4628 Kingsbury DrCASH RECEIPT
CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122 4
DATE 19
neceiveo
FROM
AMOUNT $
I ! ( _ . , i 4
& DOLLARS
' oo
? CASH F-I CHECK
FUND CODE qMOI)NT
Thank You
:::C ? . B Y _
v ?
(
?
ti
White-Payers Copy
Yellow-Posting Copy
Pink-File Copy
' CITY OF EAGAN
; 3830 Pilot Knob Road
Eagan, Minnesota 55123
' (612) 681-4675
SITE ADDRESS:
I PERMIT SUBTYPE:
INSPECTION RECORD?
PERMIT TYPE:
Permit Number.
Date Issued: si ti/,? 7 J?? 3
4 ri t ,) ,;t. APPLICANT:
I:?k ?r?: . •?i.. , . ;! , i??r . ;ri?
( t i 1.. 1 .! . . r00
?
TYPE OP WORK:
U t'1r f I+ i. 11 1 J11111
kFF'A1k
'-; I.I11Mo3/`?iiv f') t li31i1Fk:k '
Permit No. Permit Holder Date Telephone #
SNV
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspectlon Date Inap. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplece
Final Htg.
Orsat Test
Finai Plbg. Plbg. Inspector - Notity Plumber
Const. Meter
EngrJPlan
Bldg. Final
Deck Ftg.
Deck Flnal
We1l
Pr. Disp.
rf7
/
CITY OF EAGAN Fiemarks
Addition BEACON HILL ADDITPON Lot 4 Blk 4 Parcel 10 13500 040 04
ownerf ii; ::il!4", GYhiYY(C IrfJStreet 4628 Kingsbury Drive State EAgan, MN 55122
Improvement Date Amount Annual Years Payment Feceipt Date
STREETSURF. ZJHZ 1806.93 200.77 9 1806.93 C007576 10-1-81
STREET RESTOR.
GRADING (p?7 1982 526.46 58.50 9 . C007576 10-1-81
SAN SEW TRUNK ? O 1976 135.97 9.06 15 90.67 A008956 " 3 18 80
* SEWERLATERAL y 1982 3116.46 346.27 9 3116P46 C007576 10-1-81
WATERMAIN
* WATER LATERAL 1982 J
WATER AREA 1982 198.01 22,00 9 198.01- C007576 10-1-81
* Stubs 1982 g
STORMSEW TRK 1982 359.82 39.98 g 359.82 C007576 10-1-81
* STORM SEW LAT 1982 9
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 1981 185.00 8-10-81
WATER CONN. 1981 335.00 26221 8-10-81
BUILDING PER. 6805
sac 1981 525.00 26221 8-10-81
PARK
Receipt
1. Date
3. Job Address _
4. Owner `
-^ - --w.?
PLUMBING PERMIT Psrmit No.
CITY OF EAGAN
Fee •
Fill in numbered spaces S/C
Type or Prin[ legib/y Tot. i
2. Installation Cost
i
? Lot ?T Blk. 7 Tract --
5. Cnntractor ?{40r/ -Phone '
?- .
6. Address
?. .
7. City State Zip
8. Building Type: Residential E?J
9. Work Description: New Ell
10. Describe
11.
Commercial ? Institutional ?
Add ? Alter ? Repair ?
No, Fixtures
Water Closet No. Fixtures
Cesspool/Drainfield
_ Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet
Laundry Tray Other
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
Receipt
I ?
MECHANICAL PERMIT
CITY OF EAGAN
FiII in numbered speces
Type or Print /egibly
Permit No.
Fee ?
S/C ?
Tot. I
?????•?''' ?
1. Date 2. Installation Cost
3. Job Address Lot Blk. Tract
4. Owner
5. Contractor '-' N. WELTER HTG. .. . Phone :125-6867
6. Address i ,' "= ?' ??•
7. City =?• State Zip
8. Building Type: Residential Cg Commercial El Institutional ?
9. Work Description: New 0 Add ? Alter ? Repair 13
I 10. Describe 'f-A 1-1 £orced air $e ' Fuel Type
1 11•
No, Eauipment BTU • M. Ea.
