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620 Lantern Cti i ?..? <Z r - 01-3210 Bidg. Permit 01-3422 Plan Check 01-3445 Surch./Adm. 01-3446 SAC/Adm. 01-2155 Surcharge ?5-3860 Road Unit 20-2275 SAC t0-3865 Water Conn. F?0-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permit 20-3743 Sewer Permit 79-3866 SewerConn. 28-3855 Park Ded. C" ?a . ,. c r- / o . ? TOTAL CASI+RECF4PT CITY OF EA?G??N .,. , 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 DATE 19 r?cervEO . . ? / . ? FPOM '? ? - -,f-•. . ` . AMOUNT I $ - - y E? ? c- C" & DOLLARS im ? CASH ? CHECK ' v .1? ? C n 4-?!,y t White-Peyers CoPY Yellor-POSGng Copy Pink-File Copy Thank You aY SEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. P.O. Box 21199 Eagan, MN 55121 OFFICE USE ONLY PERMIT DATE ?' y WATER PERMIT # 1 +? `SEWER PERMIT # METER # B.P. RECEIPT # n 221" 9 READER # B.P. RECEIPT DATE 112 METER SIZE ISSUE DATE :2L PRV _ BOOSTER PUMP ? 'I t? tl ?G?Ur ? SITE ADDRESS " ` " . LOT ` BLOC K,LSEC/SUB ??'%'' ?• i' /a ? < .??, APPLICANT: ? 1 ?i.'' 1/' f+?n t h- i ?G r. ` ADDRESS: % J . CITY, §TATE 5 l/ /1/E ZIP PHONE: ?P " ? ? ? PLUA?BER:? !iE?-s?J/P6 9/l ? / /?+ ih9 ADDRESS: j`? r ??/ Yo v? ? CITY, STATE cs e,.,, ?: vh ZIP ?=?r-?? PHONE: 312 OWNER: •/? ?? Tro ?vs??., fi - 1 r ?, ?, c. ADDRESS: y CITY, STATE n ZIP PHONE: PERMIT REQUESTEO v SEWER - WATER _ TAPS - COMM/IND - RESIDENTIAL XNEW - EXISTING I AGREE TO COMPLY 1N17H CITY OF EAGAN ORDINANCES: SIGNATURE WHEN METER ISSUED PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. SEWER & WATER PERMIT CITY OF EAGAN 3830 Pilot Knob Rd. P.O. Box 21199 Eagan, MN 55121 OFFICE USE ONLY PERMIT DATE %4 "1 ' '" WATER . METER METER SIZE ISSUE DATE 1 SITE A DRESS LOT ?BLQCK ? SEC/SUB 01' r" H' ja *' APPLICANT: AUDRESS: _ o ' 0 CITY, STATE !?t S "/E ZIp PHONE: ,?7 PLUMBER: mqN?A41/ei SEWER PERMIT # B.P.RECEIPT#F C ''3 g B.P.RECEIPTDATE 513118G Y;: PRV _BOOSTERPUMP PERMR REOUESTED f = SEWER __?ZWATER/ _ TAPS -COMM/IND ? RESIDENTIAL XNEW - EXISTING ADDRESS: C14 a o_-e { ?':. • I AGREE TO COMPLYIAA7'H CITY OF CITY, STATE Se /^ c' UH Zip Sp ? EI?GA14'QRDINANC0: PHONE: ? ? YU ? - ? J ?O ?- " ^---_ -- _..---- " OWNER: C_!/S/J 7, ADDRESS:_ U?X S NATUR WH METERI _ CITY, STATE `??I'`'S ?, ??P 1 . '? SS' ?? i ZIP SSUED PHONE: PLEASE ALLOW TWO WORKING DAYS FOR PROCESSING. FOR STORM SEWER PERMITS, CONTACT ENGINEERING DEPT. CONTRACT PRICE: Site Address I Lot Block _ m Name Address c City PERMIT # MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: / PHONE: 454-8100 For Office Use Only: ' 1 BLDG. TYPE , WORK qESCRIF1 70N _ Sec/Sub Res. New ? MuR Add-on Comm. Repair Phone ? Name 3 Address O City Phone _ TYPE OF WORK Forced Air M BTU Boiler M BTU Unit Heater M BTU Air Cond. M BTU Vent CFM Gas Piping Outlets # ? Other FEE: 5/C: TOTAL: Other FEES ? RES. HVAC 0-100 M BTU -$24.00 ADDITIONAL 50 M 8TU - 6.00 , (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PERMIn - 1.50 EA. COMM/IND FEE - 1% OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CONDOS - RES. RATE APPLIES MINIMUM RESIDENTIAL FEE - ALL ADD-ON & ? REMODELS - 12.00 MINIMUM COMMERCIAL FEE - 20.00 - STATE SURCHARGE PER PERMIT - .50 ? (ADD $.50 S/C IF PERMIT PRICE GOES BEYOND $1,000) ! `. ,• :' '? r SIGNATURE OF PERMITTEE FOR: CITY OF EAGAN liC? L`!:«i ; _ ;; ,:;:r: : :'?