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4268 Beaver Dam Rd Use BLUE or BLACK Ink r - - - - - - - - - - For Office Use 1 City Ol ~U Permit#: I 90 I Permit Fee: I 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: I4l-/b Phone: (651) 675-5675 I I Fax: 651 675-5694 I Staff:'-- I I I 2010 RESIDENTIAL BUILDING PERMIT APPLICATION w f Date: 1 G' / .2- 010 Site Address: Z12 (=19 yC 014'11~ Tenant: Fli V Lf- L t)11- Suite M RESIDENT/ OWNER Name: Phone: 3 2 3 ZI 2- Address / City / Zip: fl oq r~ Applicant is: Owner Contractor TYPE OF WORK Description of work: S/C4 .t/ r~ pCr Construction Cos( /rte o U Multi-Family Building: (Yes / No ) CONTRACTOR Name: L 6 PLI S' ~L' v(' c e License 2 b g Z Address: ( 3 ;2 S- S / sv li ,ice City: 57~ u State: NIL) Zips: Phone: Contact: &/,t_ 1&-Y 1i4 Email: 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 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 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. X A( ( / /emu s x Applicant's Printed Name Applicant's Signature Page 1 of 3 PERMIT City of Eagan Permit Type: Building 3830 Pilot Knob Rd Permit Number: EA090073 Eagan, MN 55122 . Date Issued: 07/07/2009 (651) 675-5675~~~ EPermit Category: ePermit www.ci.eagan.mn.us lflflUl tflflLLL Site Address: 4268 Beaver Dam Rd Lot: 16 Block: 1 Addition: SunCliff 1st PID10-72975-160-01 Use Description: Sub Type: e-Reroof Construction Type: Work Type: Replace Description: House & Garage Census Code: 434- Occupancy: Zoning: Square Feet: 0 Comments: If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are not acceptable in lieu of inspections. Carbon monoxide detectors are required by law in ALL single family homes. Fee Summary: BL - Base Fee $3K $88.50 0801.4085 Surcharge - Based on Valuation $3K $1.50 9001.2195 Valuation: 3,000.00 Total: $90.00 Contractor: -Applicant - Owner: Personal Pride Exteriors Faye M Wallsten 3850 Xenia Ave N 4268 Beaver Dam Rd Robbinsdale MN 55422 Eagan MN 55122 (612) 817-5564 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 1 y~ z RESIDENTIAL BUILDING Permit Application~~` ba City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft of lot, sq. ft of house; and all roofed areas 2 copies of plan _ Cart of Survey Recd (20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions _ Tree Pres Plan Recd 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks _ Tree Pres Not Reqd 1 set of Energy Calculations Addition - indicate if on-site septic system - On-site Septic System 3 copies of Tree Preservation Plan if lot platted after 7/1193 Rim Joist Detail options selection sheet (bldgs with 3 or less units Date / a3 / 0 S /Construction Cost PpY,v~ `t 000 Site Address Zj Z L e C~ C4~;2c~ G~w~ I Unit/Ste # lv~ 51 Y~-Z- Description of Work e- ~2>' I Cl C~%-~,~ Multi-Family Bldg - Y N Fireplace(s) - 0 _X 1 - 2 Property Owner Telephone # 0 Z Contractor 1 Address itY State M K' Zip Telephone COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code Category Residential Ventilation Category 1 Worksheet New Energy Code Worksheet (q submission type) Submitted Submitted • Energy Envelope Calculations Submitted Licensed Plumber Telephone # ( ) Mechanical Contractor Telephone # ( ) Sewer/Water Contractor Telepho l I hereby apply for a Residential Building Permit and acknowledge that the information ACejtted accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and-ate 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. ~J~yr VjA lL5 _Tlff~ Applicant's Printed Name Applicant Signature OFFICE USE ONLY Sub Types ❑ 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 Ext. Alt - Multi ❑ 03 01 of_ plex ❑ 09 07-plex ❑ 17 Garage ❑ 22 Porch/Addn. (4-sea.) ❑ 33 Ext. Alt - SF ❑ 04 02-plex ❑ 10 08-plex 18 Deck ❑ 23 Porch (screen/gazebo) ❑ 36 Multi Misc. ❑ 05 03-plex ❑ 11 10-plex ❑ 19 Lower Level ❑ 24 Storm Damage ❑ 06 04-plex ❑ 12 12-plex Plbg_Y or _ N ❑ 25 Miscellaneous Work Types ❑ 31 New ❑ 35 Int Improvement ❑ 38 Demolish (Interior) ❑ 44 Siding ❑ 32 Addition ❑ 36 Move Bldg. ❑ 42 Demolish (Foundation) ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish (Bldg)` ❑ 43 Reroof ❑ 46 Windows/Doors 1 34 Replacement Temolition (Entire Bldg) - Give PCA handout to applicant Valuation Z,D0_ Occupancy -3 MC/ES System Census Code Zoning City Water SAC Units Stories Booster Pump Nbr. of Units Sq. Ft. PRV Nbr. of Bldgs ` Length Fire Sprinklered Type of Const ~f Width REQUIRED INSPECTIONS _ Footings (new bldg) _ Final/C.O. Footings (deck) ~p 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 20 Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total -7 Q A. a. L: l o - aA i., 1J 11b 1,l lug. 1, iuaa 17P25 Isleton Ave. Lakeville, MN 55044 DELMAR..H. w z 'J LANQ suavrfdo, wit APa•etrru Tar tma of nV Sam of WWWOMA 14750 SOUTH ROBERT TRAIL ROSEMOLWT. 