` 05 03-plex 0 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-pfex ❑ 12 12-pfex ` Plbg_Y or _ N ❑ 25 Miscellaneous Work Types i ❑ 31. New ❑ 35 Int Improvement ❑ 38 Demolish Interior " ❑ 44~ Siding ❑ 32 Addition ❑ 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair ❑ 33. Alteration ❑ 37 Demolish Building* 43 Reroof .0 46 Windows/Doors ❑ 34 Replacement "Demolition (Entire Bldg) - Give PCA handout to applicant Valuation Occupancy MCES System Census Code Zoning City Water SAC Units Stories Booster Pump # of Units Sq. Ft. PRV # of Bldgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. - Footings (deck) _ Final/No C.O. Footings (addition) _ Plumbing; _ Foundation _ HVAC _ Drain Tile Other Roof Ice & Water, Final _ Pool Ftgs Air/Gas Tests Final Framing _ Siding - Stucco Stone - Brick Fireplace _ R.I. Air Test -Final _ Windows Insulation Retaining Wall "Approved By: , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge 'Treatment Plant License Search Copies Other Total I v..vJ Vdi .L V'il .LllV 4A-YV L'ttd. too 011 n K~d~My~e ` ~Z~~ +~i~L II13J,d dad--altid/ddldJ67y[ p~W OU re .l '7, ZOOI Tune City offiagan 3836 Pilot Knob Road Egan, MN 55122 To Whom u May Concern: Elder Jones is authorised to p~ buiIdin Elder Jones is g petits for Renewa3 by Atcdarsan_ Please allow provide this servitce for us in EaM. 17jigs autharizatic~n is valid for any date beyond 6/6101; until a ~onewal by Andemn merger ~y ne vakes it in wilft to the aty_ g I request this autlio~W-on be a our building pcnmits any further. case can me If them am mYdelay in Qnon 1* s..1*can ~a b essivg of coutacted at 763502-47ob.a Your immgdiatc attention to ft matter is a eciated. - Sinoaialy, .j F v Vnd 2, vstion Manager Renewal by Andcrsen Corporation t'n: 'K -PI d Tnne~ k~ ~H D7AL Mt h Received Time Jug. 1:07PM RESIDENTIAL J ( IN BUILDING PERMIT APPLICATION CITY OF EAGAN j G c 3830 PILOT KNOB RD, EAGAN MN 55122 ~p -V 1~ 'CJ 651-681-4675 New Contraction Reaulremena RemodetlReoelr Reaulrements • 3 registered site surveys showing sq. ft. of lot, sq. It. of house; and all roofed areas • 2 copies of plan (20% maximum lot coverage allowed) . 1 set of Energy Calculations for heated additions • 2 copies of plan showing beam & window sizes; poured found design, etc.) • 1 site survey for exterior additions & decks 1 set of Energy Calculations . Indicate if home served by septic system for additions • 3 copies of Tree Preservation Plan I lot platted after 7/1/93 • Rim Joist Detail Options selection sheet (bilge with 3 or less units) DATE Da VALUATION ~ SITE ADDRESS C • atu-e-sD n ' MULTI-FAMILY BLDG Y ~TI TYPE OF WORK R4 S-4 r n q FIREPLACE(S) 0 1 2 APPLICANT Q ►r - STREET ADDRESS 122417 c ~4 y e S CITYB(c'r5tlt' a STATEeW&) 1I 5s"" 3 3 7 TELEPHONE # ;ELL PHONE # FAX # 0 EW 20 E_- 99 44 PROPERTY OWNER ~~c ~c rro ~crL s TELEPHONE # C~~ fSY -3b3 ------------------------------------------s--------------.----------- COMPLETE THIS SECTION FOR ,-MW-- RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 _ MINNESOTA RULES 7672 (d submission type) . Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Contractor: Phone Plumbing system includes: _ Water Softener _ Lawn Sprinkler iWater Heater No. of R.I. Baths No. of Baths Mechanical Contractor: Phone # Mechanical system includes: Air Conditioning Heat Recovery System Sewer/Water Contractor. Phone I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of AppllcantwLl V"~ OFFICE USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received Not Required Updated 4102 OFFICE USE ONLY „ ❑ 01 Foundation ❑ 07 05-plex ❑ 13 16-plex ❑ 20 Pool ❑ 30 Accessory Bldg ❑ 02 SF Dwelling ❑ 08 06-plex ❑ 16 Fireplace ❑ 21 Porch (3-sea.)` ❑ 31 East. Alt - Mufti ❑ 03 01 of _ plex ❑ 09 07-plex 0 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF 13 04 02-plex ❑ 10 08-piex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Multi ❑ 05 03-plex O 11 10-plex C3 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Pibg_Y or _ N ❑ 25 Miscellaneous ❑ 31 New ❑ 35 Int Improvement O 38 Demolish (Interior) ❑ 44 - Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldgr ❑ -43 Reroof ❑ 46 Windows/Doors ❑ 34 Replacement *Demolition (Entire Bldg only) - Give PCA handout to applicant Valuation Occupancy MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bidgs Length Fire Sprinklered Type of Const Width REQUIRED INSPECTIONS - Footings (new bldg) Final/C.O. Footings (deck) _ Final/No C.O. - Footings (addition) - Plumbing Foundation _ HVAC Drain Tile Other Roof Ice & Water Final Pool Ftgs - Air/Gas Tests Final Framing _ Siding Stucco Stone Fireplace _ R.I. Air Test Final _ Windows (new/replacement) Insulation _ Retaining Wall Approved By , Building Inspector Base Fee Surcharge Plan Review MC/ES SAG City SAC Water Supply & Storage S&W Permit & Surcharge Treatment Plant Plumbing Permit Mechanical Permit License Search Copies Other Total EAGAN TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR SEWER SERVICE CONNECTION DATE Seotember 30, 1969 NUMBER 491 OWNER: Cedar Grove Const. Co. Address 1794 E. Bluestone Drive 6-9-7 PLUMBER Stein, Inc. TYPE OF PIPE Cast Iron DESCRIPTION OF BUILDING Industrial Commercial Residential Multiple Dwelling No. of units xx Location of Connections: Connection Charge 200.00 pd 10/$/69 Permit Fee 7_So PH jn4169 Street Repairs Total Inspected by: Date Remarks: By Chief Inspector i In consideration of the issue and delivery to me of the above permit, I hereby agree to do the proposed work in accordance with the rules and regulations of Eagan Township, Dakota County, innesota By Please notify when ready for inspection and connection and before any portion of the work is covered. EAGAN TOWNSHIP 3795 Pilot Knob Road St. Paul, Minnesota 55111 Telephone 454-5242 PERMIT FOR WATER SERVICE CONNECTION Date: / September 30, 1969 Number: Billing Name: Cedar Grove Const. Co. Site Address: 1794 E. Bluestone Drive 6-9-7 Owner: Cedar Grove Const. Co. Billing Address 7343 Concord Blvd. E. Plumber: Stein, Inc. i Location of Connection Meter Size Connection Chg.Q0.00 pd 10/8/69 Meter No. Permit Fee 7.50 Pd 10/8/69 Meter Reading Meter Dep. Meter Sealed: Yes Add'1 Chg. NO Total Chg. Inspected by Date Building is a: Remarks: Residence xx Multiple No. Units Commercial Industrial By: Other Chief Inspector In consideration of the issue and delivery to me of the above permit, I hereby agree to do tte proposed work in accordance with the rules and regulations of Eagan Township, Dakota County innesota. By. Please notify the above office when ready for inspection and connection. 