4561 Cliff Ridge Ct
Use BLUE or BLACK Ink
C-----------------
Ron ity Ev I Permit I
I
Of I I
Permit Fee: l
3830 Pilot K I
nob Road
I
Eagan MN
55122
I Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I I
I Staff: I
2010 MECHANICAL PERMI APPLICATION
~ ti
Date: Site A ,w
S ddress: q5 u v, IC--
Tenant: Suite
RESIDENT / OWNER Name: Pho,-6 LO • ~'t4;;~
Address/ City / Zip: LA15u 1 ~b
Four Seasons Air Specialists Inc
CONTRACTOR Nam' 4457 White Bear Parkway Suite B License t _
Addn White Bear Lake MIN 55110 City:
State (651) 426-5254 ~,tv a~¢ _f~ a 5 tk
Contact: 1 11
Email: E I Lk ~OWS?k iVWPZYL,
_ _ II ~~l ) COlk`.
TYPE OF WORK New Replacement Additional Alteration Demolition
Description of work:
NOTE: Roof mounted and ground mounted ^mechanical equipment is required,to be screened by, City
Code. Please contact the Mechanical Inspector for information' on permitted screening? 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 $ x1%
$50.50 Minimum (includes State Surcharge)
Permit Fee
- If Permit Fee is less than $1,000, surcharge is $.50.
- If Permit Fee is > $1,000, surcharge increases by $.50 for each Surcharge
$1,000 Permit Fee (i.e. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge).
TOTAL FEE
CALL BEFORE YOU DIG. Call 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.aopherstateonecall.ora
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 withou a p it; tha he work will be in accordance
with the approved pla in the case work which requires a review and approval of plan
x o(
V~
Applicant's Printed Name Ap licant's 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
" k7,
?
?T'?"" CITY OF EAGAN ¢t? ? 73?8
3830 Pilot Knob Road, P:O. Box 21-199, Eagan, MM 55121
PHONE: 454-8100
BUILDING PERMIT ' Receipt # -
To be used for s? ?/GAR Est. Value $130tow Date NOVLMM ZZ 19 89
Site Address '4 30 1-4;
Lot 14_. Block Z
OFFICE USE ONLY
OCcupancy R-3 M-1 FEES
Zoning PD R-i ? ???
(ACtual) Const bl_ Bldg. Permit, ?L ••00 ?
(Albwable) Surcharge 65.00 ?
# of scories 372.00 s
Lenglh Plan Review ?
Depth ? SAC, City 1???
S.F. Tolal - SAC, MCWCC S?s•? '
S.F. Footprints _ s? • ? ?
On Site Sewage _ Water Conn ?
On Sile Well - Water Meter 90.00
MWCC System XK- Acct?.?
? Deposit
C+ty Water ?
PqV Required xx_ S/W Permit
Booster Pump - Z28 ?
?
SNV Surcharge ?
??
Treatment PI
3??
APPROYALS Road Unit ?
Planner - park Ded. ?
Countil _
BIdg.Off. _ Copies
M145.00 ?
Variance - TOTAL
W Name e'C:wTURE Su1LDBRS
? Address 15513 LOG?AR'[O LN
City WRNSViLLE Phone 435-8443
go Name S?
?cc Address
i- City Phone
OName
W W W
H
? ? Address
a W City Phone
I hereby acknowlege that I have read this application and state that the
information is correct and agree to comply with all applica6le State of
Minnesota Statutes and City of Eagan Ordinances.
Signature ot Permitee k? r
A Building Permit is issued to: FZWiUKL DUILUGKS
on the express condition that #li work shall be done in accordance wifh all
• Permk No. Permft Hoider Oste Telephone #
Wl{ER
1
SEWER
PLUMBING
2.:t<,?.
? ///&/,3 o
H.V.A.C. p n
ELECTRIC
Inspectfon Date Insp. Comments
FoOtings I
Foundation
framing - ?
Roofing
Fiough Plbg. rm -
Rough H,9. ?a-qv .? iV
is,i. /-/?•c? ;? O.-
Freptace
Final Htg.
Fnal Plbg
Const. Meter Pibg. Inspector - Nolity Plumber
Engr./Plan
eag. Final ? zl' 90 '<. fo dC? ?'a / ?'
Deck Ftg.
Oeck Final
Well
Pr. Disp.
??»--
(ter#ifiratit uf (Orrupttnry
titp of (Eagan
lurprtmrtci n# sudding Jnspprtinn
This Certificate issued pursuant to the requiremenrs of Section 306 of the Unifornt Building
Code certifying that at the time of irsuartce lftis structure was in compliance with the various
ordurances ojthe City regulating building construction or use. For the following:
ux clmrcauon /? atdg. ttrmi, No. I7328
Oauponcy Type R/1? ? Zorriog Diurict ? Type ComL
Owner of Buildin6 FMM Wnies pddcess 133 13 LOMM I'AM, NMOMU
4561 RIDGE CmIRT ?h?,L 10, B2, ?'F RID(?
a.mm Am,r
A=ST 21, 1990
D.tr.
au,l oRi '
POST IN A CONSPICUOUS PIACE N?,
.
-,
CONTRACT
PRICE
Site Ad?ss _
Lot ?--?,
? 1 I
-? Add
c City
`m
C
?
PLUMBING PERMIT Fc
CITY OF EAGAN PERMIT
3830 PILOT KNOB ROAD, EAGAN, MN 55122 RECEIP'
FEES
COMM./IND. FEE -1% OF CONTRACT FEE
APT. BLDGS. - COMM. RATE APPLtES
TOWNHOUSE & CONDO - AES. RATE APLLIES
MINIMUM - RESIDENTIAL FEE $12.00
MINIMUM - COMM.IND./FEE $20.00
STATE SURCHARGE PER PERMIT .50
(ADD $.50 SJC PER EACH $1,000 OF PERMIT FEE) FOR:
Res. New
. Muft. Add-0n I
- ? Comm. Repair ?
aher ?
