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2030 Bluestone Lane r-----------------~ For Office Use ~ j Permit City o1 EaV I 7~ I I Permit Fee: C J 3830 Pilot Knob Road I Eagan MN 55122 Date Received: Phone: (651) 675-5675 I Fax: (651) 675-5694 1 Staff, L--------------- PERMIT. APPLICATION/ 2008 RESIDENTIAL PLUMBING 1 .49 Date: lX tf Site Address: v v1C`i Tenant: Suite RESIDENT / OWNER Name; one: (V(2 '-7c~2 Address/ City /Zip: CONTRACTOR Name: ll~ 7~~acs~ - fik&nse Address: ~C>J 1 tj"T"v" .d t / b X51-le) City: tate: Zip: 4n -Dl6v~ Phone: Contact Person: TYPE OF WORK _ New _ Replacement ?Repair _ Rebuild Modi Space Work in R.O.W. Description of work: PERMIT TYPE RESIDENTIAL Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures RPZ PVB) L- Main _ Lower L vel) Septic System Water Turnaround New Abandonment Ef 17C -Dbxay=A, Af(~~Jtdi-l 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 $136.00,if a 5/8" meter is required) $100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge) $90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge) TOTAL FEES - I hereb nowledge that this information is complete and accurate; that the work will b m conforrnance wRh the ordinances codes of the City of Eagan, t t I under and this is not a permit, but only an application for a permit, a work ' of to start wi a permi that a work will be in actor ce with t proved in the case o work which requires a review and oval of la x~ x Ap an''s Printed Na a pplicant's Signatur FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test -Gas Test -Final Parcel Files Cover Sheet Unique ID: 1887 2030 Bluestone Lane 101670212007 INSPECTION'RECORD IfiY OF EAGAN PERMIT TYPE: 1 11621 3830 Pilot Knob Road Permit dumber: Eagan, Minnesota 55122-1897 Date issued: (612) 681-4675 SITE ADDRESS: LOT s to t-Or,* t . ~ APPLICANT: 0 :3 43 €31., f 6 to " I' iii r- i A"i` # ,1 t9 T f Cd F t t a TPA , i.: f tl x~ i > Cl ~s't (c; Vi - 0 7 6 PERMIT SUBTYPE: TYPE OF WORK: 3 a V14 0 0't w ; 3 e Wass x _ r~.tr.?:rxa ae~ ~s ^»'V hrt•+1 ~..4vext u„~h ~'N 1Fa, ~ v...•a4s.~m,X~+a3. l41 rt l tr` y Ae v''to i~sr.~R:3Mk 3~w.~~ ut ~Fw. i Permit Holder ows Telephone # PLUMENNG I4VAC k"pection Date lrop, conwwnts FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATING GAS SVC TEST INSUL r GYP BOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL DOMESTIC METER IRRIGATION METER FLUSH MAINS CONDUCTIVITY TEST HYDROSTATIC ,TEST BSMT' R.I. BSMT FINAL DECK FTG 71M 666 DECK FINAL CITY OF EAGAN Remarks Cedar Grove . cmdsition Addition Cedar Grove Lot 12 Rlk 7 Parcei 10 16702 120 07 OwnerlL.>,!LA1sJi street 2001L18 tolls. L01f state EaB]1I, 551 z2 ,92 p „ r Improvement a'te Amount Annual Years Pam 'nt Re' ipt y Date STREET SURF. STREET RESTOR. GRADING i ' SAN SEW TRUNK SEWER LATERAL 1 9 1 z o 00 6 2 Ilk WATERMAIN WATER.LATERAL 1972 WATER AREA STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT 'ji WATER CONN. BUILDING PER. SAC PARK INSPECTION RECORD CITY OF EAGAN PERMIT TYPE: i t Jig :r N l 3836 Pilot Knob Road Permit Number: Eagan, Minnesota 55-1 2-1897 Date Issued: 4r r ; (612) 681-4675 f , oil SITE ADDRESS: ' , t F ~a APPLICANT: C f t~WRI ra R t e k:';' 0114 6 t 4 2 PERMIT SUBTYPE: TYPE OF WORK: 8 ~ tl~ F ~ N1 1 r mkt OL apt holder ass* ELECTRIC PLUMSM HVAC !bb" )off ft* F69O'tY{ FOtfl`tD FRAi PLP i PLBG AIR TEST PMIGH HEATM GASC Min M#91A GYPODAM F ACE r FOMMAGE AIR TrEST FINAL PLRG FINAL HTG OMM TE$T MDG FR OL hi, OVA BStAi'f1a. MW FRAM. DECK f'TG F DE M FRVL EAGAN TOWN S H I P N. 1346 BUILDING PERMIT Owner ..r = d67.11 Eagan Township .Olt Address (present) f.._. --r. Town Hall Builder - Date _ Address DESCRIPTION Stories To' Be Used For _Front Depth Height Est. Cost Permit Fee Remarks - LOCATION Street, Road or other Description of Location Lot Block I Addition or Tract -__-2 ~ ;3-3. i+c/~ o /3 roe1;a x(37 ~ytBP C-+3 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, tthat - .____Lctx---____-1:f JL.......... ....has permission to erect a...... _ ~C upon - - - the above described paemise subject to the provisions of the Building Ordinance for Eaganwnship=` adopt April 11, 1955. v = . Per Chairman. of Tnwn Board Building Inspector This request void_ 18 f .14 61 I /M /85 r v + Request Date Fire No. 'Rough-en Inspection Required? Ready Now ill Notify Inspec- OYes ❑No for When Ready Q, Licensed Electrical Contractor 1 hereby request inspection of above ❑ Owner electrical work installed at: Street Address, Box or Route No. City _ ection o. Township Name or No. Range No. County yl 4-'d- Occupant (PRINT) Phone No. r Power Suppli r Address Electrical Contractor iCompany Name) Contractor's License No. Mailing Address (Contractor or ner Making lnstailation!' A J jC Authorized Sig toreontractor/ caner Making Installation) Phone Number MINNESOTA STATE BOA OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. Room LE BE ACCEPTED By THE STATE BOARD 1821, University Ave., St. Paul, MN 55100 UNLESS PROPER INSPECTION FEE IS Phone (6112) 297.2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB-00001-04 ' See instructions for conmleti_- fhi~ form on back of yellow copy. B 42 7 0 g 54101 " X" Below Work :Covered by This Request K Type of Building Appliances Wired EquipmentWiredHome Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heatin Commercial Bldg. Furnace Silo Unloader Industrial Bldg. Air Conditioner BulkMilk Tank Farm Other Specify Other (Specify)ther (SpecifyOther Other pection Fee Below # FeV Service Entrance Size Fee Feeders/Subfeeders' # Fee circuits: 0 to 200 Amps 0 to 30 Amps 0 to 30 Am Above 200 Amps 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100 Amps Above 100-Aull- Transformers Irrigation Booms Partial•'Other Fee Signs Special Inspection Remarks $ - TOTAL FE I,te Electrical Ins ctor,hereby EF.-a ate rtify tthe bove D e 3 inspection has been 1 made. This request void IS months from This request void ~ 55 I t)364 1 8 months from on. k 0. Request Date Fire No. Rough-in Inspection Required? []Ready Now Notify, Inspec- ~l r 8J j~14dS~' ❑ No for When Ready 9per.--rised Electrical Contractor I hereby request inspection of above Owner electrical work installed at: Street Address, Box or Route No. City d l c~ ,c' S T1~,t/~ .1A_ G x'/11 Section No. Township Name or No. 