4100 Lexington Ave
Use BLUE or BLACK Ink
1
For Office Use
I
1 Permit # I
City ofEalan Ia,a I
I Permit Fee:
3830 Pilot Knob Road I i
Eagan MN 55122 I Date Received: I
Phone: (651) 675-5675 I r
Fax: (651) 675-5684 I Staff: I
2010 COMMERCIAL PLUMBING PERMIT APPLICATION
Date• Site Add s 'T ((ICJ L k !1 ~C
Tenant: Suite
PROPERTY ~ iir
OWNER Name: ( t-y- I rA 10~ - Phonel-51, Lt5-~ °-&A
CONTRACTOR Name: License* ;16e?
Address: N6 c6cu" e l 4 City: i Y Lam' is State Zip r
Phone: 0) - `i 71\2 Email: <
TYPE OF New Replaoemept Repair RebuRd Modify Space _ Work in R.O.W.
WORK Description of work: u- t1J
c5 33
PERMIT TYPE COMMERCIAL
_ New Construction _ Modify Space
_ Irrigation System l_ yes no) Q f RPZ / PVB)
• Rain sensors required on irrigation systems
• Avg. GPM (2" turbo required unless smaller size allowed by Public Works)
Meters Gall (651) 675-5646 to verity that tests passed prior to nicking up meter.
Domestic: Size & Type Fire: 1'
Avg. GPM High demand devices? ___yes No Piushometers ,_Yes No
COMMERCIAL FEES:
$50.50 Minimum (includes State Surcharge) OR Contract value $ X1%
$ Permit Fee
Required on ALL new buildings and boulevard irrigation systems + = $ Radio Meter Read
- If Permit Fee is less than $1,000, surcharge is $.50 = $ Meter(s)
- If Permit Fee is > $1,000, surcharge increases by $.50 for each $1,000
$1,000 Permit Fee (Le, a $1,001-$2;000 Permit Fee requires a $1.00 surcharge). / State Surcharge
Following fees apply when installing a new lawn irrigation system. $ Water Permit
Call the City's Engineering Department, (651) 675-5646, for required fee amounts.
$ Treatment Plant
$ Water Supply & Storage
$ State Surcharge
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Call at (851) 454-0002 for protection against underground utility
damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.ciot)herstateonecall.org
I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and odes of the City of Eagan; that 1
understand this is not a permit, but only an application for a permit, and work is not to start without a permit; thak a rk will be in accordance Wth the approved
plan in t e of work whio0{equir a review and approval of plans.
X ,l - x
g'(a/
Ap icant's Printed Name Applicant's Sig tore
FOR OFFICE USE Approved By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final PRV Required: Yes No
Page 1 of 3
i
I
I CITY OF EAGAN
I 3830 Pilot Knob Road
Eagan, Minnesota 55123
I (612) 681-4675
I SITE ADDRESS:
It:slhi6i??r!
i PERMIT SUBTYPE:
I t 1:1irl , ! itil ,j i .
CTION RECORD
PERMIT TYPE:
Permit Number:
Date Issued:
APPLICANT:
TYPE OF WORK:
rI i t a iI t ta??
?
R {'Rik
f'11'i ftOf)Flf#41}
•
? li+, I I Pi:,. ., •
!- rli•i t Pt?, .A
'(1?1[il? fiJ ( I li?i 1?iill.rfl 1!? i11+?
I ltytlf i'I{:?? i Itif,l 111?
? i ran!
Permit No. Permit Holtler Date Telephone #
S/W
PLUMBING
HVAC
ELECTRIC
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orsat Test
Final Plbg. Plbg. Inspector - NOtity Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Ftg.
Deck Final
Well
Pr. Disp.
To be used fot
Site Address
Lot Block
Parcel No.
c Name
W
z Address
o r.irv oti„no ' '0 Name
?< Address
? city i
?s
° W
Name '
W y?
_?
Address
u
Q W
City I
I hereby acknowledge that I have read t
information is correct and agree to coi
Minnesota Statutes and City of Eagan (
Signature of Permittee _
A Building Permit is issued to:
on the express condition that all work sh
applicable State of Minnesota Statutes
Building Official
CITY OF EAGAN ,
Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
Est. Value
;Pr./Ruh
?a and state that the
applicable State of
ie done in accordance with a
I City of Eagan Ordinances.•
Receipt #
Date
14270
.19
OFFICE USE ONLY ?
,
.
? On SRe Sewage Occupancy ,
I MWCC System _ Zoning ?,
I On Site Well _ (Actual) Const
! Ciry Water _ (Allowable)
PRV Required
I # of Stories
I
Booster Pump Length .
Depth ?
S.F. Total
Footprint S.F. ?
APPROVALS FEES .1
Engr./ASSess.
I Permit
I
j Planner Surcharge !
I Council Plan Review I
? Bldg. Off. SAC, City
, Variance SAC, MWCC
I Water Conn.
I Water Meter
I Road Unit
I Treatment P1
Parks
TOTAL
,. Permit No. Permit Holder Date Telephone #
Plumbing i
H.V.A.C.
Electric
Softener ??-
In¦pactlon Date Insp. CommentE
Footings 1
Footings II
Foundation
Framing _3., n? ?-.f-?? t.f/• Cot.err?r?oya-l-G4-s?8-
Roofing j'a.o?,?tic- ?i2? S3a?- ?y-i=? ?x.?.-?
Rough Pibg.
Rough Htg.
IsuL
FirePlace
Final Htg. ??S
Final Pibg.
