1415 Cutters LaneI , . CITY OF EAGAN N? 16557
' 3$30 Pilot Knab Road, P.O. Box 21-1 99, Eagan, MN 55121
PHONE: 454-8100
/!
9
m
BUILDING PERMIT Aeceipt h- 1
5
j
To be used for SF DWG/GAR Est. Value $103 ,000 Date JIJNE 1
Site Address 1415 CVfTERS LN
Lol 9 Block Z Sec/Sub. CUTTERS RIDGE 1 OFfICE USE ONLY
PafCel No. Occupancy R-3 M=1 FEES
1
a
2oning -
-
W Name ?Y?ND HOMES (ACtuaqConst _V-`1 BIdg.Permit 650.00
o Address 14450 BURNSVILLE PKWY (Allowahle) s
n 50
51
urc
arge .
City BIIBNSVILLE phone 894-2636 uof stories _
325
00
? Plan Review .
Lengih
o Name $AME Depih 41' SAC
City 100• ?0
i
?
0 Address S.F.Total - , 575
00
,
? City Phone S.F. Footprints - SAC,MCWCC
Waler Conn .
580. 00
On Site Sewage -
F Name On Site Well _ yyater Metyr 90.00
w
iz AddfCSS MWCCSystem xx
0
oi AcCt.Deposit 3
, 0
aw City PhOne CiryWater XX_
S!W Permit 2n. n0
PRV Requiretl _
I hereby acknowlege ihat I have read this application and state that the Booster Pump - SNV Surcharge 1,00
information is correct and agree to comply wdh all applicable State of
Minnesota Statutes and City agan Ortlina c. Treatment PI 228, 00
SignaWfeofPefmitee APPFlOVALS RoadUnit 340.00
A Building Permit is issued [o: HOM4 Planner - park Ded.
on Ihe express condition that all work sh be done i ccordanCe with all Councii
applicable State of Minnesota Statutes d City of E gan Ordinances. Bltlg. Olf. _ Copies
euilding OHicial -nQ1lq B,Q? j? I A Variance _ TOTAL 21 990.50
, . .
4
• ?.. •I
. _. ,
h ' . . . .. . '?t
CITY OF EAGAN A. y µ f6JrrJ' 7
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100 ,,t- . ?., , , - •; BUILDING PERMIT Receipt # - •-%
To be used for J` 7-?NL?GAY, Est. Value $103 .000 Date ?iNE 1 , 19 8g
Site Address 1415 (:L"TTERS LN
Lot "' Block 2 Sec./Sub. GLTT'fEF.S ?1L`{;i: 11,
Parcel No.
W Name "?FVLAQID K?'?kS
3 Address ?0 BUAtiSV I LL` PKIW'Y
0
City. . i [.L.E Phone 894-2636
o Name
Address
? City Phone
?
WW Name
YE Address
a W City Phone
I hereby acknowlege that I have read this application and state that the
information is correct and agree to comply with all applicable 5tate of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permitee '
A Building Permit is issued to: ??EYwli? tiV?"-y$
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
USE ONIY
Occupancy R-3 M"Z FEES
Zoning X-1
(Actual) Const V-N Bldg. Permit 650.00
(Allowable) V-N Surcharge 51.50
# of stories
52'
Plan Review 325.00
Length
Depth 411 SAG City 100000
S.F. Total - SAC. MCWCC $75•O0
S.F. Footprints -
On Site Sewage _ water Conn 5? •?
On Site Well Water Meter 90.00
MWCCSystem xx
?
Acct. Deposit
3???
City Water 20,00
PRV Required - S'W Permit
BoosterPump - S'WSurcharge 1'00
Treatment PI 228.00
APPROVALS RoadUnit 340'00
Planner - park Ded.
Councd -- 1
6tdg.Otf. _ Copies
2
9y0• SU
Variance - TOTAL r
? Permit No. Permlt Holder Date TNephona #
'WATEB (?'.?? ?? ' ' • .?.t ? ? . ?/?f ??
SEY7ER
PLUMBING S ?e 1?445
H.V.A.C.
ELECTRIC 1. •
IAJ
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rou9h Ftt9
lsuI.
Fireplace
Fnal Htg. i
Fnal Plbg.
Const. Meter Plbg. Inspector- Notify Plumber
EngrJPlan
Bldg. Final
Deck Ftg.
DeCk Final
Well
Pr. Disp.
SEWER & WATER PERMIT
CITY OF EACAN
3830 Pilot Knob Rd.
Eagan, MN 55122-1897
SITE ADRESS
LOT BLOCK SEC/5
APPLICANT:.
