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Cit of Ea all JUL 20 2009 Permit
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Permit Fee:
3830 Pilot Knob Road
.Eagan MN 55122 Date Received: I
Phone: (651) 675-5675
Fax: (651) 675-5694. I staff:
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2009 RESIDENTIAL PLUMBING PERMIT APPLICATION '7(1 Date: Site Address: 3 (L~ Far n uxn Din V&
Tenant: eaJ2e Suite
RESIDENT /OWNER Name: 1 r' 1 , . UX ~''!Seaby' Phone:` (#S'), p f 3'(
Address / City / Zip: D gu ?WI 1 l U. I L T) V~
CONTRACTOR Name: NORBLOM_PLUMBING r.(')- License ®(Y ( 5 l--rl l r
Address: (612) 827-4033
City: 2905 GARFIELD AVE. SO. State: Zip:
MINNEAPOLIS, MN 55408
Phone: Contact Person:
TYPE OF WORK _ New ,.X Replacement Repair _ Rebuild _ Modify Space _ Work in R.O.W.
Description of work: rimtac6 V' a
PERMIT TYPE RESIDENTIAL
I Water Heater Water Softener
Lawn Irrigation Add Plumbing Fixtures
l_ RPZ PVB) l- Main _ Lower Level)
Septic System Water Turnaround
New
Abandonment
RESIDENTIAL FEES:
$50.50 Minimum Water Heater, Water Softener, or Waterl Heater and Softener (includes $.50 State Surcharge)
$30.50 Lawn Irrigation (includes $.50 State Surcharge)
$50.50 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $.50 State Surcharge)
*Water Turnaround (add $165.00 if a 5/8" meter is required)
$100.50 Septic System New ($10.00 per as built) (includes County fee and $.50 State Surcharge)
$90.50 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $.50 State Surcharge)
TOTAL FEES $
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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Applicant's Printe Name A icant's Signa ure
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground JRougp-In Air Test Gas Test -Final
CITY OF EAGAN 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 De
Reader No.•
posit:
Permit Fee:
1 agree to comply with the City of Eagan Surcharge:
Ordinances. Misc. Charges:
By Y Date Paid:
Date of Insp.: � Insp
CITY OF EAGAN
38 Pitot Knob Road SEWER S ERVICE PERMIT
E
P. O, Box 21199
Eagan, MN 55121 PERMIT NO.:
Zonin DATE:
Owner: — No. of Units:
Address:
Site Address:
Plumber:
1 agree to comply with the City of Eagan Connection Charge:
Ordinances.
Account Deposit:
Permit Fee:
By Surcharge:
Date of Insp.: Total:
Misc. Charges:
Insp.:
Dote Poid:
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_ _ _ 3830 Pilot Kno6 Road _ � PeRrrit Fee: _ (�,�.�tr/" _ I
Eaaarr MN 55122 i �
Phone:(651)675-5675 � Date Received: I
Fax:(651)675-5694 � I
� Staff: �
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2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: Site Address:
Tenant: Suite#:
.Resident/Owner R Name: Phone: vG5 l�VG��✓ 1 ��1
, Address/City/Zip:_�Q �V�-�UV u 1 ����/�
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� �C$o�� I'aC^ol',��;� Address:_) + ��' ���1��)I I L I � � S� City: 1�(�C'�"1�lC�
� State:��Zip: �����Phone: `Q� � ' � ��'" �'b� 1
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�.`�� ��=-° Contact: Email: /� ft t� C��.�'GIPY C(�1 j�/�
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- _New �Replacement _Additional _Alteration Demolition
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��>-�"jype of��l��� :�� Description of work:
� � �o e ease cq e an roun oun ed mec anical e ui me "s gqu�re �o be screene"��i it�.
OTE.Roof,moun
'�� "`� ' �` °�� ,� �� ���'°c h"�e.�l�fechanica �pec or xo�����o�a ion_p � e'�`nm�i e sc"�e�enir �e'�,hocls
.a::.e..�a.*rt'x.�"'.»..,...:r.a:�°� _.'�"^..:tsm�. � . �aa.��e. _s.s...s._d! � . .,au,,,.,.�, . P.Qe,..a.: 9 m.,.-.P. F-"_:,
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� �`�� _ -� �° RESIDENTIAL COMMERCIAL
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� _ Furnace New Construction _Interior Improvement
* �Pe t e,� �� —Air CondiGoner _Install Piping _Processed
� `�� �� "'�" Air Exchan er
— 9 Gas Exterior HVAC Unit
..�.Y.,�..:,�:.�: — —
,n �y-:,,Q a _Heat Pump UnderlAbove ground Tank (_Install/_Remove)
�n�--�•� Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit(inciudes$5.00 State Surcharge) �v
$100.00 Residential New(includes$5.00 State Surcharge) _$ �� ° TOTAL FEE '
COMMERCIAL FEES Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removai =$ Permit Fee �
*If contract value is LESS than$10,010,Surcharge=$5.00 =$ Surcharge"
**If contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005 _ •
***If the project valuation is over$1 million,please call for Surcharge =� �' TOTAL FEE
I hereby acknowiedge that this information is compiete 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 fhe approved plan in the case of work which requires a review and approval of pians.
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ApplicanYs Printed Name App icant's Signature
FOR OFFICE USE ` � „ : w.,,�, -�` . _° . �
_Required�nspections �° � �" - �ev�ewe By� a•.�N���_�. "¢ �Date•° �° `�,�:'
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��� (�! Fj� 9T1 j Permit#: '� —1 I
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3830 Pilot Knob Road � Permit Fee: �
Eagan MN 55122 � I
Phone:(651)675-5675 � Date Received: I
Fax: (651)675-5694 � �
� Staff: �
I
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2015 MECHANICAL PERMIT APPLICATION
❑ Please submit two(2)sets of plans with all commercial applications.
Date: Site Address:
Tenant: Suite#:
g � Name: ��� �L.L���� Phone: lwl.2.` ���4 1���>
� Address f City/Zip:�_���p ��� f� ���U�,
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` Name: Q � � � "�" � License#: � � � U �� S '�j �
Address: � � � T City. ''
State:��Zip:�'�j���j Phone: �/�c�,(' `C�7 - �� �
' Contact: Email:�`/x_.S�Jt P-'V� �►�� ��e[�c�u.r�a,ir,(!'J�ry-t
New �Replacement Additional Alteration Demolition
c� Description of work: � �� C
�,;- � �
RESIDENTIAL COMMERC/AL
Furnace New Construction Interior Improvement
�Air Conditioner _Install Piping _Processed
_Air Exchanger Gas Exterior HVAC Unit
_Heat Pump _Under/Above ground Tank (_Install/_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit(includes$5.00 State Surcharge)
$'9�i0.OG Residentiai New(includes$5.00 State Surcharge} _$ TOTAL FEE
COMMERCIAL FEES
Contract Value$ x.01
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal =$ Permit Fee
"If contract value is LESS than$10,010,Surcharge=$5.00 =� Surcharge*
**If contract value is GREATER than$10,010,Surcharge=Contract Value x$0.0005
***If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE
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�.S�� �c� r� X C�:e�� �
Applicant s Printed Name Applicant's Signature
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