010WI CTA MOM PHONE 41I2 43&1749 SUevErars CtXnFWA .sue a I f20c if 1 ~yl\ fib I o ya Scale: 1 inch 30 feet V I Er wt Proposed finished a age floor elevation S g.~3 Proposed fin iah-ed-vl'evat ion. I hereby certify that this i` a true and correct representation of I,ot 16, Block 1, SUN CLIFF FIRST ADDITION, Dakota County, Minnesota. Also showit:g the location of a proposed house thereon. Or: t ob e r 11, 1984 MINNESOTA REGISTRATION NO. OM g CITY. GF. EAGAN! CASHIER: Js TERMINAIL No4~ 6139' LATE : 08/09/99- TIME: LOOKS, III NAMES ALLIED. FIRESIPQV INC. `321,0.1001 420 SEC-tVER DM 60,00 205-9001 Q68 DEAVER PM :7 OWSO i. Total Fteweipt,, Ameijnt a 60 150 c~ o _J 1999 FIREPLACE PERMIT APPLICATION - CITY OF EAGAN 3830 PILOT KNOB ROAD - 55122 651 681-4675 Date: [A U Description of Work: Construct new fireplace )EGas Masonry Alterations to existing Install gas insert only Install gas line only Other Job address: _ u{~ YYIC G Lot: Block: 1 Subdivision/P.I.D. V~ Applicant (circle one only): Owner Contractor Permit Fee: $60.50 Phone C-09.3 __qaa~z Name: u)fA I kilo T PROPERTY Last First OWNER p t h Street Address: r) a City A, k State: Met, Zip: Company: ~7i'r P,:~ &-jjj2JA)1dD& JQ Phone rGK_ (area code) FIREPLACE (k-4-n 1, 9 w ) y INSTALLER Street Address: City &A(, n R F) ~ State: tA' Zip: Company: A Phone (area code) GAS LINE INSTALLER Street Address: ~J ► I City State: Zip: I hereby acknowledge that I have read this application and state that the information is correct and agree to 0 comply with all applicable State of Minnesota Statutes and ity of Eagan dinance . Signature RECEIVED AUG 0 6 1999 BY: 1 OFFICE USE ONLY $UILDING PERMIT TYPE ❑ 16 Fireplace WORK TYPE ❑ 31 New ❑ 33 Alterations ❑ 39 Gas Line ❑ 41 Wood Stove ❑ 32 Addition ❑ 34 Repair ❑ 40 Gas Insert GENERAL INFORMATION Census Code 434 SAC Code 01 REMARKS Chimney/flue must be inspected before concealing. CITY OF EAGAN NO 9678 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 BUILDING PERMIT Receipt # ~e and for SF DWG/GAR Est. Value g; r _ n n n Date NQVT-?MRFR 8 19__8A_ Site Address 4268 BEAVER DAM ROAD Erect Is Occupancy R-3 Lot 16 Block 1 Sec/Sub. SUNCLIFF 1ST Remodel ❑ Zoning 1R=1 Parcel No. Repair ❑ Type of Const. V Enlarge ❑ No. Stories W Name PIETSCH CONSTRUCTION CO. Move ❑ length 49 Address 17525 ISLETON AVE Demolish ❑ Depth 36 City LAKEVILLE Phone 435-6445 Grade ❑ Sy. Ft. b Approvals Fees o Name 96Ap4E Assessment Permit 301. 00 gu Address 0 City Phone Water $ Sew. Surcharge 28-0 Police Plan check -ISO _ 50 to! 4 W Name Fire SAC 5 2 5_ 0 0 R Address Eng. Water Conn. 4 7 0_ n n 'Cl City Phone Planner Water Meter n n Council Rood Unit X0--0.0 1 hereby acknowledge that I have read this application and state that Bldg. Off.1,1 -9-84 Parks the information is correct and agree to comply with oil applicable APC Total 1 797 _ 5f1 ng r State of Minnesota Statutes and City of Eag Ord' ~ Var. Data Signature of Permittee A Building Permit is issued to: an the express condition that all work shall be done 7i cordonce with o linable State of Minnesota Statutes and City of Eagan Ordinances. Building Official .ia 1 f 10- ".7120 015 • ALL CONTRACTORS MUST BE LICENSED,WITH THE CITY OF EAGAN c INCLUDE © SETS OF PLANS, r'~ © CERTIFICATES OF SURVEY Gj pW SET OF ENERGY CALCULATIONS v `To Be Used For: r ' Valuation: Date r, Site Address: 5333 C44 ORI 0 f Lot Block Sect/Sub:,, //41'Erect : x Occupancy : 3 Parcel Remodel: Zoning: Repair: Type Of Const: Enlarge: # Stories: Owner : c'A i~ 1 Move: Length: Address. Demolish. Depth: 3(0 City/Zip Code: Grade: Sq. Ft.. Phone r%T ~'C ;!fr:~ j~;~~,, C, ` • Contractor: o0 Address : Assessments: Permit: - ~n Water/Sewer: Surcharge: City/Zip Code:l Police: Plan Rev.: 15p, y0 Phone Fire: SAC : S?