4624 Halden Cir, • CASH RECEIPT •
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
R¢C61V60
FROM
AMOUNT $ I
' & DOLLARS
+oo
? CASH ? CHEGK
FOR •
-• i+-A c - !'. i. - Al 17
FUND . CODH nenouNr
Thank You
4_-7-- . BY
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
CITY OF EAGAN
?• 3795 Pifot Knob Road Eagan, MN 55122 N0- 6774
PHONE: 4548100
BUILDING PERMIT Receipt # _
To ba used for Est. Value y Date , 19
Site Addreu Erect ? Occupancy
Lot Blxk Sec/5ub. Alter ? Zoning
parcel ,# Repair ? Fire Zone
Enlcrge [] Type of Const.
Name Move ? # Stories
W
Z
oAddress
Demolish ?
Front ft.
-
Ci Phone `
Grnde ?
Depth ft.
? Name Approvols Fees
0
?
Address
Assessment
Permit
?
~ Woter & Sew. Surchorge
Ci ph? Police Plon check
?
?Z?Name
Fi?
$AC
?tD Address Eng. Water Conn.
a W Ci Phone Planner Water Meter
Council Road Unit
1 hereby acknowledge that I have read this application and state thct gldg. Off.
the information is correct and ogree to compiy with all upplicoble AP? Total
State of Minnesota Statutes cnd City of Eagon Ordinonces.
Signcture of Permittee
A Building Permit is issued to: ' on the express tondition thot
oll work shall be done in accordance with all applicoble Stote of Minnesota 5tatutes and City of Eugan Ordinances.
Building Officiol
,?-
PMnk # pato Inuad PaeeHttM
Plumbing S --? ?F-1LZ_.E i E,G 1
Mechnnical " (p t
TS& gs( q-Ilv-?c IjF-11 F 6c ?
INSPECTIONS DATE INSP. Rough-In Finol ?
Footings
Foundation
Frame/ins.
Finol ? ? •
Piumbing
Mechanical Dote Insp. Data lnsp..
Remarks: •
0O eQ.t.?-fi?lM
V•S'i/
?? •
Receipt ' MECHANICAL PERMIT Permit No. •
CITY OF EAGAN
Fee `?•
? . .
t. Date
&-27-81
3. Job Address ?? r''?`?? j?? "' ? '' `' ?` T?'Lot -7 Bik. ? Tract
4. Owner Ti i 1A. "SGh7
5. Contractor T?'l • C,, • Phone ? =5-68b7
6. Address , Ve• <,o.
' "-
7. City
118• State '•'
Zip ;?r, ZP7
=
8. Building Type: Residential n Commercial 13 Institutional O
9. Work Description: New ? Add ? Alter ? Repair ?
10. Describe Fuel Type
I 11.
No.
i Eqy,ipment 8TU - M. Ea.
Forced Air '-u No. Equiament CFM
Air Handli
:
Mfg. ng
Boilers
Mfg. Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg,
1 Gas, Piping Outlets
12. I hereby certify ihat the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed: for
Rough Flnal
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
Fi!l !n numbered spaces S/C
Type or Print legib/y
Tot.
?? 2. Installation Cast ' • '
Receipt
i
`?
PLUMBING PERMIT Permit No. --'
CITY OF EAGAN
Fee
Fill in numbered spaces S/C
Type or Prini legib/y
Tot. A L?' ?-•
1. Date 2. Installation Cost
-?-!
3. Job Address L?ot61k. ? Tract
4. Owner f \ ? I ' ; ? } • .
-I:
5. Contractor ?J_'A 111 C- V lb 1! ti l t!'Phone
6. Address
7. City State Zip ?
8. Building Type: Residential Q Commercial ? Institutional ?
9. Work Description: New P, Add ? Alter O Repair ?
10. Describe
11.
No.
? Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
? Bath tubs Septic Tank
? Lavatory Softner
? Shower Well
Kitchen Sink
Urinal/Bidet J
}A-t 1
Other
? Laundry Tray __
.
Floor Drains
Drinking Ftn.
Slop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed :
for
Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 454-8100
CITV OF EAGAN WATER SERVICE PERMIT
3795 iPHot Knob Rood PERMIT NO.:
Eagin, MN 55122 DATE:
Zoning: No, of Units:
Owner:
Address:
* Y?
Slt@ Address• - + .. ; ' ?' f. :1 r ? e??. (• .la7 .? ? 1?id?:
c'C ? -{
f `?:
i
Plumber:
Meter No
: Connection Churge: ? • ?, ,' ' "?'
.
Size: Atcount Oeposit:
Reader No.: Permit Fee: ' ti•?, ?
1 egree te eanpip whb tWe City oE Eaqon Surcharge:
Ordinantes. Misc. CFarges:
Total:
By Date Paid:
Date of Insp.: Insp.:
3795 P1iot Kneb Road PERMIT NO.: ?
Eagr.n, AAN 55122 DATE: , ZoMng: Na, of tJnits:
Owner. - ,
Address:
Site Address: u?c.l .
Plumber: ?
1 ayree to eospl?r wlth t6a Ciyr of Eagae 'i ? 5. Ol?
Ordinaetes.
By
Date of I nsp.:
Connedion Charge:
Account Deposit:
Permit Fee:
Surcharge:
Misc. Charges:
Totcl:
Date Paid:
CITY OF EAGAN Remarks
Addition Ridge_sl_i_ffe First Adrln Lot 7 Blk 1 Pa?cel #10 6?990 070 n1,
Owner j?? Street 4624 H31deA Circle State Eagan, NIlV 55122
Improvement Date Annual Years Payment Receipt Date
STREETSURF. lq, Jr 3? 15
STREET RESTOR. In
GRADING
SAN SEW TRUNK 1980 184.49- 12.30 15 147.62 C007635 2-18-82
SEWER LATERAL 19 o ?.?? ?•? o{?? 4
WATERMAIN
WATER LATERAL 19 JJ ?3 ^ 46 ' Z
WATER AREA 1980 . • lI{ .6'2 (,`Q 63 2-18-82
Stor-m r trunk as" 370.93 2A 1 ?
-
STORM SEW TRK ? 1982 638.24 5 638.24 C007616 12-23-81
STORM SEW LAT
r
Services 1982 637.75 5 637.75 C007616 12-23-81
CURB & GUTTJER
SIDEWALK
STREET LIGHT
Road Unit 185.00 25888 7-22-81
WATER CONN. 335.00 tv it
BUILDING PER. 6774
s,ac 525.00
PARK
E 4 CITY OF EAGAN
3795 Piloe Kno6 Roud Eagan, MN 55124 N2 6774
..PHONFs 454-8100
BUILDING PERMIT APPLICATION Rere?aT #
Site Address 4bC4 ti&1QCi1 G1TCl8 t. t'cd.lt-%. Lo
Lor 7 eiock 1 xcisub. Ridgecliffe lst
Pa,ce, # 10 9?M 070 Ol
w Name OI'I'j.A 7h0IDp30II HO1RC9
3 Address 1712 Hnzkine (:rossioad
o yra'- c?nie e11 n?no
° Name _
??
a Address
C
P
Nnme _
Address
I hereby acknowledge thot I hove read this application and state that
the informafion is correct and agree to comply with all npplicable
Stote of Minnesoto Statutes and CiTy of Eagan Ordinances.
Signoture of Permittee
A Building Permit (s issued to: --C
all work shall be done in accordance
Erect Occuponcy R3
Alter ? Zoning ' PD
Repoir [] Fire Zone MA
Enlarge ? Type of Const. V
Move ? # Stories -
Demolish ? Front 58 , rr.
Grade ? Depth z6 ft.