Bldg. Final
Cert. Occ.
Temp. LP
Deck Ftg.
Deck F(nel
Well
Pr. DisR -
?•? ? ?? Lc? ? L'?/ i4i?_?,eS?' o,c/
^y _ - - --
:%
?
` > s?. • .
?
A (gpxfifiratr of (Orrupanry
titp of (tagan
EP}iaYY1tIPtlY Df WitQtttq Jt19.}tPtttDtl
This Cerli)icate rssued pursuant to the requirements ojSection 306 of the Uniform Building
Cade certifying rhat at the rime of issuance lhis srructure was in compliance with the various
ordrnances of the City reguladng buelding cronstrucaon or use. For the followrng.Ux Clasfintirn - Bldg. Rrmit No.
Omupa-r'n'x zooin` Diw;a rype camt. -
Ownm M Building qddrm ..
... . ... . :..
Buildin8 Addrm . . .. . . . . Loulity
Dale:
Buildiog OBicial
POST IN A CONSPICUOUS PLACE
. ,. _
. •
PERMIT #
- ? • MECHANICAL PERMIT
RECEIPT # ' CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: ' ? " i`•-- ' '?
CONTRACT PRICfi: ,.. , _ _ .. ., ; PHONE:454-8100
Site Address " "' k ` ' • BLDG. TYPE WORK DESCRIPTION
Lot Block ? Sec/Su b Res. New
MuR Add-on -
? Name
?
Address Comm. Repair - , '
c
City- • ,
Phone?-'%? ? Other
?
Name FEES
RES
HVAC 0
100 M BTU
$24
00
u?
Addr
ess,
' .
-
-
.
DDITIONAL 50 M BTU - 6.00
A
, 3
p
City .
:,.,
PhonA? :-
1??t- _,) 1, RES. HVAC INCLUDES A/C ON NEW
(
CONSTRUCTION)
1 PER PEFiIAIT
GAS OUTLETS
MINIMUM
1
50 EA
(
-
) -
.
.
TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE
Forced Air M BTU APT. BLDGS. - COMM. R.4TE APPLIES
B
il TOWNHOUSE 8 CONDOS - RES. RATE APPLIES
o
er M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON &
Unit Heater M BTU REMODELS - 12.00
Air Cond. M BTU MINIMUM COMMERCIAL FEE - 20.00
Vent
CFM
$ STATE SURCHARGE PER PERMIT - .50
. (ADD $.50 S/C IF PERMIT PRICE GOES
Gas Piping Outlets # R BEYOND $1,000) ?
Other ,
FEE: f
^
'
?
?? J
S/C: '
'
SIG?rATURE OF PERMITTfE
TOTAL: ?
FOR: CITY OF EAGAN '
_ ?
, . PERMITtt
`
PLUMBING PERMIT RECEIPT ri 7,'?..t??C?
GTY OF EAGAN
?
3830 PILOT KN08 ROAD, EAGAN, MN 55122 DATE:
CONTRACT PRICE: PHONE:454-8100
Site Address. - BIOG. TYPE WORK DE?CRIPTION
Lot Block i ` Sec/Sub Res. New
Mutt. _&..I', Add-on
? Name I % • . Comm. Repair
?a Address Other
c Ciry Phone ' RES
PLBG
ONLY - COMPLETE THE FOLLOWING:
.
.
NO. FIXTURES TOTAL
Name
. -Water Closet - $3.00 $
"
' -Bath Tubs - $3.00
3 Address "
' '
',',.
7
_Lavatory - $3.00
O Ciry ( :rns::Phone 6G6 7Z4 Shower - $3
00
_
.
-Kitchen Sink - $3.00
FEES -Urinal/Bidet - $3.00
COMM/IND FEE - 1% OF CONTRACT FEE -Laundry Tray -$3.00
I APT. BIDGS - COMM RATE APPLIES _Floor Drains -$1.50
I TOWNHOUSE 8 CONDO - RES. RATE APPLIES -Water Heater -$1.50
? MINIMUM - RESIDENTIAL FEE - $12.00 -Whirlpool - $3.00
? MINIMUM - COMM/IND FEE - $20.00 -Gas Piping Outlets - $1.50
? STATE SURCHARGE PER PERMIT - .50 (MINIMUM - 1 PER PERMII)
(ADD $.50 S/C IF PERMIT PRICE GOES -Softener -$5.00
, BEYOND $1,000.00) -Well - $10.00
_Private Disp. - $10.00
.1i -Rough Openings - $1.50
SIGNATURE ERMITT FEE: -+-70 • u?
j
STATE S/C: '
FOR: CITY OF EAGAN GRAND TOTAL:
CITY OF EAGAN ?
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE; 454•8100
BUILDING PERMIT Receipt# -
Tobeusedfor .. -(''•''j"' r;t•? Est.Value Date b" ,19
SiteAddress 4100 Li-,4- 1.?1'C7?V AVF.
Lot I Block 1 Sec/Sub. LFk1NGTON H1L1.8 1
Parcel No. _
c Name a & Z PAU'6r-;ri`i
= Address P.O. BOX ?",0
° City -.1t,br.>SSh Phone 606/784-5910
UQ I Name- ?1^?£ I
o? Address
? City Phone
?