_ 5 Engr.. Water Conn " Arch./Eng: Planner: Water Meter Address: Council: Road Unit: 2(ap.°= Bldg. Off.: Parks: City/Zip Code:_ APC: phnrA#, Variance: • S ~l X 7( T~ Qyj 3 01 *-C + ?C X 28•;;0+ 150•,-,0+ UJ - 2_•50+ 470•DO+ 63• 0+ 260• CO + 1 O 6 1 g797,50* U Certificate For: PJ et sch Construction 17525 Isleton Ave. 10 Lakeville, MN 55044 DELMAR H. SCHWANZ LAND a VEVM, JW RPO.St"ed Un" Laws of T"# VW Of hhn"ONS 14750 SOUTH ROBERT TRAIL RaSEMoUnT. i1N WOOTA 55066 P"Oft 012 4MI748 SURVEYOR'S GATE -7- i / P-- 014 _ X ,o7' / "PK D ay P V te'a' \ L - aZ ~ ,d ~o 60 Scale: 1 inch 30 feet S Proposed finished arage floor elevation g q.53 Proposed finis tion. r~ 1A i L hereby certify that this i~ a true and correct representation of Wt 16, Block 1, SUN CLIFF F1RST ADDITION, Dakota County, Minnesota. Also showing the location of a proposed house thereon. (w t Ober 1 1 , 1984 MINNESOTA REGISTRATION NO. 9625 ~ City of 40000=616 I:XTFRTOE ENVELOPE AVERAGE "U" COMPU ATIO ~u, ~//7/1►/%_Phone it Description of Froperty: Lot,~6 Hlock..__Z Addition'2PV& M / Date Address AVERAGE LINEAL FEET OF EXPOSED WALL AREA ABOVE GRADE i level Cneal ft. of framed wall above grade_d!!JF x height of wall joist area ineal ft. of rim Z03 x height of rim er level = •f/, /~j'd ineal ft. of framed wall above grade 141 x height of wall yt6 ineal ft. of masonry wall above grade,0:ZS,-x height above grade TOTAL wall area above grade including windows and doors = DOWS: Area x "U" value ~Q~ x fluff 7--(U) (A) e & type /G0166V.1~,e%-~sElh.~q• ft. (U) (A) is ii .i Na q. ft. ~l , x nj~•~ _ iL1 U A) it i• a /-.c^ 3 X.~~ sq. f t. 1. f/?/ x fluff a 3_ 6 ( ) sq• ft. fluff (U) (A) sq. ft.U (A) x n'U„ sq. ft. x S ft. x rrU,► (Ll) (A) V<e 2 x of Zt A* q. ft. 9 x ►►UU►► U (A) a _Qsq. ft. x 7 9~ ( ) ~~~T~+ z_+ sq. ft. ze f 30a x ►►U,► _ (U) (A) „ sq. £t. .r sq. ft. x ►►U►r (U) (A) ►r = (U) (A) S sq. ft. x , of sq. ft. x loull -(U) (A) (U) (A) 01 sq. ft. x "U" x ,►Ul, _ (U) (A) sq. ft. sq. ft. (U) (A) x "U" _ „ sq. f t. r - " /.33023 - RS: Area x "U" value) x „U►,-~ (U) (A) e & type ?~~,Ql!~L--. sq' ft. ~o ([1) (A) sq. ft. (o x "U".o = 3 If ' '0 " °Y ly~-sq. ft. x uU,r (U) (A) ESQ rr~e!1. f~ (U) (A) „ a sq. ft. x n1J P,q a ~t a OUE WALL CONSTRUCTION; Area x value x ?full (111) (A) sq. ft. 9A -Lia a•~f (U) (A) sq. f ~a/.b,Pia flff sq. ft. g r,u,► tail refer--• pp . „~d / _ x nU►► (U) (A) ce from &A sq, ft. • s'a (t,) (A) tin uU►r = tached sq. ft. x x „U►r((I) (A) ee is sq. ft. ft. x f►U►,--------_ (U) (A) sq. t. / r TOTAL Wall Area Including TOTAL (U) (A) Windows & Doors 0-F 9. ° 'PAL (11)(A) VALUES ~~qt AVG. ,►l VIDED BY TOTAL WALL AR~ ERAGE MinJmum\ OO-di less for i & 2 family dwellings Minimum .22 or less for all other buildings TE: If avrrage "U" values as calculated above do not meet the Energv Code requirements, the "AJernate Envelope Design" as indicated on Page 5 may be used. i WA3.1, SECTIONS NUsk 107. of 01),I(fuC w.i11 area F()r fraimhig niembers R-Value FRAMING MEMBERS IN WALLS 'Po> View _ Exterior air._film.___ . _ - . - - _ Siding - - ln~ r Sheathing soft wood dry wail .45 Inteerior air ffilm _ •68 - I TOTAL R U = 1/R U = o FRAMED WALL _ Exterior air film / 17 Siding . Sheathing " batt insulation .45 31" dr wall .68 Interior air fil d~ rPQTAT U = 1/R U = . Q! - RIM JOIST AREA- Exterior air film 7 Siding Sheathin 1Y, soft Insulati .68 _ Interior air fi m - TOTAL R R = .~7 U = 1/R U MASONRY WALL Exterior air film - 12" concrete block _ Insulation Interior air film _ •68 ~ TOTAL R = f3 U = 1/R t1 = s ROOF CEILING `r Outside air film .61 - - Insulation 'y1f.0L) :1WT ' r r r 1 ~ j-- l J' Drywall .45 Interior air film .61 TOTAL R - U = 1/R U = - - Outside air film .61 Insulation - .45 31" Drywall - - - Interior air film .61 TOTAL R = U = 1/R U = - Outside air film .17 Built'-up.raofina ----s.33 - Insulation Wood decking Interior air film .61 1 TOTAL R = U = 1/R U = . ROOF/CEILING: TOTAL AREA: sq. ft. _ .2r /,p (U) (A) Detail reference "U" s0 x sq. ft.