Forced Air 1CiOu No. Equipment CFM
Air H
dli
:
Mfg. an
ng
Boilers
_
Mfg. _ Mech. Exhaust
Unit Heater
Mfg. Other
Air Cond.
Mfg.
? 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 464-6100
- . ,. CiTY OF EAGAN
, • 3795 Pllof Keob Roed Eayew, MN SSl'11
PHONE: I5I4100
BUILDING PERMIT Reuipt #
Te M wW for Est. Volue Date 19
Site Addrcu Erect 0 Occupancy
Lot Block 5ea/Sub. Alter ? Zoning
Parcel # Repoir ? Firc Zone
Name ? IoT _
Addrcss ui" ,
o I Nama
il-
?? Addrou
i- !';e., oL___
Name
Address
Enlarys ? Type of Const.
Move p # Stories
Demoliih p Length
Grade C'1 Depth Sa. Ft..
Assessment
Woter b $ew.
Poliu
Firo
Enp.
Plonner
Council
Permit -
Surchorpa
Plan check ?
SAC
Water Conn.
Water Meter
Road Unit
I hereby acknowledge that I have read this applicotion and stote that Bldp. Off.
the in(ormotion is correct ond agree to comply with oll applicoble
Stata of Minnewto Statutes and City ob Ea9an Ordinonces. APC TotQl
Sipncture of Permittee
A Building Permif is issued fo: on the express cordition tFxn
oll work sholi be done in occordance with all cpplicable Stafe of Minnesoto Stctutes and City of Eayan Ordinonces.
Buildirg Official
`.
Permit No. Permit Halder Misc. Permit No. Holder ?
Plumbin9 ./tz-- P-
H.V.A.C.
Wall
WMer
Sewer
elea.io
Inspection DaM Insp. Other
Footinpt
Foundation
Framing _4 _a1
Rouqh Pibp.
Houph HVAC
Inwlation ? -?
Finel Pibp.
Final HVAC p.
Final
i ?
WatBr Mscribe Location:
Well
Savuar
Pr. Disp.
SEWER SERVICE PERMIT
CITY OF EAGAN
8795 Pilo! Knob Road PERMIT NO.:
Eayon, MN 55122 DATE:
No. of Units:
Zo?ing,
Owner:
Address:
Site Addreu:
Plumber:
1 op?ee ro eanVh wilh eM Ckf of Eoson Connection Charpe:
Ordinaneet. Atcount Deposit:
Permit Fee:
Surchcrge:
BY Misc. Char9es:
Date of Insp.: Totol:
I nsp : Dcte Paid:
CITY OF EAGAN
3795 Pilot Kn95 Road
Eagnn, MN 55122
Zoning:
Owner,
Address:
Site Address:
Plumber. `-at'
MeMr No.:
Size:
Reader No.:
1 ageea [o comyly whfi !6 Ciry of Eegan
Ordinanees,
Bv
Date of Insp.:
WATER SERVICE PERMIT
PERMIT NO.:
DATE:
No. of Units:
PS
Connection Charge: °
Account Oeposit;
Permit Fee:
Surcharge:
Misc. Chorges:
Total:
Dote Paid:
This request void 41_q
?8 5 l6'? 9 2
L Y , t3 14 ? 13F-c?ca? 4.<<L ?.? NA 37 1 c96
.z& 373
RequgstDate
` Fire.Nn. RouPh-in Insper.tfon
R ired? -' ?Heady Nu - 1Nill Notify. Inspec-
o ?
? _ ` -S ?Na or When Ready
Licensed Electrical.COntractor . _ . _ , , . F-herebv re9uest inspection ol a6ove'
Owner electrica.l work in3talled at - '
Sireet AddresS, Box or Route No. . . .
? 7-% Y--AN?W\1 CitY • '
1011 NO•- Township.Name or No.' . Range No. County -
Occupant IPRINT) ' - '- ' Phone No.
Powej,$upplier-' Address
EIP trical Contractor (ComVdny Name)
61
L Contraclo(r?'s License'No. -
Cq1
t`-
Mailing Address (Contrector orOwnei Making InstailaFion)
CUff-
ta-OAD
;Au o 'zed5 nat (Contractw/Owner- Makinglnstallationl -- . .