W W Name -,?ATERSAK ARCHI?ECT
Address r:iSi ALbC'MHR JA, 1_ uf)
QW City 7:ic:Pi1$r;F Phone 50h47Rh__2764
I hereby acknowledge that I have read this application and state that the
inforrhation is correct and agree to comply with all applicable State of
Minnesota S[atutes and City of Eagan Ordinances.
i
Signature of Permittee
A Building Permit is issued to:
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
OFFICE USE ONLY
On SKe Sewage Occupancy
MWCC System _ Zoning
On Site Well (Actual) Const
CityWater x (Allowable) V lEiR
.
PRV Required
_ # of Stories ,
`-
Booster Pump Length 1`' 3
Depth ?' ?-'
S.F.TOtal 20, 51H1
Footprint S.F. IJ. Z 5n
APPROVALS FEES
Engr./Assess. Permit - 1,70. SU
Planner Surcharge 2 50• (X
Council Plan Review 85L.75
Bldg. Ofi. SAC, City 1.Y10 .06
Variance SAC, MWCC W U8 .11Q
water Conn. lti) 080 . t)G
WaterMeter l?/A ,
RoadUnit ?..?11sh-0()
TreatmentPl 45UU
Parks
TOTAL 34, 1 ; i . _ ?
CITY OF EAGAN '
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE; 454•8100
BUILDING PERMIT Receipt #
To be used for Est. Value FA a:l Date ,19
Site Address "110 AV."'.
Lot Block i Sec/Sub. LA` A'"'C1W; 'i 1'.LS :
Parcel No.
s Name & Z PAR'C'iNEitS
z Addrem %1•0• fl+?X 2997
° Ciry .? .( ;.=',SS:.. Phone 6U?i/7?4-•z4'IO
o Name'_
? Q Addres
? City
uw ' Name aKTEABAK ARCNITECI'S
FW
Building Official OFFICE USE ONLY
_? Address '751 8L(?C1M??: Pl]LL k:J
<W City Phone -t764
I hereby acknowledge that I have read this application and state that the
infordnation is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Signature of Permittee '
•
A Building Permit is issued to: ' ` ' =?'' ? ' ''"- •
on the express condition that all workshall be done in accordance wiih all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
OnSiteSewage - Occupancy
MWCC System Zoning
OnSiteWell _ (Actual) Const V 11*1
City Water ?(Allowable) Y 1 NR
PRV Required # of Stories 1
BoosterPump Length 1?'3
Depth 5$
S.F. Total ll',
Footprint S.F. (? ? 5J
APPROVALS FEES
? i,-Y(3.50.
Engr./ASSess. Permit
= ?'U. C3[)
Planner Surcharge
`??1•?5
Council PlanReview
81dg. Otf. SAQ City 1' 970•00
Variance SAC,MWCC 1L'01'0'00
Water Conn. 1u,080.00
Water Meter NtA
RoadUnit 7,656.00
Treatment P1 7 r 456. CN)
Parks N ! A
roraL °34,1?1 7.?y
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used for =`<--C ,NI T APZ
Receipt # ?
!4 2"2
Est.Value $500*000 Date OCTOUH b ?g n7
Site Address 4I20 LBX INGT04: AVE
Lot ' Block i Sec/Sub. LEXINGTON H1LLS 1
Parcel No.
m Name ?i S 2 PAP:'SEkr>
z Addre'9s P.O. '.St),( IL757
City 1iAiKc?SS(: Phone 608/7$4-591i'
0
a
o Namd 4faN1
? Q Address
P City Phone
?
yVj W Name ' SATEAbAii AkCH1TECT5
Address ?1:751 8L(X?1k1t:k ?:1LL R;)
a W City ' Phone ii0br? 7? as-17b?,
I hereby acknowledge that I have read this application and state that the
inlormation is wrrect and agree to comply with all applicable State of
Minnesota Statutes and City ot Eagan Ordinances.
Signature of Permittee
.
A Building Permit is issued to: << &<-
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Otlicial_
OFFICE USE ONLY
On Site Sewage Occupancy Ri
MWCC System Zoning ??
OnSiteWell (Actual) Const V 1
Ciry Water ? (Allowable) V 1!: H
PRV Required of Stories `
Booster Pump Length 1$3
Depth 56
S.F. Total 26,501.1
Pootprint S.F. 10, 1 50
APPROVALS FEES
?
1
103.5U
Engr./Assess. Permit ,
Planner Surcharge 250•UO
Council Plan Review 851 • 75
BIdg.Oft. SAC,Ciry
'
1,920•00
Variance SAC,MWCC tV?48() - 0 0
Water Conn. 1 U.(?(i0 . 00
Water Meter N/A
RoadUnit 5,&SG•OC)
Treatment P7 3.45b.00
Parks k ?
?
?34`?•`
TOTAL
_ . :
D-I ?
BLDG. PERMIT N0.
. I{ + _
...
_ .... ,y
01-3210 .?, Y .
Bldg. Permit U 3
c? "
,01-3422 Plan Check
01-3445 Surch. /Adm,
.
?01-3446
SAC/Adm. ?
01-2155 Surcharge
17-3860 Road Unit G O
20-2275 SAC l
? ? . -v
?. ? .
,
20-3865 Water Conn. b:_: 0(_';
? 20-3$68 Water Trmt. -
20-3716 tiater Meter +
20-2252 Acct. Dep.
20-3713 Water Permit
20-3743 Sewer Permit ?
79-3866 5ewer Conn. '.
11-3855 Park Ded.
TOTAL j ? ?-
.,_4
BLDG. PERMIT N0.
?
01-3210 Bldg. Permi
01-3422 Plan Check
` 01-3445 Surch./Adm.
01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 kater Meter
? 20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 Sewer Permi
79-3866 Sewer Conn.