RES. PLBG. ONLY - GOMPLETE THE FOLLOWING:
N9., FIXTURES TUTAL
? Water Closet - $3.00 $
8ath Tubs - $3
? G
00 •
.
,
Lavatory - $9.00
Sh0W9f - $3.00 r "
?
??-
Kitchen Sink - $3.00
Uri
UBid
t - $3
00
.
na
e
Laundry Tray - $3.00 Z7-
Floor Drains - $1.50
T Water Heater - $1.50
Whirlpool - $8.00
? Gas Piping Oudets - $1.50 ?
(MINIMUM -1 PER PERMIT)
? Softener - $5.00 -
Well - $10.00
Private Disp. -$10.00
-- ' Rough Openings - $1.50 ?
PERMIT FEE:
STATES S/C:
GRAND TOTAL:
PERMIT #
? t
MECHANICAL PERMIT RECEIPT #
.
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PNONE: 454-8100 For Office Use Only:
Site Address
!
BLDG. TYPE WORK DESCRIPTION
' L
Lot Block
Sec/Sub
'
Res.
New
? N Mult Add-on
°-' ame Comm. Repair
? m Address
? v,
? c
Ciiy
Phone Other
?
.
Name FEES
c
?'
r ? ` ??
11
'
?' RES. HVAC 0-100 M BTU - $24.00
? Address
!
• }.
?
,
t ADDITIONAL 50 M BTU - 6.00
O Ciiy Phone (RES. HVAC INCLUDES AIC ON NEW
, CONSTRUCTION) .
GAS OUTLETS (MINIMUM - t PER PERMIT) - 1.50 EJ
; TYPE OF WORK CONT
EE
FE
Forced Air M BTU qp gLDGS.
COMM. RA E APUES
TOWNHOUSE & CONDOS - RES. RATE APPLlES
Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent
CFM STATE SURCHARGE PER PERMIT - .50
(ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # ? BEYOND $1,000)
Other
FEE:
-57(; SIGNATURE OF PERMITTEE
S/C:
? TOTAL: FOR: CITY OF EAGAN
SEWER b WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
DATE ?? ?1?
OFFlCE USE ONLY
METER # 3o PEFiMIT DATE Y 1/ 2 8/ 89
CHIP a-S a 9 PERMIT # 11120
METER SIZE o G f B.P. RECEIPT #" 4780
ISSUE DATE.^ B.P. RECEIPT DATE11?22/89
xx pRV - BOOSTER PUMP
SITE ADDRESS
LOT 4' BLOCK SEC/SUB If-A I S t OL
. ?
A?icAnrr: i; r u r- I 3u ? ? ?
ADDRESS: ! ! 3 c,` i1 , ti
CITY'STATE u,ciffiS u !i .. - ZIp -5S ;'i ?
PHONE:
PLUMBER:
ADDRES5: ?{ 1'k 7 It tl I} c. v O.
CITY. STATE M_ v?i r K? ZIP PHONE:
O1VIlNER: __ !&14 g / ?;-
ADDRESS:_
CITY, STATE
PHONE: _
ZIP
PERMR REQ(IESTED
i'
? SEWER WATERV - TAPS
V OM M/IND v RESIDENTIAL
EW - EXISTING
Lawn Sprirkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Cred?t V?IILL NO?Di g ven for Deduct Meters.
?
1 AGREE O COMPL ITH CITY OF
GAN aRDINANCE ?
" ;
ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIONS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
SEWER & WATER PERMIT
CITY OF EAGAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1887
DATE
USE ONLY
METER # PERMIT DATE i 1 J 2 S/$ 9
CHIP # PERMIT # 11120
, , . ,.
METER SIZE B.P. RECEIPT # `' 11
ISSUE DATE B.P. RECEIPT DATE
_ PRV - BOOSTER PUMP
SITE ADDRESS 11569 ? ? 14 I6 d,?E C4
LOT BLOCK SEC/SUB
APPLICANT: ADDRESS:
CITY,.6TATE - ' ZIP ? f
PHONE: s-
PLUMBER:
ADDRESS: - ik-r k f_i t> L
CITY, STATE " ". a' i , -` •`- ZIP - ,?
PHONE:
OWNER: -
ADDRESS:_
CITY, STATE
PHQNE:
PERMIT REQUESTED
.
SEWER r WATER - TAPS
- QOMM/IND _ RESIDENTIAL
s NEW _ EXISTING
Lawn Sprinkler Meters are to be Installed
Ahead of Domestic Meters on Water Line.
Credit WILL NOT be given for Deduct Meters.
I AGREE f0 COMPLY WITH CITY OF
EAGAN ORDINANCES
ZIP
SIGNATURE WHEN METER ISSUED
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. CALL 454-5220 FOR INSPECTIQNS. FOR STORM
SEWER PERMITS, CONTACT ENGINEERING DEPT.
DATE: 11/28/89
RE: 4561 CL1FP RIDGE COUR?, L10. B2. CLIFF R1DGS
313K Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
?••. CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
r ?"our Sewer & Water Permit for the above property cannot be completed for the following
keasons;
?
y Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERC{Al PROJECTS ONLY: Please pay for meter at Ciry Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REQUIRED BY IAW.