•:.t:',e.;_ 'Nrt ? CITY OF EAGAN . . 16i734 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ` PHONE: 454-8100 BUILDING PERMIT Receipt # Tobeusedfor Est.Value 0,00() Date ?Ay 3'- , 19`rt9 Site Address 620 •' Lot Block SeciSub. "li ?f'fRy I:QI.t40U Parcel No. ¢ Name rqT':i?;aP :::C i Address ° City SUR1? J:L'. Phone : g4-W38? & :o Name Address ? City Phone Name - Address 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 State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permitee A Building Permit is issued to: ''`T??;, '-t?????':' ??????• T? on the express condition that all work shall be done in acwrdance with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Building Official OFFICE USE ONLY Occupancy R- 3 4'1 PEES Zoning ?` i (ACtuaq Const ??t? Bldg. Permit 674`Orj (Allowable) V-" Surcharge 53.Q.Q # of Stories - Lergth PlanReview ?37•? Depth 460 SAC. City 2 ?• ? S.F.7otal - Snc, MCwCC 575100 S.F. Footprints - 580600 On Site Sewage _ Water Conn On Site Well Water Meter 22U •? MWCCSystem ?? OC Ciry Water X+I Acct. Deposit . PRV Required xlx S/VJ Permit ^ 20.00 8ooster Pump - SrW Suroharge I . 00 Treatment PI 22, . • OC APPROVALS qoad Unit 14fi. Planner - park Ded. Council - BIdg.Ott. _ Copies 3 " ^ 31 `k " 6' O Variance - TOTAL Permit No. Permit Holder Date Telephone # WATER `C4, t.?s . SEWER PLUMBMG LY,.a I ^lLCli,?" ??g/? ? rsD H.V.A.C. ELECTRIC Ci 7 ? 7D Inspeetion Date Insp. Comments Footings I "1571 Foundation Framing / O Roofing Rough Plbg. . . . . Rough Htg. %2 Q S L L.- i- i r k?-- Isui. "/Vi:g a.+s G . L. '' ?? Q Fireplace ?1,2 ?/ (1? Final Htg. Final Plbg. ? Const. Meter Plbg. Inspector - Notity Plumber Engr.IPlan Bldg. Final Deck Ftg. Deck Final Well Pr. Disp. 9 . , a (gerfifiratr n# (Orrupanry titp of eagan EPpal'fttiPllY 0f lIItlbitlg JriH,pPCftDt[ This Cenificate issued pursuant ta the requiremenu ojSection 306 of rhe Unijorm Buildirtg Code certifying thar ar [he time of issuance this structure was in compliance with the various ordinances of the City regulating bui/ding construction or use. For the jollowing.• uw cmienw. SF DWG/CAR eiae. Ptriiit No. 16534 oaupaay rype R3/M l zonioe Disu;ct Ri TYPe CauL VN Owner of Building ?M ai.5rc"I HUIES Addreas BOX KA9, 3AW= Bwldi Address , L?Wity 128+ B3• OWWRY H31ZW `,. . / ?g op„,: ADQ)ST 17. 1989 ? ? POST IN A CONSPICUOUS PLACE PLUMBING PERMIT . ' CITY OF EAGAN CONTRACT 3830 PILOT KNOB ROAD, EAGAN, MN 55122 PRICE PHONE 4548100 Site Lot. Name ,?