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4241 Blackhawk Rd CITY OF EAGAN N 0 12208 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 BFJILDiN13 PERMIT PHONE: 454-8100 ReceiPt # To be used for 1/2 DUP & GAR Est. Value $71,000 Date JUNE 27 19 86 Site Address 4 241 BLACKHAWK RD Erect 43 Occupancy R3 Lot 1 Block 7 Sec/Sub. SUN CLIFF 1ST Remodel ❑ Zoning pD-R21 Parcel No. Repair ❑ Type of Const. Addition ❑ No. Stories _ Ix Name RMC DEVELOPMENT CORP Move ❑ Length 42 28 3 Address 3209 W 76TH ST. , STE 205 Demolish ❑ Depth 0 City EDINA phone 835-3773 Int. Impr. ❑ Sq. Ft. Install ❑ i o Name SAME Approvals Fees 00 0-C Address Assessment Permit $ 343.00 ~ City Phone Water & Sew. Surcharge 35.00 Police Plan Review 171.50 LW Name MINNETONKA DESIGN Fire SAC 575.00 78 Address 337 WATER ST Eng. Water Conn. 500. 0 0 <W City EXCELSTQ& 474-5991 Planner Water Meter 63.50 Council Road Unit 290.00 I hereby acknowledge that l have read this application and state that the Bldg. Off. 6/2 7/8 Tr. Pl. 156.00 information is correct and a ree to co with all applicable State of Minnesota Statutes an Cit of gan Or in ` ce APC Parks Signature of Permittee Var. Date Copies Total $ 2.13 4 00 A Building Permit is issued to. RMC DEVELOPMENT CORP on the express condition that all work shall be done in accordance with all applic bl late of Min sots tutes and City of Eagan Ordinances. Building Official L/~-+t 4 h CITY OF EAGAN 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 12 2 9 BUILDING PERMIT PHONE: 454-8100 f, Receipt # tll To be used for 1/2 DUP & GAR Est. value $71,000 Date JUNE 27 19 86 Site Address 4243 BLACKHAWK RD Erect Cff Occupancy R3 Lot ' 1 Block 7 Sec/Sub. SUN CLIFF 1ST Remodel ❑ Zoning R2-PD Parcel No. Repair ❑ Type of Const. V Addition ❑ No. Stories RMC DEVELOPMENT CORP Move ❑ Length 42 W Name Demolish ❑ Depth 2a o Address 3209 W 76TH ST., STE 205 Int.lmpr. ❑ Sq. Ft. city EDINA Phone- 835-3773 Install ❑ i o Name SAME Approvals Fees 00 Address Assessment Permit $ 343.00 ,j -R ~ City Phone Water & Sew. Surcharge 35.00 Police Plan Review 171.50 F W Name MINNETONKA DESIGN Fire SAC 575.00 Address 337 WATER ST Eng. Water Conn. 500 00 <W City EXCELSIQRe 474-5991 Planner Water Meter 63.50 Council Road Unit 290.00 1 hereby acknowledge that I have read this application and state thatthe Bldg. Off. 6/27/86 Tr. PI. 156.00 omply with al applicable State of information is correct a Mo C Parks Minnesota Statutes and Cn nc . AP Var. Date Copies Signature of PermitteTotal $2,134.00 A Building Permit is issued to: RMC DE LOPMENT CORP on the express condition that all work shall be done in accordance with all applicable\Stao of Minnesota St tutes an C' of Eagan Ordinances. Building Official x 10 - CITY OF EAGAN k, 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121Y, A PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for I/2, ow? Est. Value r ~ Date JUNE 27 19 86 Site Address 42,11 BLI ACI{NA'-, tK RD Erect ;L Occupancy X- 3 Lot 1 Block 7 Sec/Sub. )VIN CLIFF 1ST Remodel ❑ Zoning 2",-A R2 Parcel No. Repair ❑ Type of Const. Vii Addition ❑ No. Stories r t. Name <?