.. Phone Number -
e 850
'tMINNESOTA'fT:RTE 80ARD?Of EtEET111CITY = - • -.7NI51NSPECTION pEQUESTWILI NOT. ,
`Griggs-Midway'Bldq.= Room N-194 gE -ACCEPFEDBY TFiESTRTE'eOAHD ,.
.1621 UniversityAve:, St. Paul, MN 55109' . -• . ..' UNLESS PHOPER INSPECTIONFEfJS.
ow,:...,.1917t?oz??r? ENCLOSED. . . .
REQUEST FOR ELECTRICAL INSPECTION EB-00001 -03
T :5 68 g 2 See instructions for cnmpleting this form un back of yellow copY ~ ?? ???
""XBelow dNork Cavered by This Requesr
Ne htld flep. Type ot Building Appliancns Wired - Equipment WirBA
Home Range Temporary Service
Duplex Water Heater Lighting Fixtures
Apt. Buitding 7 Dryer Electric Heatin
Commercial 61dg. Furnace Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm Other Speciry Zher ISpeci£v!
SGecify Other Other
Compute Inspection Fee Below
!1 Fee Service -EntranceSize S Fee Feeders/SubtoeAers N Fee Circuits
0 to 100 Am s O to 30 Am s ZZ.00 0 to 30 Am s
17.40 101 to200AmLps? 31 to 100 Amps s.OD 31 to 100 Am s
Above 2N_?,_qmp5 Above 100._Am s Above 100_Amps
TrarygEorm lis`\ Remote Contro i Circ. Partiaf/Other Fee
Speclallnspaction
$
-
0
Remirks ??•? i??? 3
7.5 TOTAL FEE dCJ
floueh-in Datt
1, the Eiectrical
? • i/? Insoector, hereby
if
h
Final
r
9?tP
? yt
cert
at the nbove •
jnSPection has been
? ?
/??
nwde.
1_.-
This repuest vnid
18 manths fwm
C??r#ifirtttP nf COrrupanry
Citp of (Cagan
Druttrtmrnt nf +?uii?ntg .?'Jns,?prtimt
-. , ,.
This Certi ficatr irsutd purruant to the requiremenu o f 5ection 306 of the Uizi form BuiGling
Code arti f ying thai at thc time o f issuarue thit ltructure was in com pliance with the variour
ordinancct of the City ngulating building conrtruction or u.rc. For the f ollacung:
ux cialdr"em SF DWG/GAR aiae. remit r,a. 6805
Qa.uFvnryTYpe R'3 TypeCwawctlan Vn FmZOnn NA Zoning District Rl
o„w arB.ua;,,g Centex Homes A,?,e„8601 Darnel Rd.. Eden Prair
8,d,;ngAad?4628 Kingsbur.y Dr. LI,,;jot k,Block !„Beacon Hill
BuudJogorficW 4S,4-)_ D,«: October 29, 1981
. ?piT IN A CON9?ICVW? PLJ.C[
' CITY OF EAGAN
•. - • 3795 Pllot Kno! Rood Eegen, MN 55122
PHONE: 454-8100
BUILDING PERMIT
Te be wed for .SF D9JGr/CiAR Est. Volue $62f
s;te ?u 4628 Kingsbury Drive
Lor 4 Block 4 Sec/Sub. BpaCOfi H?.118
Parcel # 10 13500 040 04
W Name Centez HOID2S
Z Address 8601 Darnel Road
o I Nmne (19vnPr
?
ou Address
Name _
Address
I hereby acknowledge that I have read this opplicction ond stote that
the in(ormotion is correct ond 9?ree to c rrply with.,all applicable
Stote of Minnesom Smtutes rf /jCiry o
Signoture of P o9an inances.