Avvruvals Feea
Assessment -
Water & $ew.
Police -
Fire
Eng.
Plonner _
Council -
Bldg. Oft. -
APC
Permit 274.00
Surcharge u+•00
Plan check 137•00
sAC 525-00
Water Conn. 335•00
Water Meter 60.00
Road Unit 185-17)(7)
Total $1540-00
'$ on the express condition that
Minnesota Stalutes and City of Eagan Ordinances.
Building Official
CITY,OF £FrAf7 Iriclude 2 sets of plans,
? 1 site plan w/elevations 6
BUIIDInK; PIIdMIf APPLICATIdN 1 set of enengy calculations.
2b se vsea For valuarion $' ? oate 7- ? 6-8 I
Site Address: ?(o2?,?A?-ocK C?. CIhADet OFFIC.$ USE ODII.Y -
Lot _Z_ slocic __ sec./sub. AjoaFrJ..jFFt Erect OccupancY _ 3
Parcel #: ff? 0 3`t S'U 07o a( F?PsT Atter zonirx3 _
Repair Fire Zone
Owner: Enlarge _ 'Iype of Oonst.
Nbve # Stories
pddr-sg; a Division of U. S. Home Ca onrarn„ De[IDlish Fzont .S? ft.
-TT' KINS CROSSROAD GIadE Deptl'1 ?t(o ft.
Clty/Zlp COd2: MINNETONKA_ MwN ;SOea
Phone #: 544- 133 3 ArPROvAis
contractor: EIRRlN T!-19MrS9i ^,-HOF?S-ES
AddrE55: a Division of U, S. Home Corporation
Clt]+/Zlp COCle: MINNETONKA, MINN. 55343
Phone #:
Arch. /Eng. :
Adciress:
City/Zip Code:
Phone #:
Assessrents
Water/Sewer
POZ1C2
Fire
Eri3 -
Planner
Council
Bldg. Off.
APC
Pe.imit ;2 7</°-`'
Surcharge ;;? y -'?o
Plan Checlc /-3 !7 -g?!
SAC `A_a6_
Water Conn. 3 3
Water Meter Po o
Road Unit / S' S"
WPAL `ro 0
This request void f/?[P
18 mon[hs fmm
T56951
L" -] / •'J ? L ? ? C . ( ?/ ?-S ? C7 C?
?'CnS3U
RenUesoDate f
- Rre No.
• Rough-in Insuer,uon
Heq rte?P '
0 Ready Now?iil Nnlrtv InsPec-
es' ?NO . lor When ReadY
icensetl Electrical Convactor, , ..I herahy requast insoaction of above
Owner electricel work installed at.•
SVeet Atldress, 9ox or Route Na.
?
e
- Gtv
-
.
y ?.
cvmi o. TownStnp-Name ur No. Fange No. Cow
Occupant (PRWT) '
OR?N -MMNj31-A Phone No.
Power SupP?l.er
jLF.(
R AAdr s
-u_,?`-,
/11? ?1"^?I\?%'
\
Ele cal Conuaclnr (Co oany Name). C vactnr's License No. -
?
- ?,u 3gSzs
?
Mailiny
Address iCOntrac[or or O
wner.Makmg Instailation) - • .
t
?
1,`? 1' k vA'I T 1'?' •
Author.+se .Sign ure 1 nhaetor/Owner Making Installavnnl Phone Nvmber j '
040 S
MINNESOTq STqTE BOARD OF ELECTIIICI7V •'_• THIS.INSPECTION.flEUUEST WIIL NOT
Griggs•Mitlwey Bldq. - Poom N•797 -.'.QE ACCEPTED BY THE STATE lOMD
1821 Univarsitv Ave.; St. Paul, MN'65104 . . . , - , -UNIESS PNOPER INSPECTION FEE IS
Phone (812) 297.2111 . ENCIOSED.
