4294 Beaver Dam RdcITY oF EacnN WATER SERVICE PERMIT
3830 Pilot Knob Road 5506
P. 0. Bo4 21199. _ PERMIT NO.:
Eagan, MQ!- 5512) DATE: 5-30-84
zonins: R1 No. of units: I
Owner. SOIlS CODBt
Address:
Site Addresr 429 Beaver D8m Rd L20 B2 SuA C2iff
Plumber: Loren Browx? Plbg
Meter No.: Connection Charge: ? '?Q pd
Size: Actount Deposit: ' P
Reader No.: Permit Fee: ? p
1 ogroo M oomptp wilh Ihe Cit?r of Eagon Surchcrge: •? p?
o.dieanoes. Mtsc. cnnrges: 63. Q pd ?net??
8y
Date of Insp.:
Totai:
Date Paid:
Insp.:
CITY OF EAGAN ;. ? SEWER SERVICE PERMIT
3830 Pilot Knob Road 6695
P. O. Boxt27199 PERMIT NO.:
Eagan, MN- 557 DATE:
`
Zonirig: No. of U.nits:
Owner: 30t1R COIIst
Address:
Sire AddrQss• 4294 Beaver am un
Plumber. ??en B='oiu Plbg
-
1 egres to con+py wilb tbe Ciry of Eagan Connection Charye: .
?+25. Q?I
pd
Ordinencet. Aooount Deposit: 15.00 p a
Pertnit Fee: 10.00 B d
Surchcrge: .50 p d
Bv Misc. Chorges:.
Dote of I?isp.: Total:
Insp.: Date Paid:
-$„ - •- - - -^'?-.?4'?!?9?"'"!"r`r*?y."?r'!f'?? ?`'"s?lr'j? "?,L'e'.??pq{?"°°-?•"~.f- -•-? ?1
'T PLUM6IFIC PERMIT For Olfia We Only
CITY 4F EAQXN p„?"wT#TAM dVr%?
CONTMl4CT 38= PIl.OT KNaB ROADp BAiAAW, NW 05121• R'? (EIl?:?
PRIM PH4NE 454$1+00 b14ft: , !,&
SILe
Lot.
? Name
? Addre
? C+kY ,
, ._..,,
? ,,
? oky , P
; r
F°EES `
COMM:lIItO.) FEE -1%OF CONT-RACTfEE
APT. BLQdS. - CdMMM. RATE APPLIES
TOWNNOOSE & CONDO- RES.-RAfiE•APLLIES
MINIMUM - RESIDENTIAL FEE $12.00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $. C PER EACH t,000 ERM17 F ,
?
SIGNATURE OF PE RMITTEE
BWVr ,irE FLMprriom
Res.
Mult.??' Add?n ?Comm. qepair •,. r:`.. .
Other '
-°-??-,
RES. PLBG. ONLY - CaMPLETE THE FOUVMN[3:
NO. FIXTURES TCYTAL water ciosee - $3.00 $
Bath Tubs - $3.00 _---- ..
Lavatory - $3.00
?.- •°°
e? s??? - $ 3.0 0
gu
? T1rinaUBidet - $3.00 -
Laundry Tray - $3.00 .
Floor Drains - $1.50
Water HMer - $1.50
wnidpoa - $&oo
Gas Pipirig Outlets - $ 50
(MITIIMUM -1 PtEl??RMI''}
Softener - $ ?0
weo - $1o.c?
Private Disp. - ?1A.?
Rough Opery'ng ,4 E . ? ,
?PiRPAT FEE:
, STATES S/C: ?.
GRAND TOTAL:
FOR: CIN 4F EAGAN
' - - -. ..
-
. . . ? ` f ' 4r'? C#Uom' ' . ?` •?-',?s
3830 Pilot Knob Ropsd?,?. ?P u.?C.-?1???t 2??'1y-f99, Eagan, lY?l ?'12i N?' :
?`?74?C? 4PF'Y100 , .
'110KDING PEitM1T Receipt # - --- - ??_? ?' -
;
d ier SF I)FIG/CAR E?. Val? 65, 000 p?e 1?ARCH 26 19 84
?w '
? ...._? .?.??
44eAddreas 429 4 BF,AVER DAM RD. Erect If Occupancy R3
i.ot 20 91ock 2 Sw4ub. SUN CLIFF Alter p Zoning
10-72975-200-02
Pisswi Nq. Repoir ? Fire Zone
1kDVAI3CE DEt?. Enlarfle ? Type of Const.