11-3855 Park Ded.
TOTAL
'
L?
BLDG. PERMIT N0. fj ?
01-3210 Bldg. Permi
01-3422 Plan Check
?
01-3445 Surch./Adm.
• 01-3446 SAC/Adm.
01-2155 Surcharge
17-3860 Road Unit
20-2275 SAC
20-3865 Water Conn.
20-3868 Water Trmt.
20-3716 kater Meter
20-2252 Acct. Dep.
20-3713 Water Permi
20-3743 5ewer Permi
79-3866 5ewer Conn.
11-3855 Park Ded.
TOTAL
CAS1i RECEIPT
CITY OF EAGAN
3830 PILOT KNO(3 ROAD
EAGAN, MINNESOTA 55122
DATE 19
aeceiveo
iROM
AMOUNT $ I
8 DOLLARS
100
? CASH Q CMECK
POR "
BY .
White-Payers Copy
Yeilow-Posting CopY
Pink-File Copy
Thank You -
. 1
' OF EAGAN Permit No: Date:
Pibt Knob Road Meter No: Size:
Box 21199 Reader No: Date:
in, MN 55121
Pr ?. :' Partaz:r =:
.Chg: - 1u.O?d0.00rn? ZoNng: '.74
Dep: No. of Units: "`+
t Fee: _ 10UUp d
I agree to comply wfth the City of
Ordinances.
By
WATER SERVICE PERMIT
CITY OF EAGAN
3830 Pilot Knob I
P.O. Box Z1 Y 99 .
Eagan, k4N15512•
Permit No:
B/P Na
Date: ' - - ?
Date: - ?
I agree to comply wHh the City of
Ordinances.
By
SEWER SERVICE PERMIT
Y OF EAG AN Permit No: Date: U-15-f? i
0 pi!-.,t Knob Road Meter No: Size: ??? oc
. Box 21199
Reader No:
Date:
1
an, MN 55121
ner. ` 1 rirtnex::
Address: xiU?tou ?^ve fl i T 1 P1 Lcx, oton ilil' -
umber._ .Toe 71Pnge l
Pl
Conn
Ch
:
.
g
Acct. Dep: Rafnro d•
Permit Fee: '
Surcharge: F
t I a9r?Yb t6n
PlY with the City of Eagan
Tr. Plant ' ,
Meter.
Misc.: B
WATER SERVICE PERMyT
CITY OF EAGAN
3830 PNMJCnob Road Permit Na
B/P No:
P.O. Ffox 21799
Eilyan, MN 55121
Owner.
Site Addr
Plumber.
MWCC: _
City Chg: _
Acct Dep:_
Permit Fee:
Surcharge:
Data
Date:
i
Zoning• `
No. of Units: - ?
OOpd I agroe to eomply wilh the Gty of Eapan
Ordinances.
By ?-- ?_
SEWER 8ERVICE PERMIT - _ _ ??
CASH RECEIPT
, CITY OF EAGAN
3830 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
onrE ?s ? 43
Kcerveo
FPOM
nMOUNr
& DOLLARS
O CASH IXEHECK '?
_ c?2
y?-?2.?Lp ??-cG/ /- 5/ '-?
FUND I OBJECT
z-111a ,1- j2 ,,
AMOUNT
Thank You
sv
/?-G (l7'--t7
81563 White-Payrers CppY
i Yellow--Pos?ing CopY
Pink-File CApy
This request void
18 nwnths irom
69336 /-?///,'"?r
,?? ?? _ "?-. ?/?,;
s7?6 Iel?s
??A 0-0
Request baie
. Fire No.
Rouph-in InsVartion
/
'
) - Require . OReady Now Q Will Noti(y Inspec-
r
{ ?Yes No ^ ? ? tor When Ready
Ucensed ElecVical Contractor ?- ?
?
Owner 1 hereby reque5l ins pection ot ahove
electricel work installed at: u
Sheet Address, Boz or Route Na. Citv
er.uon o. Township Name or No. R»ngc No. Count
Y
OccuUant IPRWT) Phone No,
N G?
Power Supplier Address
b e
Electrical Contractor ICompany Name) Contractor's License No.
?,*???s? ?F?? o a ",
Maiiin AdJress IContractor or Owner Making Instailation)
Authorized Si ature IContractor/Owner Making Ir stallation) ph??e ryimbyr
mirvrv[bUiq STATE BOqpD OA.ELECTRICITY THIS INSPECTION REQUEST WILI NO7
Griggs-Midwey 91dg. - poom N•191 BE ACCEP7EO BY THE STATE BOARO
1821 Universitv Ave., St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone(612)642-0800 ENCLOSED.
00001-06
`7 REQUEST FOR ELECTRICAL INSPECTION w EB- ?C? 5/
'. '7
0 See inslructions for completing this form on back of yellow copy.
3 3 6 "X" Below Work Covered by This Request 179 -2 C,? ti
p Fee Service Entranca Size H Fee PePders/Su6feeders k Fee Circuits
0 ta 200 qm s 0 to 30 Am s 0 tn 30 An s
Above 200 Ampsl 31 to 100 Amps 31 to 100 Aps
Swimminy Pool Above 100_-Amps Above 100_Amlri
Transformers Irrigation Booms , Partial•"Other?'
Signs Speciallnspection i?
TOTAL E ?
Nemarks
Rough-in ? Ua 1, the lecvicaI
? Inspect aby
ertity that the Tbove
Final ,-.?
7 j?'9,? inspection h een
r mada. ?