CONTACT COMMUNITY DEVELOPMENT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
DATE: 11/28/89
RE: 4561 CL1FF R1DGE COURT, L10. B2. 'UL1FF R1DGE
xx Your Sewer & Water Permit for the above property has been completed. It will be held at the
Public Works Garage (3501 Coachman Road) until the meter is picked up. BE SURE TO
? CALL PUBLIC WORKS (454-5220) FOR YOUR PERMANENT WATER TURN ON.
"our Sewer & Water Permit for the above property cannot be completed for the following
reasons:
?.,:. . ,
Your Sewer & Water Permit for the above property has been completed, but the meter cannot
be issued or occupancy allowed until further notice.
COMMERCIAL PROJECTS ONLY: Please pay for meter at City Hall. Meter size must be
confirmed by Bill Adams or Dirk House (Plumbing Inspectors - 454-8100) before issuance.
WARNING: BEFORE DIGGING, CALL LOCAL UTILITIES - TELEPHONE, ELECTRIC, GAS, ETC.
- REOUIRED BY LAW.
CONTACT COMMUNITY DEVELOPMEPIT DEPARTMENT FOR WATER TURN ON POLICY.
Secretary, Building Inspections Dept.
,?` CASH RECEIpT. . .- ?
• y.
CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE
REceroEo
Fna.
na+ouNr s l L? ?: I
a ooLuRs
loo
? CASH ?CHECK
wn ; ? • ? ? ! j? -'??'l/ ?? / ` t --?tfJ' t `???. ,? .
1
C 47P0 COPY
„CW„
Ph*-F+e cavy
Thank You
sv
INS
CITY OF EAGAN
3830 Pilot Knob Road
:Eagan, Minnesota 55122-1897
(612) 681-4675
SITE ADDRESS:
Is(?f ? I
( PERMIT SUBTYPE:
f
ON
PERMIT TYPE:
Permit Number: 1 ! ?H
Date Issued: ? I%!/ 97
100-" APPLICANT:
cs ? a r.? t
TYPE OF WORK:
asw Oa-a iM-,FitTjQn-i
ne?.I I? tr•J 1 nN
i I iiH t N
FTNAI
F
?
Permlt No. Permft Flolder Data Telephone 8
ELECTRIC
PLUMBING
HVAC
Inspectlon Date Insp. Comments
FOOTINGS
FOUND
FRAMING
ROOFING
ROUGH
PLUMBING
PLBG
AIR TEST
ROUGH
HEATING
GAS SVC
TEST
INSUL .
GYP 60ARD
FIREPLACE ? y
FIREPLACE
AIR TEST
!2- [d'?t7
rV{?
•
FINAL PLBG
FINAL HTG
ORSAT
TEST
BLDG FINAL
BSMT R.I.
BSMT FINAL
DECK FTG
DECK FINAL
? CITY OF EAGAN N2 17 3 2 8
•
BUILDING PERMIT 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 Receipt #ftr?? DC)
To be used for SF DidG/GAR Est. Value $130, 000 Date NOVEMBER 22 19 89
Site Address 4561
Lot 10 Biock 2
PdfC21 N0. CLIFF RIDGE CT
Sec/Sub. CLIFF RIDGE
Occupancy
OFFICE USE ONLY
R-3 M-1 FEES
P
1
Zoning "-
W Name FEATURE BUILDERS (Actual) Const Bldg. Permit
Vn $ 744.00
; Address 15513 L OGARTO LN (Allowable) -
vn- 65.00
0 City BURNSVIL LE Phone 435-8443 # otStones Surcharge
_
Plan Review 372.00
Name SAME Length
Deplh ?!
?! SAC
City 1Q0. ??
0
00¢ Address S.F. Total ,
- 575.00
? City Phone S.F. Foolprints SAC. MCWCC
-
t
C
W
580.00
r
On Site Sewage
er
onn
a
_
W W Name On Site Well
M
t
W 90.00
X;
Address
MwCC System ater
er
e
gx
30
??
O
=
¢ < W CitY Phone city water Acct.Deposit
xx? •
?
1 00
PRV R e quired ? S/1N Permit
I hereby acknowlege that I have read this application and state that ihe
information is correct and agree to comply with all applicable State of
Minnesota Statutes and
agan Ordinan Booster Pump - ?yy Surcharge
Treatment PI ?
e?;o 340 00
Signature of Permitee (L4AA-AA- APPROVALS Road Unit
A euilding Permit is issued to:
on the express condition g
applicable State of Minne
Building Olficial FEATURE BUILDERS
Ea ne in accordance with all
f E an Ordinances.
?
- -? Planner
Council
Bldg.Olf.
Variance - park Ded.
CaP+es
- TOTAL
- -
3 , 145. 00
?-?anC) 4
REQUEST FOR ELECTRICAL INSPECTION
? Sca instmctions Por completing Ihis form on back of yellow Copy.
X" Selaw Work Covered By This Request
r EB-00001-07
uew .Add Rep. TypeolBuilding ApplianceSWired EquipmeniWired
Home Range Temporary Service
Duplex Water Heater EleCiric Heating
ApL 8uilding Dryer Other (Specify)
Comm./Intlustrial Furnace
Farm Air Conditioner
Diher (specity) Contredor's Femarlts:
Campute lnspection Fee 8elow.
# Other Fee Feeders Fee
Swimming Pool Sn n s
IZ
Transtormers p
Amps
U
SignS Use Only:
lnsp?ork TOTAL c?
Irrigation Booms ????
Special Inspection
Alarm/Communication
Other Fee
I, the Electrical I
nspector, hereby
Rough-in
Date
certify that the above inspection has
been made. F?nai
OFFlCE USE ONLY
This request voitl 16 manihs irom
r? 7 40 54??: y
Request Date
, ?
lf'V Ro gh-in I ection
Raquiretl?
