3267 Hill Ridge Dr
Use BLUE or BLACK Ink
1-----------------,
1 For Office Use
! Permit
City o -
f Ealan 1 I
3830 Pilot Knob Road I Permit Fee: . Q
I _ I
Eagan MN 55122 ~ Date Receive
~
::6
Phone: (651) 675-5675
Fax: (651) 675-5694 / j Staff:
41-75,- -77
2011 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: L4, an • a0/1 Site Address: 7 Unit
[Address me: f ate, ~ ]`~J^ n~ ~wtr n~ rh'1 ~ Phone: `/y9 -Dar)
RESIDENT
OWNER 1City1Zip: 05~4-b ✓e, fJ b5~ lo?, R11.1V,_A4=. 7 /C f
Applicant is: Owner Contractor
r7 -I-
TYPE OF WORK Description of work.- Of
Construction Cost y Multi-Family Building: (Yes X _ 1 No }
Company:, -~o n r;,g- -knw,-./~
Contact: ~Je,,,Z?
CONTRACTOR Address: 5~ 7 fo b ne- City:.5
State: 11A-_. Zip: Sj/1 p Phone: WL2 - 9~ 41
License Lead Certificate* NAi -_2a9 o
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
conclude that the are trade secrets.
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. Aww.gopnerstateonecall.orq
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 app vai qf-oa
r
x _ X50&1 PO+ 1't x
Applicant's Printed Name A p nt's Signature
Page 1 of 3
Cities Di ital ualitv Control
The following image represents the best
available image from the original page.
Every effort was made to capture the content
from the original page.
110/ cr1-),tcra7,'z- P1o-7`"
CITa' C^ rl1G3N
?'7`?
3:: ? P7l ot KYiCb F?.ad
Ea.-n, N,innesolua 551122
PE?'S'LIT IdO,;
i..e City oi ;-.can hereby gr<-its to Milbert Co. - G1t111gan _
of 1001 !larie Ane. So., So. St._ Pa4j, l4a 550Z?
J. Hexmann, K. Stroeky, J. Draqer, C. Irish,
Pcrmi.t${'or: (Ocaner) D. Gausman. H. MOraan, and M. Hes'=1i1
appiic<ntion da i,ed 5/5/76 ?
_
&:ted this _25 day o.° 76-
3.50 s/c
----
I:?^,-",--,..J_ rerrits.
e.?.i ToI :_-? ¢
?O
.? ,
EAGAN TOWNSHIP
BUILDING PERMIT
oWOe: _...' .. . _..
. . .... ...... ......... .................
u.?...........
Addrese (yresen!) ?`?`? :
......................... .....................................................
Buildez
Addreu
DESCRIPTION
N° 2916
Eagaa Towns6ip
Town Hall
V/
Dale ..?01'- .°27- 71"
..............
To Be Used Foz Froni Depth Haigdi Esf. Cos! Permi! Fee Remarks
7 OS?3o
? ?PJ1
(.?Lo _10e0.eo
r?? LOCATION ?q X37• ^3
Sfreel, Roed or olhar Deacripiion of Loeation I Lo! I Bloek I AddilSon o: Trae!
.A` A& :An?.
This pesmit does no! auffiorise the uae of streets, zoada, allepa oz aidewelka nor does i! give !he owaez or hh agen2
the righ! !o azeale anp situalion whieL is a nuisanea or whieh presents a ha:ard !o the healtd, sefely, eoavenienee and
genaral welfaca lo anpoae in the eommunilp.
THIS PERMIT MUST BE EPT O_N TH E? PAEM23E WHILE THE WORK IS IN PROGRESS. ,
This ia !o eertifp. !he!•°-°---.° ........::.:........?..°..C..?'...?...------..........haa permksioa !o erect a...«o...f.?!k...?-._a.__....... _Upon
the above described premise subjeM !o the provisiona o! the Building Ordinanee for Eagan Township adopled Aprll 11.
1955.
K........ . ............?' .`••°...:,........?
.......... .. ....... ?..?:.._.4r_../.?...-.. ....... t........ "...:.Per ..................
43 Chaisntsa-oi-@nwn-Bsasd BuAdin Im aetor
?`oZ/- e)/
ipo-4ml /ZwCr?