Thla requesl vofd 18 montha Irom
?
This request void
18 rnon[hs ?f+rom I? ^ 7 (/' ?{
? V ?J /? J 51_ I . ),, ? ,? /1li /Y/ ., i n,/e"-i.r . /?-K??ri ` ??/.? J ?• ?'"?
Request fJate Fire No. Rph•in Insperlion
??eqoLuired?
[]AeadyNowjgWillNotify.lnspec-
1-9? 19Yes ?No lor When Ready
IN L-censed Electrical Contractor I hereby request inspection of a6ove
? Owner electrical work installed at:
Street Address, Bux or Route No. City
y/ a LC- 4017 ??tr.*AJ
ecuon o. Township Name or No. Range No. Counly
L F. ?r? ?- .j i??,
Or.cuuantlPRINT)
1 / Phone No.
. 4 /vGEG C. ? ?'" p -S,V/t?j
Power Supplier AddresS
7AKa rxt i'C !G ? i
Electrical Contractor (Company Name) Contrar,tor's License No.
dj!?M.e_ FL ?c. P7? ! C_ D 4?0 7
Mailing Contractor or Owner Makinu Instailation)
a Z,5;Fri
Authorized SiOnature (Contractor/Owner Makiny Installation) Phone Number
4 %? ?J Sr
MINNEJOIA STqTE BOAHD OF EDECTRICITY THIS iNSPECTION REQUEST WILL NOT
Griggs-Midway Bld9. - Hoom N•191 gE ACCEPTED BV THE STqTE BOARD
1821 Universitv Ave.. St. Peul. MN 55104 UNLESS PROPEN INSPECTION FEE IS'
Phone 16121 642-0800 ENCLOSED.
REQUEST FOR ELECTRICAL INSPECTION . es-oooot-os
Ii, See instructions tor completing Ihis form on back o( Vellow copy. ?(/Gd
6929 5 "X" Below Work Coveied by This Request
New Add Rep. Type ol 81.1iltling ApDliancee Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
Apt. Building Dryer Electrie Heatin
Commercial Bldy. Fumace Siio Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tanl<
Farm Ofne, pPCify il,er (Sp?er,ifv)
t er $UCCify 0thC?
Comoute lnspection Fee 8elow
#
Fee
ServicB EntrenceSize
R
Pex
Fexders/Subfeeders
N
Fr.e
Circuits
-----------------------
U to 200 Am s 0 to 30 Am s 0 to 30 Aurps
Above 200 Amps 31 to 100 Amps Z 31 to 100 A s
Swimming Pool Above 100_Amps Above 100_Am s
Transtormers Irrigation Booms o$D Partial-'Other Fee
Signs Special Inspection
? 4
TOT FEE
Rertmrks -0 1
.
flouBh-in DaVI, the 'spector, heroby
3, .,certify thet the above
Final DA"' nspection has been
W141.4-4) . 3 Y?Y mada.
Thin request void 18 months Irom
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHON E: 454-8100
BUILDING PERMIT
To be used fbr 24-liNIT APT Est. Value $500,000
N° 1427'0
Receipt # tl?R? --7 ;? ? `i , D ?
Date OCTOBER 8 19 87
Site Address 4100 LEXINGTON AVE
Lot 1 elock 1 Sec/Sub. LEXINGTON HILLS 1
Parcel No.
c Name H& Z PARTNERS
z Address P.O. BOX 2997
o City LACROSSE phone 608/7$4-5910
, o Name SAME
? a Address
?m City Phone
pjW Name SATERBAK ARCHITECT
_? Address N751 BL00 F.R M.. RD
V
4W =
City i.A
CRf1SSF Phone. 6DA1788_7764
I hereby acknowledge that I have read this application and state that the
information is correct and agree t comply wi h all applicab State ot
Minnesota Statutes and Cit o an Ovan es.
Signature of PermitteeX _
A Building Permit is issued to: -? P TN S.
on the express condition that all work shall be done in accordance with all
applicable State Of Minnesota S tes and City of agan Ordinances.
?
8uilding OfliciaL _
I _ J
OFFICE USE ONLY
On Site Sewage Occupancy Rl
MWCC System X Zoning PD
On Site Well (ACtual) Const V 1HR
City Weter X (Allowable) V 1HR
PRV Required # of Stories 2
Booster Pump _ Length 183
oePth 56
S.F. rotal 20, 500
Pootprint S.F. 10, 250
APPROVALS FEES
Engr./Assess_ _ Permit 1,703.5(
Planner _ Surcharge 250.0(
Council Plan Review 851 . 7-'
BIdg.Off. SAC, City _1 . 920.0(
Variance SAC, MWCC 10?080.0(
Water Conn. -Lo'o 8 0 ? 0(
Water Meter N/A
Road Unit T 6 _ 0(
Treatment Pt _L45kL. 0(
Parks
TOTAL $34,197.2'
V9 36-1
2005 CONIIVERCIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Date -8 / ? l / 3c6'rj
Site Address ky I nq-"Q ? &v°t, - 19• U nit #
Tenant Name l?C,k 1?'llT?`?'p {-?-1 ???; rCIU ?- Former Tenant Name
Property Owner elephone # ( j
Contractor Vv I C,Lga?
Address 3 4LV) 175;1 f-4 L&F7 City -f•}A ry)n L/4--IL?