Name -MO`'° O * Stories
AddrassEDIA1A 7700 XFRXES Demolish p Length.9,9.
Ctty . Phone Grode p Dep#+ Sq. Ft.
Neme SONS CONSTRUCTI4N Aaproweb
Address ' Assessment
City YA Phone 452-4721 Woter & Sew. --
NamB GEORGE MANSTELEIaY
Address 9001 - 3 5W FRONTAGE RD.
Citv BLOOMINCTOl?h4n.
1 htreby atkrnywledge`thot 1 have reGd this opplicotion cnd stata that
Oe in(ormotion is torced d cgree to ly ' "oll oppliccble
Stute of Minnesota Stotut 'ond C?yr/of nances.
5lqnoture of Permittes
A 8utlding P•emit is issued to: 50 S CONSTRUCTIOId
all work ahall be done in accordonos witfi,y?i oppi? f_Minn
i? i
Police
Fire
Enp.
Plonnix ?
Counqil '
Bidg. Qff.
APC
32411. .<
.s ?? 2. D?!
Plan eFeck-?^• aQ ;
?fl?aober Conn. ??• ? ?
WetorUeter-?63,• 00
--260. 00 ;.
*Add : Unit
Totnl
_..?.__ on ft exprmn eawiNien Ow ;
Stotutes crd Ciry of Eapan Or?
ouihlinC Officitd
,?P ; .
?Jb
ftrmit Me. ftrmit MoleMr Nfw- Pwmit Na. Nader
Pkimbktg ?f3??d c ?P I h 5-?-?
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-
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Pr. cww , -
Raceipt 3 MECHANICAL PERMIT Parmit No9 J 3?
CITY OF EAGAN
h??-? ? F« '
1.
Fill in numbered spaces
Type or Prini leglb/y
Date 2. Installation Cast
3. Job Address Lot ?Blk. -'? T?c4
4. Owner p oN G/ScN Sc,tiv 5AIrv e}
5. Contractor Na a/5 !7 Qa Phone 3vcf 7
6. Address 7 Z't`f r3fiv5ol( // W Lv SU .
7. City
k IG6f /?ld
8. Buiiding Type: Residential 91
9. Work Description: New 16
State f*,rln
rp 55 Z 3
Commercial 0 Institutional O
Add O Alter 0 Repair ?
10. Describe Fuei Type 13
11
No. Equipment BTU - M. Ea.
Forced Air 5Z I ooG No. Eauiument CFM
Ai
H
dli
Mfg. 1- Q iviuoX r
an
ng:
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg.
Other
Air Cond.
Mfg.
Gas, Piping Outlsts ?
12. t hereby oertify that the ahoue information is true and oorrect, atW l apres to
aomply withWi oninanas???es g4verning this type of rvork.
bmosetlarw. Dste _ 'bnsp. -Dete h"p.
rat is Yrrw prr"k whm rwr*med *-A appraaMcl.
_ ?? ?tiw i-' . _ . M - i? ??.r? ?? • " ?T ? ??,. . • .
. . M?• . ? . _. . .. ? ... . _. . ?? . . "
y
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4 y
s/c
Tot.
1700. o0
? Pf. T #ar+r* F&. 41
;
'-
CtTY OF PAGAN
c..? F?e
Fill in numbered spaoes s1c ?
7`ype or Prirat legibly Ta#.
?t.
9. Date t.t 2. Ins#allatian Cost ?
S. Job Address L.ot Blk,vrf- Trast
' 4. OAiV178C sy I
. r., . ?r ' ?• % . `i ! !
5. ?"rofttI`w1'AI'C LL t4 ^a ti ?? ' fY ?i PhUINE
Addf e55 x .
?
? • =? _?_
7. CFty 4iU r) State
& Building Type: Residential EC Commerciat CI lnstitutiarral CI
0. Wrark Description; i;few El Add ? Alter CI Repair 0
`t$. Qeseribs
Fi u s
1Nater Cioset
Ba#h tubs
t.avatnry
I(iteien S'(nI€
Fixtur2s
Cesspool JDrairrf ield
SeRtie Tank .
Softner
weIf
?"
• , ?
CASH RECEIFT
?
? C1TY t3F EAGAN
` P. 0. B(>)( 21-199
EAGAN, MIN"ESOTA 55121
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ANfOUNT
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CITY OF EAGAN RemarksJ??'J,''' ??V ?I?`'??
