The URL can be used to link to this page

1245 Carlson Lake Lane CITY OF EAGAN SEWER SERVICE PERMIT 3795 silo! Knbb Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: Address: Site Address: Plumber: 1 agree to comply with the City of Eagan Connection Charge: ` L'!") 10 Ordinances. Account Deposit: - Permit Fee: Surcharge: By Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: CITY OF EAGAN WATER SERVICE PERMIT 3795 Pilot "ob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: No. of Units: Owner; Address: Site Address: 11""' 17rtrlgrsr. 3?; r• Ts± T.f Plumber: Meter No.: - Connection Charge: 'l Size: - Account Deposit: Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Date Paid: Date of I nsp.: I nsp.: CITY OF EA"N 3795 Pilot Knob Road Eagan, Minnesota 55122 Phone: 454-8100 PERMIT No. Date: 1-37 Receipt No.: Single Site Address: 1` ' Residential Lot Block Sub/Sec. Multi Res., Comm./Ind. Name ne.; New/Alter./ Repair Address 4701 W. th St. Cost of Installation City p:loomington phone: Permit Fee 20. C,0 Name Uenz-Ryan Plumbing . liea,',4nr Surcharge g Address 14745 So. Robert Trail a C city Phone: Total This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN 3795 Pilot Knob Road 1 Eagan, Minnesota 55122 Phone: 454-8100 - PERMIT No. i l f Date: x_977 Receipt No.: ,-1 Single Site Address; 1 " Residential Lot Block i Sub/Sec. Multi Res., Comm./Ind. Name Pc>----sea n?` - New/Alter./Repair. Addre f r'~~ _ lint] Sr_;_c~ Cost of Installation Phone; Permit Fee 2 nn Name Project Plumbing Co. .5n Surcharge - "Address '43 Humboldt Ave. So. 0 City ~q Phone: Total 'Q. i(; This Permit is issued on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official CITY OF EAGAN 3795 Pilot Knob Road Eagan, MN 55122 N4 4 2 2 8 PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for Date 19 Site Address Erect Ej Occupancy Lot Block Sec/Sub. - Alter ❑ Zoning Parcel # _ Repair ❑ Fire Zone Enlarge E] Type of Const. awC Name Sri Cons t. Move E] # Stories Z Address Demolish ❑ Front ft. 3 Grade ❑ Depth ft. _ City Phone Name Approvals Fees O OU< Address Assessment Permit ce Water & Sew. Surcharge city Phone F Police Plan check UjW Name Fire SAC I~ Address Eng. Water Conn. <W City Phone Planner Water Meter Council It ` hereby acknowledge that I have read this application and state that Bldg. Off. the information is correct and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. APC Total Signature of Permittee A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official 1 Permit #k Data hsaed Plumbing Mechanical INSPECTIONS DATE INSP. _ Rough-In Find Footings Date Insp. Date Insp. Foundation Plumbing .3 77 _Frome/ins. Mechanical Final Remarks: I i CITY OF EAGAN Remarks Addition Wilderness Park Lot 6 Blk 1 Parcel 10 84250 060 01 OWner~*j Z.~~ E f 1` , Street 1245 Carlson Lake Lane State Eagan,MN 55123 Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK ( 1973 176.05 8.80 20 132.05 0003475 8-22-77 SEWER LATERAL WATERMAIN WATER LATERAL WATER AREA 31// 1077 im-nn 10-66 15 149.34 0003476 8-22-77 STORM SEW TRK 1981 21-97 1 STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT -no.00 5398 WATER CONN. -8-77 BUILDING PER. - SAC 5.U() 5398 -8-77 PARK 120.00 5398 -8-77 2005 RESIDENTIAL PLUMBING PERMIT APPLICATION CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date <~~2 / (3- / 6,5- Site Street Address rarlsnn (a", l Me? Unit # Property Owner )qar!