State rn t,? Zip55R b Telephone #(? ?? SSO I" r O's 1
LicensP # Expires:
The Applicant is _ Owner Contractor Other
Work Type _ New Bldg _ Modify Tenant Space RPZ PVB _ New Repair ebuil _ Replace
_ Irrigation system Work within public right of-way/easement _ Yes _ o
Rain sensors are re uired on irri ation s stems
Description of Work ?f iDU 1 Id 12 PZ ?a [v'e gria i3b
To inquire if Pressure Reducing Valve is required on new service, call 651-675-5646
Meters - Cal1651-675-5300 to verify that hydrostatic, conductivity, and bacteria tests passed prior to oickine up meter.
Irrigation Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works
Fire Size & Price 3/4" disolacement $161.00
Domesric Size & Type Avg GPM Includes high demand devices? _ Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No
Pertnit Fee $50.50 minimum (includes State Surcharge)
Contract Value $ x 1% _ $ Permit Fee
$ Meter(s)
Required on all new buildings & boulevard irri arion systems $ Radio Meter Read
If permit fee is $1,000 or less, surc6arge is $.50 $ State Surcharge
If permit fee is over $1,000, surcharge is $SO per $1,000 of the Permit Fee
Following fees apply only when installing new irrigation system? Y$ ' Water Permit
Call Jerry Wobschall a[ 651-675-5024 for required fee amounts
$ Treatment Plant
$ Water Supply & Storage
$ State Surcharge
-------------------------------------------------------------------------------------------------------------------------------
$ ---------------------------------
Total Fee
? 1- , , ., ? rn r
I hereby apply for a Commercial Plumbing Pemut and aclmowledge that the informarion is complete and accurate; 'tha6, t}ie ';workE?will be in6 ?
conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is ta I iot a pemut, but only an !!
application for a permit, and work is not to start without a pemut; that the work will be in accordance with the approvedyplan inLtl'te casefbNNi V
which requires a review and approval of plans.
f? I 1 GY?LI C( W e S}YY?lrl .? :f .
ApplicanPs Printed Name Applicant's Signature t??_ -- --- --
CITY USE ONLY .
REQU[RED INSPECTIONS: _ U.G. _ Air Test _ Gas Test _ Rough In _ Final
PLANS SUBMITTED APPROVED BY: BUILDING INSPECTOR
?
General Information • Radio Meter Read (required on all new buildings & boulevard irrigation systems- $141.00
• RPZ's must be tested every year and rebuilt every five yeazs. Test results should be mailed to Paul Heuer at the City of Eagari.
• A minimum fee perxnit per address is required for the following RPZ's: new, rebuild, repair, remove. ?
• Water meters include copper horn/strainer, remote wire, and touch-pad meter.
METERS REOUIRING 4-HOUR ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
1-20 518" residenfial $125.00 4-120 1-1/2" itiigatlon syst $ 735.00
displacement sm commercial turbine** Public Works
maX"nu°' must approve
continuous meter size
10
2-30 3/4" lawn irrigarion $161.00 4-160 2" turbine lg irrigafion syst $ 931.00
mazimum displacement residenrial &
continuous sm commercial production lines
15
3-50 1" displacement very lg res $296.00 1/4 to 160 2" compound bldgs over $ 1,849.00
bldg to 24 units 65 units
maximum sm commercial &
continuous & lg comm bldgs
25 irri ation s stems
5-100 1-1/2" bldgs 25-64 units $429.00
maacimum displacement &
continuous most comm bldgs
50
METERS REOLJIRING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbine very lg irrigation $1,182.00 6-500 4" compound +300 unit bldgs & $3,563.00
syst & production very lg comm bldgs
lines
1/2-320 3" compound +200 unit bldgs $2,282.00 10-1000 6" compound +400 unit bldgs $6,076.00
very Ig comm bldgs very lg comm bldgs
15-1000 4" turbine very Ig irrigation $2,226.00
syst
& production lines
c;omments
• To schedule inspection of the inside water line and backflow preventer, ca11 65 1-675-5675.
• To arrange for water tum-on, call 651-675-5300.
cc: Maintenance Division Clenca] Technician January 2005
f Q
Y • y :d ?i?.? ? {.., r ? s ?': r _:f F?. ? ?;; a . _ ?:'., ' _
?I a 8 ?
CITY USE U1%Y
4 . . .. . ., .? 3 - . .
PERMIT # RECEIP'f DATE•
_ VtStF .._..._ ._??v: ?:,ffti ?iI1.?.rzf;:3.?f?f?U?f?l.i!f>? Tt. ?, ?.,.... • . r_ .
wm?iipV4'iL TYVMLL?G FEMET AMPUVlil LVl\
. .. . _ "i'•?...6,???I/T?LlIVM?.;?ai,,, , :. . '.'i?? .? . ? . . ., ?, .l
?70?/ 1 ?f01/i W\Va ??V
??N; IiW lfS188
851?81?08?S
INCOMPLETE APPUCARONS tMLL NOT BE PROCESSF?
WORKTYPE _.New.Bldg. Add-0n ._. _ Repait........ _.RPZ _A/ PVB 'Irrigationsystcm .
• Must complete reveree side of application also. Required meter size is 2" tiubo unles smalier siu pemiitted by Public Works
DESCRIPTIONOF WORK , .. /mZ 14 f 1S-/ I -_.