REQUEST FOR ELECTRICAL INSPECTION ;-« EB-00001-03
5 6 9 5'1? Sae instrucvons for comClatfng this torm on bnck of yellow cnpy.
" X"' Below Work Covered by Thrs Request
Ei? A q . Tyne ol Buiiding Appliancas Wired Equipment Wiratl
Home Range Ternporary Service
Duplex Water Heater Lighting Fixtures
Apt. 8widiny Dryer Hectric Haatin
Commeraal Bldg.
Industiial Bldg.
Farm Fumace
Air Conditioner
pther Spemryl Silo Unloader
Bulk Milk T.ank
Othor (SUer,ify)
thrr SGemfy Ot ei Other
Compute lnspection Fee Below
# Fee ServiceEnVenceSize # Fee Feeders/5ubfeednrs N Fen Circurts
0 to 100 qm ps 0 [0 30 Am ps 0 to 30 Am s
101 to 200 Amps 31 to l0U Amps 31 to 100 Am s
A6ove 200 q?s ? Above 100-Amps Ahove 100-AmPs
Transtormers '•, U ? Aemote Conirol Grc. ,5 01beir-fiae
-
Signs ' °? ?
M .'? Special Inspection
$?~
T
iW
Remaiks ? OTAL Ea
l
Huuqh-in Dnte
A I, tha Electr?cal
r ?17 Inspactaq hereby
certdy [hat the above
Fn?l ( Uate inspection hes baen
C . J /?? ede.
?- Thiz r ec? vmd
18 months froni
(?exfifirtttr nf (Orritpttnrg
Citp ot (Eagan
Uepttrhnent nf Nixilding Jnsperiitm
Thit Certifirule iJrued purraant to the requirements of Sertion 306 af 1he Uitiform Building
Code catifying tbut at the trme of irtuarut this ttrurlurr wau in romPliunce with the variouJ
ordinanat o f the City regulating building ronstrtution or utt. For the fo!lourr+g:
SF DWG/GAR Bldg. Pertnn No. 6774
UxClamfaGOn ?
O.F?TYP. p-3 -TYPCanewc4an V nRZ.. NA z-MPD
OwmraEBUlldu?E Orrin Thompson AaaR? 1712 Ropklns U:rsrd., Mtka.
BY
w1< October 26, 1981
3830 Pilot Knob Road
Eagan MN 55122
Phone:(651) 675-5675
Fax: (651) 675-5694
?-----------------
1 F,"ffice";llse ?
? Pertnit#:
? Permit Fee:
? Date Received:
j Staff: (?? I
i
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: '?2 y AGt Idcn /r-%
Tenant:
Suite #:
RESIDENT / OWNER Name: 4r k)/ lcc?x Phone: 152` E'lJ 6-aS
Address / City / Zip: 7(? D_ / ?CcI?iS 6 r 561?ltY? JUl?1/ ?,? Z-
Applicant is: _ Owner Contractor
TYPE OF WORK Description of work:
Construction Cost: Multi-Family Building: (Yes No
CONTRACTOR Name: License #:
Address: , d
Ciry: ? State: Zip:
Phone: 4?L2 Ll`/ 0-SI,J 0 Contact Person: C Gl /
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 7 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
(4 submission type) • 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?
_Yes _No If yes, date and address of master plan:
Licensed Plumber: Phone:
Mechanical Contractor: Phone:
Sewer & Water Contractor: Phone:
NOTE: Plans and suppoRing documents fhat you submif are considered to be publicinforination. Portionsoi -. _
_ fhe'inforrnation may be:classrfied`as`:non; public if you -? provide specific'reasonsfhat would permit the City to ;
coriclude thaf fhe "aretraale secrets., ? . - I hereby acknowledge that this information is complete and accurate; that the work will 6e in conformance with the ordinances and codes
of the City of
Eagan; that I understand this is not a permit, 6ut only an application for a permit, and work is not to start without a permit; that the work will be in
accordance with the aooroved olan in the case of work which reauires a review and approval of plans.