MASTER CARD
Permii I
No ?
Issued Issued To
Coniractor Owner
BUILDING
PLUMBING
CESSPOOL - SEPTIC TANK
YJELL
ELECTRICAL
HEATING
GAS INSTALLING ?
SANIiARY SEWER
OTHER
OTHER
Items Approved
Onitiap
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOUNDATION CESSPOOL
FRAMING
FINAL
ELECTRICAL TILE FIELD FT.
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD 7 4_?
PLUMBING
WELL
SANITARY SEWER
?
Violations Noted
on 8ack
COMMENTS:
?
t,IKUI.IUKt HNU
??? ?
LAND USED AS 6 v t.)
COMPLIANCE INSPECTION REPORTS
TO BE USED ONIY IN EVENT OF OBSERVED VIOIATIONS
CERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPLIANCE. BUIIDER WILI COMPLY
WITHOUT DELAY.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
DESCRIBED AS FOLLOWS:
? REINSPECTION REQUIRED
DATE OF REINSPECTION
REVEALED
CERTI FICATION - I certify that 1 have carefully inspected the above in which 1 have no interest present or prospective, and that I have reported herein
all significant conditions observed to 6e at variance with ordinances of the Town of Ea9an, approved plans and spacifications, and any specific require-
menrs for off-site imprwements relating to the property inspected.
? All IMPROVEMENTS ACCEPTABLY COMPLETED
9uILOING
pATE
,eg--I- /rava09
MASTER CAR?D°Z? o?
? . ????-?9-7/•7s-?.r- ??
LAND USED AS?
Permit
No.
Issued Issued To
Coniractor Owner
BUILDING 9le _I
PLUMBING ?
CESSPOOL - SEPTIC TANK
WELL
EIKTRICAL
HEATING /"LV
GAS INSTALLING
SANITARY SEWER
OTHER I
OTHER I
Items Approved
(Initial) Date Remarks Distance From Well
FGOTING _ 21r-7? SEPTIC
FOUNDATION _ X9 -73 CESSPOOL
FRAMING C_.z4 - 7-I TILE FIELD FT.
FINAL
ELECTRICAL
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSGOOL
DRAINFIELD
PLUMBING -7; !
WELL
SANITARY SEWER
r 1- i
Violations Noted
on Back
COMMENTS:
?
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVEU VIOLATIONS
PERMIT NO.
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
1:1 ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
1
ITEMIZED
AS FOLLOWS:
F-I NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED BY CONDITIONS BEYOND
CONTROL.
? REINSPECTION REQUIRED
REI
DATE OF REINSPEC710N
CE RTI FICATI ON - I certify that I have carefully inspected the above in which I have no interest present or prospectiva, and that 1 have reported heretn
all significant conditions observed to 6e at variance with ordinances of the Town of Eagan, approved plans and spacifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENTS ACCEPTABLY COMPLETED
NG INSPECTOR
DATE
_ aa
l'ozaf 4r?a-6_
EAGAN TOWNSHIP
3795 Pi1ot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PERKIT FOR SEWER SERVICE COIdNECTION
DATE:12/29/72 (4/25/73)
OWNER•Rivergate Pilla -Bldg• 16
PLUMBERBerghorst Plwnbing Co.
NUMBER 1330
Addresa 3267-69-71-73-75-77 xillridge Drive
TYPE OF PIPE heavy cast iron
OF BUIIDING
Industriall Commerciall Residential
Location of Connectione:
aa 1 6 - townhouses
Connection Charge 1170.00 billed 4/25/73
PermiY Fee 10.00 pd 12/26/72
P
Street Repairs
Total
Inapected by:
Date
Remarks•
Multiple Dwelling ` No, of units
Sy. Chief Inspector
In consideratioa of the issue aad delivery to me of the above pexmit, I
hereby agree Co do the proposed work in accordance with the rules and
regulaCions of Eagan Tox-mship, Dakota County, Minaeaota
By
Berghorst Plumbing Co.
Please notify whea readq for inspection and connection and before any portioa
of the work is covered.