ADDRESS:
,
?
? OFFICE USE ONLY
f
METER # `O? 70 1 PERMIT DATE == iS I `}"
CHIP # 0?5'AO 7 WA7ER PERMIT # 10494
METER SIZE e -,,r`1d.P. RECEIPT # - 2 305
ISSUt DATE f - ' 1 B.P. RECEtPT DATE / r9
,. - PRV - BOOSTER PUMP
PERMIT REdUESTED
_,Z-SEWER ,, ?'WATER - TAPS
- COMM/IND RESIDENTIAL
CITY, STATE r?_ «
ZIP
PHONE: EXISTING
PLUMBER:
ADDRESS: ? I AGREE TO COMPLY WITH CITY OF
CITY, STATE ZIP EAGAN ORDINANCES:
PHONE: r ` ? ' ??-- / ? ti?< <?
?
'
• • .
+?.
r
????
OWNER:
ADDRESS: SI N UR WHE
ETER I UED
STATE
CITY ZIP 7
, I
PHONE:
PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMfTS, CONTACT
ENGINEERING DEPT. APPLICANT AND PLUMBER WILL BE NOTIFlED WHEN PERMIT IS PROCESSED.
.` i? .
gertFf`ra1t ol (Orrupa.fry
titp of olagan
liFptt2"wPitt Af ltltniltg J[8pPttiiUll
77eis Certificate issued pursuant to the requirements ojSection 306 of the Unfform Building
Code certrfying that at the tirne of issuance this strucJUre was in compliance wrth 1he various
ordinanees of rhe City regulating buildrng canstruction or use. For the following.•
U.C,g;fic„ion SF DGIG/GAR Bldg. FftII,;t No. 16557
Occ„pancy Type R3/141 zooing niss,ria Rl Tyye consc. VN
OwnerofBudding KEY•&M ?•S pddrm 144$0 SRW.U PIWY, B1 VIII.E
eu"naarm l415 Q= IM Lomiity 19, E2, QTIZFRS R7DZ IST
SWMWR 22, 1989
' BuMing Offfff
POST IN A CONSPICUOU5 PLACE
1989 BQILDING PEFMIT APPLICATION - CTTY OF EAGAN
SINGLE F1IMILY DWELLINGS
IG561
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OF SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTEs ADDRESSES FOR CORNER GOTS - CONTR9CTOR/HOMEOWNER MtTST DESIGNATE WHICH ADDRESS
I3 DFSIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSOED.
MQLTIPLE DWELLZNGS RENTAL IINITS FOR SALE IINITS I OF ONITS
INCLUDE 2 SETS OF PLANS,
CALCULATIONS
INCLUDE 2 SETS OF ARCHITECTURAL
1 SET OF SPECIFICATIONS ND 1
To Be Used
Site Address /I/ /S-
Lot 2- Bloek Oz
Pareel/Sub
Owner
OF SIIRVEY - CHECH WITH BLDG. DEPT., 1 SET OF ENERGY
& STRUCTURAL PLANS, MAY 2 $ 1989
SET OF ENERGY CALCULATIONS
Valuation: C) 3 C>d 0 Date:
Address / q qSo (y
City/2ip Code .6
Phone SA-le L/
Contractor ,?---?
Address
City/Zip Code
Phone
Areh./Engr.?
Address
City/Zip Code
Phone S
P3 ,1 -
Occupaney ?-?
Zoning -Z /
Actual Const . LIC
Allowable /
S of stories
Length S2
,Bepth
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System Y`
City water J
PRV required _
Booster Pump `
APPRDDALS
Planner _
Couneil
Bldg. Off. tEra/r-
Variance
Couneil
NOTE: Sewer & Water Permit fees and acQOUnt deposit feea will
permit fee. Processing time for sever and rrater permits
plumber has applied For a permit at City Eiall.
ONLY
FE6S
Bldg. Permit
Surcharge
Plan Review 32S
SAC, City 1120
SAC, MWCC rzs
Water Conn -.S 80
Water Meter 90
Aeet. Deposit 30
S/W Permit -;)0
S/W Surcharge /
Treatment P1. Z 7
Road Unit -39,4
Park Ded.
Copies
ToTAL 0. ? 0
be included in the building
is two days onQe a liaenaed
?? ? ?
US? -
26 a- Z/i? ? ?? 7 Z 1?3
t:
f ib ?f^aN iis ?•
12-
? 6-
Ze
? Q Z%?