-? Addre?s ? F? `>", `' J c CRy ` '? ' phone ' Name ? c ? Addre L Cfty Phone FEES COMM./IND. FEE - 1%OF CONTRACT FEE APT. BLDGS. - COMM. RATE APPLIES TOWNHOUSE 8 CANDO - RES. RATE APLLIES MINIMUM - RESIDENTIAL FEE $12.00 MINIMUM - COMM.IND./FEE $20.00 STATE SURCHARGE PER PERMIT .50 (ADD $ 50 S/C PER EACH $1,000 OF PERMIT FEE) FOR: CITY OF EAGAN For Offi???Un)y/ PERMIT #? C !? RECEIPT* 7 DATE: BLDG.TYPE WORK Res. New _ Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: NQ, FIXTURES TQTAL? d? Water Closet - $3.00 $ I -r Bath Tubs - $3.00 - ? Lavatory - $3.00 S snower - $3.00 -r iGtchen Sink - $3.00 UrinaVBidet - $3.00 -r Laundry Tray - $3.00 ? -r Floor Dreins - $1.50 -? Water Heater - $1.50 ?- Whirlpool - $3.00 ' ?- Gas Piping Outlets - $1.50 ?- (MINIMUM • 1 PER PERMIn Softener - $5.00 _ Well - $10.00 _ Private Disp. - $10.00 _ Rough Openings - $1.50 PERMIT FEE: STATES S/C: . "r l o0 GRAND TOTAL: v-?' NO CO WITHOUT ENG APPROVAL CITY OF EAGAN N? 16534 ? • 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 ???? PHONE: 454-8100 BUILDING PERMIT Receipt # To be used for SF DWG/GAR Est. Value $110, 000 Date MAY 30 , 1g 89 Site Address 620 LANTERN CT Lot 28 Block 3_ Sec/Sub. COITNTRY HOLLOW Parcel No. W Name METRO CUSTOM HOMES. INC o Address BOX 1049 City BURNSVILI.E Phone 454-9383 =o Name SA14E $? Address City Phone UQ W w Name ? ? ; Address a w City Phone I hereby acknowlege that I have read ihis application and state that the information is correct agree to comply with all applicable State of Minnesota Statutes an an Ordinances. Signature of Permitee A Building Permit is issued to: MF.TRO C1iSTOM HOMF'S, TNC on the express condition that all work shall be done in accordance with all applicahle State of Minnesota Statutes and City of Eagan Ordinances. Building Oflicial -(^\J"l 1' OFFICE USE ONLY Oceupancy R-3 M=1 FEES zoning R=1 (Actuaq Const V-N Bidg. Permit 674. 00 (Allowable) V-N Surcharge 55.00 # of stories - ?L Plan Review 337, 00 Length Depth 46' SAG City 100. 00 S.F. Total - SAC, MCWCC 575.00 S.F. Footprints - On Site Sewage - Water Conn 580.00 On Site Well - Water Meter 90- ?0 MWCC Sys[em XX XX Acct.Deposit 30-n0 City Watar PRV Required xx S!W Permit 20.00 Booster Pump - SNJ Surcharge 1. ?O Treatment PI 228, n0 APPROVALS RoadUnit 34n_o0 Planner - Park Ded. Council BIdg.Off. _ Copies Variance - TOTAL 1,030.00 REQUEST FOR ELECTRICAL INSPECTION ? See instruCAOns for co ?pleflng (his form on 6ack of yelbw copy. f? 3.4. 9 0 4 "X" Below Work Covered by This Request • ea-ooooi-o7 " ?o yz Nplp dd Rep. Type of Building AppliancesWired EquipmentWired .a Home Range Temporary Service . Duplex Water Heater Electric Heating Apt. Building e Dry Other (Specity) Comm./industrial urnace Farm Air Conditioner Other (speciry) CoMractor5 Remarks: Compute Inspection Fee Below: # Other Fee # ServiceEntranceSize # CircuitslFeeders e Swimming Pool 0 to 200 Amps 0 to 100 Amps Transiormers Above 200 _ Amps A 0- Amps SignS Inapector5 Use Onty: i ) TOTAL ? Irtigation Booms ?C ?;? i ? s• Special Inspection Alarm/Communication Other Fee I, the Elecirical Inspector, hereby certify that the above inspection has been made. Rouyn-io r Finai Date?? oat ? DFFICE USE ONLY . This requast voitl 18 months from ` ?