<3C = 1T i.13 . #T CORP Move ❑ Length 42 z2 Demolish C1 Depth 2il - 3 Address , 205 Int. Impr. ❑ Sq. Ft. o CityItdri Phone 835-3773 Install ❑ o Name h Approvals Fees v°q Address Assessment Permit City Phone Water & Sew. Surcharge 35.00 Police Plan Review 171.50 LU W Name 3=1 -14NRTONXA DESIGN Fire SAC 575.00 Address 337 wNrER i Eng. Water Conn. 500 • 0 a W city 474--5991 Planner Water Meter 63.50 Council Road Unit 290.00 1 hereby acknowledge that I have read this application and state thatthe Bldg. Off. 6/27/86 Tr. PL 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Parks ' Signature of Permittee Var. Date Copies $2,134.00 V C DEVELOPMENT COO Total A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable.State of Minnesota Statutes and City of Eagan Ordinances. Building Official- X- ; F Permit No. Permit Holder Date Telephone # Plumbing - H.V.A.C. Elebtric . Softener Inspection Date Insp. Comments Footings I ~r & Footings 11 Foundation Framing Rooting Rough Plbg. 9 Rough Htg. Insul. Fireplace Final Hig. All Final Plbg. In-7, Bldg. Final Carl.Occ. ra Deck Fig. Deck Frmg. Describe Location: Well Pr. Disp. I CITY OF EAGAN 2209 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 14 - PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for 1/2 D UP & `-JAREst. Value $71,000 Date JUNE 27 '19- 86 Site Address 4243 8J, CK1"T i Yi PD Erect Occupancy -P3 ~ Lot I Block 7 Sec/Sub. 5114 t.:.Y I.V ' I.ST Remodel ❑ Zoning R2-w) Parcel No. Repair ❑ Type of Const. :f Addition ❑ No. Stories s =4C f)E; EL0PM' 14T C'OR ? Move ❑ Length 2 Name , Demolish ❑ Depth 2 a 3 Address 3243 9 s 75 2t?5 O City ED T' A Phone 635-3773 Install ~ Sq. Ft c Name Approvals Fees U< Address Assessment - Permit 343.00 I'- City Phone Water & Sew. Surcharge 31' 50 Police Plan Review X71 .50 w W Name DESIGN Fire SAC 575.00 Address 337 'WEP R ST Eng. Water Conn. 500.00 a city a_.'~;t,x'L 474-5991 Planner Water Meter 63 * 50 Council Road Unit 290.00 I hereby acknowledge that l have read this application and state that the Bldg. Off. 6/27/86 Tr. PI. 156.00 information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Parks Signature of Permittee Var. Date Copies Total :5 2, 1-3 ° .1dT i„OR ~ A Building Permit is issued to: RMC D VELC;I' a on the express condition that ` all work shall be done in accordance with all applicable Stage of Minnesota Statutes and City of Eagan Ordinances. Building Official' r an- i Permit No. Permit Holder Date Telephone # Plumbing- rl - H.V.A.C. Electric Softener Inspection Date Insp. Comments Footings I 17171r Footings II Foundation Framing Roofing Rough Plbg. Rough Htg. Insul. Fireplace Final Htg. Final Plbg.; Bldg. Final Cert.Occ. GU Deck Fig. Deck Frmg. Describe Location: Well Pr. Disp. ALAN WA?k SEWXE Per Knob Road 7 655 Bo PERMIT NO.s. IERW, MN %121 DATE: R2 No.- of prate: ex Ownsr: RMC Dev. Coop. SR., A f Imu: 4243 Blaekhavk Road .Ll a C~ 3£f I Planter; Valle Plumbiz 'MsW No.: -374 7 SOCK, 0apa .=00 l r No.:*f-7A ,7n 30 p - t - t ofmoo to monwh Wilk The My oF wave ~ .502d RAC 156.0O d TP Tatak ' 63.5204 iseter By D4" Fes; .Dote of Inst.; fr+t.: CITY OF EAGAN Remarka>«`~ Addition So CLIFF 1ST 1 rt 7 Parcel 10- 297$- 0-Q9 Owner dddz L-'~ A Street 4241 se.te EAGAN M SS122 Improvement Date -Amount-- Ahno.1 YaNw Payment Receipt Date STREET SURF. oZ 1985 3047.77 203.18 15 STREET RESTOR. GRADING SAN SEW TRUNK /d y 1970 56.25 2.25 25 *SEWER LATERAL 1985 78 15 WATERMAIN *WATER LATERAL trunk 198 WATER AREA 3 977 95. aU 6.33 1S *Services 1985 STORM SEW TRK 10< 1971 322.29 16,11 20 * STORM SEW LAT 1985 Storm Sewer Trunk 29 1985 566.72 37.78 15 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. BUILDING