- )50en4e~ Telephone# (&Ci/) U5(%-7/47 Contractor Telephone # (7/5) 31~ $1Q(P7 Address . /Or City f"~1aL~S(Y] StateGc_~T_ ZipS~~ The Applicant is: _ Owner Contractor -Other Alterations to existing dwelling $ 50.00 Add plumbing fixtures (excludes water softener and/or water heater--complete next section if installing these appliances). -Septic System Abandonment -Water Turnaround (add $125.00 if a 5/8" meter is required) Other: Z Water Softener _ Water Heater $ 15.00 - new replacement Lawn Irrigation _RPZ _PVB -new -repair -rebuild $ 30.00 State Surcharge $ .50 Total $15,50 I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the 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 accordance with the approved plan in the event a plan is required to be reviewed and approved. ~Jm Sr_hnGeFz - ~ I~ ~ U Is ~ ~Applicant's Printed Name Ap'plicant's Signature FMAR 2 2005 6 3 2006 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone 4 651-675-5675 FAX 4 651-675-5694 New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. It. of lot sq. fL of house; and all roofed areas 2 copies of plan showing footings, beams, joists Gen of Survey Recd.:. Y N (20% maximum lot coverage allowed) l set of Energy Calculations for heated additions Soils Report Y. _ N 1 Soils Report if proposed building is to be placed on disturbed soil 1 site survey for additions & decks Tree Pres Plan Recd _Y _N 2 copies of plan showing beam & window saes; poured found design, etc. Addition - indicate ff on-site septic system Tree Pres Required . Y _ N 1 set of Energy Calculations On-site Septic System ' Y N 3 copies of Tree Preservation Plan it lot platted after 711193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Minnegasco mechanical ventilation form QQ Date Construction Cost ~ • Site Address e Unit/Ste# Description of Work Multi-Family Bldg - Y N Fireplace(s) - 0 - 1 - 2 Property Owner Telephone # (4Slj X91 y el- Z/-// Contractor Address City State 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 (4 submission type submitted Submitted • Energy Envelope Calculations S ifted In the last 12 months, has the City of Eag ssu permit for a similar plan based on a master plan? Y _ N If yes, date and-o of master plan: Licensed Plumber Telephone ) Mechanical C ractor Telephone # ( ) Sewer/ a er Contractor 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 State of MN Statutes; I understand this is not a permit, but only an application for a permit, and work is start without a permit; that the work will be to a erdance with the approved plan in the case of c s a review and approval of pl i !Applicant's Printed Name Applicant's gna to Z153 O PLUMBING (RESIDENTIAL) Permit Application -X/5s~v City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5694 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit Site Address / `l , \ l l l tC~(JN (u tiX- Unit # Property Owner ~C Telephone # / O/ Contractor M .P. PIPE a ORKS Address 3670 DODD ROAD City EA6, MN 5812 State (651) 365 1340 Zip Telephone # ( ) The Applicant is Owner Contractor Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00 Includes County fee. Additional consultant fees may apply. Alterations To Existing Dwelling Unit, Including $ 50.00 - Adding fixtures to lower levels or room additions, excluding water softener and water heater Abandonment of septic system - Water turnaround 5/8" meter if needed - $121.00) Other: - RPZ _ new installation _ repair _ rebuild $ 30.00 - Lawn irrigation system - Water softener Y Water heater $ 15.00 X replacement _ additional State Surcharge .50 Fs Total P DEC C 9 200 15 I. I hereby apply for a Residential Plumbing Permit and acknowledge that the information is complete and accurat ; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Tumbing Codes; that I and rstand this is not a permit, but only an application for a permit, and work is not to start without a pe -that the work will be in-accordance with the ap roved plan in the cas of work which requires a review and approval of plans. b AXA OAQJL~-k Applicant's Printed Name Applicant's Signature 12/22/2003 03:08 6124341699 AIR MECHAN PAGE 02 p~,,,1 _ .d lea >~A~nr~n;t~l~n i ►:.r~ V 711 ! />rli1..VI )/'71i/Vi}'71r II TV b~~b IEATING & COOLING l~ "Creating Custom Comfort" House H1&Unz1K81Lcr&W (Orsatt Test) Address_ ~7 Apt.Floor= City A5G Suburb Occupant.. `r Owner, & LA+ Heat LOS!.. _ Date Heating Installed / ~ ~-j Sold By _ u Installed Sy kv Electrical Work By_`_- -Gas Line By ~m T Type of Ileat:GA- FA_ __W '-Steatu_`-__Space Htr_Unit Htr^C Ler- GAS DESIGN CO RSION Make` ~rm Make of er ~(odei U, N`j~QV (~Q Y/ ~Q ~[odel Scr ial D 0 <7 5 N(az BTU Rating - - Input- Make of Fumac Model CONTR(",S i) Thcnnost :A _Hez& :"lug_ _ Veut Size Valvc- {2kT Kind of Liter Size None n _ U:wt_ ~i r~ n5 DrattHoodgLLtetr' _Regulator LunitSetYng_ 1 ~l Filters Size /Number Fan Setting_ tL G Chimney Location: Inside --X_Outside- - Pilot Type_ s' . Chimney Construction Pilot t✓akc Smoke Bomb Wilin Pilot Tutils,~ - DratYY! 4i Test Tag LW Cur Off Door Pressure Lighting Inst z yN L Pressuc: l Percent COZ~1 Date Tested-_~3 rnput C H 10) "Operccat 12 6 Company Testing -A m I _ Stack I mp l~ 0 Perecot t Name of Tester ArAivt Yt 164 1: Abe: 'eon -,root N.E. • Ham Lake. Minnesota 55304 • (612) 434-7747 CITY OF EAGAN 3795 Pilot Knob Rood Eagan, MN 55122 N2 4228 PHONE: 454-8100 BUILDING PERMIT APPLICATION $48,000. Receipt # 5398 To be used for Sing. Fam Dwl.g W Att. Garg. Date Mar. 8, 19 77 Site Address 1245 Carlson Lake Ln Erect E` Occupancy Lot 6 Block 1 sec/Sub. Wilderness Park Alter ❑ Zoning Parcel # Repair ❑ Fire Zone _ Enlarge ❑ Type of Const. V c Name Syend Petersen Const. Move ❑ # Stories Z Address_ 47.01 W 110th St Demolish ❑ Front ft. 0 City 1 _ phone 884-5144 Grade ❑ Depth ft. ame as above Approvals Fees 0 o ~ Add Name Address Assessment Permit 24.00 ~ City Phone Water & Sew. Surcharge Police Plan check uw Name 475.00 rw Fire SAC Address Eng. Water Conn. 220. 00 ¢W city Phone _ Planner Water Meter 60.00 Council Park Bon. 120.00 1 hereby acknowledge that I have read thi pp ation and state that Bldg. Off. the information is correct and agree p h applicable 1034.50 State of Minnesota Statutes and o Egan f nces. APC Total Signature of Permitt~.'/ A Building Permit is issued to: S d Petersen ons on the express condition that all work shall be done in cord nce wit I a I State Minnescta Statutes and City of Eagan Ordinances. Building Official Certificate For: . Ewen Peterson 47:11 West ll )th Sr,reot ~ nloorrirW.ton, Minn. T~ k : 2 ?,,'33 DELMAR H. SCHWANZ LANC) SURVEY OR Raq.s2arad Unoor Laws of TM Slate of Wrinasoto 14516 SOUTH ROBERT TRAIL P.O. BOX M ROSEMOUNT, MINNESOTA "OU PHONE 912 421-1769 SURVEYOR'S CERTIFICATE I hereby certify that this is a true f 68.37 EAST and correct representation of Lot 6, Elock 1, WILDERNESS PARK ADDITION, $ according to the recorded plat thereof, Dakota County, Minnesoba. Also showing the location of a proposed noose staked thereon. LOT 6 Q February 28, 1977 o ~ Q 0 r O a 2D.O 0 i 26.0 ~ 'ROPOsfD 26.0 10.0 - N0~ GAR. N 14.5 2 3 S C 26.37 / N q.94_ 4 80 w ~ f Drainage SCALE: 1 inch = 4~ feet utility esn't" _o 0 3 0 115.00 N W 38 13 E 0 to MINNESOTA REGISTRATION NO 66?5 ao2(P-] MECHANICAL (RESIDENTIAL) 42150.5-0 Permit Application City Of Eagan 3830 Pilot Knob Road, Eagan Mn 55122 Telephone # 651-675-5675 FAX # 651-675-5674 Please complete for: Single Family Dwellings Townhomes and Condos when permits are required for each unit Date / 3/ Site Address I qr-, rlm t iL2 tam 2 Unit # Property Owner _r o Telephone # 14 t q /2 1 Contractor 4 -Mn Street Address l OE '2 City State / r Zip Telephone # (T3) The Applicant is Owner Contractor Other Add- , modification or alteration to existing dwelling unit $ 30.00 furnace replacement air exchanger air conditioner other State Surcharge $ .50 Total $ J ey ..,.J I hereby apply for a Residential Mechanical Permit and acknowledge that the info on complete ana. accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Me apical Codes; that I e to this is not a permit, but only an application for a permit, and work is not to start tfiout a pe ; that the work wil in ac rdance with the approved la a case of work which requires a review and approva~of plans. 