'
ermittee / A 8uilding Permif Is issued to: ?'+8AtB8 Ugm"
oll work shull be done in accordance?w,ith nll o li b State of Mir
BuRding Official
I+?° 6805
Receipt # >
Date Au6wst 10 , 1981
Erect ? Occuponcy R3
Alter ? Zoning Pa
Repoir ? Fire Zone
Enlorge p Type of Const. Vn
Move ? # Stories
Demolish ? Length53_
Grode ? Depth ---44_Sq. Ft.-
Approvals 500
Fees
Assessment Permit 322.nn
Woter & Sew. Surchorge 31.50
Police Plan check 161.00
Fire SAC 525.00
Eng. WoTer Conn. 335.00
Pionner WaterMeter 60_00
Council Road Unit 1 A5_f1[1
Bldg
Off.
.
APG Totol $1F'1 Q_ 5t1.
on the express condition that
ond City.of Eagan Ordinances.
•, , ? CITY OF EACAN Include 2 sets of plans,
? 1 site pIan w/el.evations &
r/Qn 531/ BUILDING PERMIT.APPLICATION 1 set of energy calculations.
To Be Used For ?"9 mW??tion /?? sap ?te 261/?a'/
Site Address:
Lot _Y _Block ? /Sub.
Parcel #: jm O<(v e? U
Owner: e-e TIDm-[_S
- - Address: Sf/Dl DvY'/l-t1 ---
City/Zip Code: Adth Pjsrtri e
Phone #: 4Sl/- blo7f
??.
OFFICE USE ONLY :
Erect occupancy ?-3
Alter Zoning -I
Repair Fire Zone
Enlarge 7.me of Const. ?.
Nlove # Stories
Demolish Front s 3 ft.
Grade Depth :94 ft.
APPRDVALS FEFS
Contractc
Address:
City/Zip
Phone #:
Arch./Eng
Address:
Assessrents Pesmit rt?22 °Q
Water/Scxwer Surcharge
Police Plan Check.
Flre SAC
Fng. Water Conn. 3} S-°O
Planner Water Nleter gp
COUriCll RAdd UT11t. j?J? no
Bldg. Off.
APC
City/Zip Code:
Phone #: TpTpL
C\-P_ e.?-? 1(? o ?
2004 RESIDENTIAL PLUMBtNG PERMIT APPLICATION
CITY OF EAGAN
??? b ? I 3830 PILOT KNOB ROAD, EAGAN MN 55122 ?
~? 651-675-5675
Please complete for modifications to existing residential dwellings.
oate A9 I b q
Site Street Address Unit #
Property Owner Telephone # (?/ ) -4(:,
Contractor Telephone # /c3 4/0
Address 3?b PO Q.Q_ (AA0• City ? State h`?» • Zip.f55lo23
The Applicant is: _ Owner VContractor _Other
Alterations to existing dwelling $ 50.00
_Add fixtures to rooms, excluding water softener and water heater
F
_Septic System Abandonment
_Water Turnaround (add $121.00 if a 5/8" meter is required)
Other:
Water Softener '-Water Heater $ 15.00
replacement _ additional
Lawn Irrigation System RPZ_ new _ repair _rebuild $ 30.00
State Surcharge $ .50
Total $ /5• 5d
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.
kn V le? h ? cti ?
ApplicanYs Pr nted Name Applicant's ignature ? ?
CC CT 2 7 2004 ?
4is, s. D
4 ?
CITY OF EAGAN
3830 Pilot Knob Road
Eagan, Minnesota 55123
(612) 681-4675
PERMIT TYPE:
Permit Number:
Date Issued:
BUILDTNG?
021069
05i27/93
SITE ADDRESS:
P.I.N.: 10-13500-040-04
DESCRIPTION:
PERMIT ?
4628 KING56URY DR
LOTr 4 BLOCK: 4
BEACON HILLS
SIDIN6/SDFFIT/GUTTER
Permit Type SF (MI5C.)
lJp,rk Type REPAIR
?
?..
?M
,.