EAGAN 10WNSHIP
3795 Yilot Knob Rosd
St. Paal, Mianeaota 55111
Telephone 454-5242
PSR4UT FOR WATER SERVICE CONNECTION
Date: 4/25/73 (12/29/72)
Number• 1186
Billing Name: Rivereate 4illa-Bldg• 16 Site Address;3267-69-71-73-75-77 Hillridge Drive
Owaer:
Plumber: Berghorst plumbing Co.
Billing Addreas
M er Size Connectioa Chg 0.00 il ed 4/25/73
Meter No, ? I Permit Fee 0.00 Ed 12/26/72
.Opd12 2/72
Meter Reading Meter Dep.
Meter Sealed: Yea Add'i Chg.
NO ' Total Chg.
Building is a:
Residence
t3ultiple X No. Units
Commercial
Industrial
Other
Inspected by
Date
Remarka; ,??DN FrE ?ERS•
By:
Chief Iaspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do ttn proposed work in accordance with the rules and
regulatioas of Eagan Township, Dakota County, Miunesot?
By °-??'?'??
Berghorst Plumbing Co.
Please aotify the above office eohen ready for inspection and connection.
?
MECHANICAL (RESIDENTIAL)
Permit Application
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits aze required for each unit
$ 3b-.Sz
Date-?L--
Site Address Unit #
Property Owner J) o? S 11 1,U e-I ? Telephone #(6/ a)
?
Contractor T
A
d Cit
ress
Street
d y
State Y\ Zip Telephone #?, j l) 3
The Appticant is _ Owner -11-4Conhactor _ Other
Add-on, modification or alteration to existing dwelling unit $ 30.00
?
furnace replacement
air exchanger
? air conditioner^,
other
(l ? t C c?
State Surcharge $ .50
?
Total ? $ ?
r r' ? 1
?l
I hereby apply for a Residential Mechanical Permit and aclrnowledge that the information is complete and accurat? the work will
be in conformance with the ordinances and codes of the City of Eagan and with the Mechbnfcei Codes;'tfiat I understand this is not a
permit, but only an application for a pernut, and work is not to start without ? 't; that the wo will be in accordance with the
approved plan in the case of work which requires a review and approval of pl S.
n
Applicant's Pi d Name pplicant's gnature
MECHANICAL (COMMERCIAL)
Permit Appiication
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: commeccial/industrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date
Site Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Teiephoue # ( )
Contractor
Street Address City
State Zip Telephone # ( )
The Appticant is _ Owner _ Contractor _ Other
Work Type
New construction Underground Tank _ Install _Remove
Interior Improvement Call for inspection du ring installation/removal of tank
Processed Piping
Nature of Work:
Permlt F0e $50.50 Minimum Fee (inclubes Sfate Surcharge)
Conhact Value $ x .01% _ $ Permit Fee
• If petmit fee is $1,000 or less, add $.50 => $ State Surcharge
If permit fee is over $1,000, add $.50 per
$1,000 Permit Fee
$ Total Fee
I hereby apply for a Commercial Mechanical Pernut and acknowledge that the information is complete and accurate; that the work
will be in conformance with the ordinances and codes of the Ciry of Eagan and with the Mechanical Codes; that I understand tlils is
not a permit, but only an application for a permit, and work is not to staR 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.
Applicant's Printed Name
Applicant's Signahue
Approved By: , Inspecror Date:
41300 ROBERT KARATZ
(PAGE 2 OF 2)
3267/ 10 41300 02505 25 (6-PLEX - CEDAR BLUFF TOWNHOMES)
3269/ 02605 26
3271/ 02705 27
3273/ 02805 28
3275/ 029 05 29
3277 03005 30
3279/ 10 41300 06105 61 (6-PLEX - CEDAR BLUFF TOWNHOMES)
3281/ 06205 62
3283/ 06305 63
3285/ 06405 64
3287/ 06505 65
3289 06605 66
3290/ 10 41300 05505 55 (C-PLEX - CEDAR BLUFF TOWNHOMES)
3292/ 05605 56
3294/ 05705 57
3296/ 05805 58
3298/ 059 05 59
3300 06005 60
3291/ 10 41300 06705 67 (6-Pr.ex - ceD.aR BLUFF rowNHOMES)
3293/ ; 06805 68
3295! 06905 69
3297/ 070 05 70
3299/ 07105 71
3301 07205 72
HILL RIDGE DRIVE
CONDO
LINIT #
24
7l? 8?'tl
3lg, `5
zoo7COMMERCIAL BUILDING rERi'KIT aPPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675
. ._ . .