/rg/8y 9?ao ? r 3 4 9 0 4,C?? Re Da[e //?? ire No. Rouqh-in I tion Requiretl. 0 Yes No ? Reatly Now ? Wili Notity Inspeclor When Ready? I censed contractor ? owner hereby request inspection of above electrical work at: Jo Atldress tree Box or M Ciry }? ,?, ?, {? _ Se lon No. Township Na e or No. I I Rarg¢ No. CAUnty [ Occ tS? v-i \ ? / /' l L Phon ? Power Supplier Address Electricel CorrtracNt (Compeny Name) KENDRI ntr w?s Li se No. Mailing Addre?s?trdc?qr ?Owner akin I Iludial, 4 ? U EIVIVOCK Authori 7]Idipfng?t5124 L. 1 , PhoneNum6er MINNESOTp STATE BOARD OF ELECTRICITY THIS INSPECiION REQUEST WILL NOT GNggs-Nlidway Bldg. - Hoom 5-773 BE ACCEPTED BY THE STATE BOARD 7827 University Ave., SL Peul, MN 55104 UNLESS PROPEFl INSPECTION FEE IS Phone (812) 642-0800 ENCIOSED. `I 'J?'l:? J ?P ? ? 15134 Request D ire o. Rough-in Ins ection ? Requiied7 ? Resdy Now ? Will Nolify Inspedar ? Yes ? No When Ready? Iylicensed contractor ? owner hereby request inspection of above electrical work at: Job Address ( treet Box or Roule No.) . Clly Section No. Township Name or No. Range No. Co OCCUp i( RI ) - Phone ? ? Povrer lier qtldress Elei?cf?6?pqelpqJ?ppt?.a?{NSp181 L+/^P7Li'.\..l+RT/`l.. ? f?1Vl,Jill\.+ia A l Co trec 5 L.icrense N MaiOng Addr E VALLEY MN 55124 JPI ? . ANh ' ed Sgneture (COntractor/Owner Meking Installation) Phon N ber MINNESOTA-STATE 80ABD OF ELECTRICffY - THIS INSPECTION REQUEST WILL NOT Grigga-Mltlway Bltlg. - Room &173 BE ACCEPTED BV THE ST.4TE BOARD 7821 Unlversity Ava., SL Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS Phone (612) 842-0800 ENClOSED. REQUEST FOR ELECTRICAL INSPECTION ? ? See instrud'mns for completing this form on back of yellow Copy. 151 3 4 `X" Below Work Covered by This Request r'. ee-00001-07 ew lidd Rep. Type of Building AppliancesWirad EquipmentWired Home Range Temporary Service Duplex Water Heater lectric Heating Apt. Building Dryer Other (Speciiy) Comm./Industrial Furnace Farm Air Conditioner Other (specify) CoMractor?s Remarks: Compute lnspection Fee Below: # Other Fee # Service Entrance Size Fee # Circuits/Feeders Fee Swimming Pool 0 to 200 Amps 0 to 100 Amps Transformers Above 200 _ Amps Above 100 _ Amps S19115 Inspector's Use Only: TOT Irrigation Booms Special Inspection Alarm/Communication Other Fee - I, the Electrical Inspector, hereby tif h h Rouqn-in ( oafe cer y t at t e above inspection has been made. Fnal 0 ate OFFICE USE ONLY - This requesl void 18 monihs from RESIDENTIAL ? 