'
REMARKS:
FEE SUMMARY:
Base Fes
Suraharge
Tptal Fee
vaLu,arIoN
$108.00
$4.50
$112.50
$9,000
COIVTRACTOR: - APPZxcant - sT. LxC. OWNER:
MINNESOTA ExTERIpRS INC 14786001 0002877 WEGLEITNER PATRICK
295 HWV 55 4628 KINGSBURY DR
HAMEL MN 55340 EAGAN MIV 55122
(612) 473-6001 (612)688-6749
I hereby acknowledge ?that'-1 :.have r???od. ,thi:s
' information 3,s 'correct., arict boree to Olo" 1)
Statutes and C3'ty 6t fag?a' 07rdiimanoe s.
? _ .. ,._ _ .. .
APPLICANT/PERMITEE SIGNATURE
11?J
S ED B: S GNATURE'
PERMITJ
REACTIYATE _
2io(pt
CITY OF EAGAN
1992 BUILDING PERMIT APPLICATION
681-4675
?f 01..50
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy of energy
calcs.
COMMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications. 1 copy of energy calcs.
Penalty applies when typing of permit is requested, but not picked up by last working day
of month in which re uest is made or lot chan e is re uested once ermit is issued.
Date ?"? / ?? Valuation of work ?_
Site Address • V5.?
STREET J SUITE M
Tenant Name: (commercial only)
IAT 4- BLOCK 4- SUBD. ff?? Y.I.D. 0
Descri tion of work: d&_u -
The applicant is: O Owner Contrac or ? Othe (Deseribe)
Name : p ? Phone
zW
Property _
LAST F,RST
Owner Address /e?fi57 ??cr,r Z- .
STREET SiE R
City State k?;PWtJ Zip
Company Phone -
Contractor Address 75?5j- License # Exp.
City 5tate _ Zip 637
Company Phone
Architect/
Engineer Name Registratian #
Address
City State Zip
Sewer 8 water licensed plumber . Processing time for
sewer 6 water permits is two days once area as been approved.
I hereby acknowledge 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 Appl icant:
OFFICE USE ONLY
BUILDING PERMIT TYPE
? 01 Foundation
? 02 SF Dwg.
? 03 SF Addition
O 04 SF Porch
? 05 SF Misc.
WORK TYPE
? 31 New
? 32 Addltion
D 06 Duplex
O 07 4-Plex
? 08 8-Plex
? 09 12-Plex
? 10 Multi. Add'1.
? 33 Alterations
O 34 Repair
O 11 Apt./Lodging
O 12 Multi. Misc.
? 13 Garage/Accessory
? 14 Fireplace
0 15 Deck
? 35 Tenant Finish
? 36 Move
^E??ERa:. „sr?M???-;,O,.
Const. (Actual)
SAllowable)
UBC ccupancy
Zoning
# of Stories
Length
Depth
APPROVALS
?3annirig
Engineering
REQUIRED INSPECTIONS
r] Site
? Wallboard
Basement sq, ft.
lst Fl..sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq..ft.
On-site well
On-site sewage
Building
Variance
? Footing
? Final
? Framing
? Draintile
? Insulation
? Fireplace
Permit Fee Loi- 60 vei,ati,,,:
curcharSe
Plan Review License MWCC SAC
City SAC
Water Conn. -
Water Meter . Acct. Deposit
S/W Permit
S/W Surcharge
Treatment P1.
Road !Jn i t
Park Ded. •
Trails Ded. Cap ies
Other
Total:
SAC %
SAC Units
?t6 Basement Finish
? 17 Swim Poal
? 18 Comm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRY Required
Booster PumP
Fire 5prinkler
Census Code
SAC Code
Assessments
Certificate for:
? -Centex Hames Midwest.,inc. plan No. 534
8601 Darnell Road
Eden Prairie, Mn. 55344
DELidIAR H. SCHWANZ
LANOSURVEVOR
RapistonC Undor laws o1 Tho Stal* Of Minnesola
' 2978 - 146TM STREET W. - BOX M ROEEMOUNT, MINNE80TA 66068 PHONE 612 423-1789
? SURVEYOfi'S CERiIFICATE
?
c?c ?I ??? 5 g6 tl 33 ??-? E '
Cl 67?° ? 3r. ?o _? 44 z 130,40 44 L 0'T 4- ? O
?
j I , ?? Cv ypNS? CO
?? ,? ? 2?•6 Q ?