/
r"
EXTERIOR ENVELOPE AVf_RAGE "11 "._COMPI)TAfI0N
nnrr: tizr13-8$
oWHER; _
S?7E AODRESS: PhIONE:
CONTRAC?OR: PLAN ? T?-33 Cas' ?T
Determ ine working square foota9e of each
1. Total exoosed wall area... .. = .S9• ft. x. 11
2. ToLa] roof/ceiling area... .. sq. ft, x. 026
Tctal exposed wall area above,floor=__ 7-Z1?(o
1?{(O
a. Total wali window area ................ ........................... ?
b. Totz7 door area....................... .................... ........ r
c. Total sliding glass door.area ......... ............................
r -
d. Totzl fireplace wall area .............
rea (average 10%)
i ...........................
............
............... 'z
e. Total .
ng a
wa11 fram .
: s7
Z
f. fiotal rim joist area ............ ...... .........................
. .
,
4.'-/
g. net wal] arez a6ove floor .......... ................... ........
h. wall area above floor .......... ...........................
'
i. xall area a6ove floor........... ......................
.... .
j. `rzme wall zrea aT =oL,--idat:on .....:.. ....:......................
To-Lal exposed foundation area= -7`? _
k. Total foundation window area ..........
d .............
8, $
C
l. Total e .
net fioundation area above gra .............
v
Determine "u" value of e ach wall segment
(e,g, window, door, each separate wail section)
lLf !o X ,L/7 = Co$?CoZ_ ?
a.
X l,ul, >
h ? 1 = 11,75S
.
x „u„
?
. _ .
d X liull_
zZ? ?(p X llu,l
e.
X
X "1Z? 3Z
X liuii
n.
_
i. X flull _
? X 'lull
X a`.I = s?
X 11 ul.
If item a3 is the si
as, or less than.it,
11, you have met thi
intent of SSC 6006
3 . ........ ............. ............ Total = r-Z-Il `1 1
• - Total exposed zoof/ceiling area
a. ?=z1 skyli.ght a=ea ............................
a. ^ctzl roo`/cei'ir., framing zrra (:rvcrajc 10x) :.. . ? ' ' ' ...
o. ?o.zl ^et i^s_lztcd roof/ceiling +irc:a.. , ...... , .
Deternir.e °U" value for each roof/ceiling segnent ..
?-- -
- ^ x 'lU u
r CJC} ??. x iiU" r ?Z.-_ . Z- ? . _ . . . , -, .
??--
. . . _. " _ . '
c. X. -U- 177,57
^ ........................... Toial =
" co_zl c= _z is the sama as, or less 1:han 112, you have met the intenL- oi •
S,?C 5005 ic? 2
Alter,ate Building Enve'..ope Design_
^c •____izz the totzl e.^.velooe'system method, the values established by the s:n oE '
±tzms =3 2^.d =4 sha11 ,.ot be qreatez than the sum of items 1;1 and n2.
l. +2. Z.Si?o7 = ?rL/
3. z- ZrLf Li? +4.
P1.arr # ? -
* LixEAL ?r EXPosID waLL
sLocx: '{ & t Iz t"- o f I`1 + 2: '6 -I- ZE.p ? 7? g
1QNEE:
ac.r,
W.O.: z?
£ULL 1:4 S 4{Z. 4- z o 1 f`k a z. rc 4- ZRo -I14 $
f v L L z : Z. ? 7 Z.. L 1 7 + Z. (0+ r , s = l I I
FIREPLAcE:
xIN: z s ?
* sQuARE FEEr EXPosm wAU ,9xEA `
BLOCK: 1 `a x . S = -J ?f
KME: x 5 = .
w.o.: ?-.?r x e = ?zy
FUa.L 1: 1 L-(c6 X 8=
Ftna.z: 1lt x 8= 88`6
FIREpLACE: X ?
RIM: z S" `'I x 1= .2S7
Z co z°1
* SQUARE FEET EXPOS£D CEILING 9 g ?
? sw L u cowS
Il -3z4o ? g,g = 17,(0
tt?-l - z3 43 - cr ,?= 3?{
il-ZYqa
?y11 - ?`iK$ - ? ? 3Z
SL
? r z y "ot 'r
J`k
? DOORS
3 ° yv
? PATIO DOORS
? ?'- t."' -? 32
* BA5E1EN'P tTNITs
??-z7?y -z.?
I `-( Co
, c?k 1 ? ? C, o?