~J Ifull x sq. ft. from above. _ (U)(A) - Describe openings ..U.e x sq. ft. = (J!) (A) in roof "U" x sq. ft. (A) „U„ x sq. ft. - - x sq. ft. (A) x sq. ft. _ (I!) (A) TOTALS sq. ft. (tJ) (Al 1'0'I'AI. (U) (A) VALUES "U's DIVIDE[) BY TOTAL AVC. CL•'ILINC AREA our AVERA(:E "l;" Y5 1 ~C ventilated roofs .10 for all other construction NOTE: If aver:ige "tve' values as calculated above do not meet the Engergy Code requirements, the "Alternate Envelope Design" as indicated on Page 5 may be used. Ahl Exterior air film •92 Crawl Space 31 " plywood & ~1" particle board .66 Insulation _ Interior air film .92 - TOTAL R = U=1jR U - I _ Min. R 7.5 q U y Slab on grade Min. x=7.5 I Grade Min. R 7.5 insulation shall have a minimum R-Value of 7.5 and must extend horizontally (as illustrated) or vertically a distance equivalent to the design frost line; that is: Zone 2 = 3 feet 6 inches Insulation shall have a minimum R-Value of 7.5 around the perimeter of slab on grade floors. THE: TOTAL ENVELOPE CALCULATION METHOD The regulations state that alternative overall "U" values for building sections are permissable if it is shown that the total. building envelope heat lass/gain does not exceed that of a similar building that meets the regulation "U" value maximums. In this case, we will consider only the walls and roof/ceiling criteria, assuming. that the remainder of the building meets i-CgUlation requirements. A. Total. heat loss as designed (walls and roof/ceiling) BTU/hr. degree F. Walls - UoAo = Average "U" of - wall assembly x average wall area sq. ft. Roof/(veiling = UoAo = Average "U" of ceiling x average ceiling area - sq. ft. - TOTAL B. Total heat loss if designed to meet the regulation minimum (walls and roof/ceiling) Walls = UoAo = Minimum required "U" value of wall x average wall area sq. ft. _ Roof/Ceiling = UoAo = Minimum required "U" value of ceiling x average ceiling area sq. ft. = TOTAL The following table may be used as a general guide line for determining allowable percentage of wall openings when lowest "U" value is established. % Wall 0 enin 10.6 13.4 15.6 17.2 18.6 19.7 20.6 21.4 22.1 Minimum R-Value O a ue Wall 8 9 10 11 12 13 14 15 16 % Wall Opening E22.623.11 23.6 24.0 24.4 24.7 25.0 25.2 25.5 Minimum R-Value 0 a ue Wall 19 20 21 22 23 24 25 0 area (sq. ft.) X 100 = n Penig Opening & wall area above grade (sq. ft.) opening in wall The following table may be used as a general guide line for determining allowable percentage of roof openings when lowest "U" value is established. Roof 6 -Opening 0. _T1-._ 2 P3344 5 Mini mum [t-Value of .Opaque Roof 20.0 22.3 _ 25.1 42.2 55_3 Open in area (sq. ft.) X 100 Opening & roof/ceiling area (sq. ft.) opening in wall Prepared by: ,/CITY AGAru WATER SERVICE PERMIT 3 Pilot Knob Road 5814 P. O. Box 21199 1rq PERMIT NO.: 11_ Eagan, IVIN 551r DATE: Zoning: No. of Units: Owner: Fietsch Ooot 426 E Aver 'Dam Road 1.16 :B1 Sun Cliff 1 Site 7llddress: unsber. Wei& `ka' Trench- 9 Exc & No.: - Ooprwx 470 iq~+- Charge, .00 pd 15.00 pd Size: tclic, ~ _ ;Acoourrt'iieposit: Reader No.: n9[. 4 3 S 3 3 Permit Fee: 1 Ca . 00 p 3. Gore. to Pb wah the City of fiWn Surcharge: . 50 pd Ordim Misc. Charges: 63.00 pd meter Total: By Paid: Dote of Insp.: - insp.: - JCIT.Y p I Rl1AIT ~ 77" F EAGAN w WATER SERVCVPE 38¢30 Pilot Kri6!~Road P , O,~Bax 26.199. PERMIT NO 1 EaganMN a5NN : DATE: Zoning Na. of Units:, Owner. Tistsel const 77777 Addre~~° ,1)1. gift CUR t7,-, Site Address: 4,268 B 7tv irs . a B L16, Plumberi • Weiorke Trench R a~~ y p Meter No.: Connection Charge "+F W r LF Size:. - Account Deposit. • --W 0 Reader No':= Permit' Fee I ,,1 to eem* whh the City'af-Eagan SU"atge ^ fW: .JIM ss y Ordimear. .Misc. Chorges:, F+ Total: By data Paid Date of insp.: Ir~ap.: CtITYtOF~rE~AGAN 'SEWERS SERVICEPER'MI1'K s 383Q Pd$ot Knob~Road' P OE Box 21199 PERMIT NO P Eagan, MN ;55121 DATE: Zoning $ No. of Units.' It "Owner Pi*tsa t ~ Address ~ . f J. x368. saver I) m RgsW L16 91 Su13 Cam ; x, Stte:Address: : 3r Plurr+ber marks Trench 6 Ime z 11.84 47581 ` bOW> P4 I,aBree to empli with the 117 of Baton Conneatlon`Chorpe: s ~rd111a110e4 Accour* Deposit: i T 4 a Permit Fee: 10.00 O pd Surcharge: 50 ` BY Misc. Charger, Dote' of Insp.: Total: Insp.: Date: Paid: :u r 2/84 CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION (PLEASE PRINT) 1) PROPERTY ADDRESS: /7113* L,~-/~ LEGr+L DESCRIPTICN: J34oG& 1 S'G e-1if1c /4T (Lot/Block/Su x•.ivisicn or Tax Parcel I.D. N=zer) C IF E:{I _=i, STRUC :RE, DATE OF =IGMaL a I- %D:G PFLr=7' ^~+I.r~+/ = x?OPOS USE: Zc~-, S_l FAtiIILY _=~M ❑ R-2 ICU= ('P:~ UNITS) ❑ R-3 TC:,.NHMISE (T= 1 u~.TI-.S) UNITS ❑ R-4 L':+ITS ) ❑ CCi•L%E CLAL/'REI;AIL/CFFICE ❑ =S i RI?.L ❑ IN Si17,TIC~L/GGVEM, I M7. 