3 j C?? BUILDING PERMIT APPLICATION CITY OF EAGAN 3830 PiLOT KNOB RD, EACAN MN 55122 651-681•4675 New Construction Reauirements • 3 registered site surveys sh(ywing sq. ft. of !ot, ;q. ry. ot house; and all mofed areas (20°; maximum lot coverage allowed) • ? copies of plan showing beam & windcw ;izes; poured found design, etc.) • 1 sel of Energy Calculations • 3 copies af Tree Preservation Plan if lot platted after 7/1193 . Rim doist Detail options selecfion sheet i bidgs with 3 or less units) DATE / - , ?-- 7. L?> RemodellRepair Requirements • 2 copies af plan • i set of Energy Calculabons fcr,heated adCitions • 1 site survey `or extenor additions 3 decks • Indicate f home served by septic system for additions OQ vALuarioN ?gov r SITE ADDRESS ? L?v Z?N?AI /Io ej' MULTI-FAMILY BLDG Y N TYPE OF WORK 'gUc )?- FIREPLACE(S) _ 0_ 1_ 2 APPLICANT ?r c l STREET ADDRESS 17 sS- /? Q?/? ? CITY Avoni-t4i STATE TELEPHONE # CELL PHONE # PAX # PROPERTY OWNER e Ze,G 6 TELEPHONE # ZI P ----------------------------------------------------------------------------------------------- COMPLETE THIS SECTION FOR "NEW" RESIDENTIAL BUILDINGS ONLY Energy Code Category _ ?(INVESOT.1 RC;LES 7670 CA"l'EC;ORY" I ?II?\CS01':A W1. FS 767? (•J submission type) • Residential Ventiiation Category 1 Worksheet Sutimitted • New r7n Qp?le? ost?t • Energy Envelope Calculatlons Submitted l?r? I?' ?J 15 2002 Plumbing Contractor: ?_. Pluiiibing system includes Mechanical Contractor: Mcch.uiic.il scstcm inclu(Ie5 Sewer/Water Contractor. _ Water Softencr Water Heater v o. of Baths Air Conditioning HeaC Recoven Svstem Phone # Pcc: Si0.0O --------------- ------------------------------------•------------•---------------------•------------...-------------------- I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ory?r)r_eis., Slgnature of Applicant OFFICE USE ONLY _ Phone # L.awti Sprinkler No. of R.I. Baths Phone # Certificates of Survey Received _ Tree Preservation Plan Received _ Not Required _ Updated 4102 -t ie , 1989 BIIILDING PEffiKIT APPLICATIDN - CITY OF EAGAN co w'?k" ?nq kPINJ"t SINGLE FAMZLY DWELLINGS ? ? INCLUDE 2 SETS OF PLANS' 3 CERTIFICATES ENERGY CALCULATIONS - - NOTSs ADDRES5E5 FOR CORNER LOTS - CONTR9CTOR/HOMEOiiNER MOST DESIGNATE WHICH ADDRFSS IS DFSIAED. NO CHANGFS WILL BE ALLOWED ONCE BUILDING PERMIT I3 I33IIED. IiQI.TIPLE DFIELLINGS RENT9L DNITS FOx SALE UNITS # OF UNITS INCLUDE 2 SETS OF PLANS, CERTIFICATE OF SURDEY - CHECg WITB BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS COhR4ERCIAL INCLUDE 2 SETS QF ARCHITECTURAL 1 SET OF SPECIFICATIONS AND 1 To Be Used For: Site Address F'/vZCa 2d h??? 1 i & STROCTURAL PLANS, SET OF ENERGY CALCULATIONS ?jl p ada Valuation: ?0O Date: DSE Lot oZg Block Pareel/Sub Owner Address fQ. &z( IC2?I/ City/Zip Code ,j 5337 Phone `-/ 5 7 - Contractor / //d , Address L - 422S /2 Y9 City/Zip Code ??Ur'nS?il/_p 5533? Phone ?L/ Arch./Engr. Sddress City/Zip Code Phone # Oecupancy Zoning ? Aetual Const j//// Allowable 1//li # of stories Length Depth ? S.F. Total Footprint S.F. On site sewage On site well MWCC System ? City water v? PRV required _ Booster Pump ` ARAY 2 5 