• Structural Plans
2 sets
O
• ArchitecNral Plans
sets
(2)
• Architectural Plans
• Code Anatysis
(z) seTs
(1) "
• Civil Plans (2) . Structural Plans (2)
Z
(? . project Specs (1)
• Certifcate of Survey
l
sis
A (1)
'
O ' • Civil Plans
• Landscaping Plans
(z) . Key Plan (1)
(1)
y
na
• Code
. ProjectSpecs (1) • CodeAnalysis (1)
(1) . Master E)tit Plan
• Energy Calculations
(1) not always°
• Spec. Insp. & Testing Schedule " 1 • Certificate of Survey
& Testing Schedule
Insp
• Spec (1) " • Elec. Power & Lighiing Fortn (1) not always"`
bl
li
• Soils Report (
) .
.
• Meter size must be established e
ca
• Meter size must be established-if app
. Meter size must be established l11
y . ProjectSpecs
'? y
y . EnergyCalculati ons (1)
`? y
y . ElecVic Power & Lighting Form (1)
y
y . Master Exit Plan (1)
???
y
y . Emergency Response Site Plan (1) l
y • Soils Report (»
II 651-602-1000
• SAC detertninaUOn - call 651-
602-1000
. SAC determination - call 651-602-1000 • SAC detertnmahon - ca
. Fire Stopping Submittals
. Fire Su ressionlAlarrn Form
Call MN Dept of Heal[h at 651-201-4500 for details regarding food & beverage or lodging facilit
*+ Contact Building Inspecnons for sample and if required
'•* Pemvt for new bmlding or addition will not be processed without Emergency Response Site Plan.
Date -a_ ? -7 ? 0 -7
N l I <
Site Address .So4V ( `?-7l 1' ' ? 1"`?"" "" -
TeuantName :?(P9 ?7/0 3973
2,;177
Former Tenant Name
,
Description ot
Property Owner
Applicant is: _ Owner X Contractor
Contractor C?AA? ?
Address 3 7 3,3 /l i
State M A-)
ArchlEngr
Address
State
I b installin new sewer/water
Phone #:
)
Licensed p um er 9_ -
I hereby apply for a Commercial Building Pemut and aclmowledge ttiat the informarion is complete and accurate; that the work will be in
conforniance with the ordinances and codes of the Ciry of Eagan and the State of MN Statutes; I understand this is not a pemut, but only an
applicauon for a pemrit, 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.
Telephone # ( )
Gfi,e? /{ 3 3
Contact #: ( :6 I , --) '
"'q U ? City .? ?
_ Zip SS yd Telephott¢ #( bl?-) ?a ?'-S 33-3
Construction Cost ?? S?O 2
Unit/Ste t!
Registration #
City _
ZiP Telephone # (
G?/?-? /-! f1 ?Tk? A hcanRi ature
Applicant's Pnnted Name pp
r�ug ia io i i:�oa ounnsercemoaeiers o�i-ro�-y3yo p.��
Use BLI�E or BLA�CK Ink
r_.����
-----------i
1 For O(fice Use �
E j ,�
. ` Per�nit#: / ����� i
��u� U� ����� I Permit Fee: � ' > �
I �
3830 Pilot Knob Road �
Eagan MN 55122 � �ate Received- I
Phcne:(669)675-5675 � � �
� Staff: �
Fax:(631)675-5694 � �
.�Y V ��.E, � �, � . ��el�€,'� C..i�� G` �,�°'`,'�C.t'1 iCt►'�^ ---_-__...__�_�__��
2015 6���IDENTI�►� ��llL�t�VG PERNfIT A1�PLi��4TtON
C-2 d-�.�° 13G��'� Tc,,�n h.:�i s-�s'
Qate:�1�4�1 ti Si4e Address:���0'7�� i i �•:��a� ��r���- 55��I u��t�: _
- _......_._�.._z_.r.s.��-_Y�.._,,,.,.��.c:i�ci%�s`-�`a,Co�_;3�-iJ� ,m3��3;��--7�� 3�-1''7 �
>
Name: Phone:
t �$@S149�17�
Owner ; Address!C�ty I Zip:
- r
�
, .
