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
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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'•'? /
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BUST')2"r?G PEFulIIi RM'C.aT IO'd
ADDITIO':i
P?Y.CEL & SSCiiOi", '9::1MFeR 1;^ : i,iT?-?9?TED
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Ef3!`iiV"j."EU Gc`5T
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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
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wtamEx M:ER
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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
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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
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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.
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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
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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.
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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
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New 2( Replacement — Repair
Rebuild Modify Space Work in R.O W.
Description of work: i•a b ConverSitn,
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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 $280.00 if a 3/4" meter Is required)
New (Includes County fee and State Surcharge)
CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage.
Call 48 hours before you Intend to dig to receive locates of underground utilities. )rvvw.Qopherstateoneeail.org
I hereby acknowledge that this Information is complete and accurate: that the work will be In conformance with the ordinances and codes of the City of
Eagan; that I understand this Is not a permit, but only an application for a permit, and work Is not to start without a permit; that the work will be in
accordance with the approved plan In the case of work which requires a review and approval of plans.
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Applrca t Printed Name
t e($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