2) APP=war ^E ASE PRI.N i ) A P1 -T5 - ADDRESS : 1 2s S` sL- Ty-v A lIc CIT`_', STATE, ZIP: PHONE: y S Are ~Yy 3) PLL';•',BE;', PLEASE rRINT) T FOR CITY USE ONLY PLUMB R5 LICENSE: ADDRESS: la CITY, STATE, 'LIP: r1f «~y,,.,. Z f 3 Expired Hai m Q Not f Re rd 19 PHONE: -e1 PLUMBER LICENSE l T-` at nltla 4) OCCUPANT/CSv1`IER (PLEASE PRINT) NAME: ADDRESS: CITY, STATE, ZIP: PHONE: 5) INDICATE WHICH PERMIT IS BEING REQUESTED: LION TO CITY SEFIER CONNDCI'ICN TO CITY WATER ❑ OmER (PLEASE DESC2IBE) 6) INDICA-1 . CNE : &LE-~SE HOLD APPROVED PERMIT FOR PICK-UP BY ONE OF ABOVE ❑ PLEASE ',7LIL APPROVED PERMIT TO 1, 2, 3, 4 ABOVE (Circle one) 7) SICaMME: DATE: 2z - " k- :ii AM it !l~iE.ltll~it! OSM=OMii.¢4/ F O R C I T Y U S E O N L Y . PERMIT " ISSUED L - I FEES: $ SEivER PERMIT (I`ICL::^.E SU.,....aRGL) WATER PERMIT (INCLUDE SURCHARGE) WATER METER/COPPERHORN/OUTSIDE RE"',DER $ WATER TAP (INCLUDE CORPORATION STOP) $ SEWER TAP $ _.CCCU::_ OSIT - -='R $ ACCOUNT DEPOSIT - WATER WAC $ SAC $ TRUNK WATER ASSESS.IENT $ TRUNK SEWER ASSESSMENT $ LATERAL BENEFIT/TRUNK SETTER $ LATERAL BENEFIT/TRUNK WATER $ OTHER $ TOTAL $ AMOUNT PAID/RECEIPT # 4 '(J DOES UTILITY CONNECTION REQUIRE EXCAVATION IN PUBLIC RIGHT OF WAY? YES IF YES, THEN A "PERMIT FOR WORK WITHIN PUBLIC ROADWAY" MUST BE ISSUED BY THE NO ENGINEERING DIVISION. LIST AS A CONDI- TION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : w sir ww s+~ wt~ r w~ wo w w S44 wso MEW pow rf mm:pm wpm mum 0*10 pa Wi! • "m mm 04 sis w . CASH RECEIPT CITY OF EAGAN 1 P. O. BOX 21-199 EAGAN, MJNNS TA 5512 DATE" 19 R@CaI FROM VBDAy AMOUNT DOLLARS goo CASH CHECK } FU TIO coos AMOUNT' OZ~ kne 7410 tau r, - 3.`.,' lay White-flyers Cogv I 1p, EA"N F 0.0.96X 21-199 EAGAN, MINNESOTA 55121 L9JIT6 it mcmvsD FROM AMOUNT 6 DOLLARS +oo 0 CASH HECK Pon FUND CODE AMOUNT .3v 37i lv ~~fr 4O_ Thank You 7 7 6 47 White-Payers Copy Yellow-Posting Copy Pink-File Copy PERMIT s MECHANICAL PERMIT RECEIPT CITY OF EAGAN DATE: a7~ -3830 PILOT KNOB ROAD, EAGAN, MN $5122 CONTRACT PRICE: PHONE: 454-8100 For Office Use Only: Site Address BLDG. TYPE WORK aescUPTIOIN Lot / Block S/Sub Res. New A`` I m Name ...rr Molt Add-an Address f Comm. Repair . c city Phone Other < - ;f' FEES Name, RES. HVAC 4-100 M BTU -$24.00 c Address r' r f '✓Ay :~'"r/'` ADDITIONAL 50 M BTU - 8.00 p City Phone (RES. HVAC INCLUDES A/C ON NEW CONSTRUMON) GAS OUTLETS (MINIMUM -1 PER PERMIT) - 1.50 EA. TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE Forced Air M BTU APT. BLDG& - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON & Unit Heater M BTU REMODELS . Air Cond. f` M BTU MINIMUM COMMERCIAL FEE - 20.00 , Vent CFM STATE SURCHARGE PER PERMIT (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets # BEYOND $1,000) Other FEE: - t- TOTAL: FOR cITY OF EAGAN _ - . - - . ; - - , r-..,......_;...~ tae.-.,-..v--~~m...- ~ ~'-1 CITY OF EAGAN j 967 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHONE: 454-8100 C~~9/ - BUILDING PERMIT Receipt # ae used for SF DWG/GAR Est. Value 56.000 Dote N[3 .MR -R 8 19_ u Site Address 4268 BEAVER DAM ROAD Erect 0 Occupancy R-3 Lot 16 Block 1 Sec/Sub. SUNCLIFF 1$T Remodel ❑ Zoning R-1 Parcel No. Repair ❑ Type of cont. V Enlarge ❑ No. Stories Name PIETSCH CONSTRUCTION CO. Move ❑ Length 4 i Address 17525 ISLETON AVE Demolish 11 Depth 36 . 9 City LAKEVILLE. Phone 435-6445 Grade ❑ Sq. Ft. Name _ SI%ME Approvok Fees ,o ~ Assessment Permit ~n V Address Water & Sew. Surcharge 28,-0 City Phone . 