. ;
� � Ap�icant is:.. .._�n Owrier �Coatractor ..,�.�
..... __.,.......,.,.._..,_.�......._, Description o�wo�lc: ��� � ��� - -
; �yp�o��lork
__....:..,.,_......�._.�..�-_�..a... - ConstructionCost: � �����1�%�.'__LJY---.._y�^.�_a_N Mulii-FamilyBuildir�gf(Yes�lNo_, `..�..�
_:.; Campany:���Y�, �; �� ��w1 ci,-e..-t-� �S �aniact: �G� 1 �-4-�.�'�.�:��'1
��ntTdG�Of ^ Address:� �� �D 't'"��-'�-. �-.c�'tll-� City: ��` r '�`�"� 1
� State: I,�`Zip: � G l /C� Pho�e: Email: i Y1�"� � �-Z�'►+�'��'����+�=c��..�:sr
� ,� ;cu:,.
�` � Lic�nse#:��1-: l� � � `-r� I � �ead Certificate#:�`��!`f� " r�c������ ���.�
� ..,�____._,..�......__.._.._w._.........__.._._�� ._,�.�._�.._._..�w____..._..__..__�...�T�..._�_.� �..,.__._._.-----.._,_,.,.._
� if the praject is exempt from lead csrtification,P�ease explain why: �
;
' � �~�v CONiPl.E'E�THIS �EA ORILYTIF CONSTRUCTINC A I�EW BUI�DlNG
: Ic+the IaSY 12 rnonths.has the City of Eagan issu�ed a perrrtit for a simifar pian 6ased an a�aster plan?
s Yes f�o f�yes,date and address of master plan:
` Licertsed Plumber. Phone:
E�echanic�Can�fractor: Phone:
� Sewer�Water Con�ractor. Ft�one:
3 Fire Suppression GontraCtar: Phone: r�
�NOTE:Plans and sup�or�ing documtnn�s tha�yace subrnit are canseBereat tv be public inforra�ation.i Poi�ions of
,
�ie 1rrf�Ptt�ation may be classifred�s aoe��vu6lic i�you provide sp�cific reasons that w�uld perlrrit�fre City ta
: �
; cvx�clvde that fhey are frade secre�s. �
a..__:..._.-.:�.:.�.w.:_.:.::......_._ti,..�:.:.:._..�...:.:.._. .,_�..._..y�_. ..,.,....�.,�.....r....,..._...
C14LL BEFORE YOU DIG. Call Gopher S4ate One Call at t651)4540002for protecifon against underground utility damage. Ca11481�urs
before you irrter�d to dlg to reCeive loCates of underground ulilities. www aopherstateonecall.ora
I hereby acknow�edge that Ihis inFormation is complete and accurate;that the work will be in co�formance with Ihe ordinances and eodes of the City of
Eagan; that I under5tand Ehis is not a permit,but only an application far e permit.entl wOdC is not to start without a permit;thai ihe woric will be:n
accordance vrith thQ approved�lan in ihe case off woric wlvch requires a review and app�rovsl ofi pterrs.
Exterior work auth�rized by a bvihfing pertnit issued In accordeece vrdh the Hlinnesota State Buiiding CaBe musi be compleEed wititin 160
days of permle issuar�ce. �—'—"
x �j�` �L-F�^"� Ci'r'1 X -��/
Applicant's Pri�ted Name A 4's ignat�are
Page 1 of 3
Use BLUE or BLACK Ink
r----------------�
I For Office Use �
' � Permit#: / �% � /� I
Clty of ����� � Permit Fee: �e �- �
3830 Pilot Knob Road
� �� �
Eagan MN 55122 � Date Received: �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: I
I I
2015 RESIDENTIAL BUILDING PERMIT APPLICATION
�. 3��7`7
Date: Site Address: G1C_ T �v� 7 �J�� k��7..� ���� Unit#:
' Name: Phone: I
R�SI�f���/ ..���
�(�y���; '� Address/City/Zip: �''� � �:��i�;ac�� . �}6,�1+•>, I1�1 rv• 55/�3
- Applicant is Owner �Contractor
� ��� �� ����� Description of work: �S�Pt,A�tfi, (� �ja2S
T�j� t3f It1/aCk � �
I Construction Cost: 3(��� Multi-Family Building: (Yes ✓ /No�
Company:_�N►���► �iA�u,��Aii�9fr� �Oo�t.as. (.L G Contact: � � e�Ohl*�So�
Address: �57�0 90��0. City: (.,�¢NyUii,�J ��2Ls
CU?t'�1`14'�O�i'
State:�/� Zip: 5500� Phone: 65/--?5�S—D3//Email: SJoNn►.SDr��tiwvOn�lJMti�^t� •��""
License#: N�A' Lead Certificate#: *�
If the project is exempt from lead certification, please explain why: /vo (�}� PR�Sg,�„
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:
Fire Suppression Contractor: Phone:
; I�aDT�.Fl�ias ar�d',�t�Rpor�r���foc�met�t�r�t yr�u s�rb��are ca�rs��Iered to���rt��c fnfor�r��i�an. l�or�vf
�ire�rrt'ort�re�iaaa r�t���e cl�s�r�ed�s r��rn p�blic�f you pror��d?e�s��c�c reasorrs�t�#aw�o��t perr��t t�:G►"f,y t�
cur�cfwtle tl�a�.th$ are t�'��ale secr�s
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. wuvw.qopherstateonecall.orq
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 Build' must be completed within 180
days of permit issuance.
X ��.✓�i �JVH'N.S6N X
ApplicanYs Printed Name Ap ' anYs Sign ture
Page 1 of 3
r For Office Use
` •
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%.„‘,‘ ‘,.•,,,, E AG A N
Permit Fee:
.�1. Date Received:
3830 PILOT KNOB ROAD I EAGAN,MN 55122-1810
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 Staff:
buiidinginspectionse.cityofeaaan.com -J
2019 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: ? 1/1i-//19Site Address: `J 1 b fJ/ V0
Tenant: Suite#:
r.77r1_,; -wa4. •Ems..::y rrµr�s..V
•
Ni ;:44,,A1:144.:-.1,
� ` Name: 7:-/A-
��VL �J I t1 t�Ul Phone: 1d LZ — L --- : -.5 7-7
{ - . r` Address/City/Zip: ,-� t�' 41 Vim
0 r4 — x Champion Plumbing License#: PC000308
_�f v Name:
..- ,. --
.1';,,.-- e4,,-.,-. : 3670 Dodd Rd. Suite #100 Eagan
•-,%,,.,"---->;,-,_':---W-4:-. Ci
,: x Address: ty:
" e 6MN 55123 651-362-2622 •
z State: Zip: Phone.
6:m' tiF ` ' Jessie/Cole Email: Permits cham ion lumbin •net
..k:•. - - 7Contact:
.
S "�A5 J H, New _Replacement Repair Rebuild Modify Space Work in R.O.W.
Oxy•
g-eCkt
/�y M r�z f z,- 7CZ- �y 4 �. 1 LAJn.N' r If K 64e �i��x-.:f.,� ��=3 } � �=�y Description of work: . 9
4" 4 � � _.1�w; - Water Heater
= F Lawn Irrigation( RPZ/ PVB)
;� 7 r J V d o t . Water Softener
t��.
Add Plumbing Fixtures Main/ Lower Level)
, 4Septic System
r 3 . �F} £�_ Description:
�---, z:%,;<.G New
a 54ii-- r Connection to City Water from Well
:� • x : ..: Abandonment
RESIDENTIAL FEES
$60.00 Water Heater,Water Softener,or Water Heater agd 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)
$116.00 New Septic System (includes County fee and State Surcharge)
$60.00 Connecting to City Water from Weil*+$290 for Meter and$190 for Radio Read =$540
*Sewer&Water Permit also required for connection charges
TOTAL FEES$ ‘)0,00
CALL BEFORE YOU DIG. Call Gopher State One Call at(661)464-0002 for protection against underground utility damage. Call 48 hours before you
intend to dig to receive locates of underground utilities. www,gopherstateonecail.orq
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.citvofeaean.com/subscribe.
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 Troy M Good il----r:tictrif -..X /fagots,
Applicant's Printed Name Applicant's !gnat
• Page 1 of 2