? ReadY Now ? Nolity
CS ?? es ? No
I licensed contractor ? owner hereby request inspection of a6ove electrical work at:
Job Address (Sireet, Box or Rou[e No ) Clry
Section No. Tawnship Name or No. Range No. CouMy
Occupant(PRINi)
'C Phone No.
Power SupPli Atldress
ElecMCal Comractor (COmparry Name) / Contra License No.
?/1 `' ? ~? til?•c . ???I?S?3
Malling Atltlres (Contraclor or awner Making Instailation)
7 rue 3-
`iZZ
AWFarizeA Siqq?ture (CoMraciw/Owneaking Ins[alietion)
.C Phone Num?er
MINNESOTA STAiE BOARD OF ELECTflICIiV THIS INSPECTION FEQUEST WILL NOT
Grigga-Mldwey BMg. - Boum 5-173 BE ACCEPTED BY THE STATE 60ARD
1811 University Ave., 51. Peul, MN 55104 IINLESS PqOPER INSPECTION FEE IS
Phone (612) 642-0000 ENCLOSED.
13036,
Request Da[e Fire Roug in In" eci
Repuiretl?
? fleatly Now F&Aill Notify Inspector
R
C ? Ves ? No When
eatly?
licensed contractor ? owner hereby request inspection of above electrical work at:
i
Job Aoaress (SVeet, 6ax cr Rode Na.) Ciry
Section No. Townshlp Name r o. " Range No. Counry ' ?
?
Occupmi[ RINT)
--C?L`?-? Phone No.
Powee Su pliejr {
_ ??-f F-_ ? k /"1" ?ir? ' Atldress
C?C/? i ""?' ./dC1/ ' c??
Elecvical ffonhaotor (GOmpany Name) Cqntrecrorg icensa No.
MaiM1ng Atldres5 (Contractor or Ownar Maklog InsffiIlatlon/I,
lt' / ? , / `?/ '?`?
AmhonEe Signature (ConlractonOwner Meking Inelalla?ion) Phone Number
,
MINNESOTA STATE BDARO OF ELECTRICITV
THIS INSPECTION REOUEST WILL NOT
Griggs•MlEway 61tlg. - Room S113 BE ACCEPTEO BV THE STATE BOAqp
1821 UnlversHy Ave., St. Vaul, MN 55104 UNLESS PROPEF INSPEQION FEE IS
Phane (612) 804-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION ea-ooooI-o7
0- See ins[ruallons for completing thls lorm on back oi yeliow copy, q?/
.
?
?.3 y? (? 3 p (? ?
?. "X" Below Work Covered by This Request Us?
e Atld Rep. TypeoiBuilding AppliancesWired EquipmentWired
Home Ranqe Temporary Service
Duplex Watei Heater Electric Heatinq
Apt. Buildinq Dryer Other (Specify)
Comm./Indusirial Purnace
Farm Air Conditioner
Other(spacity) Conhaclor4 RemarRS:
Compute Inspection Fee Below:
# Other Fee # ServiceEntrenceSire Fee # Circuits/Feeders Fee
Swimming Pool 0 to 200 Amps ' 0 tu 100 Amps
Transformers A6ove 2D0 _ Amps Fil?ove Amps
Si9f15 InspectorSlJSeOnly. TO
Iff193fiOn BOOlIlS
p' ° l
d
Special Inspeclon
Alarm/Communication THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT
Other Fee COMPLETED WITHIN 78" ONT -?
I, the Electrical Inspector, hereby
that th
c
tit
b
i
ti Rough-in _ ?ale `? (?rj?
er
y
e a
ove
nspec
on has
beenmade. ? .
?.c.P
?. .3/r???' oaie
OFFICE IISE ONLV
IThis requebt voitl 18 monihs from
PERMIT
CITY OF EAGAN
3830 P'6rot Knob Road
Eagan, Minnesota 55122-1897
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDING
031156
11/21/97
SITE ADDRESS:
P,I.N.: 10-17800-100-02
DESCRIPTION:
`-
n
7
:'Lli o j ??
?a
u °p,
?
?*??,ULL3
LJ
REMARKS:
FEE SUMMARY:
Base Fee
5urcharge
Total Fee
,
4561 CLIFF RIDGE CT
LOT: 10 BLOCK: 2
CLIFF RIDGE
GAS INSERT/GAS LINE
Buil?dinPermit 7ype FIREPLACE
9uil,tling Wa,r.,k Type NEW
Cens;us Cod:e, 434 ALT. RESIDENTIAL
$50.00
$.50
$50.50
CONTRACTOR: - ppplicant - OWNER:
GAS LTNE PLUS INC 12266220 HIMROD RALPH
4806 RUTLEDGE S7 4561 CLIFF RIDC,E CT
PRIOR LAKE MN 55372 EAGAN MN
(612) 226-6220 (612)686-4424
I hereby acknowledge thatI- hava read ,this a{sfplication arrd stater Yhatthe
informetion is correct and agree to comply wi-th ali applieable 5tate a'f Mn.
Statu?ea and.City ot Eagatt Ord3.Aances
L •t.. ?4 ??a . n ? . L. £ vm . . . L&«E T?
LA.