PER. tr" SAC PARK PLUMBING (RESIDENTIAL) Permit Application City Of Eagan l 38M -Pilot Knob Road, Eagan Mn 55122 Telepho-ue # b51-675-$675 FAX # 651-675-56 ~C~ q 6 Please complete for: Single Famify Dwellings Townhomes and Condos when permits are required for each unit " Date f I / r~✓ - - - - - - HINRICHS, RON Site Address 4243 BLACKHAWK ROAD Unit # EAGAN, MN 55122 (651) 405-8324 Property Owner elephone # ( ) Contractor N MLOM PLUMING We Address (612) 8274= City • State MINNEAP-01 MN ip Telephone # ( ) The Applicant is Owner Contractor Other Septic System New Refurp 5}leyd Submit 2 sets of plans and MPC license $ 100.00 Includes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Includl ; . $ 50.00 - Adding fixtures to lower levels or room additions, excluding water softener and water heater Abandonment of septic system Water turnaround 5/8" meter if needed - $121.00) Other: - RPZ _ new installation r repair ! rebuild $ 30.00 Lawn irrigation system Water softener X Water heater $ 15.00 X replacement additional State Surcharge $ .50 Total $ 15, E(D I hereby apply for a Residential Plumbing 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 with the Plumbing Codes; that I understand this is not a permit, but only an application for a permit, a.-id 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. jio- i\~o C U o-a-N - - "7~1 Applicant's Printed Name A nt's Signature PERMrt R IPT DATE, - f.. PLUMO Ma 1v"+ TM, CITY' tom' f~, T` ffi~fi'B`R1i A"AN, MN "122 ire oompleft f6 r aftle famtty dwellings,. townhomes and condos when permft are uirlt for, ear IN* baddfiow prgveftter for "ate system t / OWNER NAME:: TELEPHONE "VAC41t?,~~ , ' # "§TALLER NANIE; -9-fa ~ TELEPHONE _ tAiE{t Gam) STR E"i' ADDRESS: f CITY: STATE: t(J~ SEPTIC SYSTSM, f hefurbigied (requires two ` of plans and MPG limnse) 104 00 iidud $40.00 County fee Note: Additional consultant ffts may apply t t w 101 FICAMNI&TERATION TO OUSTING DWELLING UNfT, fNOLUOM: Adding Mum to louver Wets or rocrrr+ additions; #xcl ftV war softener arisl water 11e6tws, Abendonment'of septic system. We* turnaround - existing dwaiffng wit 51W meter if nteded - $116) Cutter: RR :new inste#lsf nfrepairir+ buiici S 3D,00 . law RepWcomentladditionsf: water soft ter waver treate r $ 15.t1Q Steje Surc3e $ -4r.2 9 f - not ~ 1 hsnntsi+&&cnoWkdQs ftt i have road # ft ~Piicatitsn, s4fe thM tt~ ►nkftatiort is corrsck and agm to OM* OR ip~spiit £#yot Eris It is to al's tw9pons0 ft to notify the prop" owrser that the City of Eagan aswrnes no ty for any dam ra~u t~yibm.C~y ~WArsU ape rojo sW amt msin*nw" adv u" to the faailoeas oweruded under this p xrait w'rthirs ri~sf csf r atGNA E OF P i E 912 r,, _T...- .-..e_.~.--a=c4nn;.ins.-_-..-.«._...-.:.:,, ~.•+wi,e+.r:..nwa..++u,. c - w. ..a.......... ,rr..u.~a.~.. _ - C. R. WINDEN b ASSOCIATES, INC. LAND SURVEYORS T*t t45-3946 0i1 EUSTIS SL, ST. ►AUL, MINN. 00108 R.M.C. DEVELOPMENT CORP. .00 NOTE: 8 Denotes Wooden Stake. Scale: 1"=30' Proposed Garage Floor E1.=9o7,. o Denotes Iron (904.7 ) Denotes Proposed Monument Finished Ground E1. Bearings Are Assumed --.4--- Denotes Direction Of Surface Drainage. Vertical Datam - N.G.V.D. 1929 N84.45110"E 9 !30.00 , o q ~ i ~~--jj-- ftl Q DYPr/wn~ ~ Q 30,3 g; l0 Q1 ! 