? ?? --._ -------? ? ._?
't-A
..
? 30 ' ? o Zz. 3 r1
D?Pt?u+A?F ? ? ? a
?NUTILIT c
N?` ? 3s -__Y E MFuT; ?.
? Denotes aet wood hub ?37 86 v*,o
CDDenotea proposed elevation
Top of Block .
(3arage Floor 9?65 .
Baaement Floor
?CA?F; 1 Y =
BENCHMARK: Top hydrant at end of Beacon
Hill Court Elev. - 963.23 Pt.
I hereby certify that this is a tYUe and correct representatian of
Lot 4, Block 4, BEACON HILL, according to the recorded plat thereof,
Dakota County, Minneaota.
Dated: June 18, 1979 1
Revised to show proposed houee July 22, 1981.
r
i , j
?,?,j ??l lt
MINNESOTA REGISTRATION N0.882r?
R
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA119251
Date Issued:11/20/2013
Permit Category:ePermit
Site Address: 4628 Kingsbury Dr
Lot:4 Block: 4 Addition: Beacon Hill
PID:10-13500-04-040
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Furnace
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Stephanie Vought
3451 W Burnsville Parkway Suite 120
Fee Summary:ME - Permit Fee (Replacements)$55.00 0801.4088
Surcharge-Fixed $5.00 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 -
Patrick J Wegleitner
4628 Kingsbury Dr
Eagan MN 55122
Burnsville Heating & Air Conditioning
3451 West Burnsville Parkway, Ste. 120
Burnsville MN 55337
(952) 894-0005
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA127592
Date Issued:10/07/2014
Permit Category:ePermit
Site Address: 4628 Kingsbury Dr
Lot:4 Block: 4 Addition: Beacon Hill
PID:10-13500-04-040
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Melissa Reese
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 -
Patrick J Wegleitner
4628 Kingsbury Dr
Eagan MN 55122
Minnesota Exteriors
8600 Jefferson Hwy
Osseo MN 55369
(763) 391-5514
Applicant/Permitee: Signature Issued By: Signature
!"
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�City otEaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
1 L12:1323 j U20
JUN 241016
Use BLUE or BLACK Ink
1
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2016 MECHANICAL PERMIT APPLICATION
0 Please submit two (2) setsof plans with all commercial applications.
Date: ie 4 `l . / Site Address: I 1i22) 9%%,16011 PY •
Tenant: J
Suite #:
-.
r .
Name: Pt�"1 1 IC ki Y `� �.IG�\� e Phone: 1,51- Lop & - 1.07c8
LI p^
�LC J
Address /City /Zip: Y N I'1
Li
t� rr
Name: One H ou r i1a di hq and Thr License #: til g Ler.11 1
JJ
Address: 1101j V r)n I I i) ol'1 SI- • City: flash MS
State: Zi
11 p 55b33 Phone: 1Q51- LI 3-1 - L1117
Contact: J di Email: laJI "S.1r✓1 _- ► OS.COW
A ' .
New )( Replacement Additional Alteration Demolition
Description of work:
• �, .'#:x` p*y ^5
_<
i s,;
New Construction
'?
ground
COMMERCIAL
Interior Improvement
-
< '
4
RESIDENTIAL
Fumace
Air Conditioner
Install Piping
Processed
_ Air Exchanger
Gas
Exterior HVAC Unit
Heat Pump
Under/Above
Tank ( Install / Remove)
Other
_
RESIDENTIAL FEES
$60.00 Minimum Add or alteration
to an existing unit, includes State Surcharge ' n /�
includes State Surcharge = $ VC a TOTAL FEE
$100.00 Residential New,
COMMERCIAL FEES
$60.00 Permit Fee Minimum
Contract
=
_
=
Value $ x .01
$ Permit Fee
$70.00 Underground tank installation/removal
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
$ 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 kasse A MaKhckl 1
Applicant's Printed Name
x
Applicant's Sign
)44.,,,hde
FOR OFFICE USE
Required Inspections:
Underground ' Rough In Air Test '
Date
Reviewed By: .
Service Test in -floor Heat Final, HVAC Screening