APPLICANT/PERMITEE SIGNATURE ISSUED BY SIG T
CITY OF EAGAN
1156 3830 PILOT KNOB RD - 55122
3 1997 FIREPLACE PERMIT APPLICATION
6si-a67s
DATE: II 19 9-1
DESCRIPTION OF WORK: CONSTRUCT NEW FIREPLACE
_ INSTALL GAS INSERT ONLY
_ INSTALL GAS LINE ONLY
? OTHER: S4a n uiwwA a
STREET ADDRESS: q 5
LOT --[D_ BLOCK ? SUBD./P.I.D. #:
APPLICANT: (circle one only) OWNER / I
Z0..? 0
PERMIT FEE: $50.50
_ ALTERATIONS TO EXISTING
I hereby acknowledge that I have read this application and state that the information is coaect and agree to comply with
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
PROPERTY Name: _FNMfOA Phone #:
OWNER
Signature:
Street Address:
City: State: Zip:
FIREPLACE Company; GaA Linn p?? I Phone #:
-
INSTALLER n
4806 $nttedge 3tree D
r/12z
????`
Signature: ••? Ls?er?H?-6Qr9T" .
,
?
Sveet Address: License #:
City: State: Zip:
GAS LINE Company: Phone #:
INSTALLER
Name:
Signature:
Street Address:
City:
State:
Zip:
. ?
SINGLE FAMILY DWEI.LZNGS
STEAED SITE SIIR9EYS
OF ENERGY C9LC3,
09
2 SETS OF PLANS
REGI3TERED 3ITE SIIRGEYS -
(CHECB iIITH BLDG DI9.)
1 SIsT OF ENERGY CALCS.
!lULTIPLE DWELLING3 RENT9L WTITS FOA 39LE DNIT3
HOTE: 1DDRESSES FOH CARNER LOTS - CONTRACTOR/HOMEOWNER MOST DE3IGNATE flHICH iDDRFSS
IS DFSIRED. NO CAANGES i1ILL BE ALLOWED ONCE BQILDING PEAMIT IS ISSIIED..
SEWER & A9TER PERMTT FEES AND ACCOUNT DEP03IT FEE3 Te1ILL BE INCLTJDED WITH THE HOILDINfi
PERMIT FEE. PROCESSING TIME FOR SEWER AND iTATER PERMST3 IS TWO DAYS ONCE 9 PERMTT HAS
HEEN COhtPLETED INDICATING A LICEN3ED PLUHBER.
PENALTY APPLIFS WHENs PERMST IS NOT PAID FOR IH S9ME MONTH IT IS AEQIJESTED.
LOT CHANGE IS REpQE3TED DNCfi PERMIT IS I33ITED.
Q /? ?pY 15 1984
To Be Used ForS iza.u Gr:n, Valuation: ??- Date:
Site Address
ro a
Lot .? Hlock 49
Pareel/Sub ui
Owner ? • e . '(,{)r?.? a r
Address / 5-,15-13-?.?..?'?
City/Zip Code 8,"1;-?3 3'7
Phone t-1-3 S- 53 LF-4-3
Contractor t-l atf-e?
Address
City/21p Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone B
1989 HIIILDIHG PERMZT APPLIGATION
CTTY OF EHGAN
?
?
MOLTIPLE DWELLINGS "
I30,000? orflUr usi
Oecupancy R 3 M-1-
Zoning PD R_ 1
Actual Const N/-N
Allowable V-N
# of stories
Length 5ZT
-
Depth °fOT
S.F. Total ?
Footprint S.F.
On site sewage
On site well
MWCC System ?
City water
PRV required ??
Booster Pump _
APPROV9LS
Planner _
Council
Bldg,, Off. Wf1/17
Varianee
COMRdERCIAL
2 5ETS OF ARCHITECTURAL
6 STHIICTIIRAL PLAN3
1 SET OF SPECIFICATIONS
1 3ET OF ENERGY CALCS.
# OF ONITS
rEs
Bldg. Permit 'yy'00
Surcharge 6 6" ov
Plan Review L cb
SAC, City I00,00
SAC, MWCC s', 0
Water Conn S6"o, n?
Water Meter qo,oa
Acet. Deposit o,oo
S/W Permit oa
S/W Surcharge 1,00
Treatment P1. 22 ,ao
Road Unit 3 4o.on
Park Ded.
Copies
S[TBTOT6L
Penalty
TOT9L
? ?4r'l
? - VAUuATroN
?
a
}3sm-r
3 r? X W rs = 1"?`?r?
Z,
?---I ZZ`d X?`?= I?119 Z
/,S7 FL,on_
35m?, = I 22:?6
2N? r•"c o
=7a,
I x i r = ?t
y xi z = +8
'??1G1 X 50= 38?
? 2?66 z
TRl-LAND C0.
SURVEYING
SERVICES
1260 YANKEE DOODLE ROAD
SITE PLAN FOR:
FEATURE BUILDERS
EAGAN, MINNESOTA 55126
LEGAL DESCRIPTION; LOT 10,BLOCK-2-, CLIFF RIDGE
ACCORDING TO THE RECORDED PLAT
, r THEREOF DAKOTA COUNTY,MINNESOTA
•l \
SCALE: I"=30'
B ,,
T?a±c
taTlL'EE12I. GDEPT
I
0
V
V
?
?
A LOT 9
9Z?, 53 N89°34'11°93o'y 105.00
? ?3 as.so ?z.zz
R.8°
3 Sp6,
3 •,/ `?
8 ` m r 9so.?g / (
?
? ' NI
32.Td
e ?
? N
7e 4p
5 `
S ? S' ,
?3?52'4n•.? `-_'IV.,so.+3LOT 10
Cn
CD
(6
? -° o
?53 z9
Lo-r 11
? . i
LEGEND
o DENOTES IRON MONUMENT
o DENOTES WOOD HUB SET
DENOTES EXISTING SPOT
ELEVATION
DENOTES PROPOSED SPOT
ELEVATION
? DENOTES DRAINAGE DIRECTION
I hxsby carfify thaf this turvey,plan or
report wes preparsd by me or under my
direct supervision and that I am a duly
Reqistered Land Surveyor undsr fhe
Laws of tha State of Minnesota.