241) O i N 30 o - Proposed z - ,1'~ 4 ru 4 ©041,61e r, r Z~ CE clu N Buny17/0W - (42ti3) 12 , T _ 01 1 i 30.3 Lil T ,CE N89'!9'ID"E /3rgina9e ~ vfi'~ity ~ctSem~nf i Lot 1, Block 7, SUN CLIFF FIRST ADDITION, Dakota County, Minnesota. WE HERE&Y CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION Of A SURVEY OF THE &MNDARIES OF THE LAND AIOVE DESCRIIIED AND OF THE LOCATION OF ALL BUILDINGS, If ANY THEREON, AND ALL VISI&LE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. Doted Mis 13 th iir *i slum -A.D. 11186 C. It. WINDEN t ASSOCIATES, INC. fi*r Surveyor, MinMbOto 11"istrotion Ne. ryas n 4 e 0 1986 BUILDING PERMIT APPLICATION - CITY OF EAGAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN COMMERCIAL SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS) $2,000 LANDSCAPE BOND To Be Used For: luation: Date: 0 1UC Site Address 3 0 OFFICE USE ONLY Lot l Block. 7 Erect X Occupancy JV~~_fl f ~ Remodel Zoning 1~--, Parcel/Sub y_ _ Repair Type of Const rG Addition # of Stories Owner Move Length Demolish Depth Address •3.709 Sq Ft Install City/Zip Code ZIAIW SCir Phone ~'r 3~ 73 APPROVALS FEES Contractor ,J,I,,W~ Assessments Permit g~/3 Water/Sewer Surcharge 3 S Address Police Plan Review Fire SAC City/Zip Code Engr Water Conn Planner Water Meter Phone Council R ad Unit 7? Bldg Off eatment P1 /S Areh./Engr.f#r.oW APC Parks Variance Copies Address ? L(/~r OT..kl TOTAL, City/Zip Code A=/S~C4 /Y~tddS .Z~, Phone vr*`9'9/ NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT 13 ISSUED. 2 zZ = 12 = SCE r 'x 7077. ,r - t - , . !.:{J= ii{Q{Z I l1V1 { ON Ab1 1MW "11" 1.1.I•{i'4i1A11t11! ~ f ~ v-i S I Tt;. ADDRCSS _ renomr : CONTRACTOR: ~'`[~✓y~C Determine working square footage of each G-. r 1. Total exposed wail area.... ft. X--.I1 2. Total roof/ceiling area.... __sq. ft. x .026 = Total exposed wall area above floor= rL', a. Total wall window area b. Total door area . ? 1 c. Total sliding glass door area d. Total fireplace wall area e. Total wall framing area (average 10") f. Total rim joist area g. net wall area above floor..... { 1 h. wall area above floor _ i. wall area above floor - j, frame wall area at fourdatior.................................... Total exposed foundation area= 1~b k. Total foundation window area 1. Total net foundation area ihove grade Determine "u" value of each wall segment (e.g. window, door, each separate wall section) a.. i 1 _ X II u II b._ -7X 'lull, _ Ulf C. X d. X flues X 'lull h, X I'u" _ j X IIuII_ If item 13 is the same k. X 'lull = as, or less than item III , You have met the 1 - - X LIt - ' int-ent of SilC 6006 (C; 3. .................................Total C PAGAN ~ WATlt SERW RER3! b R94 f P.'.O. Box:21I"- PERMIT tilt?: 7654 E+. 55121 DATE: 4 c ors , of nits: t. RMC DOV, R - - r r Addmw. , 4241 - B Road ■1 D 4sutt ..Cliff ink valley plip ,79'.'4;2 A-, .cat a Rc 15 n d Reader No : M,+f/ ?-V 3 (p 3a ° la. Qp ofisk. ON i mam to aoMwy► wm the City j tEPHON Sf . t -d &r b3 5M teeter By - Pold: P., tWe of Insp.: Ir~sp CITY OFXAGAN SEWER SERVICE PERMIT 34311"PiI& Knob Road td_e P.,O.-Box 21199" PERMIT NO.. Eagan, MN 55121 DATE: 7 Zoning: No. of Units: Owner:' Address: Site Address: 't M i4~. c % r?c R-7~sd it B7 Sun -3.1 f 2 Y € Plumber: z. I?a~, a31y 1 some to Sent r wbh the City of Began Connection Charge: ~ 75 1 orm00ANi. Account Deposit: vs M,I,.