1500 Police Plan check ~OLY W Name Fire SAC 52&,00 11 Address Eng. Water Conn. 47-0. ~F, city Phone Planner Water Meter 63.00 Council Rood Unit 260.00 I hereby acknowledge that I have read this application and state that Bldg. Off.11-5-84 Parks the information is correct and agree to comply with all applicable APC Total 1•797.50 State of Minnesota Statutes a ity of Eaq Ordi P~ Var. Date Signature of Permittee A Building Permit is issued to: P ETSCH CONSTRUCTION CO. an the eutpress mwwwn thw all work shall be done iP0(70 rdonce with 1 applicable State of Minnesota Statutes and City of Eagan OnAnanceL Building Official J/ ,7 Building ` r N T Permk No. Permit Holler Date l' Plumbing r la 3,0 H.V.AX. a. Jf v~ d 1 I ~ `f ~ - 33 Electric y ' Softener Inspection Date Insp. Other Footings Foundation Framing t x Rough Plbg. Rough HVAC Insulation Arg~ Final Pibg. Final HVAC Final - CWVOCe. water Describe Location: YIIeIt S+wac' Pr. Dies. i., _ ;.;.,_r,:f.t.»~„k- 3a,...::►..,.:~... ..,~..,,.3 s, ..._ai...ia-+ --_t~ , r .c„- '~yr'k'd Receipt PLUMA%~-kBING PERMIT Permit No CITY OF EAGAN Fee r F,Fill n numbered spaces 8/C e or Print legibly Tot. _ v 1. Date nstallat ion Cost 2-?. ! 3. Job Address L) (V Cot _Blk. t Tract h 4. Owner 5. Contractor 1. rl7T CA' la~~~A£C i ~~(C Phone V Z- 6. Address lSl 'i5 Ian ty .l I~C; I X 6. 7. City )Co Sit C u , t State i✓ Zip T 8. Building Type: Residential Commercial ❑ . Institutional ❑ 9. Work Description: New Add ❑ Alter ❑ Repair ❑ 10. Describe 11. No, Fixtures No. Fixtures 2- Water Closet Cesspool/Drainfield _L Bath tubs Septic Tank Lavatory Softner 1 Shower Well 1 Kitchen Sink Urinal/Bidet Other Laundry Tray Floor Drains Drinking Ftn. Slop Sink Gas Piping Outlets 12. 1 hereby certify that the above information is true and correct, and I agree to comply with a.11 dnances and codes governing this type of work. Signed : for • Rough Fine) Inspections: Date Insp. Oats Insp. This is your permit when numbered and approved. Approved CITY OF EAGAN 4644100 `From"* 31111ir Y d.IT1r t EJ4 P Fill in numbered Amen S/c Type or Print legibly Tat. t ate 2. Installation Cost G t t Aft*a Lot .mac c ; ` : p ( Off. Tr y l_.C f s" .!L er r Phone e, A 1 C` X f= c Gyp tala.$p Ty€lss: Residarrria ❑ InsOwdatW, Q Add l l -W lliparlpdmn NHS I. D s itaa at; Fuel Type P d Air '~5 e t c .~.~.w Air Har4iin a r't ' aSC4 1~!'-4 ~1.J yr NYdy t CITY OF EAGAN Remarks '162 Addition SUN- CLIFF 1ST Lot 16 Blk 1 Parcel 10-72975-160-01 Owner '40 YX6 Z' ''"Z461`2 Street 4268 BEAVER DM ROAD State EAGAN NN 55122 Improvement K,11,,,e Amount Annual Years Payment Receipt Date STREET SURF. 125 690.05 69.01 1 STREETESroR. 030,40 2 3 4 10 1015.20 0009992 1-4-85 GRADING SAN SEW TRUNK 1978 ' 54 3.06 25 27.58 0009992 1-4-85 SEWER LATERAL 1274 2,95 15 8.93 * Sewer Lateral q 51 441.97 _ 10 2209.89 WATERMAIN • WATER LATERAL 10 WATER AREA 9-s- SS 6-24 IS 12.56 0009992 1-4-85 STORM SEW TRK I O5 1971 322.29 16.11 20 80.64 009992 1-4-85 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT Road Unit 260.00 #47581 10-8-84 WATER CONN. 470.00 n 1r BUILDING PER. #9678 io T~ SAC 525-00 91 PAR K This request void C/ 18 months from Request rate ire No. Rou ti h inspection L c' Re fired? (Ready Now ❑ WWII Notify Inspec (tlv ❑ Yes No r for When Ready tensed Electrical Contractor 1 hereby request inspection of above Owner electrical work installed at: Street Address, Box or Route No. City action o. Township Name or No. Range No. County 16.4 r,,,_ Occupant IPRINT) Phone No. y~ Power Supplier Address Electrical Contractor (Company Name) Contractor's License No. 5 0,4, 5 C, Mailing Address (Contractor or Owner Making Installation) I °i ( -7 -1 a r.,_.. C- PC,. + t Ito, t I < Authorized Signature (Contractor/Owner Making Installation) Phone Number C fem., a-- -'D 0-4 4 b C, - l ~-I 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 Universitv Ave.. St. Paul. MN 55104 o ti....e ra~~r ae-,_nr:nn ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION EB--00 of-os ' See instructions for completing this form on back of yellow copy. E 2 6 3 5 5 "X" Below Work Covered by This Request 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) lher ISper: fyl Other Specify ter 01her Compute Inspection Fee Below tt Fee Service Entrance Size ff Fee Feeders /Subfeeders k Fee Circuits 0to200Amps 0to30Amps 0to30Amps Above 200 Amps 31 to 100 Amps 31 to 100 Amps Swimming Pool Above 100_Amps Above 100_Amps Transformers Irrigation Booms Partial- Other Fee Signs Special Inspection E15'5'O TOTAL E Remarks /I • D Rough-in Date I, the Electrical Inspector. hereby certify that the above Final i Date inspection has been / 3- 7- made. This