SU
I 7-a?-oo
2000 FIREPLACE PERMIT APPLICATION -
CITY OF EAGAN
3830 P1LOT KNOB ROAD - 55122
651 681-4675
Date: +J G ?S l 1 0
?
Description of Work: _ Construct new fireplace ,Gas _Masonry _ Alterations to existing
? Install eas insen onlv _ Install gas line onlv
Qther
Job address: /74s ?C.t. //e jr'S 4 Gt ,
I,ot: _2 Block: ? Subdivision/P.I.D.#:
Applicant (circle one only): Owner Contractor
I5t
Permit Fee: $60.50
? / -,?
Name: /c ?(? b 0?i}, 1r?l/Y Y- Phone #: ( 9 63-07a?'
PROPERTY Last Fust
OWNER /? r ? e?s ?
Street Address: / `"7 1J e.(A /?./ ,?'J e-
City EG( State: -T / / /// . Zip: •?-?02.?
r
a: /ftzz ry
(azea code)
FIREPLACE
INSTALLER Street
City 1-ti S-L4/ State: ? Zip:
Company:
GAS LINE
INSTALLER Street
City
Phone #:
(area code)
State:
Zip:
I hereby acknowledge that I have read this application and state that the information is conect and agree to .
comply with all applicable State of Minnesota Statutes d Citycof g Ordin nces ?
ssgnanue -
JUL ? I
2004 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 Al?' ! 5: ? f /???
/?{/ )?
Site Street Address
L
'??4?/S?/L/ P1 Unit #
?
_
l
Property Owner 4 ? ( Telephone # -11?9
Contrector121lt'ir7e A -- Telephone# 0;A1 -
Address J,1=?L???j City J??Za p5 Uj/ -P _ Stateo?!L Zip .
The Applicant is: _ Owner _ Contrector _Other
Alterations to existing dwelling
_Add fixtures to rooms, excluding water softener and water heater
_Septic System Abandonment
_Water Turnaround (add $127.00 if a 518" meter is required)
Other: $ 50.00
X Water Softener _ Water Heater
? replacement _ additional $ 15.00
Lawn Irrigation System RPZ_ 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 event a plan is required to be reviewed and approved.
. i
Ap icp anYs Prin et d Name ' Ap licant's S' nature
OCT 2 6 H04
7
SU
IYW Nv11Ln?+ ?'+.? "-
VEYOR'S CERTIFICATE KEYLAND HOMES
RevisEo 4-2e-ee iosrww
NEW HOLLSE 6 tACATION
REVISED 6-22-69 TO SFIOW
NfiW HOUSE
(69D.o1 f? 86.00
---? e
W
0
?
0
z
? -?•r
O
0
?
8
'59'W -
o , o
'"-+DRAWKiE a unurr?/ ?g
i EASEMENT PER PLAT : I
? LOT 9 1
I ?
c$°'A Sl
\
1
SW
g
0
z
..
".(?) 1
I
/ I
?/PFtOPOSEO
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' =?AGA1?
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Q%AR/ ? ? S
a
' ??=x-------- _A2 ,
'
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L ? y I ^A'(E_
e
?-_
`- 86.00 N8905659 W? (e984)
0
M
C UTTERS
REPRESEN7AT10N OF A SURVEY OF THE BOUNDARIES OF:
Lot 9, 81xk 2, CUTTERS RIDGE IST ADDlTION, accordir?q to the recorded
plat thereot, Dakota CouMy, Minnesota.
Byr ( _..?.?? _ .
Data ? r
EAGAN ENGINEERIN DEtT
f---- DENOTES PROPOSED SURFACE DRAINA(3E
O DENOTES IRON MONUMENT•SEf SCALE: 1 INCH = 30 FEET
• DENOTES IRON MONUMENT FOUND PROPOSED QARAO£ FLOOR - 899•0 FEET
X000.0 QENOTES EXISTING ELEVATION RROPOSED LOWEST FLOdR - $9 1.3 FEET
(000.0) DENOTES PROPOSED ELEVATION PROPOSED TOP OF BLOCK - 6k4,4 FEEf
WE HEREBY CERTIFY TO KEYLAND HOMES THAT THIS IS A 7RUE AND CORRECT
IT DOES NOT PURPORT TO SHOW iMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN. AS
SURVEYED BY ME OR UNDEA MY DIRECT SUPERVISION THIS 27TH DAY OF APRIL , t989•
PROPOSED GRADES SNOWN WERE
TAKEN RROM THE DEVELAPMENT
PIAN FOR CUSTER9 R100E IST
@ 2ND ADDITION PREPARED BY
ROBEiiT A. TMENE, P.E. IAS7
OATEG 5-20-88.