(,),;jA I Permit Fee: - Y Surcharge: ~~t»r By Misc. Charges: Dote of Insp.: Total: Insp.: Date Paid: CtsiibF PAGAN SEWER SERVECfi PERNI{T 3830 Pilot Knob Road P. O. Box 21199 PERMIT NO.: Eagan, MN 85121 DATE: Zoning: No. of Units: Owners :C `bey . Caro. Addess: i Ot a Address, 4' 41L !"J a Z 'lwA . R ar d i=i V cur: Cliff 1 Piumber: P'.u`n'bJ nF; 00. 00pd t E 1 • me to empty whh the city of Eosew Connection Charge: '475,002d G OsdMeneN. Account Deposit. 15 Q01kd Permit Fee: : 0A' ? Surcharge: c;?pig BY Misc. Charges: Dote of Insp.: Total: Insp.: Data Paid. { 1.x4.'1 ~ltL' I:IIVQ~(11)/1 l1Vtl1 ~Ufl' .~11.~ ll t111N11.11 1~N1 I~~I~f1: f of 4 't'otal cxix)-;-1 rtx)I,~t• ililµ~ :Irt.1 i. m. Total shyli.,jht wren n. Total roof/ctalincf frilnlilt(I ill(~.l ~it~lt'1'il'It• lt~•1•~... -r~- o. Total net insulated roof/cci.lincg ai-va........... 2 Determine ~~~ltt Villue ft)1' t_:It':1 i tu)f 1 1 t INl ::t!tJNlt!121. M.- x foul$ _ n. X Stu-- C27 0. x M 4 If t.otnl. oc 114 i.21 Ow Wit 1• ilt.~li U:', }"it Il.r.,'! 1:u i. 1:11 iuLt nt- of, SHC 6006 !cj 1. - Alternate Build-ill Eltvc 1cl 9~t ::.i<in - To utilize the total envelope 'Systc~n method, the values established by the sum of items #3 And 44 shall not be greater than the stun of item: t and it2. 1. L :r + 2. 7 . t!ri~a 3. t-- + 4. - 1 = I I r; L &jFAL F7T. FXPOSED WALL FULL M EE / x - 1 , x • w .0 ~:vl.L. ,r 'ro tq DWIS D ooaS t~ T t o DDS j . y TESM4 Vi'i+s 1985 BUILDING PERMIT APPLICATION - CYOF A GAN NOTE: ALL CONTRACTORS MUST BE LICENSED WITH THE CITY OF EAGAN COMMERCIAL SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF ARCHITECTURAL INCLUDE 2 SETS OF PLANS & STRUCTURAL PLANS, 1 SET OF 3 CERTIFICATES OF SURVEY SPECIFICATIONS AND 1 SET OF j 1 SET OF ENERGY CALCULATIONS ENERGY CALCULATIONS~ $2,000 LANDSCAPE BOND/ To Be Used For: 7 Valuation: Date: Viof Site Address 3 4 OFFICE USE ONLY Lot / _ Block Erect Occupancy Parcel/Sub Re Ty Repair air Type of o f Const Addition # of Stories Owner 1zq" Move Length / Demolish Depth Address Sq Ft Install City/Zip Code .6"S'SC3S----------------------------------- Phone 3 77 APPROVALS FEES Contractor Assessments Permit Water/Sewer Surcharge 3 Address Police Plan Review /7/, Fire SAC City/Zip Code Engr Water Conn Planner Water Meter =0 Phone Council Road Unit Q Bldg Off - veatment P1 Arch./Engr. APC Parka Variance Copies Address 337 KlA9,B 1.1r~~ TOTAL ~C City/Zip Code Act'').J/O-'~r--&4414- X6'33/ Phone # NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED. y = '550 70/ ~77 , I For c~a of Eap I Permit I I Permit Fee: / 6` 3830 Pilot Knob Road I 1 Eagan MN 55122 i Date Received: Phone: (651) 675-5675 I 1 Fax: (651) 675-5694 1 Staff: 1 I I 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date- 1440 Site Address: 4~ / fd Tenant: Suite M RESIDENT /OWNER Name: Phone: b 7I3° OWl Address / City / Zip: Applicant is: Owner Contractor TYPE OF WORK Description of work: ~C. Construction Cost: _ Multi-Family Building: (Yes / N CONTRACTOR Name: _ /Z 0a i)0~4S ZI&C License#: Address: C2 7~ City: Ln/Y wG ~L ~ State: Zip: S Y0414 Phone: Sf " 7~~-C37Yf Contact Person: e q s''J SL~j~ L,~C COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet New Energy Code Worksheet Category Submitted Submitted submission type) • Energy Envelope Calculations Submitted 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 supporting documents that you submit are considered to:be public information.' Portions of - the information may be classified as non-public if you provide specific reasons that would permit the City to conclude that the are trade secrets. 