4473 Clover Lane B
for Office Use
n
City of Eayn Permit 9 7~
Permit Fee: C1 CSC 1
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: l
Phone: (651) 675-5675 I
Fax: (651) 675-5694 Staff:
I
2009 MECHANICAL PERMIT APPLICATION
Date: Site Address:
Tenant: Suite #
RESIDENT / OWNER Name: U Phone: `QS
Address / City / Zip: 4413-6 r ACtTLL
CONTRACTOR Name: o'Q >1a~/A Lic
Address: 190 /~~Y//LLJ ~rl 5T
City:- A4 sr,ti75
/ State:~Q[ Zip:~a.~3
Phone: S/ 4132- q/ -2-7 Contact Person:
TYPE OF WORK New Replacement Addi Tonal Alteration Demolition
Description of work:
NOTE: Both roof mounted and ground mounted mechanical equipment is required to
be screened by City Code. Please contact the Mechanical Inspector or one of the
Planners for information on permitted screenin methods.
PERMIT TYPE RESIDENTIAL COMMERCIAL
Furnace New Construction _ Interior Improvement
Air Conditioner Install Piping ! Processed
Air Exchanger _ Gas _ Exterior HVAC Unit
Heat Pump Under / Above ground Tank Install / _ Remove)
When installing/removing tank(s), call for inspection by Fire
Other Marshal and Plumbing Inspector
RESIDENTIAL FEES:
$50.50 Minimum Add-on or alteration to an existing unit (includes $.50 State Surcharge)
$90.50 Fire repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
$ TOTAL FEE
COMMERCIAL FEES:
$70.50 Underground tank installation/removal OR Contract Value $ x 1%
$50.50 Minimum includes State Sur
( charge)
- If Permit _F &e is less than $1,000, surcharge is $.50. _ $ Permit Fee
If Permit Fee is > $1,000, surcharge increases by $.50 for each = $ State Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
$ TOTAL FEE
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and gode 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 p it; that the work will be in, a ordance wit the approved
pl i ase of work which uire a review n approv I of plans. fir
X x
Applic 's Printed Name Applic is Signature
FOR OFFICE USE
Reviewed By: Date:
Required Inspections ,Under Ground - Rough In Air Test Gas Service Test In-floor Heat Final
- Exterior HVAC Screening Inspection
CITY OF E :GAN WATER SERVICE PERMIT
3830 Pilot Knob Road
P. O. 'box 21199 PERMIT NO.:
Eagan, MN 55121 DATE:
Zoning: _ No. of Units:
Owner: — —
Address:
Site Address:
Plumber: —
Meter No.: Connection Charge:
Size: Account Deposit:
Reader No.: Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
Total:
By
Dote Paid:
Date of Insp.: Insp.:
CITY OF EAGAN SEWER SERVICE PERMIT
3830 Pilot Knob Road
P. O: Box 21199 PERMIT NO.•
Eagan, MN 55121 DATE: _
Zoning: No. of Units:
Owner:
Address:
Site Address:
Plumber:
I agree to comply with the City of Eagan Connection Charge:
Ordinances. Account Deposit:
Permit Fee:
Surcharge:
By Misc. Charges:
Date of Insp.: Total:
Insp.• Date Paid:
From:ALLSTAR CONSTRUCTION 19529427464 09/17/2013 08:29 #582 P.014/079
Use BLUE or BLACK Ink
I For OfficeUse--------- I
j Permit M City j
of EaflaIl I Permit Fee: J 0 , r7
3830 Pilot Knob Road
Eagan MN 55122 I Date Received: i
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff: I
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: q 1,512-013 Site Address: 'Iy1I,4~h1 g,yy13.yy13B CtUve►~ Lahr unit
Name: Ean big CIO*, &_Qlal I COMWA Phone:
Resident/ i~ ~n~
Owner Address / City / Zip: tt/13t G tm Y ~a1 1 Pa1,m C'CiG') IPM Ae f MN 55391 t(Applicant is: Owner Contractor
Type of Work Description of work: T@GY and Ve-=f
Construction Cost: 5,1150 • y0 Multi-Family Building: (Yes / No
Company: AiMar MwWw Mau , L LC, contact: (hit alftrgd
Contractor Address: uy s Indunjoi l M+ *103 City: Mapt , I iai n
State:M N Zip: ~J3 Phone: q~JZ" q~1Z" -I~'IS"1
f
License Bu.24 G- 1r, Certificate N T" i0y
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
r~ 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:
E NOTE. Plans and supporting documents that you submit are considered to be public information. Portions of
the information maybe 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. Cali 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.oooherstateonecall.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 State Building Code must pe completed within 180
days of permit issuance. rfl
X_ Hai&
Applicant's Printed Name Appff/ant's Signature
Page 1 of 3
ff
% z , 0
® I I
e r
®
�.•• •®,V®
EAGAN
3830 PILOT KNOB ROAD I EAGAN, MN 55122-1810
(651) 675-5675 1 FAX: (651) 675-5694
buildinginspections a�cityofeagan.com
-------------
For Office Use
I
I Building Permit #: I
I I
I I
S&W Permit #:
I � I
I I
Permit Fee:
I I
I I
Date Received: I
I I
I Date Issued:
I
t----------------------
RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address:
Applicant is: ❑ Owner Contractor
Unit #:
I
Name: IGt e sA b ul�e— (z:> �_�� y,_ ._- _f4s�5 o C' A Ot_4 k 6 In
Homeowner Address: J "i -�, I N—t! � i q "1 —+ D"�/ City: �aaOL
State: Wip: S51 ?—Phone: OoQ6-✓ LEmail:
I Description of work: �2 C, tD,
Type of 2
Work Construction Cost)
of building: ❑ Single Family ❑ Townhome,
of units 14,Twin Home
Compan �ThQ��tl
Building Address: �� T KAA/. City:��iLe
Contractor � / '/
State:M&6: 5-37 Phone�otZ�7)' Email. _Vlke�C ,\^_e,v�
License #: o O Ex Iration Date:
Sewer & Company:
Water
Contractor Address:
Required for State: _
new construction
Zip: Phone:
Contact:
Email:
License #: Expiration Date:
City:
I understand that Plumbing, Mechanical, and Fire Suppression work require separate applications.
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. Contact Gopher State One Call at (651) 454-0002 or v~.gopherstateonecall.org for protection against underground utility
damage. Contact Gopher State One Call 48 hours before you intend to dig to receive locates of underground utilities.
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
Applicant's Printed Name A licant's Signature