request void 18 months from This request void f I i 18 months from A 096891 Request Da J Fire No_ Rouph-in Inspect" 2 n []Ready Now [}IMTfI Notify InsPec- ❑No for When Ready da-If'censed Electrical Contractor I hereby request inspection of above 0 Owner electrical work installed at: Street Addre Sox o ute No. City tap - ~ .J Section No. Township me or No. Range No. County O upant IPRINTI Rhone No. n~~T'u ' `OtiJ 34C'-l05' Power Supplier Address MA) El trical Contrac or (Company Namel Contract 's License No. Mailing Address (Contracto or Owner Making Instaal tion) w, ' qqj_ r 6,Lm Author" Signature (Contractor Making Installati ) Phone Number 3 - 73'7 MIN OTA STATE OA F ELECTRI THIS INSPECTION REQUEST WILL NOT Griggs-Midway Bldg.B- N-191 BE ACCEPTED BY THE STATE BOARD 1821 University Ave.. St. Paul. MN 66101 UNLESS PROPER INSPECTION FEE IS Pe-- 16121 297-2111 ENCLOSED. REQUEST FOR ELECTRICAL INSPECTION Adftk EBXOOU1-04 See instructions for completing this form on hack of Yellow copv. 15 A "X"" Below Work Covemd 1?V This Request. Mew 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 45pecity) ther (Specify) Other (Specify) Other Compute Inspection Fee Below If Fee Service EntrenceSize p Fee Feederso$ubfeedem 8 Fee Circuits Q 0 to 200 Amps 0 to 30 Amps 1 .:X 0 to 30 Anys 4- X0 Above 200 Amps 31 to 100 Amps 31 to 100 A Swimming Pool Above 100 Above 00-Arrivis Transformers Irrigation Booms Partial."Other Fqe Signs Special Inspection $ C TOTAL~U Remarks Hough-in r at~~~ , the Electrical i erector. hereby e6rtifv that the above Final p iris lit t J Df to inspection has been made. This request Vold 18 monft from Use BLUE or BLACK Ink I For Office Use I I t I Permit* CItV of E~ ~YJ I l d~ ~5 Permit Fee: I 3830 Pilot Knob Road Eagan MN 55122 Date Received: ' 3 Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: - - - - - - - - - - - - - - 2012 RESIDENTIAL BUILDING PERMIT APPLICATION Date: ! Site Address: q'S'4n k4/ Unit Name: Phone: RESIDENT / _6e+E~ OWNER Address /City /Zip: o'- iu Applicant is: Owner X- Contractor TYPE OF WORK Description of work: && 4rnr Construction Cost: Multi-Family Building: (Yes / No ) 0 Company: tr.-v f,11az-r ZLG Contact: ~,A-01,4-G,4e CONTRACTOR Address: S- SA /J City: 4e ~C~TCV State: Zip: _ rnlb 7.~ Phone: 7V License 8C Co,3063 7 Lead Certificate /t/ry ;r- 105?2/ / 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 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. 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.Clol)herstateonecall.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 Minnesota Building Code must be completed within 180 days of p nit issuance. x ~ x Appli nt's Printe Name A nt's Sin re Page 1 of 3 PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA117866 Date Issued:10/24/2013 Permit Category:ePermit Site Address: 4268 Beaver Dam Rd Lot:16 Block: 1 Addition: Sun Cliff 1st PID:10-72975-01-160 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952) 445-2840. Janel Behrends 122 West 3rd S Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088 Surcharge-Fixed $5.00 9001.2195 $60.00 Total: I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Contractor:Owner:- Applicant - Faye M Wallsten 4268 Beaver Dam Rd Eagan MN 55122 Haley Comfort Systems 122 West 3rd St Hastings MN 55033 (651) 437-0338 Applicant/Permitee: Signature Issued By: Signature t~ r k.~'Z J r s. r ♦ r j~ 7 r ,r"1, ~j< ~ ' Use BLUE or BLACK Ink .y s,1 t,h1t 3 - c,+:yaa~;.•.~~~{ + h For Office Use." - - - It ofa af~ ~`it xr.s ~35-~ . ~ .,~~40~_ry7~{ Permit a: , 3830 pttot 'r Jr~.. '4lanlta~tr,iu~k~ryw, • 31 Knob Road 1y Permit Fee: i a ~ Eagn MN 55122 " Phone: (661) 676-6676 t Date Received: Fax: (681) 67516694 w ' *z c' Y t t Stall: . . _4 .t .r• t . - - 2011 RESIDENTIAL-BU IL~bING'P ERM1T APPLICATIQN - -Data: Site Address; (p ~l • , Unit q; . • Name: "WALL R ,-'d _ ~sioENT / - Phone OWNER Address I City / Zip: • Appilcant is .Ownef,.;;- ',•Contmctor ; TYPE OF WORK Descriptionotwock;,ps9;Q-~ Construction Cos C J MulU•Femll e it Y ding: (Yes I No Company~Z`'`e*tf Contact~~u~ ST`~2 ,7 i CONTRACTOR Addtegs; D~J ,(/wiQl9r 12Zols . air 7 , Ctty: a7 , State•,' 'tZ;;;gt' PhOr18.