SIGNED: JA LL, INC.
BY: C, P HAROLD C. PE7ERSON, LAND SURVEYOR
MINNESOTA IICENSE NUMBER 12294
James R. Hill, inc.
PLANNERS ! ENGINEERS ! SURVEYORS
9401 JAMES AVE. S. • 6LOOMINGTON, MN. 56431 • 812•884•3028
R
{.
Use BLUE or BLACK Ink
r
For Office Use
Permit
City of '"a
I Permit Fee: 1,05, ~ S I
3830 Pilot Knob Road I I
Eagan MN 55122 Date Received:
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 1 Staff. Il
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit
. ~la• 38? . 9-7-7-7
Name: o~r+ ~ Phone: 8
Resident/ 1915 (A-r5 L,-4-
Owner Address / City I Zip: is: Owner _ Contractor
Applicant SS J'2 2
I I Description of work: ~efo
Type of Work
i Construction Cost: 3 80 Multi-Family Building: (Yes / No
Company: (,f~.+ ~o.a-ice re5~~vrt Contact: Eel Address: Soo /4N/bric.►,. • W S~. t (c) City: 040"*
Contractor n ~
i State:) /y Zip: SS ~I 3 Phone: ~~a g3 1 t 3S
License BC Lead Certificate
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
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:
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
_ ._a.... . _ conclude that they are trade secrets.
a a
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.gopherstateonecall.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 be completed within 180
days of permit issuance.
X 1% o4^L n kreavvVIA
Applicants Printed Name 4Ap Pt'silignature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA153228
Date Issued:12/03/2018
Permit Category:ePermit
Site Address: 1415 Cutters Lane
Lot:9 Block: 2 Addition: Cutters Ridge 1st
PID:10-19100-02-090
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Water Heater
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener).
Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087
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 -
Robert J Dejdar
1415 Cutters Lane
Eagan MN 55122
(612) 387-8777
Champion Plumbing
3670 Dodd Rd., #100
Eagan MN 55123
(651) 365-1340
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA167234
Date Issued:03/03/2021
Permit Category:ePermit
Site Address: 1415 Cutters Lane
Lot:9 Block: 2 Addition: Cutters Ridge 1st
PID:10-19100-02-090
Use:
Description:
Sub Type:Windows/Doors
Work Type:Replace
Description:One Window/Door
Census Code:434 - Residential Additions, Alterations
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow
windows, call for framing inspection. Call for final inspection after installation.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Valuation: 1,500.00
Fee Summary:BL - Base Fee $1500 $62.50 0801.4085
Surcharge - Based on Valuation $1500 $0.75 9001.2195
$63.25 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 -
Khalid Adnan Bo-subait
1415 Cutters Ln
Eagan MN 55122
(952) 797-6512
Home Depot Usa Dba The Home Depot
2455 Paces Ferry Rd
Atlanta GA 30339
(763) 852-1044
Applicant/Permitee: Signature Issued By: Signature
t 0 p
! 00
—�
I For Office Use I
I I
-�J
I Permit #: � 9&I
T
I
AGAN
I
I Permit Fee:
I
I Date Received: toI
1 5122 '
3830 PILOT KNOB ROAD EAGAN, MN 55122-1810
I
(651) 675-5675 1 FAX: (651) 675-5694
Staff: I
building inspections(Qcityofeaaan.com
- - - - - - - - - - - - - - - - -
2022 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: O Vr5111 Site Address: / r ( C-~'t'fer57 G'jV1 b"n /4-IN ( l
Tenant: Suite #:
Resident/Owner
Name: ,��-����� �- Phone:
Address / City / Zip: P r .x �`v. /'"�► t' 2Z
Name: License #:
Contractor Address: City:
State: Zip: Phone:
Contact: Email:
Type of Work New Replacement Repair Rebuild Modify Space Work in R.O.W.
Description of work:
Tankless Water Heater
Lawn Irrigation ( RPZ / PVB)
Description Standard Water Heater
Add Plumbing Fixtures (_ Main / Lower Level)
Water Softener
Septic System Description:r^^�^ti
New 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* + $300 for Meter and $205 for Radio Read = $565
*Sewer & Water Permit also required for connection charges
TOTAL FEES $
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's website at
www.cityofeaaan.com/subscribe.
CALL BEFORE YOU DIG. Contact Gopher State One Call at (651) 454-0002 or www.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.
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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Applicant's Printed Name Applicant's Signature