'Range No. County IoOccupant (PRINT) Phone No. Power Supplier Add esQQ -Al _S . R ` Q R_t__ Electri al Contractor (Company Name) Contractor's License No. v:At L r Ecr IC_ b_,9 F Mailing Address (Contractor Owner Making Installation) A, 32 7- / Al Authorized ignature (Contractor/Owner Making nstallation) -hone Number 3 7. 7~ MINNESOTA STATE BOARD OF ELECTRICITY THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg. -Room N-191' BE ACCEPTED BY THE STATE BOARD UNLESS PROPER INSPECTION FEE IS 1821 University Ave., St. Paul, MN .55104 Phone (612)297_2111 ENCLOSED. EB VEST FOR ELECTRICAL` INSPECTION -oooot-a~ See instructions for completing this form on back of yellow copy. D RM 7'6 "X" `Below Work Golered by this Request Now Add Rep. Type of Building Appliances Wired Equipment Wired Home Range Temporary Service Duplex Water Heater Lighting Fixtures Apt. Building Dryer Electric Heating Commercial Bldg. Furnace Silo Unloader " Industrial Bldg. Air Conditioner Bulk Milk Tank Farm Other (Specify Other (Specify) Ht er Specify Other Other Vomp2 Inspection Fee Below # Fee Service Entrance Size l Fee Feeders /Subfeeders Fee Circuits 0to200Amps 0to30Am s 'Rticwl 0to30Am s Above 200 Amps 31 to 100 Amps 31 to 100 Amps Swimmin Pool Above 100 Amps Above 100-Amps Transformers Irrigation Booms : Partial%'Other Fee Signs Special Inspection 1) Remarks $ 7O TOTA j E Rough-in Date 1. the E /ttG7/ Inspector, hereby certify that the above Final r a? i on has been z/V 41,1, 4% made. This request void 18 months from CITY O EAGAN CASHIER: S 't'i~.RMINAL NO 50 DATE, 05/19/97 TIME: ff:14:48 ID NAME: GENE'S HOME CARE & REPAIRS 320 9001. 2030 1F L 1I: STONE 74-. i` 21.55 9001. 2030 BLUESTONE J..50 Total Receipt, ACtett+.tt't+x 76.2 CRO r 4080 USI:"R ID: NANCY PERMIT CITY OF EAGAN \ 3830 Pilot Knob Road PERMIT TYPE: D U I L D I N G Eagan, Minnesota 55122-1897 , Permit Number: 0 2 9 9 9 7 (612) 681-4675 Date Issued: 0 5 / 19 / 9 7 j SITE ADDRESS: 2030 BLUESTONE LANE j; LOT: 12 BLOCK 7 CEDAR GROVE *3 P . I . N 10--16702--120-07 DESCRIPTION: (ROOFING-) U0 _1d_rrr4 Permit Type SF (M7SC.;~ 8iriId r"i7 ',lurk Type REPATR Cen Cone 434 ALT-RESIDENTIAL REMARKS: FEE SUMMARY: VALUATION $3,000 Base Fee _ $74.75 Surcharge 1.50 Total Fee $76.25_ CONTRACTOR: - A p p l i c a n t - ST. L I C OWNER: GEtN'E'S NOME 'CARE & REPAIRS 14543402 0002715 i'REGONING BERNADINE 20017 FLINT LN 2030 BLUESTONE LN EAGAN MN 55122 EAGAN MN 55122 J-1512) 454-3402 (612),i54--2486 f] E' f i'1 + f= s ° d t, ~ ] i t; 1 J. d o ~ fl !l tint rt d 1(lf-,-)ro t:Lot1 i t t dry E ~~O ( iffRpl ':•J7_Th crA,c appj,~_Li~d~] L StaCe. of mn I hpw. APPLICANT/PERMITEE SIGNATURE ISSUED B : SI ATU E 1997 BUILDING PERMIT APPLICATION (RESIDENTIAL) ,...j' f CITY OF EAGAN 3830 PILOT KNOB RD - 55122 681-4675 New Construction Requirements $emodeVReoair Requirements ♦ 3 registered site surveys ♦ 2 copies of plan ♦ 2 copies of plans (include beam & window sizes; poured fnd. design; etc.) ♦ 2 site surveys (exterior additions & decks) ♦ 1 energy calculations ♦ 1 energy calculations for heated additions 4 3 copies of tree preservation plan if lot platted after 7/1/93 required: _ Yes ^ No DATE: :!5--/,,' _.q CONSTRUCTION COST. DESCRIPTION OF WORK: .~'cJd 741 STREET ADDRESS: ;Id 30 /31~ ' LOT BLOCK SUBD./P.I.D. PROPERTY Name: Phone OWNER LW FMT Street Address: 5Ta.