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; t 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 accord ith the approve 1 plan in the case of work which requires a review and approval of tans. X_ X 7/ App nrs Pri d Name Applicant's Signature Page 1 of 3 Use BLUE or BLACK ink --------- � Fos Office Use j ��� U��� �!t I Permit#: �0��� f Y � � �; � 3830 Pilot Knob Road � Permit Fee: � Eagan MN 55122 � � Phone:(651)675-5675 i Date Received: � Fax:{651)675-5694 i � � Staff: � �����������������J 2014 MECHANICAL PERMIT APPLICATION ❑ Please submit two(2)sets of plans with all commerciai applications. Date: Site Address: �l�/ �� ,�L r�t t"�/l.�t UI�f��"L- Tenant: Suite#: ResidenUOwner Name:_�����t� �� i.t t�� �._ Pno►,e: t'�l� —�G''� ` ��fS> Address/City/Zip: � � � Name: '� " )8 � ^ License#:��8 �'�`'���c — Contractor ' Aadress: .� � �" ��c. v�- � � ��� ciry: �Y l�1 v�'�%�c , � State: '��Zip:����1 Phone: �d,�l- ��—���� Contact: ��� �6` ;.�' i U`� Emaif: � ��-�i � � -�'`e- New Reptacement Additional Aiteratian Demolitian Type of Work Description of work: ' � ��- NQTE:Roaf maunted and ground mounted meehanical equipment is required to be screened by City ; Code. Plea�e contact the Mechanical Inspector for information on permi#ted screening me#hods. RESiDENTIAL COMMERC/AL � _Furnace New Construction _Interior Improvement P2rmI�Typ@ —Air Conditioner _Install Piping _Processed _Air Exchanger Gas E�cterior HVAC Unit _Heat Pump Under/Above ground Tank (_Install/_Remove) Other RESIDENTIAL FEES $60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge) , �y� $100.00 Residential New(includes$5.00 State Surcharge) _$ �'-'U TOTAL FEE COMMERCIAL FEES Contract Va1ue$ x.01 $55.00 Permit Fee Minimum $70.Q0 Underground tank installation/remova! _$ Permit Fee "!fi contract vaiue is LESS than$10,010,Surcharge=$5.00 =$ Surcharge"` **If contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005 *""`If the project valuatian is over$1 million, please call for Surcharge =� TQTAL FEE I hereby acknowledge that this in#ormation is complete and accurate; that the work;tvill 6e in confarmance with the ordinances and codes ofi the City of Eagan;that I understand this is not a permit, but only an application far a permit,and wark is not to start without a permit;tha#the work wilf be'n accordance with the approved plan in the case of wrork which requires a review and appraval of plans. . � ., � � x � �-t �, X`./ .�`' � 1 Applicant's Printed Name Applicant's Signature FOR OFFICE USE Required Inspections: Reviewed By: Dafe: Underground Rough In Air Test Gas Service Test 1n-flaor Heat Fina#` HVAC Sereening; PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA128342 Date Issued:11/06/2014 Permit Category:ePermit Site Address: 4241 Blackhawk Rd Lot:012 Block: 07 Addition: Sun Cliff 1st PID:10-72975-07-012 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Tony Boerner 2090 County Road 42 W Burnsville, MN 55337 Fee Summary:PL - Permit Fee (WS &/or WH)$55.00 0801.4087 Surcharge-Fixed $5.00 9001.2195 $60.00 Total: 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. Contractor:Owner:- Applicant - Thuy L Nguyen 12843 Eastview Curv Apple Valley MN 55124 Tony's Appliance 2090 County Road 42 West Burnsville MN 55337 (952) 435-2442 Applicant/Permitee: Signature Issued By: Signature