PRoPOSEV Fuur 8'{56Ne5NT - No waLKOUT ?
INVERT EI.EVATION AT SERVICE EXTENSION=
PROPOSED GARAGE FLOOR ELEVATION=`/Z -3
PROPOSED FIRST FLOOR ELEVATION =
PROPOSED BASEMENT FLOOR = ? ? y
ELEVATION
N07E'. ?RIFY'°AL.L° L0 F°iiEi81i?5 °1'NhlQ
FIMAL HOUSE PLANS
odley
Mn. Rey. No. 15235
oate
• MINNESOTA STATE ENERGY LODE CALCULATIONS
` . ' BASED ON CHAPTER 5 OF THE
' MODEL ENERGY CODE - 1983 EDITIOtJ
' Adoptlon Effective I/l/84
Owner
Slte Address
GI CLirF
,
li P
e
Date
, tp.,, SS l 13
Lontractor ?P4<S Phone
Bullding Classification: Type A) (Single Family E Duplex)ype A2(Residenttal)
' (3 stories or less
NOTE: Complete pages 3 and 4 first. '
(O[her) (Over 3 stories)
GENERAL INFORMATION
N y?
1. Bullding Perimeterljee •' ' ft. ,
2. Wall height (ground to eave) N ft.
3. 1. x 2. (above) gross wall area Z %-I ft.
4. Bullding dimensions (L) X(W) - _ AA I ft.Z roof b floor area
5. Square foot area of rfm }oist - Floor Joist size (2 x lo ) I r
10 X Perim ter = Rim o st area = ({?1 _
7Z ft2
? I??
6. Doors - Area ?000
I?
414),
T'hickness in. U factor , Type of Construction Perimeter ft.
Manufacturer 7. Tota) door's perimeter ft.
8. Windows: Manufacturer ?
opy*-7?'?'?" ?v- State approved
U factor
TYPE SIZE AREA (Ft.2) NUMBER OF
h 'N EACH UNITS
9. Tocal rt.z cias5 Z9115
10. Flreplace area; Wldth X helght = X =
TOTAI FEET Z
Ft.2
Il. Exposed foundation: Height X Perlmeter_,?_(QI X I"f-1 _ ??+?1?/ Ft.Z
COMPLETION OF THIS FORM IS REQUIRED FoR ALL A€GJ CONSTRUCT-iON, wnJOR REMODEL NG AND BUILDINGS BElru
MOVED WHERE ENERGY, OTHER THAN THE MINIMAI CODE ALLOWANCE, IS USED.
12. Frnming'area = 10% of gross wall area.
13. Gross wail area
Q1 ? 2
Windorr area A ZIJ1+'7 ft.
Rim joi st area A ( ??? rJ Z ft.Z
Door area A' ft.
1Vvr
2
iffaep area A Z ft.
Exposed foundation A q(,o 1?g ft.2
Framing area A Z4Z( cQ-? ft.2
Net wall area A I ?0 cco r Z ft.
a
ft.2
U windovrs U x A n
U rim jaist = +O? U x A - 4tg_
U door area - . i4 U x A = (P• g(o
U totgtZloce = o ? U x A ?
U foundation = 1070 U x A =
U framino area =,O?S ll x A = 72 191
u Wall= 0 3 u Xa ? ?-01
ZZZ =?v
(138) TOTAL . . . . . . . . . . U x = ?? J
14. Gross walt area x 0.11 (A-1 single family & duolex = allowable U x A/Code
(13. above) .
x 0.23 (A-2 other residential)
x .23 (Other buildings)
x .23 (Over 3 stories)
1
Z?? ?? ? ?
l e rger than
B136t
b
l
??
1
!
A x l,
Code.• _= a
ov
r
,
J
15. Ceiling framing area ( Af) equals lOX of ceiling area (. or the same as)
15A. Gross ceiling area = (L) ? x (W) I C9 ) _ft.2
158 Joist area (Af) = lOp ceiling area = 121 ft.2
2
Z
15C. Net ceiling area (Ac) (15A - 158) _ '' J _ ft.
U ceiling x A
_ x 87,
c
U framing x A f= t?Z?J x log
15D. TOTAL U x A .......... .............................
16. Ceiling area (15A) x 0.026 (A-1 sinqle `amily 3 duplex - code allowable U x A
x 0.033 (Fi-2 other residential)
x 0.06 (other)
,0 ZLO D -7 BaUH Must be larger than 15D (above)
A(15.4) 1?1 x U(code)= ZO?? 1 F (or the same as)
NOTE: Use U and A values obtained from pages 1, 3 and 4.
CERTIFICATION: I hereby certify that i have calculated the "U" factors and "R" values
ere n and that the building here described meets or exceeds the State of Minnesota
Energy Conservation Act. te Signature
0
?.
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li
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...----- ?,i
? lr? l1 ^ S " _-- - - -
-- .., - - - _.
>/,4= Zz??X1=2Z,? --
_ ?I ??; cczX4k = z2??xv ?o - ----
, ??.
? ? --?
?' I I"' GG I N3 - 5, z?xZ= I??S
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? 1, _ _. `... .
_--
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--
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1 zZ?SX j
---
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------ '? ? ? __
;; - _-_._--- - -
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----- - ? ? ?
r.,_...?..... ..??-- ,-..
_?
. ?
t+ALL
y ` SECTION
57'UD
SECTION
SECTION.