5//n sap Applicant's Pri ed Name Applicant's rl~~ 2005 RESIDENTIAL BUILDING PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 FAX # 651-675-5694 LLUjd-gja Tf v New Construction Requirements Remodel/Repair Requirements Office Use Only 3 registered site surveys showing sq. ft. of lot, sq. fL of house; and all rooted areas 2 copies of plan ✓ Carl of Survey Recd _Y _N (20% maximum lot coverage allowed) l set of Energy Calculations for healed additions 0 aTree Pres Plan Read _Y _N, 2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks ✓ Tree Pros Required _Y _N 1 set of Energy Calculations Addition - indicate Hon-ske septic system On-site Septic System _Y _N 3 copies of Tree Preservation Plan 0 lot platted after 7/1193 Rim Joist Detail Options selection sheet (buildings with 3 or less units) Date ) / / 05- Construction Cost Site Address /11;2 yS (sgAe1-5oA/ ~e- a ~C q Unit/Ste # Description of Work Le l!212 C 2 Ce (J A LL &P -C-k- £ 5 fZ,S Multi-Family Bldg - Y N Fireplace(s) - 0 - 1 1 2 heM e Property Owner lz+~r2 Linn GE ~c(rz t P,Ef~ ~i1e rZ{ o Telephone # ( (QSI) $(o - o B S 2 eel( io 2 °0-'766 S r 563 zR -!03011 Contractor Se/ Address City State 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 (J submission type) Submitted Submitted • Energy Envelope Calculations Submitted In the last 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? - Y - N If yes, date and address of master plan: Licensed Plumber Telephone J Mechanical Contractor Telephone ) Sewer/Water Contractor Telephone J 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 S ~f MN Statutes; I understand this is not a permit, but only an application for a permit, and work is not to stafawtthout a permit; that the work will be in accordance with the approved plan in the case of work which requires a r vie\ \v and approval of plans. fe- i2AA-e /A Iq Fite ✓ofuJ _r~ ~r~ Applicant's Printed Name Applic is 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 X 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 O 36 Move Building ❑ 42 Demolish Foundation ❑ 45 Fire Repair ❑ 33 Alteration ❑ 37 Demolish Building` ❑ 43 Reroof ❑ 46 Windows/Doors X 34 Replacement 'Demolition (Entire Bldg) - Give PCA handout to applicant Valuation - z"v Occupancy MCES System Plan Review/V, 100% or _ 25% Census Code /-/3y Zoning City Water SAC Units - Stories Booster Pump # of Units _ Sq. Ft. 9 C PRV # of Bldgs _ Length Fire Sprinklered Type of Const Width & REQUIRED INSPECTIONS Footings (new bldg) _ Final/C.O. Footings (deck) FinaVNo C.O. Footings (addition) - Plumbing _ Foundation _ HVAC _ Drain Tile Other Roof _ Ice & Water _ Final - Pool - Ftgs - Air/Gas Tests _ Final Framing - Siding _ Stucco -Stone -Brick Fireplace - R.I. - Air Test - Final - Windows Insulation _ Retaining Wall Approved By: Building Inspector Base Fee-- - Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Plant License Search Copies Other Total Certificate For: Nen °eterson 47101 'lest 11'`th Street Bloomington, Minn, Bk: 24/33 DELMAR H. SCHWANZ LANDSURVEYOR Registerao Under Laws or The State of Whh*sota 14515 SOUTH ROBERT TRAIL P.O. BOX M ROSEMOUNT, MINNESOTA 55066 PHONE 612 423-1769 SURVEYOR'S CERTIFICATE I hereby certify that this :.s a tr•1e 68.37 EAST L~1 r and correct representation of ht Flock 1, WILDSRNFSS PAFK AD:DImIO , according to the recorded plat thereof, Dakota Coanty, Minnes:-)ha. Also showing the location of a proposed house staked t':ereon. 3 LOT 6 4 February 19 ? 61 0 T i. ° 0 °e F z 2 t_ ~1 I r 20.0 p N 26.0 N. m/RO?OSEO 260 / 10.0 'D - n //HOUSE / GAR./ N 23.5 13.90 14.5 0 26.33 p 8.0 4 d f" f Y Drainage p M SCAT.