2010-05-0710:19 » 651975 5694 P 212 ivV Use or BLACK ink nj For Office Use I Permit N: 5 S City of Ea Permit Fee t 3630 Pilot Knob Road I I Eagan MN 55122 1 Date Received. S- I Phone: (651) 675-5675 I Stall: Fax: (651) 675-5694 I 2010 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: ti? Site Address, ~ Jl ltd >~~1t? lJ Tenant: Suits M. RESIDENT / OWNER Name: j~ 1l l k K'14yl [ Phone: LL _I ~`~'~-f •'~t=? Address I City I Zip: C..t_s (Cy]c. CONTRACTOR Name: -J.O-x. ~ ~ ~ LL&y► j~ t \ License _ Ao S . Address-.41;- ddress' ca Leke.. MIt k'~:[City: J. Y.Aejtj ~ State: (VI IN Zip: Phone: t 1 r Lcf L~' C Contact: ^ ~~~•4T 11 Email TYPE OF WORK ~ New _ Replacement _Repair ^ Rebuild „ Modify Space _ Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Imigation Add Plumbing Fixtures RPZ I PVB) Main _ Lower Level) Septic System _ Water Turnaround New Abandonment RESIDENTIAL FEES: $50.50 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $.50 State Surcharge) $30.50 Lawn irrigation (includes $.50 State Surcharge) $50.50 Add Plumbing Fixtures. Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge) 'Water Turnaround (add $166.00 if a 518" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $80.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 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. I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the orpinances and codes of the City of Eagan; that I unoerstand 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 acmMance with the approved plan in the case of work which requires a review and approval of plans. / i` Applicant's Printed Name Apptic s Sig ture FOR OFFICE USE Reviewed By: Date; Required Inspections: Under Ground _Rough-In -Air Test -Gas Test -Final PERMIT City of Eagan Permit Type: Mechanical Permit Number: EA105280 Date Issued: 0710612012 itj of 0n Permit Category: ePermit R Site Address: 1794 Bluestone Dr E Lot: 6 Block: 9 Addition: Cedar Grove 7th PID: 10-16706-09-060 Use: Description: Sub Type: e - Furnace & Air Conditioner Work Type: New Description: Furnace & Air Conditioner Comments: Questions regarding electrical permit requirements should be directed to Mark Anderson, State Electrical Inspector, (952) 445-2840 Fee Summary: ME - Permit Fee (Replacements) $55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 Total: $60.00 Contractor: - Applicant - Owner: Home Energy Center Richard L Reynolds 2415 Annapolis Lane N #170 1794 Bluestone Dr E Plymouth MN 55441 Eagan MN 55122 (651) 766-6763 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 Use BLUE or BLACK Ink r---- I For Office Use Permit#: inan City of EaRd I as Permit Fee: 3830 Pilot Knob Road ~f ? I Eagan MN 55122 I Date Received: > I Phone: (651) 675-5675 I /lra I Fax: (651) 675-5694 i Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION l Date: Site Address: Unit Name: et ~Y1GCJ Phone: Resident/ Owner Address/City/Zip: Applicant is: Owner Contractor Type of Work Description of work: ~e' ~ 6~ I ~-`s GI ` n _had / Construction Cost:! 3, 600 . ou Multi-Family Building: (Yes / No Company: I si d eawt~~ '7X tact: c~ 17Z~ i"(i►-i Address: /C 0 Vd U J7~'1Cf /1'-~~ 1 Ccll City: 2Z -A't SG(4 Contractor q / State: /OV Zip: 3 6 Phone: License I~ C Q ~ Lead Certificate M If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) 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: NOTE: Plans and A . m,~,,.,~_ supporting documents that you submit are considered to be public information. Portions of i the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that they are trade secrets. 