RIH
JOISI
rlor alz film R= .66
la:tor.
datton
rtor afr film R= .17
F 7OTAL
sed 91uck
U 4ALUE CALCULATIOfIS kv?l n
R VALUE U VALUE
Ineide att film .68 '
45'
Interior vall . (Nall) U :
Insulation
I
?
Shea[hing Z'«0 • '
Slding • ?O?
Outalde alr film .11 '
R TOTAL Z. 3• a3
Inslde.air film .68
lntetiot vall •? ?
P'' stud R= [:'rA (D,S (Framing)U. R .
,
Sheathing
d •?7 ? ??
Si
ing
. ?
Outsfde air film .17
R 70TAL JO e 5"?j
Inslde air film R= .68
Intettor wall '
Insulatlon (Wali ) U . R .
2
Extetior vsll to?
Ex[etlar a[r film R ..17
R TO?AI,
inrer{or alr film R= .68
Insulation
I 1'Od
ich soft waoJ R=1.88 (Rim
JO15t)
Sheathing Z,D(,p
Exterior wall covering 4(*1
Exterior air film R= ,17
R T01'AL 7-'1 . 44499
?
U•1?=
1 04)
?
(Fdn,? U = ? =
. 07fo
3.
,
,-_
+ 0.61
r
(p, D
s
1 '
. .
0.61
4i+ I ?
I OZ3
Air Film 0.61
Insulation 44• Oo
Joist
Ceiling
Air Film 0.6)
Total R
1 •
u = ? r o7.2
FLAT ROOF OR CATHEDRAL CEIIING '
Va ue R 4AlUE
FRAhi1NG CEILING
0.61
. 0.17
Inside a1r film 0.61
Ceiling
Joist (stu
Insutation
Air space
Roaf decking
Insulation
euilt-up roof
Outside Air fSlm 0.17
iotal
I U
R
R
IindoN infiltration .5 cfm/lineal foot of crack '
tesldentlal door infiltration 0.5 cfm/square foot or door and minimum code requlrement
Ion-residential door infiltration 11.0 cfm/lineal foot o# crack ,
1b 12" concrete block no lnsulation = .47 R 2.1
)b 120 concrete block insulated cores = .26 R 3.8
1y 12" liglitweight block = .32 R 3.1
Jb 12'? lightv+eight block insulated cares = .12 R 8.3
1 51ng1t glass = 1.13;
1 double glass = .55
J triple glass = .41
with storm window .54
A11 exterior walls and ceilings must have a vaPo* barrier (0.10 perm max.)+
;apor barrier must be on the lnside (heated side) of wati. iapor barriers of the polyethelene thin film have no R va]ue.
I?
, - CEILING WITH VENTED ATTIC SPQCE ABOYE
R 'I LUE UE
FRAMING CEILING
4.
. ? 1991 BUILDING PERMIT APPLICATION 7 3??
CITY OF EAGAN ?
SINGLE FAMILY DWELLINGS M[TLTIPLE DWELLINGS COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUCTURAL PIANS
1 SET OF ENERGY CALCUTATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIDNS
1 SET OF ENERGY CALCUTATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS
# OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY IAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
IAT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER IATS - CONTRACTOR/HOMEOWNER HUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
s^
To Be Used Foz: !?,?L Valuation: Date:
Site Address ?/56/ liV1ff C, 4A= Cie. OFFICE IISE ONLY
Lot 4-z) Block Z FEES
Occupancy ? Bldg. Permit
Gc.iF? ? in?? Zoning Surcharge
?
Parcel Sub Actual Const Plan Review
Allowable SAC, City
Owner # of stories SAC, MWCC
Length .26 ' Water Conn.
,p
Address ?jCW-s Depth ? Water Meter
S.F. Total Acct. Deposit
City/2ip Code ??GyG1.i? `?-/23
- Footprint S.F. S/w Permit
? S/W SurchargE
?
Phone Z -(SSZ/ (c??L2/^-?f'// On site sewage_ Treatment Pl.
On site well Road Unit
Contractor /'1• ? MWCC System _ Park Ded.
City water Trail Ded.
Address -?+-?..t C1?1 rt PRV Copies
_
Booster Pump _
City/Zip Code SIIBTOTAL
APPROVALS Penalty
Phone Planner Lot Change
_
Council TOTAL
Arch./Engr. Bldg. Off. ?C q"zs8/
Variance
Address
City/Zip Code
Phone #
Sewer/Water Licensed Contr.
agrees that all woik shall be done in accordance with
(Signature f Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
ec.s'. O o
LEGAL DESCRIPTION: F0r?a?o eDo:cx;, s! IFF RioGE_-
, ACCORpING?'TO THE RECOROED Pt-AT
,s (THEREOF DAKOTA COUNTY,AAINNESOTA
:.. -, ..
V I L W r ;_ .... ?_.._.. ...._
_..-
SCALE: I"=30'
oAr1411-16-5°t
_
4
?
\
GIDiEER N G EPT
EaGAxL??j" 9
a
u
N89°34'll" 9??'? 105.00
9ZS ? 35.SV F2.12 ?
dR38e / / ? -?
? ° ss 63 .,, '1 ?n
`3 8? ? ? ° • ?-? J I o
dL ' .\ N til
\
J • i a" b J ,r
VO
ys?.o6 ?
r 1 I
W
g 35 ?
, Q 7 • 2400 .E LOT 10 0
---= U -- - - _ = ;?:`LOT I I 153'29 .
LEGEND »zovosev Fuu.. a4saHeNT =No ..?e.t.xoor
INVERT ELEVATION AT SERVICE EXTENStON=
a DENOTES IRON MONUMENT pROPOSED GARAGE FLOOR ELEVATION -3
o DENOTES WOOD HUB SET PROPOSED FIRST FLOOR ELEVATtON = y. ?•?.'