To inquire if Pressure Reducing.Yalve is required; on new`servic,,caR 651-681-4646
METER$ -.Ca1165,1481 4300,to, verify, that hydrostatic, conductiyity, and bacteria tests, passed prior to uicldna up meter
Irrigation Size & Type Avg GPM
Fire" Size-Bc Type . Avg GPM
Domestic Size 8t Type Avg GPM
Does this include high demand devices7 Yes _ No
FLUSHOMETERS _ Yes _ No PRV REQUIRED _ Yes _ No
Site Address: 'S??D O /. Z°Xj j 1 Q/ Qz-)
Tenant Name:
Wes there a previous tenant in this epace? _ Y_ N. If Yes, Name:
InstaUerName: /7).;?Z(2 ?Ql'?o.') /0/n'l
Imtalier naaress: ?3?6a2 ?? b ra ry
City:
?
State: Zip Code
FEES Contract price $ 11% ($50.00 minimnm) Contract Fee $
. . . .. . . .., _.. . , . __......,...... .. _. . _ , - . . Meter(3? ._ . $ ... -
Required on all new bnildings &.boulevs"rd_irrlgation systems (Acct # 92211=4509).
Surcharge: $.50 Minimum: If eontract fee exceeds $1,000, calculate at
50 cents per $1,000 contract fee.
Total From Reverse
Rsdio Meter Read $
State Snrcharge $ 1_?o
New Service $
Totat S ?JO. eo
I hereby aclmowladge that I have read this application, state that the information is correct, and agee to comply with all applicable Ciry of Eagan
ocdinances: It is the appficanYs responsibilityto notifythe propertyoavner thatthe CityofFaganassumasuo liability for anydamages oausedbytheCiry
during its normal operationat and maintenance activities to the facilities constructed underis pe?mt within City property/right-of-way/easement
116'o
SIGNATURE OF PERMITTEE
. .-:. , . . . . . .:.. . . ..... .. ... . . . .. ?. CIT'Y USE ONLY ° .: .
REQUIItED IlVSPECTIONS: _ U.G. _ Air Test Gas Test .._ Rough In, • _ Final
PLANS.SUBMI'I"I'ED
APPROVED BY:
BUILDING INSPECTOR
Telephone #: 6 1'.?- Y?a'
(acea Code)
Telephone#: •/vo?- 9620 -aeo ?"/V
(/vea Code)
PERM[T #:
CITY USE ONLY
14- c) 1
RECEIPT DATE:
FLU$Mfi;PW=APMCAT10N
CIIYOF E146lkN
8850 PDMT HNOB $D
$i46M.IdP" I22
e51-6$14675
ING4MPL.ETE APPLICATIONS WILL NOT 8E PROCESSED
Date: C?..,) - a<g ' c) I
WORK TYPE New Bldg Add-on Repair x RPZ _ PVB • Irrigation system
• Must complete reverse side of application also. Required meter size is 2" turbo unless smaller size permitted by Public Works
DESCRIPTION OF WORK
To inquire lf Pressure Reducing Vatve is required on new service, call 651-6814646
METERS - Ca11651-681 -4300 to verify that hydrostatic, conductivity, and bacteria tests passed pr[or to oicldna ua meter
Irrigation Size & Type
Fire Size & Type
Domestic Size & Type
Dces this include high demand devices?
_ Yes _ No
Avg GPM
Avg GPM
Avg GPM
FLUSHOMETERS Yes No PRV REQUIRED _ Yes _ No
_% A? e S.
Le_x'%r-%$Aoj
sice Aaaress: 4 ldr
Tenant Name: LEX? nq? n Telephone #: Cos )_ y S a- O 313
1 (Area Code)
Was there a previous tenant in this space? _ Y_ N. If Yes, Name:
Installer Name: M (
I-, A fz,So-fN
Installer Address: Sy ()
Telephone #: 9 S o`L - 9 02 O- o? l0 9 Z?
(nrea coae)
City: State: TYIt?
FEES Contractprice $ 00 xl% ($SO.OOmioimum)
Contract Fee
Zip Code S Sy oZ tp
g .?"? . 60
$ -
Meter(s)
Requved on ell new buildings 8c boulevard irrigation systems
Swchazge: $.50 Minanum If contract fee exceeds $1,000, calculate at
50 cents per $1,000 contract fee.
Total From Reverse
Radio Meter Read $
State Surcharge $
New Service $
- 1_?a
Total $ 13'0. sa
I hereby acknowledge that I have read this application, state that the information is correct, and agree to comply with all applicable Ciry of Eagan
ordinances. It is the applicant's responsibility to notify the property owner that the City of Eaga?n? ounes no liability for any damages caused by the City
during its normal operational and maintenance activities to the facilities constructed under fs perm within City property/right-of-way/easement.
SIGNATURE OF PERMF
CITY USE ONLY
REQ[JIRED INSPECTIONS: _ U.G. _ Air Test _ Gas Test _ Rough In _ Fina1
PLANS SUBMITTED APPROVED BY: , BUILDING INSPECTOR
A city oF eegan
December 12, 2000
MR PETER HILGER
PORTFOLIO DESIGN SERVICES NC
2500 W COUNTY ROAD B
ROSEVILLE MN 55113
RE: STORAGE BUILDING
4100 LEXINGTON AVENUE
LOT 1, BLOCK 1, LEXLNGTON HILLS 1ST
Dear Mr. Hilger:
PATRICIA E. AWADA
Mayor
PAUIBAKKEN
BEA BLOMQUIST
PEGGY A. CARLSON
SANDRA A MASIN
Council Members
THOMAS HEDGES
City Atlmirnstrotor
We have completed our review of the construction documents submitted in pursuit of obtaining a building
permit for the above-referenced project. This review is not intended to be an exhaustive and
comprehensive report. Unless otherwise noted, all references are to the 1997 U.B.C. It is our goal that
this review will help you in complying with the applicable codes and we are, therefore, requesting that the
following items be addressed.