Addition MM CLIFP W Lot 20 Blk Z Parcel? a
owner •street 4294 ?VER DAM RQAD seate E? ?SS 3
Improvement Date Amouni Annual Years Payment Receipt Date
STREET SURF. 1 1970 690.05 69.01 10
STREET AESTOR. ?Jjj 1981 2030.40 203.04 10 1015.20 C010 OQ 6-2 -$
GRADING
SAN SEW TRUNK G?q 197D 76.54 3.06 2S 2.$
SEWERLATERAL Zqi 1974 44.21 2?95 is 1 8.93
*. Sawer Lateral H51 1981 4419.74 441.97 10 220 .$0
WATERMAIN
* WATER LATERAL 19$1 IO
WATER AREA ZO 1973 93.5?"J 6.24 IS 12.56
STORM SEW TRK " 1971 322.29 16.11 $Q 8o.64
STORM SEW LAT
CURB & GUTTER '
SIDEWALK
STREET LIGHT
ROAD UNIT 260.00 #42165 3-26-84
WATER CONN. 470.00
BUILDING PER. 8913
SAC 525.00
PARK
. CITY OF EAGAN ?T p
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 jr • 8
PHONE: 454-8100 J-
BUILDING PERMIT Rece?Pt .# d?I c?
To bs wed im SF DWG/GAR Est. Voiue $ 65,000 Dote MARCH Z 6 198 4
Site Address 4294 BEAVER DAM RD. Erect 8 Occuponcy R3
Lot 20 Block 2 Sec/Sub. SUN CLIFF Aiter ? Zoning Rl
Parcel No. 10-72975-200-02 Repair ? Ftre Zone N A
W Name ADVANCE DEV.
Z Address 7700 XERXES
9 City EDINA Phone
Name SONS CONSTRUCTION
?? Address 4370 RAHN RD.
? City EAGAN phone 452-4721
? W Name GEORGE MANSTELELY
?? Address 9001 - 35W FRONTAGE RD.
?W CityBLOOMINGTONphone
Enlorpe ? Type of Const. V
Move (] #k Stories
Demolish p Length 40
Grode p Depth 9 9 Sq. Ft.
Approvals Fees
Assessment _
Water & Sew
Police
Fire
Eng.
Plonner ?
Council ?
Permit 329.00
Surcharge 32.50
Plan check 164.00
SAC S25 00
Water Conn. 470.00
Water Meter 63.00
Rood Unit 260.00
I hereby acknowledge that I have read this opplicction ond state thot gldg. Off.
the information is correct d ogre to co pl ??? aDPlicabl@ APC Total $1 ,$4 Z.50
State of Minnesota Statut and of nances.
r
$ipnoture of Permittee
A Building Permit is issued to: SO S CONSTRUCTION on the express conciition that
all work sholl be done in accordance witly*1 appli te of Mlnnesota Statutes ond City of Eagon Ordinances.
Building Official
C .. ft
3 2 2 a +
? ? T C +
1 6!e ° +
5 2 5 a + '
47C•+
0 +
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1P4205*
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CITY QF EAGAN Inelude 2 sets' af pZans, ..
Gertificate.: of: SurveY & . .
BUTLDING PEPItIT RPPLICATION 1 set of enerry ca1.c[ilatioi'ns. °
ZL7 Be Used For Valuation ?, ?v``0-zrta Date
Site Pddress - p?5l??.? OFFI{E USE ONL.Y .
Lot Bloc3c Sec. /5ub. .5G Ar Erect )C Occupancy
Parcel #: ? ?ei ?..00 Alter
Repair Zoning r
Fire.Zane.
Owner • i? ?v' A N C l? ?
? ??e ?-'YIe af Const.
Nbve #.5tories
Address: +7,700 Yei /es DetroTish Front - ? - - --- ft'
City/Zip Code: Grade Depth y'y ft:
Phone # : APPRM7ATS- FEES: '
.
Confractar: 56 ti 5 ?0'4-j stA?..o7k-+!E,0
Assesstnents ?
Permit 3PLff
Address : ? wa?.er/s?r surcharge
Pal.ice Plan Check / 6 ?
C:ity/Zip Cacle: ?5-4 6- A V Fi:re SAC
/
Phone YS ) L/7 ; Eng' Water Conn. p ?
`-
.