✓ City: State: Zip: CONTRACTOR Company: ,v-, A4F'F ~ C s" Phone Street Address: ,V/2 License City: Staters Zip: ARCHITECT/ Company: Phone ENGINEER Name: Registration Street Address: City: State: Zip: Sewer & water licensed plumber (new construction only): Penalty applies when address change and lot change are requested once permit is issued. I hereby acknowledge that I have read this application and state that the information is correct and agr to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: OFFICE USE ONLY Certificates of Survey Received Yes No Tree Preservation Plan Received Yes No Not Required OFFICE USE ONLY BUILDING PERMIT TYPE` ❑ 01 Foundation ❑ 06 Duplex ❑ 11 Apt./Lodging ❑ 16 Basement Finish ❑ 02 SF Dwelling ❑ 07 4-plex ❑ 12 Multi Repair/Rem. ❑ 17 Swim Pool ❑ 03 SF Addition ❑ 08 8-plex o 13 Garage/Accessory ❑ 20 Public Facility ❑ 04 SF Porch ❑ 09 12-plex ❑ 14 Fireplace n 21 Miscellaneous ❑ 05 SF Misc. ❑ 10 _-plex ❑ 15 Deck WORK TYPE ❑ 31 New 0 33 Alterations ❑ 36 Move ❑ 32 Addition ❑ 34 Repair ❑ 37 Demolition GENERAL INFORMATION Const. (Actual) Basement sq. ft. MC/WS System (Allowable) Main level sq. ft. City Water UBC Occupancy sq. ft. Fire Sprinklered Zoning sq. ft. PRV # of Stories sq. ft. Booster Pump Length sq. ft. Census Code. Depth Footprint sq. ft. SAC Code Census Bldg Census Unit APPROVALS Planning Building Engineering Variance Permit Fee Valuation: $ Surcharge ~T= Plan Review License MC/WS SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Road Unit Park Ded. Trails Ded. Other Copies Total: ! c % SAC SAC Units CITY OF EAGAN CASHIER: JS TERMINAL NO: 767 DATE: 04/24/00 TIME: 11:14:57 ID: NAME: GENE'S HOME CARE & REPAIRS 3210 9001 2030 BLUESTN LA 97.25 2155 9001 2030 BLUESTN LA 2.00 Total Receipt Amount: 99.25 CR127161 USER ID: JAN P/77 2000 BUILDING PERMIT APPLICATION (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD - 55122 q q J 651-681-4675 Now Construction Reauiremenh > 3 registered site surveys showing s% of lot, sq. it. of house 2 copies of plan and gj roofed areas (20% maximum lot coverage Mowed) i set of energy calculations for heated additions > 2 copies of plans (show bea rn do window sizes, poured fnd. design, etc.) 1 site survey for extedw additions & decks > 1 set of energy calculation > 3 copies of free preservation pion if lot platted alter 7/1/93 DATE: .y ~ y✓ O ~ CONSTRUCTION COST. DESCRIPTION OF WORK: add STREET ADDRESS: LOT: BLOCK: _ SUED./P.I.D. Ce4ar (aro& # Al Phone Name: PROPERTY Mast First OWNER Sheet Address: CityState: ~g~s'~S' Phone L Company. (area code) CONTRACTOR / ,~'~irT ~,9~►' 7l S Sheet Address: License# ~ Ems. - City Aeg;9--✓ State: Zip: ARCHITECT/ ENGINEER Company: Name: Telephone ( ) Sheet Addreaa: Registration CRY State: Zip: Sewertwater licensed plumber (if installing sewedwaterPhone I hereby acknowledge that 1 have read this application, state that the Information is correct, and oWee to comply with ail applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applicant: c OFFICE USE ONLY Certificates of Survey Received Yes No (`~2 4 Tree Preservation Plan Received Yes No Not Required OFFICE USE ONLY BUILDING PERMIT SUBTYPES ❑ 01 Foundation ❑ 07 05-piex 0 13 16-piex ❑ 