1969 Bldg. Permit G Surcharge Is`s Plan Review 3 3 SAC, City ldo SAC, MWCC S9 5 Water Conn 5-80 Water Meter ?D Acet. Deposit 30 S/W Permit z D S/W Surcharge / Treatment P1. zzl Road Unit 3 Yo Park Ded. Copies TOT9L ,. ? APPROYAIS ? Planner / Couneil Bldg. Off. ? Variance Couneil NOTE: 3ewer & Wates Permit fees and account deposit Pees will be ineluded in the building permit fee. Processing time for seWer and water permits is tvo days once a licensed plumber has applied for a permit at City 8a11. s?. - 7' . ? SS ? z -2- ? -z ?S s ?- ?? ? ss 22,??z v Li ?? !! X Z z z -z. S° ...?- Z,ykZzklS ? ?Zo 'L..,I ; ?. /floae .. ENGINEEtiING COMP(INM, INC. ± ..1000 EA9T I46111 STftEET, i19ETR0 CvSroM ca11SVi,TIIIU ENUIi1E4117? ?2237,0/ f'lI1NNElIS ond LIIIIU ?UIIVEVoI1S i24 PA6E 68 BUf1145VILLE, MINI1ESOlA 653377 PII 433 2?3 000 Certificate ofi Survey Leyal Descripfit LANTERN GovRT 10 z 50` 93fcs ? Q - ?,52•? / . ? °- ?8Z3.5? r ` 5 _ [r.. L e ' o ?? -? J ? I : 1-07 29, BL46X 3, GDUNTKY 11,04WW, , pA,COTA COUNTY) M/NNE$OTfI ?22.4'(8z3.o? 30' ,r,eavr Bv1t,oiAvF, ? ?; ?SETBACf? G?NE 9" 6y `• 0 6AR?E $ ? 5•p0 ? i Z2 00 rr $ ODOSE 8 i e 00 t.0 % ?. I ab. • 5&v!0 - e-o / p o??, a1 50 0 I - Y 5 go z? OR4 /NA6E ANO U71U7Y gY " ? z,?s9 DATE i By Dat° ? EAG , ?GI EERi?d?l' lr. , ir L ? T ?8 Jf?:. , i-? L i i i r _i-?'?-?'? ?.??j-?:.% ? NwL = 8on.m Nj,vL = 8/8• o0 EP:;, ? :. :N \ ? 18916 9 n n ? ?? ? ? N 89° 55' d8" E ? o o ? , V. {?; ? .--' ? ? . . . 9fphy v4rtlfy Ihatthls Is.a Srue anO 9orroct repre4entatlorl of A lrnai of innd ns ehown and descilbed heteon, prepered by me onthls L-7-!' d"ny vf 18 REV/SEG 5,-19-89 FGiPPED f/SE ? CE111`..55D 5-23- 89 MoVED ? SC11GE : /„ - 30• ?$?3 % ; DENOTES EXISTINO ELEVATION (BZ¢. 3) DENOTES PROPOSED ELEVATION r INDICATES DIRECTION OF SURFACE DRAINAGE 82-9, 60 m FINISHED GARAGE FLOOR ELEVATION 916.g9 - gASEMENT FLOOR ELEVATION SZ4.93 2 m TOP OF BLOCK ELEVATION ° 3 K ? ? ? ? ? A `' S ?? 4z- REVIEWED L Vol , p ~r 7 City Off F.~~~~11 0 ! 2010 1 Permit I Permit Fee: 1_ 3830 Pilot Knob Road Eagan MN 55122 l Date Received: Phone: (651) 675-5675 Fax: (651) 675-5694 i_ Staff- - - 2009 RESIDENTIAL PLUMBING PERMIT APPLICATION Date: 0 Site Address: 6 2,0 Tenant: Suite RESIDENT / OWNER Name: _6cb.61 Czech Phone: b1~ bV _C6 Address / City / Zip: ?)CLM& F-Cl q Q l~ _ j :2-3 CONTRACTOR Name: I 1'y License Address: City: afi e '1 State: / )V1 N Zip: Phone: ~ ~ ~7 / 2- " ) `"t o Contact Person: TYPE OF WORK _ New /Replacement Repair -Rebuild _ Modify Space Work in R.O.W. -CP Description of work: ~lC~ GtJJC,( r 1e ~t 1 5~~ ~~~r PERMIT TYPE RESIDENTIAL ✓Water Heater Water Softener Lawn Irrigation Add Plumbing Fixtures l RPZ PVB) Main - Lower Level) Septic System Water Turnaround New Abandonment RESIDENTIAL FEES. $50.50 Minimum Water Heater, Water Softener, or Water 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 $_C50_ 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.. XX_ # Applicants Printed Name Applicant's, FOR OFFICE USE Reviewed By: Date: Required Inspections: -Under Ground --Rough=In -Air Test Gas Test ---Final ~~`J 014-0 Use BLUE or BLACK ink For Office Use j - Permit of 1 ,"T~ WY n Wan 1 Permit Fee_TT 3x30 Pilot Knob Road 1 Eagan MN 55122 r. pate Received: Phone: (651) 675-5675 Fax: (651) 675-5694 Staff INFLOW & INFILTRATION PERMIT APPLICATION - Plumbing / Sewer & Water Date: Site Address: Tenant: Suite P RESIDENT /OWNER Name: g/ p Phone: &4V 1480 "O /ZZ Address 1 City / Zip: 6ZD Lai: t ld 4VC! t- , twit Art riz-3 E Name: - P -S 3 i C. r. f 1 . h > h e v rr , T)n c License* Address: U > c ! `1 a City: `C ry CONTRACTOR State: k, Zip. SS/- Phone: tom) tm ! 5 n Contact: -i'n KNe l' t t)- Email: tyi Mil h t - s s 1 ~ ~ P w. r. b r 0, ro c.., C".", PLUMBING (Within the building envelope) SEWER & WATER (Outside the building envelope) TYPE OF WORK Sump Pump Repair Repair Other. Other. DESCRIPTION Description of work: e ►0 t ~ , ,t,h ~ ~ , ~ ~ ~ } ~ ~ ) FEES:,. ~ e ~ ch t vt $60.001 Each (includes $5.00 State Surcharge) (-;j', G TOTAL FEE r 0 0 *Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit Ill repair costs for reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors can be found by visiting www.cityofeacian.com/inflow, or City Hail at 3830 Pilot Knob Rd. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 454-0002 for protection against underground utility damage. Cali 4t3 hours before you intend to dig to receive locates of underground utilities, www.ooP erstateonecall.orc ! 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 permit; that the work a will be in accordance with the approved plan in the case of work which requires a review and approval of plans. x t, Kg_ S 1+z- X 422A~L- ~J~ Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-!n ____Final PERMIT City of Eagan Permit Type:Building Permit Number:EA168392 Date Issued:04/20/2021 Permit Category:ePermit Site Address: 620 Lantern Ct Lot:28 Block: 3 Addition: Country Hollow PID:10-18275-03-280 Use: Description: Sub Type:Reroof Work Type:Replace Description:Does not include skylight(s) Census Code:434 - Residential Additions, Alterations Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Please print pictures of ice and water protection and leave on site. We encourage you to retain an electronic copy of photos until the project passes a final inspection. *Roof permits issued between December and March will be inspected in the spring or when weather warms up. Valuation: 5,000.00 Fee Summary:BL - Base Fee $5K $118.00 0801.4085 Surcharge - Based on Valuation $5K $2.50 9001.2195 $120.50 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 - Bradley C Czech 620 Lantern Ct Saint Paul MN 55123--161 (651) 688-8422 Ashton Mcgee Restoration Group Llc 5555 W 78th St, Suite J Minneapolis MN 55439 (952) 426-3736 Applicant/Permitee: Signature Issued By: Signature