x `f?a?_Z2
Applicant's Printed Name
X
App)`"a Signature
`? Page 1 of 3
RESIDENTIAL
BUILDING PERMIT APPLICATION
CITY OP EAGAN
?/"? C? ?3830 PILOT KNOB RD, EAGAN MN 55722
v ? 651-681-4675
New Constructbn Reaulrementa HamodeUNaoelr Peaulremente
•• 3 registered stte surveys showing sq. tt. of bt, sq. R of house; an0 AI roofetl areas • 2 mpies of Dlan
(200/emaximumlotcoverageallowetl) • lsetofEnergyCalculatbnsforhestedaAAalons
. 2 copies of plen slwwmg beam & window slzes; poured lountl design, etc.) • 1 sile survey lor ezlerior addttlons & decks
• 1 set of Energy Cakulatbns • Intlicete il trome served by saptic system for add'Abns
• 3 copies of TrBB Preservatlon Plan 8 bt platted afler 7/1193
• Rim Jolst Defail Optbns seledbn sheet (bldgs with 3 or less untts)
DATE S13 / / D "Z
VALUATION / ?"f 3 3 P. s, 4?
SITE ADDRESS
NPE OF
?
MULTI-FAMILY BLDG _ Y _ N
_ FIREPLACE(S) _ 0 _ 1 _ 2
APPLICANT a O b E I) L)I4L 1?eA:_ 4EX7 %
STREET ADDRESS /6,0 7 G( n ? v cu r,2 T`t CITY 5? % A`T?e_STATE m'? ZIP SS/a
TELEPHONE # -&y,7'r-"77?CELL PHONE # ? FAX #/.5 7
PROPERNOWNER _bPq-?LPZ-( n B P-Li4°?1 TELEPHONE# 'S1&7
----------------------------------------- ------- --------------------------°-------------------
COMPLETE THIS SECTION FOR -NEW- RESIDENTIAL BUILDINGS ONLY
Energy Code Category _ MINNESOTA RULES 7670 CATEGORY 1 _ MINNESOTA RULES 7672
(4 submission type) • Residential Ventilatlon Category 1 Worksheet Su6mitted . New Energy Code Worksheet Submitted
• Energy Envelope Calculations Submitted
Plumbing Contractor:
Plumbing system includes:
Mechanical Conhactor:
Mechanical system includes:
Sewer/Water Conhactor:
_ Water Softener
_ Water Heater
_ No. of Baths
_ Air Conditioning
_ Heat Recovery System
Phone #
Phone #
Fee: $90.00
? ??t L? T•149
MAY 3 1 2002 ?
I hereby acknowledge that I have read ihis applicatlon, sTate that the information is correct, and agree comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances ?
?
Signature of Applicant
OFFICE USE ONLY
Phone #
Lawn Sprixikler
No. of R.I. Baths
Certificates of Survey Received - Tree Preservation Plan Received _ Not Required _
Updated 4/02
OFFICE USE ONLY
O 01 Foundation ? 07 OSplex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? OB 06-plex O 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Ak - Multi
? 03 01 of _ plex ? 09 07-plex ? 17 Garage ? 22 PorchlAddn. (4-sea.) ? 33 EM. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screened) ? 36 Multi
O 05 03-plex O 11 10-plex ? 19 Lower Level ? 24 Storm Damage
O 06 04-plex O 12 12-plex Plbg_Yor_ N ? 25 Miscellaneous
? 31 New O 35 Int Improvement O 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move Bldg. ? 42 Demolish (FOUndation) ? 45 Fire Repair
? 33 Atteration ? 37 Demolish (Bldg)' ? 43 Reroof ? 46 Windows/DOOrs
? 34 Replacement 'Demolition (Entire Bldg only) - Give PCA handout to applicaM
Valuation Occupancy , MC/ES System
Census Code Zoning City Water
SAC Units Stories ' Booster Pump
Nbr. of Units Sq. Ft. PRV
Nbr. of Bldgs Length Fire Sprinklered +
Type of Const W idth
REQUIRED INSPECTIONS
_ Footings (new bldg) FinaUC.O.