21 Porch (3-sea.) ❑ 31 Ext. Alt - Multi ❑ 02 SF Dwelling ❑ 08 06-piex ; ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Aft - SF ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 18 Deck ❑ 23 Porch (screened) ❑ 36 Mufti ❑ 04 02-plex 0 10 08-plex 0 19 Lower Level ❑ 24 Storm Damage ❑ 05 03-piex ❑ 11 10-plex P1bg Y or _ N 0 25 Miscellaneous ❑ 06 04-piex ❑ 12 12-piex 0 20 Pool ❑ 30 Accessory Bldg. WORK TYPE E] 31 New D 36 Move Bldg. ❑ 43 Reroof ❑ 32 Addition ❑ 37 Demolish (Bldg)* ❑ 44 Siding ❑ 33 Alteration ❑ 38 Demolish (Interior) ❑ 45 Fire Repair ❑ 34 Repair ❑ 42 Demolish (Foundation) 0 46 Windows/Doors * Give PCA handout to applicant for demolition permit GENERAL INFORMATION SAC Code # of Stories sq. ft. No. of Units Length sq. ft. No. of Buildings Width Footprint sq. ft. Const. (Actual) Basement sq. ft. Census Code (Allowable) Main level sq. ft. MC/ES System UBC Occupancy sq. ft.. City water Zoning sq. ft. Booster Pump PRV Fire Sprinklered MISCELLANEOUS INSPECTIONS ❑ Stucco/Stone APPROVALS Planning Building Engineering Variance I' Permit Fee Valuation: $ Surcharge Plan Review License MC/ES SAC City SAC Water Conn. Water Meter Acct. Deposit S/W Permit S/W Surcharge Treatment Pl. Park Ded. Trails Ded. Other Copies Total: SAC Units % SAC r For Office Use •• i i •% • ::::ee: E AG A N 441C ..39 S-.9(..) ........... •-. 0-19 lEEivE CDate Receiv3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 I TDD:(651)454-8535 I FAX: (651)675-5694 t AUG 2 0 2019 ;` ' Staff: buildinginspectionsCa)_citvofeagan.com '�' Livl _„Ig_tq. , 2019 RESIDENTIAL BUIL% ' , - , , APPLICATION Date: 06/19 Site Address: ?03 O 6lNCshc 1.-41, Unit#: Name: Y e;''f /"t i I I it t r'. , Phone —( -Resident/ J • Owner Address I CityI Zi 9J3 0 /� Al cc i a� P� ���.�:S v.. � a EI/ . ) Applicant is: X Owner Contractor t Maki Pc r Ai liner- @ jrn ot t l ,C 0.,-,-, Type of Work Description of work: ect e ri P�},L fj d / U i/ o , 3 Construction Cost: t �-I du(7‘ Multi-Family Building: (Yes /No X) Company: Contact: Contractor ' Address: City: State: Zip: Phone: Email: License#: Lead Certificate#: If the project is exempt from lead certification, please explain why: 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 8 Water Contractor: Phone: • • i Fire Suppression Contractor: Phone: NOTE:Phanand supe g;ifdatimenti that Sire ubinft are considered to be public information. Portions of the information maybe classified as non-public if you provide specific reasons that would permit the City to conclude that they 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.citvofeaaan.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.aopherstateonecall.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 stpr J ut a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approve f plans. x `f rr ,\1I'A°C x Applicant's tinted Name Applic nt's S'! ature I I e's 7y/z5--- DO YDO NOT WRITE BELOW THIS LINE SUB TYPES _ Foundation _ Fireplace _ Porch(3-Season) _ Exterior Alteration(Single Family) l6 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 50/7 20 Occupancy 1Z4— MCES System Plan Review Code Edition onsei"Zsa 15 SAC Units (25% 100% ) .Zoning P. -I City Water Census Code Stories