- Planner Water Meter (P3
?/ /
Arch. /Eig. t ?F ra? C ?` e Couricil Rraad Unit
Zw-
Adaress ? . Off. !l? ? 4, 1/
----:.-
City/Zip Cac3e: ?L0d J-,
Fhone #: TOTAL
CiTV oF EacaN WATER SERVICE PERMIT
3830 Pilot Knob Road
P., O. Box 27199 PERMIT NO.: 5506
Eagan, MN 55121.,? DATE: 5-30-84
iny: Itl No. ot unin: 1
ner: S611S COriSt
?ess:
5tte Address: 42 Beaver Dam Rd L20 B2 Sun Cliff
y,?„?r; Loren Brown Plbg
?ter No.: 3414 8/ 7? Connection Charge: 470.00 pd
iize: Acoount Deposlt: 15.00 pd
teoder No.: 1? fS 1- 63l n t pe?mit Fee: 10.00 pd
egree M eemPlg wltb t6e Ciyr ef Eegon
kdinn
ly
)ate of Insp.: ?
Surcharge: .50 pd
Miac. Chorges: _ 63.00 nd mete-
Totui:
Dare. Paid:
inap.;
0 0
C. R. WINOEN a ASSOCIAtE$ 1NC:
V f ? l ANO suIIvEroRS TiL sas• 3646
1391 EUSTIS ST.. si, iAUli MINN. 55100
FOR: SON'S CONSTRUCTTON COMPANY
o ?
?- ? Q-19
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s
.
No ? , 6e J'
0??ry
ry
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q>
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a[ 4' ?c°c°?? i ??`•' ?' .?p ? c(' \.' . /O
`'6 el
7*
.,
b-
,
s pose /
Finished Ground E1.
qq---- nenotes.Direction /?c
Of Surface Drainage Vertical Datum - N.G.V.D. 1929 • ?
Lot 20, Block 2, SUN CLIFF FIRST
ADDITION, Dakota Countv, Minnesota.
cale: 1" = 30'
O Denotes Iron
Monument
1
A?.
/q0'
,?
NOTE : 17il1 () Dw
o Denotes Wooden Stake
Proposed Garage Floor EI. 894.73
?8944 ) Denote Pro d ?' ?? ?
WE MERElY CERTIFY TMAT TMIS IS A TRUE /1ND CORRECT REPRESENTATION OF A SURVEY OF TME
SOUNDARIES OF tME tAND A60vE GESCRf6ED AND OF TME tiDCAT10N OF ALL euIICINGS, If ANtf,
TMEREON, AND ALL VlS16lE ENCROACNMENTS, IF AN1f, fROM OR ON SAID IAND.
darvd tbii 12 ?h der of MarcA A,O. 1084 C. R. WI DEN ? ASSOCIATES. INC.
br
3wrveyror. 1Ninnewro Rpistro?een Ne.77
IM19
?i
S ?1 y/?/, /??qf 1y¢
S? ? in IcU' L% Pv
P
Al r .he 0
r.
( yU G ??r/C £
? Y..?
EXTERIOR EPJVELC:'E AVERAGE '`U ° COiI??.;TATIQ:I
OW-Lm
SITE ADDRESS 5 Li
C4NTRACTOR?.?S ?'l3>t1ST??GTl4n.7 DATZ P HOIIE S? -
Aetermifle working square footaae of each.
1. Total exposed wall area. . . . . /??? o tq. ft. x .19 ? i?/• ?
2. Total rooflceiling area . . . . fOG ?o sq. ft. x .04. .
Total` exposed Wall area abave floo'r
a. Total wa31 windocr area . . . . . . . . . . . . . . . . . J'?/?8
b.,-.,T4t. a1 door zrea ........................
e. `Total siiding gZass area.;..........,...:..?
ct. Total fireplace wall area . . . . . . . . . . . . . . c7 _
e. Tat a1 wall frariing area (average 10%) . . .?8? •
f. Total net- wall area abave floor ....... S. Total rim joist area ....
.............:. ?.
. Total.exposed foundation area
h. Tota3..foun3ation w•indow area .........: a
: i. Total' net foundation area above -&rade .!lG• ,
Determ3ne va3:ue, of each wa3.1. se ,. Pnt.
re ? . •
a. /3/$ x Ut:
'
? X atUr. m
. d 9'/ .
b .
C.? X nU:: SS ? _3 • .
. I? . D X U" Cv?? °' p
e.? X .2 ? . '•.?
f. 1yzj4,0L R aB,y
?. / x "U,` ?<?G4 ? `• ? h. ? x .•UI. . o . o
,.
, ' . . / • ?-
i, ?f? X 'Ujr
,.
. .
_ , . .
;.? 3-.-? • ..t:.a ?s??a? .? • • • •? ? ? • a_.'-s ? • •-• s.a,s ? rr?? s . ?.• • s• .Totao3?•? ' .
If ltera #3 is. the same as, or less•' than item #I, you have met the
intent.oP SHC 6006(c)2.
AL
??3? • G ? ? .?-t'? r ?3 -?
? 3..
.
..o,,e.ld,,?.? .ua.t.? C? C?l •
?
Sl,? c
? r`.?W J . - ? ? . . . • ? . r . .
,, . ?". . . . . . . .
e,` r _? . . . . . . . , .
r .. ?
- Total exposed roof/ceiling area
J. Total skylight area .................. O
? k. Total roof/ceiling £raming area (average la• O?s.
l. Total net insulated roaP/ceiline area ....,.. ? '-
Determine "U'.va2ue for each roof/ceiling segment:
?• b X t'tJR O s p
? k. OG. X??U" . DyS = ? 8
.:
?l....... ..;w :. ........... ..... .............. TOt83. a v??-'?'
If total of fk. is the same, as, or less than 92, you have met the
intent of SHC 6006 ( c)1..940*: A 3 4/2• G??
A lternate: Huiiding Envelope Des ign
To uti?3ze the total.envelope_system nethod, the values established
by the sum of` ltems #f3 and #4 shall not be greater than the sum. of
items 91 an3 #2_
i
? i
2/84
,
' CITY OF EAGAN
APPLICATION FOR PERMIT
16
- SEWEA AND/OR WATER CONNECTION
(PLEASE PRi1Vi)
1) PROPFRTY ADDRESS : _ 45 c),Fc '07h"}
IEGAL DE.SCRIPI'ION •
. . -
?
(Lot/Block/Subdivision or Tax Parcel
iEXI32" Y`:G STRL'C'17-112E, DATE OF ORIGi dAL :Ju'ILDD, IG P? ?ST TSs?"?aNG'°:
;•:.`?•?.__. -_._ ,
? P2.S=71171 --^`iI:;r/PROPCSr..D. U5E. J8r rt-I SuNQZE r???.ILY
C? R-2 DUP= UNITS )
p R-3 TGA11HOL?5E ('Tf3RF" + LMTS) ( UNITS)
[3 R-4 ApAR'Il'fl.E27'I'/CON1DaLT.Nl'L'yi ( LNZTS)
Q CdMNERCIALJRETAII.,/dFFICE
p 2MUSTRIAL
? INSTITUTICNAL/GMT-??
2} APPI:ICP-NT ., (PLEASE PAINI) .
ADDRESS : ? ? d IIAI? ? kG 4
CI'1'Y, STATE, ZIP: FAr64 Ai
PHOiVE :
3) pLC= =PLEASE PRIHT) FOft CITl' t1SE ONLY
NANTE:
? .
.ADDRESS: PLUM S LICENSE:
:
acti ve
CITY, STATE, ZzP: ' 7 Q Exp.ired
I
t
PHONE: PLUMBER LICENSE Q Not F. R
rd
atr nitia
4} Q=ANT/a+,T1`jM f (F'LtASt NH1RF) ..
NAME: b? n.' 6 L S vA.'
ADDRESS: ??-At A)
czTY, sTATE, ziP: ??,&AA)
pxorrE: qS'>
5) INUICA`F'E WHICH FEP,NIIT IS BEIhG REQCIESTFJ): .
? CuV'NmcrION TO CiTY SETr7ER
? . COmE7GTI0N TO CITY 6VATEFt
Q M'I'M ( PLF.A.SE DESCRI BE )
6) L'VDI??T'?' aZ:
. ? P=E f:pLa APPftQVED PERti1TT FOR PIC'r:-UP :BY ONE OF ABWE .
Q PLF'ASE 1iAIL APPRdVED PF,RbLIT M 1, 2,? 4 A6QVE
, - (Circle one)
7} SI? DATE:
,
MR rre G44wt4MeAW?r pq IM ne M.s ww:,s,-:a,Ei,i as is s..
?`'?. . . . .. .. . .y? `W--ac s?
?.
FDR CITY U5E 0'N-LY
PERMZT " TSSUED '
FEES: $ . ?.?zX. SETr?E?, pERMTm, ,(.I?NCLU'DL SURCH??Gi)
? / ?, ?? . • WATER FERl!4IT (INCLUDE SURCHARGE )
WATER METER/COFPERHORN/OIITSIDE READER
$ WATLR TAP (INCL'JDE CORPORATICN STOP)
$ SEWER TAp
ACCOUNT GEPOS IT - SEWER
ACCOUNT I3EPOSIT - WATER -
$ ??7 g • e^-? WAC
SAC
? $ TRUtiIK ?dATER ASSESSP4EyT
$ TRIJNK SEWER ASSESSMENT
$ LATERAL BENEFIT/TRi3NK SEWER
$ .
LRTERAL BENEFITfTRUNK WATER '
$ ' OTHER Y. .
.?
$ TOTAL
AMOUNT. PAID/RECEIPT t
DOES iJTILITY CQNNECTIOIV REQUIRE EXCAVATION IiV PUBLIC RIG"rIT OP WAY?
? YE5 IF YES, THEN A"FERMIT FOR WORK WITHIN
PUBLIC RQAD.WAY" MUST BE ISSUED SY THE '
NQ ` ENGINEERING DIVISYQIV. LIST AS A CONDI-
TIOCV. ..
SUBJECT TO TFIE FOLLOWTNG CONDITIONS:
APPROVED BY:
t
T.ITLE :
DATE :
_ . '? ?.?•rt ?s-? ?ar ?+? rrt ?s? rs ..
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA137540
Date Issued:07/08/2016
Permit Category:ePermit
Site Address: 4294 Beaver Dam Rd
Lot:20 Block: 2 Addition: Sun Cliff 1st
PID:10-72975-02-200
Use:
Description:
Sub Type:Reroof & Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and house wrap and leave on site.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 8,000.00
Fee Summary:BL - Base Fee $8K $162.25 0801.4085
Surcharge - Based on Valuation $8K $4.00 9001.2195
$166.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Michael K Hewitt
4294 Beaver Dam Rd
Eagan MN 55122
Minnesota Exteriors
8600 Jefferson Hwy
Osseo MN 55369
(763) 391-5514
Applicant/Permitee: Signature Issued By: Signature
i
i
r For Office Use
�� s ?` ,0
t
A
:::'::
; �` ,Y ee: Dei,---
--„ ,,‘',,2
,. .._ 14ECE1VE
Dale Received:
3830 PILOT KNOB ROAD 1 EAGAN, MN 55122-1810 DEC 0 2 2019
(651)675-56751 TDD: (651)454-8535 I FAX: (651)6755 94 Staff:
buildinginspections(cilcityofeagan.comBr _
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: \\,--ao-ilSite Address:, a.- 4 1 , / / i� �� _t as` - 'd,
Tenant: �r'A...4 Suite#:
1111 II
Reside D.N4 er,
Name: 1 A .14____ I Phone: jp r 0-�1L$
f ` ' (iiCiZi : 0.',13-,..,,,..,.-,4.-0,,,,r,..,0%+ Address City
Name: MILBERT COMPANY dba CULLIGAN WATER
License#: WC641376
CG'•- .- tOr,`•� Address: 1801 50TH STREET EAST City: INVER GROVE HEIGHTS
. State: MN Zip: 55077 Phone: 651-451-2241 ,
Contact: BILL MILBERT Email: gloria.abas@culligan4water.com
New Replacement Repair Rebuild Modify Space Work in R.O.W.
Typ:e';of Work . : — —
Description of work:
Water Heater
_Lawn Irrigation( RPZ/—PVB)
y Water Softener
Add Plumbing Fixtures (_Main/_Lower Level) i
Descr•iption ^_Septic System •
Description: -
-New
` Connection to City Water from Well
__Abandonment
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
TOTAL FEES $ 60'0
CALL BEFORE YOU DIG. Call Gopher Slate Ono Call at(651)454-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locales of underground utilities. www•gopherstaleonecall.org
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
wobsito at www.cityofeaean.com/subscribe.
I hereby acknowledge that this information is complete and accurate: that the work will be in conformance with the ordinances and codes of the Cityof
Eaga that I understand this Is note erns
gpermit,t, but on y an application for a permit, and work is not to start without a permit; that the work will be In
actor ant wit he approved ptai In the c s,e of worklwhich requires a.review and approval or pians. r I
Clc ,
x
x
2
Applicant's Printed Name Applicant's Signature
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