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.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; 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 Minnesot Hdin Code must be completed within 180 days of rmit issuance. X C= 3s% Cc, Fnz Applicant's Printed Name icant's Signature Page 1 of 3 !II Use BLUE or BLACK Ink �--------- --, � For O�ce Use � • � a �l�� I (��} 0� nn �T I Pertnit#: U 4� lJu� li i "% ' I � Permit Fee: � I 3830 Pilot Knob Raad � � Eagan MN 55122 I Date Received: � Phone: (651) 675-5675 � 4 ', � ' ..,Y' I �; � , �� Staff: Fax: (651)675-5694 � �� "�"°` � ________________� � 2015 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: �� Site Address: /��_7�/__O��a��/��. �.`'J�' . `-' �3 � `"v"-. �� Tenant: Suite#: � � � ��hone: � � /— G�� '�� ` � "� 'i� � �- �� ` Name: , � . � �� / �� '�:'�,�� ;��;� Address/City/Zip:/ �� Q ��u��-�"� �� l �l� �� , �� Name: � G ` � � icense#: � ' �� ' � �� , � �- � i , �� - � ��_ Address: � i ��`� "� - � �� .s ) �� State i�Zip: Phone: �� v�T� �/ � � ��y , - '�,�'"�'�` � ��' ' Contact• �' Email: e� �� S� "" "� � �� _ �� : �� ; ,� � _New _Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. �'�'��{` �k'- Description of work: ��,°�r�r�� , ��`� RESID NTIAL � �� _ � � � k � �,� .�,�� Water Heater � �� _ "� °'� � �� Lawn Irri ation RPZ/ PVB water Softener �- 9 �— — ) �-� � , �° � ��' � Add Plumbing Fixtures(_Main/_Lower Level) ^` � � Septic System � ��'��" d Water Turnaround ��r , , �� _New � ��,�"��"i��w� ��r's�$� � �� " Abandonment �� "' �_�� RESIDENTIAL FEES: $60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge) $60.00 Lawn Irrigation(includes$5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Septic Svstem Abandonment,Water Turnaround*(includes$5.00 State Surcharge) `Water Turnaround(add$200.00 if a 5/8"meter is required) $115.00 Septic Svstem New($10.00 per as built)(includes County fee and$5.00 State Surcharge) TOTAL FEES $ � �r� 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.caopherstateonecall.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 will be in accordance with the approved lan in the case of work which requires a review and approval of plans. / X � C:f� U" ApplicanYs Printed Name p Ys Signature 3 ;"3 .. �; �i��t a � ..Fk_�` �5 j�� ,�*t l- �' { Y&'T,R "�;",^�ik '`� �` �' p �k3s,?� . .1�� .;��d�'^!. �y� p�. ��`u 2+� � ,�,'� 4� �+�` ( ��g,T .�.?+'�k E y � t 41�� /p �jy� !;'.1F�h �5 �.�y�'Li � '��4�F y�� 'k°+� '4.'+��. 1��'�,��Z�a+�S��' S`v' ��°��,., n��s � ��45�':�� t�a�'�"��'.�Y�rA �;,� i�.i�r�� -;�� 1.�� z�' i�.S�'c��' s.�.. �� „' '.�':`�-a`r�..;�.�"�= �, r ' z�' a,�, � � �- ��'d. r�".� � a •+,� � : �� .+ - - � .� �r `> w � ,�� '� �� a J�`$ �,r{+�t� �� ; � " .. � � .� S� ��"�„ '§`_ . . �7. a m �ti�, ��k��3'S� �� - €�: �. "k-�a�ti-,r , �`�� '� � e . { ��- � , �� "� = �,.`�-�: �� i� - a �'z� IotF�.`s� r�� '�j'µi�xa�"=��..-�-.�,` �^r�� ,� ('y i �^ � � � . ,f'-�.+it�� 7" . . ,�.� � �` ,� �� ,�:�,E �'�,'��, � w �-�=.� , �d'�..�,�tj s ��} ,�,� � �IK� _ �=�a� 1e'= � k., - � �r��';-«;,s,-'-�`- ,.��ti iai� ��-.=.� -