DENOTES EXISTING SPOT. PROPOSEDBASEMENT FLOOR
ELEVATION ELEVATION
OENOTES PROPaSED SPOT P R?J n
DENOTES DRAINAGE'DIRECTION NOTE'? VERIFY ALL FLOOR HEI?riTSP-4ISh'
FiNAL HOUSE PLANS
I I herepy cartity TAat this survsy,plan ar
roport wos preparsd by me or under my
diroc: supxvisicn and that i am a duly
RaQistered Lind Surveror under !h•
Laws o}.'he Slcta nt
•-?--
8rac,ay ?:;Sq?,ort, Mn. Req. `lo. i:.23-
n?._' . ii'-/1 9 '?.
Lo () ?j ? S PLUMBING (RESIDENTIAL)
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
gc4p-!!?
/S. so
0-7
03
Date
/ V b!
HIMROD, JOHN ,
Site Address 4561 CLIFF RIDGE COURT Unit #
EAGAN, MN 55123
- (651) 686-4424
Property Owner _ Telephone # ( )
Cun[rxctor NORgLOM PL??? ??
(612) 827'4033
Address City
•
State
ip - Telephone # ( )
The Applicant is _ Ownex ? Contracror _ Other
Septic System New Refufbished 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, exciuding 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 X Water heater $ 15.00
x replacemenl _ additional ?
n ?
?
I
I
r
..
f
??
1 I
State Surcharge
?
JUL 1 6 2003
$
.so
To?a? gy - $ i5. SC?
I hereby apply for a Residential Plumbing Permit and aclmowledge 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 with the Plumbing Codes; that I understand this is not a
pemut, but only an application for a permit, and work is not to start without a pernrir, that the work will be in accordance with the
approved plan in the case of work which requires a review and approval of plans.
?.-? NoCb?ti?
J
Applicant's Printed Name 9blicant's Signature
1` 2005 RESIDENTIAL PLUMBING PERMIT APPLICATION
4 CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Please complete for modifications to existing residentiai dwellings.
?
Date_/ /5;k -7_1
/ /
Site Street Address Unit #
PropertyOwner C`/?`?f9? .1//1 Telephone#
Contractor C'?"m b!d A) /?,:/l9 Telephone #(9S'?2) 7Y2D
Address io'ZD ? Wbl 9) City y 6 jZ&rJS'D1LLF_ State_J-7).V Zip
The Applicant is: _ Owner ? Contractor _ Other
Alterations to existing dwelling $ 50.00
_ Add plumbing fixtures. This fee includes putting in a water softener andlor water
heater at the same time. If vou are insiallincr onlv a water softener and/or water
heater, do not complete this section. Move to the next section and check the
appliance(s) you are installing.
_Septic System Abandonment
_Water Turnaround (add $125.00 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
Total $
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 Z a plan is required to be reviewed and approved.
, ?
`_ Ld6.`//
Appli anYs Printed Name A p canYs Signaturef?°
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA116081
Date Issued:10/02/2013
Permit Category:ePermit
Site Address: 4561 Cliff Ridge Ct
Lot:10 Block: 2 Addition: Cliff Ridge
PID:10-17800-02-100
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder, flat bar and printed
pictures of ice and water protection.
Carbon monoxide detectors are required by law in ALL single family homes .
Chuck Glum
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
John R Himrod
4561 Cliff Ridge Ct
Eagan MN 55123
Highmark Exteriors
11237 Nicollet Ave S
Burnsville MN 55337
(952) 882-8904
Applicant/Permitee: Signature Issued By: Signature
e o ; r .,.,. •
For Office Use l
a w t4 ,�i JB1 it { _ ,! c // l u Q
, Permit#:
�„- i RE
jPermit Fee: G2
3830 PILOT KNOB ROAD 1 EAGAN, MN 55122-1810 DEC 0 9 2419 Date Received: �t} l- (�
(651)675-56751 TDD:(651)454-8535 FAX: (651)675-5694 111
buildinginspections aAcityofeagan-com Staff:
_J i
1
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: IltSite Address: �" 1 CL-44614""� .�
Tenant:
Suite#:
es(dt�t/e .„ .
R �
Name•
------
•:r +>. ; �rY� '�J� W F Phone:
` '''` Address/Cit / i /
Name: MILBERT COMPANY dba CULLIGAN WATER
License#: WC641376
Address: 1801 50TH STREET EAST
`Oci.r raCtO.r City: INVER GROVE HEIGHTS
State: MN Zip: 55072 Phone: 651-451-2241
Contact. BILL MILBERT Email: gloria.abas@culligan4water-com
Ty;p:e of VV:Onk' . -- New Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work: •
Water Heater •
Lawn Irrigation( RPZ/ PVB):
x Water Softener
DeS'e'ripfi'Am Add Plumbing Fixtures (—Main/ Lower Level).
Septic System )
New Description:-
-
_Abandonment _Connection to City Water from Well
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 $ 6Q•00
CABEFORE YOU DIG. Call Gopher State Ono Call al(551) 00
454. 02 for pctio
roten against der
unground utility damage. Call 48 hours before you _
intend to dig to receive locales of underground utilities. www,gopherslateonecall.orq I
LL
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an omall update on the City's
wobsito at www.cityo(oagan.com/subscrlbo-
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 +
Fa an; 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 )
i
ac rdence I tie approved plan he is a of work wh' h requires a review and approval of pians.
\1110
x
Applicant's Printed Name
x �"
Applicant's Signature
Page 1 o1_2
f
1