~ Ucenso . L3©3 emy3~'" ' , AdC9 ficate : JU o~ I It the project is exem t fro p , m lead cettlticatlon, piease explain 'why; (8e.'e Page 3•for additional information) COMPLETE THIS AREA ONLY IF'20$UCTINO A NEW BUILDING In the last 12 months, has tlio City of Eagan.lsauod'a permit fora 'similar plan based on a master plan? a r m ._.Yes -No 1f yes, data and address ottnaster,plan= . W + ;At'R+N v-0, Y't1",t f 1lY x { • 5 1.. I;Jeonsod Plumber: 7 « .,•yf r,;r :.x a i, ..r.,: Phone' Mechanical Contractor.' . f Phone: & Wer Contractor' .w Phone: SewenhM ns and supparting; docrlmetl ' ts q8'i yo~t stlbmlt ~,rtp 09p,37 d to•be putiifc Information. Pvrtlons of atlon maY4v`cJasst(le'd,°~s~n' c •'}cdiiLudk''at~4~?i'~`Ya9.sr11'c~'lerrsons that would permit the City to • . , ~ v .•~rc}'t ks~~,svcrvts'' . CALL. BEFORE YOU bIQCa es of unurxiStsito Ono Cail Ot tt?6,~) ~6{-ppp2 fb protgctlon 1981n4i underground vt damage. Cali ta.hovrz t:elcre you intend to dig to receive locales Of er r 1tJei ..9,o~nd.u!>!~ ~ ~ Y~loooheretaleone t~u.+.., a Y 1 r, r ,'•j I rveby acmowtedge that LN3 intotrTteUpn Is CotTlpiel0 afYltaCGUtate;, Eagan: teal l under3tand this is not a nly i the work wSU bo confortnenco with the ordlnanCOS and codes of the City of catIon accordance with the approved plan in Iho -e 01, vain requiroa a rWe endltapprovalo ,plansi to can without a porrr,it; that ►ne worx hill ee i, Exterior work authortzod by a butidln r t days of permit issuancor q porrpJt 11409d in accordanco with the Mlnnotsota Stato 8ullding Codo must be compiotod within tbQ :•ppUcant's Printed Name x :1 2 • sir 4'r{i"' yAf x~r < App*Va turo Page t or ; Use BLUE or BLACK Ink I For Office I City EaE O p~ I Permit LO I Permit Fee: 1 O ~l 3830 Pilot Knob Road Eagan MN 55122 I Date Received: I I /I h3 Phone: (651) 675-5675 I 1 Fax: (651) 675-5694 1 Staff: 1 _ 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: 6/ Site Address: 7 4r/cF2 ,0,9--i l Unit Name: Phone: r~ ' 83 9 la Resident/ Owner Address / City / Zip: Applicant is: _X_ Owner Contractor Type of Work Description of work: /i9Ce' cti.4sr~ S~d,,N %vr. 'f dt- f c.1 t~ O~- V C, Construction Cost: 3 q-6 c) Multi-Family Building: (Yes / Np~) Company: Contact: Contractor Address: City: State: Zip: Phone: License Lead Certificate If th{e' 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 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. 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.gogherstateonecall.orci 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 Minnesota State Building Code must be completed within 180 days of permit issuance. x_ l/V~i " x Applicant's Printed Name Ap n 's Signature Page 1 of 3 Use BLUE or BLACK Ink r----------------- I For Office Use � I � � I � � Permit#: � I City of �a��� � �,= � � Permit Fee: � � I � 3830 Pilot Knob Road i Eagan MN 55122 � Date Received: � Phone: (651) 675-5675 I � Fax: (651) 675-5694 L Staff: --------------i 2014 RESIDENTIAL PLUMBING PERMIT APPLICATION Dat � �� � Site Address: ��CJ ����r ��c�1n ��-.� Tenant: Suite#: ResidentlQwner Name:_�(? (��f/�S� Phone:�OJ � "�C��JU ��� �� �` Address/City/Zip: `'�" LV v ��-��� ��� � Name: License#: Contractor Address: City: State: Zip: Phone: ` Contact: Email: Type of Work �New _Replacement _Repair _Rebuild _Modify Space _Work in R.O.W. Description of work: � r� � � RESIDENTIAL Water Heater y Water Softener /1 Lawn Irrigation �RPZ/_PVB) Pet'1'T1it Type Add Plumbing Fixtures�Main/_Lower Level) Septic System New Water Turnaround Abandonment RESIDENTIAL FEES: $60.00 Water Heater, Water Softener, or Water Heater and Softener(inciudes$5.00 State Surcharge) $60.00 L wn Irrigation (includes$5.00 minimum State Surcharge) $60.00 Add Plumbing Fixtures, Se�tic Svstem Abandonment, Water Turnaround*(includes$5.00 State Surcharge) *Water Turnaround (add$200.00 if a 5/8"meter is required) $115.00 SeptiC System New($10.00 per as built) (includes County fee and$5.00 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. 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. X ���� t,��u� ��� ' X Applicant's Printed Name Applicant Signature FOR:OFFICE USE ' Reviewed By: Date: Required Inspections: Under Ground' ' Rough-In Air Test Gas Test FinaL Meter Related Items: Meter Size Radio Read Staff: