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1356 Balsam St ECITY OF EAGAN 3793 Pilot Knob Rood Eagan, MN 55122 Zoning: Owner: Address: Site Address: PI umber: 1 agree ro eomply with rhe City of Eagan Ordinanees. R„ Doie of Insp.: I nso. - SEVIIER SERVICE PERMtT PERMIT NO.: DATE: No. of Units: Connection Charge: Account Deposit: _ Permit Fee: Surcharge: - Misc. Charges: Total: Dote Poid: CITY OF EAGAN 37% Pilot ? Kno6 Rood Eagan, MN 55122 Zoning:__ . Owner: :• !-,-?. Address: WATER SERVICE PERMIT PERMIT NO.: DATE: No. of Units: Site Address: I E-" PI umherr Meter No.: Sisa• Reoder No.; 1 ogree to wmply witfi the City of Eagon Ordinances. R? Dote of Insp.: Connection Chorge: Account Deposit: _ Permit Fee: Surthorge: Misc. Charges: - Totol: DoYe Paid: GTY OF EAGAN . 3795 Pilot Keob Road Eagan, MN 55122 W? 42 12 • PHONE: 454-8100 BUILDING PERMIT (,Oo J Receipt # To ba used for Dcte , 19 Site Address ' Erect 0 Occupancy Lot Block Sec/Sub. Alter ? Zoning Parcel # Repair ? Fire Zone _ Enlarge ? Type of Const. 0: Nome - Move ? .#' Stories Z Addreu Demolish ? Front ft. 3 ? Grade ? Depth ft. Ci Phone . ' •? Approrols Fees 0 Z ou U?Q ? Nume _ Addres, Nome I hereby ackrtowledge that I have read this applicotion and state that the information is correct ond agree to comply with all opplicable Stote of Minnesota 5totutes and City of Eagon Ordinqnces. f Signoture of Permittee -- - -- -- ,/,;; , Assessment Water & 5ew. Police Fire Eng. Planner Council Bldg. Off. APC Permit -- Surcharge ( • 50 Plan check SAC .•:;`` Water Conn. ?• "0 • 00 WaYer Meter OMR" Total A Building Permit is issued to: on the express condition that oll work shall be done in cccordonce with all applicoble State of Minnescto Stotutes and City of Eacon Ordinances. Building Official -- -- - Pwwk # pafo lawd ?wwkh? Plumbing ? - - Mechanicol INSPECTI01y5 _DATE INSP• Rouph-In Final Footings 7 7 ' Dote Irnp. Dote Irap. Fount datio^ 3• i?/ - 7'_7 Plumbing _ Frame/ins. 3-,t! - 7 7 Mechanical Final Remurks: CITY OF EAGAN ' 3795 Pilot Knob Road . Eagan, Minnesota 55122 Phone: 454-8100 PERMIT Date: 3rc:h 9. 1077 r,al s.•_-, Site Address: Lot Block Sub/Sec. - WR 5 U? Name i ? . .. , . 3 Address O CGty =;mington _ Phone: Nome `qpson Plumbing Co. . ? Address l:'.?`?]. ttinnetonka Blod. g C ? C'ty rln--tr-^. ::4 - - Phone: This Permit is issued on the express condition thor oll work sholl be Minnesota 5tatutes ond City of Eogon Ordinonces. ? `---?? No. ' ;0 - ,-- ,, , Receipt No.: ' Single Residentiol x Multi Res., Comm./ind. ? New/Alter./Repuir II Cost of Instolletion Permit Fee ?n, f;0 rn Surcharge ?. Total ?.J. 5.'.' 1l1 done in occordance with all applicable Stote of Building Officiol = MECHANICAL PERMIT RECEIPT # CITY OF EAGAN , 3830 PiLOT KNOB ROAD, EAGAN, MN 55122 DATE: I Site Address ? Name _ m Address c City - ? BLDG. TYPE WORK DESCRIPTION Sec/Sub pes. f New ? Mult Add-on ? L? Comm. Repair Name -_1_ . C. , ? 3 Address S` O City " r`e ^ Phone y TYPE OF WORK / ,. Forced Air ? o M BTU 8oiler M BTU Unit Heater M BTU Air Cond. M gw Vent CFM Gas Piping Outlets # 4ther FEE: SlC: TOTAL: ?- Other ? FEES C RES. HVAC 0-100 M BTU -$24.00 ? -.- 5?,? ADQITIONAL 50 M BTU - 6.00 b (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. COMM/IND FEE - 19b OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE & CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 ? STATE SURCHARGE P£R PERMfT - ? - ` .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) SI R F M EE FO : CITY OF EAGAN \ v ? ? ?? ?a, ? ? ? V J? ? ? Do ?? ? ?r' ? ? y CITY OF EAGAN Remarks Addition Wilderness Run Sth Addition Lot 12 Qik 1 Parcel 10 84354 120 Ol Owner Street 1356EBalsam 5? ?et State Eaqan, MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF, STREET RESTOR. GRADING SAN SEW TRUNK aa? 1973 5132.60 $6.63 20 99,45 A004235 6-17-77 SEWER LATERAL WATERMAIN WATER LATERAL WATERAREA 1977 160.00 10.66 15 149.34 004235 6-17-77 STORM SEW TRK fJ<.-`? 1981 246.04 16.40 15 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. S360 2-28-77 BUILDING PER. # 2 SAC 75.00 5360 2-28-77 PARK cirr oF ?a,?aN - , ? 3795 Pilo? Knob Roud Eagan, MN SS722 N? 42 ?? PHONE: 454-87 DO BUILDING PERMIT APPLICATION Receipt # S--3C?'o $33,000. To be used for SinQ, F R7 W, G8iQ. Date Fah $ , 19-?'J ? Site Address ??S? o? gg?g? -- Erect ? Occupancy I Lot?- Block ?_ Sec/Sub. WR Sth _ Alter ? Zoning R 1 Parcel .fk _ Repair ? Fire Zane _ Enlorge ? Type of Const. V z Nome Mdt'ell COIISi . CO Move ? # Stories ; Address- 10800 Lyndale Ave. So. Su1te llgemolish ? Front ??+ ff. ? Cit Phone Grade ? Depth 3? ft. p Name S?e App?ovalf Feas ?? Address _____ ?sessment _ ~ Water 3 Sew. Ci Phone ~? w Name Police - ? Fi , „ w re r ?? Address Eng. a"' Cit Phone Planner - Council _ I hereby acknowledge that I have read this applicotion ond state that Bldg. Off. _ the information is correct and agree to comply with all applicable State of Minnesota Statutes an City aga Ordin ce APC ? Signature of Permittee Permit yp•VV _ Surcharge 16.50 Plon check snc 475.00 Water Conn. ZZ?,00 Water Meter ? 7otal 8?9. 50 A Building Permit is issued to: on the express condition that oll work sholl be done i 'o?rd?[pn?c?e ??ith?"yII a?? State of Minnesota Statutes and City of Eogan Ordinonces. Building Official ------?!??2uu'5GE-"" =?'??? D,.L'•'? / -?T BUST')2"r?G PEFulIIi RM'C.aT IO'd ADDITIO':i P?Y.CEL & SSCiiOi", '9::1MFeR 1;^ : i,iT?-?9?TED i Ef3!`iiV"j."EU Gc`5T .a.; •-?? --, ?J?t;7>51: - - _ TEI,:?_c N0 C0M-A='_:Ca'01t TELEPFi02vu ;10. ADLR?:>5 tdot-o: Iucll,cie :-:.*_e plan, buiJ.liag plar.s, and energy calcul-tiun0 Wit1: thzs an,ol:.r.ation Signed ? OFFICr USE VA_T,UIMOE? OV ? ?d - SAC erLTM caJrMc^ro'ZT wtamEx M:ER DU2T:D-MG FERG3?:1' P^:' ??Jit^ u7EC,u F^F PI,II:T CE:43C7: Fv,^r. PAF:.L D"'J_'C:1`CICi:i FEE ?_ 6'IA+NMlri? T ?..r• ? '- G•"????.e?"?` .".. _ TC??'i1i,k O? ----- 11P'?:7T ASSFSwI"'s3' CLEF?iC---d---//-BUILDIIQG D£PT. POLICE DFiT. 971iER &F:LFSEEZ? DEF"T. FI?L DT'PT. PAIcK DEsi. Cities Digital Quality Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. SCerttficate For: ldasell Inc. 19800 iyndale Ave. So. Hloomington, :4finn. 55402 Ce: t . #52 • . ' ?_ : DELMAR H. SCHWANZ ' 1 - LANUiURVFVpR Rtqi50Brap V naer LawS OI ThP $tal[ OI M.nnG1Dtd 14515 SOU7H ROBERT TRAIL P.O. BOX M ROSEMOUNT, MINNESOTA 55088 PNONE 811 423=1789 SURVEYOR'S CERTIFICATE cL I ??? ?.? < . ? - \ r\ --?..__?--- -?- _ - ---t-- -- ? ?i< 7 V ?--,- I C1 ? I0, ? . r". ; , r L= , ?. i fil . S hereby certi.ty th._t tMs is & true an(i cnrrnct reareser.tation of I.ot 12, Block 1 'PTI.T);?.RY'?-S Rt'!v F'rFTu eintmrc`,p, ?k•,ta Countq, Ninneeote. Al!zo sho-.ing the location ef n aroposPd houee ann qarape t.i^.ereon. ,_?(,_7b ?',??;S?v ;,'.•;c v-_ %'? r MINNESOTA REGISTRATION N0.8625?1---1- 51 r ? a RESIDENTIAL BUILDING PERMIT APPLICATION CITY OF EACAN 3830 PILOT KNOB RD, EACAN MN 55122 657-681-4675 New Conatruction Reauirements • 3 registered site surveys showing sq. ft. of lot, sq. il of house; aiM all roofed areas (20% mazimum lat coverage allowed) • 2 copies of plan showirg beam & window s¢es; poured found design, etc.) • 1 set of Energy Cakulations • 3 copies of Tree Preservalion Plan if lot platted aRer 711/93 . Rim Joisl Detail Options selection sheet (bldgs with 3 ar leu unNs) DATE -9--7- (V2 Phone # SITE ADDRESS MULTI-FAMILY BLDG _Y _N TYPE OF WORK ? FIREPLACE(S) _ 0_ 1_ 2 APPLICANT ?.CIPr d), d16qe STREET ADDRESS _ 3S-`/ 3 CITYSTAT?ZIP s S'i"a7 TELEPHONE CELI PHONE # 4r??112V-?-O"4'7? FAX #??2? 2??' ?r? PROPERTYOWNER J l?,O-4w TELEPHONE# COMPLETE FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ MINNFSOTA RiJISS 7670 CA'1'CGORY 1 MINNESOTA RIJLES 7672 (J submission type) • Residential Ventilation Category 1 Worksheet Submitted • New Energy Code Worksheet Submitted • Energy Envelope Calculations Submitted Plumbing Conhactor: ___ Plumbing system includes: Mechanical Contractor: Mechanical system includes: Sewer/Water Contractor: Air Conditioning _ Heat Recovery SysLem Fee: $90.00 Fee: $70.00 ?P" Phone # ? I hereby acknowledge that I have read this application, state that th nfo ation is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan nces. ? Sfgnature of Applican} ? ----------------------------- USE ONLY Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 Water Softencr Water Heatcr _ No. of Badis RemodellReuair Reauirements . 2 copies of plan . 1 set of Energy Calculations (or heated additions . 7 sile survey for exterior additions & decks • Indicate if home served by septic system for add'Nons _ Phone # . Iawn Sprinkler No. of R.I. Badis VALUATION S?? ? r 2004 RESIDENTIAL BUILDING PERMIT APPLICATION - City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 New Construc6on Reauirements RemodeVReoair Reauiremen5 3 regisle2d site surveys showirg sq. ft of lot, sq. ft. of house; and all roofed areas 2 copies ot plan (20%maximum lot coverage allowed) 1 set of Energy CalcWations tor heated additions 2 copies ot plan sMwing beam & window sizes; poured found design, etc. 7 site survey for addilions & decks 1 set of Energy Calculations AddRion - indicate if on-ske septic system 3 copies of Tree Preservation Plan if lot platted after 711/93 Rim Joist Detail Options selection sheet (bldgs with 3 or less units Co.Sl-?s-c? ?` ?-3 6ffm: UsebnfS Gert of Suivey Recd =T Y -h Tree Preolin Reed ! Y fY98P?llt?2d OnsiteSejiticSystem'.' L7 Date ? / ? / ? r1 r Constructian Cost O ??'} ? v Site Address 1? a ? S ?... :Sj'r? E? ?J Unit/Ste # md S9ia3 l vf Description of Work '`^ 1 Multi-Family Bldg _ Y x N Fireplace(s) _ 0 X 1 _ 2 Proper[y Owner Telep o e#( 65 l) ? 9`f- `?? 7 ?"e°,ar S? SZ B- `F 32 . Contractor Address City State Zip Telephone # ( ) COMPLETE THIS AREA ONLY IF Energy Code Category Minnesota Rules 7670 Ca[e¢orv 1 _ • Residential Ventilation Category 1 Worksheet (J submission type) Submitted • Energy Envelope Calculations Submitted Have you previously constructed a building in Eagan with a similar plan? _ Y fee applies. Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone # ( Telephone #( Telephone #( I hereby apply for a Residential Building Permit and acknowledge that the inform N If so, 25% plan review rMkAY 1'0 'on is coe and a curate; that the wark will be m conformance with the ordmances and codes of the City F M1V Statutes; I understand this is not a permit, but only an application for a permit, and wark 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. ApplicanYs Printed Name Applicant's Signature A NEW BUILDING Minnesota Rules 7672 . New Energy Code Worksheet Submitted OFFICE USE ONLY Sub Types ? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 04 02-plex ? 10 OS-plex X 18 Deck ? 23 Porch (screen/gazebo) ? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage ? 06 04-piex ? 12 12-plex Plbg_Y or_ N? 25 Miscellaneous Work Types ? 31 New )? 32 Addition ? 33 Alteration ? 34 Replacement Valuation ?OG Census Code y3y SAC Units # of Units # of Bldgs - Type of Const ? ? 30 Accessary Bldg ? 31 EM. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair ? 37 Demolish Building• ? 43 Reroof ? 46 WindowslDoors `Demolition (Entire Bldg) - Give PCA handout to applicant Occupancy R- 3 MCES System Zoning City Water - Stories - Booster Pump - Sq. Ft. 3oP1- PRV ? Length Fire Sprinklered ? Width Footings (new bldg) ? Footings (deck) _ Footings (addition) Foundation Drain Tile Roof Ice & Water Final ? Framing _ Fireplace _ R.I. _ Air Test _ Final _ Insularion ? Approved By: _, Base Fee Surcharge Plan Review MCIES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies - o-'S Other Total REQUIREDINSPECTIONS FinaUC.O. FinaVNo C.O. _ Plumbing HVAC Other _ Pool _ Ftgs _ Air/Gas Tests Final _ Siding _ Stucco _ Stone _ Brick Windows _ Retaining Wall _, Building Inspector ities Digital Oualitv Control The following image represents the best available image from the original page. Every effort was made to capture the content from the original page. r'or ; ndale pve. So. ' ngton, J!inn. 55402 Cert. 052 DELMAR H. SCHWANZ LANDSURVEvOR Re9istereG UnCer laws of Tne State of M.nneeota 14515 SOUTH R08ERT TRAII P.O. BOX M ROSEMOUNT, MINNESOTA 55088 PHONE 812 429F1769 SURVEYOR'S CERTIFICATE -{,-----'-- ---- .?._.------ 1 ? -, „ --- __ - - ? .. , O ? ?i ? 1 i_ I r, -=-- ---- ?-- __ ---'?-_-1 ? ?. ^ J . . T hereby certify that this is Aotrue and cnrrect represer.tation oY ;ot 12, Alock 1 'P?L?r.R\'?'PS RUN F-rF'!'u an??TTtlN, Pa!cota !:ounty, uinnesota. AlFo sho-_inc the location ef anmpoee!: hnune anr. garaPe t'r.ereon. R???s<<? ;,?-.?>= 9-:•?? ? % ? l , MINNESOTA IfiEGISTRATION N0.8625 ?? RESIDENTIAL BUII,DING Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 J115'7 025 New ConsWCBOn Reauiremen6 RemodeVReoair Reauirements Office Use OnN 3 registered site surveys showing sq. R of lot, sq. ft ol house; and all roofed areas 2 copies of plan Ced of Survey Recd (20°h maximum bt coverage allowed) 7 sei of Energy Calculatlons tor healed addi6ons Tree Pres Plan Recd 2 copies of plan showing beam & windax sizes; poured (omW design, etc. 1 sde survey far additions 8 decks Tree Pres Not Reqd 1 set of Energy Calculafiar Addifion - indicafe i/on-sife sepfic sysMm _ On-site Seplic SYstem 3 copies of Tree Preservatlai Plan B lot platted aRer 711193 Rim Joist Demil Options selection sheef (hldgs with 3 or less uniLs Date t-F / b / Site Address ? j s? C) 3 6 „? c Construction Cost ? 71 SO" ?.._ <,? l'r' r c? ?,. c? UuiUSte # Description of Work Multi-Family Bldg _ YKN Fireplace(s) _ 0_ 1 _ 2 ProperTy Owner A bc r rc....? Telephone # Contractar Address State City. Zip Telep6one # ( ) , COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING -- Minnesota Rules 7670 Cateeorv 1 Minnesota Rules 7672 Energy Code Category . Residentlal Ventilation Category 1 Worksheet • New Energy Code Worksheet (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted Licensed Plumber Telephone # ( Mechanical Contractor Sewer/Water Contractor r? Teiephone #( ) Telephone #( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of IvN Statutes; I understand this is not a permit, but only an application for a pernut, and work is not to start without a pertnit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. ApplicanYs Printed Name ApplicanYs Signature `?Of i 2 "?-D MECHANICAL (RESIDENTIAL) Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 551-675-5675 FAX # 651-675-5694 Please wmplete for. Single Family Dwellings Townhomes and Condos when permits aze required for each uni[ s 30 -?P Date Site Address ? J? `? ?? ? V?1,S?? ? • Unit # tiwner R6jWA U1LA" Pro ert hone # ( 07 1 -q3a7 le ? LJ? W? v ? v p y p e Contractor 1 - ? \J?11 yW V'? 1 Street Address rG?-o? Y UV?.? ? c`7 City Stste 1 yY N Zip FV?H Telephone # ( ?j?Q3) ?Ll> ??, ) The Applicant is _ Ownec . V4 Contractor _ Other Add-on, modification or alteration to eaisting dweliing unit $ 30.00 ? furnace replacement air exchanger air conditioner other State Surcharge ? o Lrl $ .50 Total UCT ? 7 a) I hereby apply for a Residential Mechanical Permit and acknowledge that the information is complete and accura[e; that the work wil] be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechariical Codes, that I understand this is not a permit, but onty an application for_ a permit, and work is not to start without a permit; that the work wil] be in accordance with the apprQved plan in the case of work which requires a review and approval of plank ? n ApplicanYs Pri ted Name ApplicanYs 5Watixre zoos RESIDENTIAL PLUMBlNG PERMiraPPUCarioN C1TY OF EAGAtJ 3830 PILOT KNOB ROAD, EAGAN MN 55122 851-675-5675 'lease complete for modifications to existing residentiai dweilings. ?: t5. ?.? . .. )ate F 1 ,L3 / 0`6- ;ite Street Address Unit # 'roperty Owner Telephone # 65Lrl) :J L ?' iCL'S Telephone# ' j t or :ontrac ?ddres.?,/ Z /l?iil?.? ! ioNQYState Zip?-?'?`S`??37 ? t -he Applicant is _ Owner XContractor _Other ieptic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-buili ? 10.00 alterations to existing dwelling $ 50.00 Add plumbing fixtures. This fee inctudes installation of a water softener and/or water heater at the same time. S you are instaJling oniv a wafer sofrener andlor water heater, do not complete this section; move to the next section and check the. .__._.__ _ appliance(s) you are installing. ?? _Septic System Abandonment ' fil.I'`? Water Turnaround (add $130.00 if a 5/8" meter is required) Other: ? - , -. Water Softener ? Water Heater $ 15.00 _ new ? replacement _ Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ .50 l T ?j? sZ?! " ota I hereby apply for a Residential Plumbing Permit and acknowledge ihat the information is complete and accurate; that the vvork will be in conformance with the ordinancas and codes of the City of Eagan and khe plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start without a permit and work will be in acco?rjance with the approved plan in the event a plan is required /to?be reviewed and? p?pro?ved. pi(ican?t's Printed Name ? AFf¢IicAnYs Signature PERMIT City of Eagan Permit Type:Building Permit Number:EA121563 Date Issued:04/07/2014 Permit Category:ePermit Site Address: 1356 Balsam St E Lot:012 Block: 001 Addition: Wilderness Run 5th PID:10-84354-01-120 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. 