_ Footings (deck) FinaUNo C.O.
_ Footings (addition) _ Plumbing
_ Foandation HVpC
_ Drain Tile Other
Roof _ Ice & Water _ Final Pool
Ftgs
Av/Gas Tests Final
_ Framing _
_ _
_
Siding Stucco Stone _
_ Fireplace _ R.I. _ Air Test _ Final _ Windows (new/replacement)
_ Insulation _ Retaining Wall
Approved By
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Water Supply 8 Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Building Inspector
Copies
Other
Total
4624
P'OR :
U. S. HOME CORPORAToN
C. R. WINDfN & ASSOCIATES, INC.
IAND SURVEVORS Te1. 646•3648
1381 EUSTIS ST., ST. PAUI, MINN. 65108
3
..,0 / %3O
?
?O L_??: i ;
2 /
O / .
?
J `
pV- \
4?
5
Lot 7, Block 1, Ridgecliffe ?2e \ /
First Addition, Dakota County,
Minnesota. ? y?,c ?
- .5C,ALE J"=3O'
? 0 DENOTES IRON
\
\
.?
Se ,
??J \
?
Z\
? o
5 `
C?AV'DEN
GWE HEREBY CERTIFY TMAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY Of THE
lOUNDARIES OF THF lANO ABOVE DESCRIlED AND Of TME LOCATION OF ALL BUIIDINGS, If ANY,
THEREON, AND All VISIBIE ENCROACMMENTS, IF ANV, FROM OR ON SAID LAND. ,
Dotad IhisL-LiLdoy ofkr',QF' q,p, 195) C. R. WINDEN 3 ASSOCIATES, INC,
br ???
Sur.oYOr. Minnesola Ropisrrotion No.772C
?f
N77519
CITY USE ONLY ix 310 LOT ? BL RECEIPT #: t N3V0
SUBD. RECEIPT DATE:
U ua -
1999 MECiiANICAL PEfiMTf (RESIDENTIAI.)
Date: 1 -Z?u -q 1
CITY OF f.l1fiAN
5930 f'll.OT KNOB RD
BA&t4N b!N 55122
(651) 681-4675
Complete this section onlv if you are installing HVAC in single family, townhomes or condos under
construction and not owner /occupied
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAF: 50 M BTU 6.00
• Gas outlets (minimum of one required @$3.00 ea.)
• State Surcharge: .50
• TOTAL:
Complete this section onlv if you aze remodeling, adding to, or repairing existing single family dwellings,
townhomes, or condos. Please indicate if it is a new item, replacement item, or repair.
New _ Replacement
Furnace
_ Air exchanger, i.e. Vanee system, etc.
Ren:iiider: Call 68I-4675 for inspectians.
_ Repair -X Other A.aOf
Air conditioning
Other
$ 30.00
State Surcharge:
Total: $30.50
sITEADDREss: LALPay -Ha lden .I V'
OWNERNAME:?1amleJ F)CvU?eV PHONE#: LD5I-Uai-09N
IVSTALLER NAME: W O? IeYS ?U`'k'" ISiAP; ?. PHOrE#: (P 12.- 4 31- ?Oqq
STREETADDRESS: jq 1?? FbnnOGv-, TNQ2
C[TY: -ovjOIA V(/v{lW STATE: MN)_ ZIP: S?
k" r- k)"410
SIGNATURE OF PERMITTEE
JS,FORN15 BLD/MECH PERM1T (RES) - 1999
L Bl
SUBD.