Booster Pump #of Units Square Feet PRV #of Buildings Length Fire Suppression Required Type of Construction 1/5 Width REQUIRED INSPECTIONS Footings(New Building) Meter Size: Footings(Deck) Final I C.O. Required Footings(Addition) ?o Final I No C.O. Required Foundation Foundation Before Backfill ( HVAC Service Test Gas Line Air Test Hood Roof: Ice&Water Final Pool: Footings Air/Gas Tests Final '70 Framing 30 Minutes 1 Hour Drain Tile Fireplace: Rough In Air Test Final Siding: Stucco Lath Stone Lath Brick EFTS Insulation a Windows Sheathing Retaining Wall: Footings Backfill Final Sheetrock Radon Control Fire Walls Fire Suppression: Rough In Final Braced Walls Erosion Control Shower Pan Other: Reviewed By: t5(AA. W '<< (444 , Building Inspector RESIDENTIAL FEES . . . Ft-- C_ Z o,e)o sq.fr Base Fee Surcharge A t:?/-We eq P• 55 w o t� Plan Review MCES SAC City SAC Utility Connection Charge S&W Permit& Surcharge Treatment Plant Radio Meter Read Copies TOTAL Page 2 of 3 f For Office Use rJ ‘,.. �� ::t:e: 7 Lig je,E AG A `e 0 ✓ EOEIVED Date Received: g 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 17 (651)675-5675 I TDD: (651)454-8535 �VUG 2 FAX: (651)675-5 2019 Staff: buildinginspectionsecityofeaoan.com LJ I 2019 RESIDENTIAL PLUMBING PERMIT APPLICATION DateADate: Address: Do3(0 tive,.54-ont F174 n ^� A! 5SI IVIJU Tenant: Suite#: • rr Name: tIr .M t ,(►�-- Phone: w�(-.50O' ResidentOvner r Address/City/ ip: )0 131t44-014, Lh. Fqrci M I U _El )1 Name: ��' I c License#: ContractorAddress: City: State: Zip: Phone: Contact: Email: o/New Replacement Repair Rebuild Modify Space Work in R.O.W. Type of Work elDescription of work: Add I Z S ft 4d Lowers- Le yt- Tankless Water Heater Lawn Irrigation( RPZ/ PVB) Standard Water Heater Description Add Plumbing Fixtures( Main/ Lower Level) Water Softener O I'G1� Septic System Description: � U��, � S��'fir New Abandonment Connection to City Water from e 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 New fixtures, adding or removing piping (includes State Surcharge) $60.00 Septic System Abandonment $100.00 New Residential (fee collected with Building Permit) $115.00 New Septic System (includes County fee and State Surcharge) $60.00 Connecting to City Water from Well*+ $290 for Meter and $190 for Radio Read = $540 *Sewer&Water Permit also required for connection charges (00 TOTAL FEES$ , o(9 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.aooherstateonecall.orq You may bsite at itv subscribe toofeaganreceive an electroniccom/subscribenotification from the City of proposed ordinances by signing up for an email update on the City's wewww.c . . 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 actor ante with the approved plan in the case of work which requires a review and approv of plans. X /A- 1 1 I1-e r X71AAJt--\ App icant' Printed Name Applicant's ignature Page 1 of 2 FOR OFFICE USE Reviewed By: Date: Required Inspections: : Under GroUnd '' Rough-In Air Test Gas Test Final Meter Related Items: Meter Size Radio Read Manometer ' Staff: 3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810 (651)675-5675 TDD: (651)454-8535 FAX: (651)675-5694 buildinginsoectionsAcityofeagan.com Page 2 of 2