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 - Richard E Barney 1356 Balsam St E Eagan MN 55123 Walker Roofing Company 2274 Capp Rd St Paul MN 55114 (651) 251-0910 Applicant/Permitee: Signature Issued By: Signature Jun. 29. 2016 8:23AM . Date: City of EaQall 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 -160-7t0G1 No. 2851 P. 1/2 use rsLUE or t3LACK Ink L For Office Use �} Permit #: / 7 (.6 Permit Fee: 0 --Q 0 Date Received: Staff: 2016 RESIDENTIAL PLUMBING PERMIT APPLICATION ( 3.% Ratsctin S-•ro.&4- I g-- .55123 Tenant: Site Address: • es'dE:;t/: y' '.: I......n, Ownd..;::; ':; Name: O �?��s- 'd -- Q'lt%'vil&J_ Phone: ((/z.) 2Ka.—ZCI Z Address / City / Zi u A c.S' a. arA4 • ;< K on rec. :'l/IIiA TcIPii✓QJ C:jPC License • 7o S2bc Address: • `1 g N C -Le City: 4 UrY1 a�f SLI P " j Stale: MN 4:55337 Phone: to C7.) /3Z_ 217.1 `, J Co ntact:u Email: 4 I t • /, 'r f f,torti e ;Of• ....•...• ............... .:. . New 2( Replacement — Repair Rebuild Modify Space Work in R.O W. Description of work: i•a b ConverSitn, — — 1.Lp1ove, Vowti va,,;1 lop1 •!-- 1o)IG4 ° ` ' : ` ` ; '` :` `':' ortnik:Type;_.: ":: '• • •• . *:" ................... RESIDENTIAL Water Heater Water Softener Lawn irrigation L_ RPZ / PVB) chawwgqin9/par 4ain1 )< Add Pl6rnbing Fixtures L_ Main / Lower Level) Septic System New — Abandonment Water Turnaround RESIDENTIAL FEES: $60.00 Water Heater, $60.00 Lawn Irrigation $60.00 Add Plumbing 'Water Turnaround $115.00 Septic System Water Softener, or Water Heater and Softener Water (includes State Surcharge) • Turnaround' (includes State Surcharge) TOTAL FEES $ (includes State Surcharge) Fixtures, Septic System Abandonment, (add $280.00 if a 3/4" meter Is required) New (Includes County fee and State Surcharge) CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Call 48 hours before you Intend to dig to receive locates of underground utilities. )rvvw.Qopherstateoneeail.org I hereby acknowledge that this Information is complete and accurate: that the work will be In conformance with the ordinances and codes of the City of Eagan; that I understand this Is not a permit, but only an application for a permit, and work Is not to start without a permit; that the work will be in accordance with the approved plan In the case of work which requires a review and approval of plans. Xr�ie cd( Applrca t Printed Name t e($lApplicangnature PERMIT City of Eagan Permit Type:Mechanical Permit Number:EA173554 Date Issued:11/16/2021 Permit Category:ePermit Site Address: 1356 Balsam St E Lot:012 Block: 001 Addition: Wilderness Run 5th PID:10-84354-01-120 Use: Description: Sub Type:Residential Work Type:Replace Description:Furnace & Air Conditioner Comments:Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State Building Code). Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Pete DeGrood at (507) Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088 Surcharge-Fixed $1.00 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 - Richard Eugene Jr Barney 1356 Balsam St E Eagan MN 55123 (651) 994-4327 Controlled Air 21210 Eaton Ave Farmington MN 55024 (651) 460-6022 X253 Applicant/Permitee: Signature Issued By: Signature