APPROVEO BY:
INSPECTOR
RECEIPT #:
RECEIPT DATE:
1999 M£CH4NICRL PERMIT (CO1NM£RCIAL)
CITY OF EAfiAN
3$30 PILOT KNOB iiD
EASAN, bfN 551 EE
(651) 6$1-4675
Please complete for: all commercial/industrial buildings
multi-family buildings when separate permits are nQt required for each dwelling unit
DATE: COiJTRt1C'T PRICE:
WORK TYPE: NEW CONSTRUCTION INTERIOR IMPROVEMENT
DESCRIPTION OF WORK:
FEES: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Processed piping - $30.00
CONTRACT PRICE x 1%
PROCESSED PIPING
PERMIT FEE
STATESURCHARGE
TOTAL
SITE ADDRESS:
OWNER NAME:
($.50 per $1,000 of pgmiut fee due on all pemuts.)
PHONE #:
TENANT NAME (IMPROVEMENTS ONLl):
INSTALLER:
ADDRESS: PHONE #:
CITY: STATE:
CITY USE ONLY
ZIP:
SIGNATURE OF PE-RMITTEE
? CITY IISE ONLY
LOT 7 BL I PERMiT #: tl I 7 y0
SUBD. K I CICIP CJl ?F ?'rf RE? fi1PT
. :cECEIPT DATE: 7-I % ' GU
2000 MECHANICXG PERMIT (RESIDENTIAL)
CITY OE EAGAN
3830 PILOT F¢dOH RD
, EAGAN I+aI 55122
--7 651-681-4675
Date: /
Complete this section only if you are installir,g HVAC in a single family dwelling, townhome or condo under
constructior and not ownedoccupied.
• HVAC: 0-100 M B T U $ 30.00
ADDITIONAL 50 M BTU 6.00
• Gas outlets (minimum of one required @$3.00 ea.)
State Surcharge .50
Total $
Complete this section onlv if you are remodelins, addin¢ to, or re airin an existing single-family dwelling,
townhome, or condo. Piease indicate if it is a new item, alteration, or repair.
_ New ? Alteration
? Furnace
T?
Air exchanger
Reminder: Call for inspections
SITE ADDRESS: wpcA '
OWNERNAME: ? 1/Jl////T.
INSl'ALLER NAME: I.A112h
STREET ADDRESS: (OOPJ-D
CITY:
_ Repair _ Other
Air conditioning
Other
Fee $ 30.00
State Surcharge .50
Total $ 30.50
PHONE #: ' D016
(pREA ODE)
PHONE 0: '
?ty * (AREA ODE)
P
_ STAT'E: AAO ZIP: 55k;`
&a'MA vjddl&?__
SIG ATURE OF PERMITTEE
L BL
SUBD.
APPROVED BY:
CITY USE ONLY
INSPE^,TOR
PERMIT #:
RECEIPT#:
RECEIPT DATE:
2000 MECHANICAL PERMIT (COLMRCIAI.)
CITY OF EAGAN
3830 PILOT RNOH RD
LP,GAN, MII7 55122
651-681-4675
Please compiete for all commerciaUndustrial buildings
multi-family buildings when separate permits are nof required for each dwelling unit
DATE:
WORK TYPE: New wnstruction Install U.G. Tank
_ InteriorImprovement _ Remove U.G.Tank
_ Processed Piping
When installing/remaving underground tank, call 651-681-4675 jor inspection by fire marshal and
plumbing inspector.
Description of work:
Fees: 1% of contract price OR $30.00 minimum fee, whichever is greater.
Underground tank removaVinstallation = minimum fee
Contract price: $ x 1% = E (Base Fee)
State surchazge calculate at 5.50 for each $1,000 Base Fee
TOTAL $
SITE ADDRiSS:
OWNER NAME: PHONE #:
(AREA CODE)
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOUS TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
ADDRESS:
CITY:
PHONE #:
(AREA CODE)
STATE:
ZIP:
SIGNATURE OF PERM[TTEE