`.?,: itch ":=t=t utility esnatl 0 ° 115.00 N 85038 13 'E 0 M 0 m ~$PcRL - - 2J r r MINNESOTA R OISTRATION N0.8625 / Use BLUE or BLACK Ink r-----------------1 1 For Office Use 1 *My Permit 0 / of Eagan I ~ ~ - C I Permit Fee: 3830 Pilot Knob Road 1 I Eagan MN 55122 ; Date Received- 1 Phone: (651) 675-5675 1 j Staff: Fax: (651) 675-5694 I I 2011 MECHANICAL PERMIT) APPLICATION Date: 1114111 Site Address: c4tz'lS on CAP- L 0~ Tenant: Suite M~ ~rll~.~n ~c.Lr_y~CM Name: Phone: ~~l' ~►t/, gyyl RESIDENT / OWNER Address / City /Zip: 54n-122 Ls Name: K S~ v1"mom C.e License # D.~~1-63 CONTRACTOR` Address: y 3 ~oa.n+u ~o•cd 1> E - City: State: r► Zip: ► Phone: ks') t Contact Email: t New Re lacement Additional Alteration Demolition TYPE Of WORK Description of work: )ucc. A c.~C_ NOTE: #f motntted and grnu rurted Pl lanit e9 is rlEif1C screened bitttt Code, ease cowtact the 'Mechanical Insr`vr ir~rrtit4iYon perms scr7ng mew RESIDENTAL COMMERCIAL Furnace New Construction Interior Improvement PERMIT TYPE -Air Conditioner Install Piping Processed -Air Exchanger _ Gas Exterior HVAC Unit - Heat Pump - Under / Above ground Tank Install Remove) Other t I RESIDENTIAL FEES: $55_00 Minimum. Add-on or alteration to an existing unit (uncludes 55 00 State Surcharge) $95.00 Fire repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) Jo TOTAL FEE COMMERCIAL FEES: $75.00 Underground tank installationiremoval OR Contract Value $ x1% $55.00 Minimum (includes State Surcharge) Permit Fee - If the Permit Fee is less than $10,010, surcharge is $ 5.00 - If the Permit Fee is > $10,010, surcharge increases by $.50 for each $1,000 Permit Fee =3 $ surcharge (i.e. a $10,010-$11,010 Permit Fee requires a $ 5.50 surcharge) TOTAL FEE CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 45440002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.oooherstateonecatt: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 proved plan in the case of work which requires a review and approval of plans. x (an ~21 S t)h x L/ivy A.~~ Applicants Printed Name Applicants Signature FOR OFFICE USE Required Inspections: Reviewed By: Date: Undergr"nd Rout In -Air 'tc Gas Service Test In-flooq# eat Final HVAC Screeching Use BLUE or BLACK Ink r-----------------1 1 For Office Use 1 1, 1 City of J.1~ ; Permit 1!~~~~ 2 ~ ( I 1 / I 4'r 1 1 Permit Fee: d f I I I 3830 Pilot Knob Road Eagan MN 55122 i Dole Received: 1 Phone: (651) 675-5675 1 Fax: (651) 675-5694 L Staff. 2011 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: Site Address: / ~c on Lam- Z1 Tenant: a ~cvt Suite RESIDENT 1 OWNER Name: .c„1.rc~ Phone: 1, 51--~I rf - 9S/~ Address / City l Zip: _!S14yn ' I CONTRACTOR Name: ter, l D19 4--A License * Address: -1 7~%i e State: Zip: Phone: F n Contact: Email t TYPE OF WORK _ New Replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. DescriplJon work: PERMIT TYPE RESIDENTIAL Water Water Heater Water Softener Lawn Irrigation RPZPVB) Add Plumbing Fixtures Main Lower Level) Water Turnaround 4 Septic System -New Abandonment RESIDENTIAL FEES. $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) All $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment. Water Turnaround` (includes $5.00 State Surcharge) 'Water Turnaround (add $166.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) I $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $5.00 State Surcharge) TOTAL FEES $ CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4544)002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www_oopherstateonecall_oru 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 accorda a with the approved plan in the case of work which requires a review and approval of plans. X Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required inspections: Under Ground Rough-In Air Test Gas Test Final