Please have the enclosed Special Inspection and Testing Schedule filled out and signed by both
the owner and contractor. This must be done before a building permit can be granted.
2. Submit two sets of landscape plans.
3. Provide a fire protection plan on an 8-1/2" x 11" sheet of paper and a floppy disk in Auto CAD
dwg release 14 or dxf release 14. This will assist emergency personnel responding to the site. An
example is enclosed.
4. A contractor must be named.
5. Submit construction cost.
If you have any questions regardina the above requirements, pleae feel free to call me at 651-681-4683.
Thank you.
Sincerely,
J. Craig Novaczyk
Building Inspector
JCN/j s
Enc.
MUNICIPAL CENTER
3830 PILOT KNOB ROAD
EAGAN. MINNESOTA 55122-1897
PHONE: (651) 681 d600
FAX: (651) 681-4612
TDD: (651) 454-8535
THE LONE OAK TREE
THE SYMBOL OF STRENGTH AND GROWfH IN OUR COMMUNIN
Equal Opportunity Employer
www.cityofeagan.com
MAINTENANCE FACIIITY
3501 COACHMAN POINT
EAGAN, MINNESOTA 55122
PHONE: (651) 681-4300
FAX;(651)681-4J60
TDD: (651) 454-8535 .
INSPECTION RECORD
CITY OF EAGAN PERMIT TYPE:
3830 Pilot Knob Road Permit Number:
Eagan, Minnesota 55123 Date Issued:
(612) 681-4675
SITE ADDRESS:
LOT: 1
4100 IEXING70N AVE
LEXINGTON HILLS
PERMIT SUBTYPE:
COMM./IND. MISC.
BUILDING
024538
09/15/94
B L 0 C K: 1 APPLICANT:
A70P ROOFING CO
(612) 649-0156
TYPE OF WORK:
DESCRIP7ION
REPAIR
(APT ROQFING)
INSPECTION ., . .•
FOOTIN6S FRAMING
ROUGH IN PLB6 ROUGH IN HTG
FINAL PLBG FINAL H7G
FINAL ?
F- - ?
L
.? PERMIT 31 s/j
CITYOF EAGAN
3830PilotKnobRoad PERMITTYPE: auILoxNG
Eagan, Minnesota 55123 Permit Number: 0 2 4 5 3 B
(612) 681-4675 Date Issued: 0 9/ 15 / 9 A
SITE ADDRESS:
4190 LEXING70N HVE
LOT: 1 BLOCK: 1
LEXINGTtlN HIIIS
P.I.N.: 10-45025-010-01
DESCRIPTION:
(APT ROOFING)
B/uilding",Permit Type COMM./IND. MTSC.
Suilding Wo`r-k, 7ype REPAIR
.;
45+;
-uL,?D
-?\
REMARKS:
FEE SUMMARY:
VALUATZON $12,000
Base Fee $135.00
Surcharge $6.09
Tatal Fee $141.00
CONTRACTOR: - Applicant - OWNER:
ATOP ROOFING CO 26490156 REACQR LTD
1845 UNIVER5YTY AVE 4116 LEXINGTpN AVE
S7 PAUL MN 55104 • EAGAN MN 55123
(612) 649-0156 (612)452-0.313
I hereby acknowledge that I Mave read tFris applicat-ion and state that the
znformation is correct and agree to comply with all appliaable State of Mn.
8tatutes artd City f E an Ordinances^. "
L 4 ;1) - /I VL _ _
APPLICANT/ R EE SIGNATURE ISSUED IGI?TU?E' ?
?
JCITY OF EAGAN
1994 BUILDING PERMIT APPLICATION
681-4675
_?_ 4I"J`,9
SINGLE & MULTI-FAMILY 2 sets of plans, 3 registered site surveys, 1 copy af energy
calcs.
MMERCIAL 2 sets of architectural & structural plans, 1 set of
specifications, 1 copy of energy calcs.
Penalty applies: 1) when permit is typed, but not picked up by last working day of month
in which request is made, 2) address is changed or 3) lot change is requested once permit
is issued.
Date S e,cT Valuation of wor ?
Site Address: ?`id? .. e e, ?
STREET SUITE #
Tenant Name: (commercial only)
LOT -1_ BLOCK ___?_, SUBD. ? • ??1f .? ?}
3bf ,A? P . I . D . #
Descri tion of work: ?lZed '"? d- ?- cr'
The applicant is: ? Owner W Contractor ? Other (Describe)
Name _ "A-/ ?Lf •roea_ 6ca/z- Phone 5 Z 0-9?3
Property LAST FIRST
Owner
pddress L1l1? Le x".d 4,1
STREET STE #
City 5tate Zip ?5S/Z 3
Company A720C f2eW:,dG C0102.u41".4 Phone
COntraCtOr Address 19116-
-/1 A-ile- License # Exp.
City 6
-4 State ,Lj'#j Zip S.?"la
Company I'luNf?- Phone
Architect/
Engineer Name Registration #
Address '
City State Zip
Sewer & water licensed plumber . Processing time for
sewer & water permits is two days once area has been approved. -
I hereby acknowledge that I have read this application nd tate that the informatian is
correct and agree to comply 11 appl'cable State o Mi sota Statutes and City of
Eagan Ordinances.
Si
t
f
l
gna
ure o
App
icant:
v
OFFICE USE ONLY
BUILDING PERMIT TYPE
O 01 Foundation ? 06 Duplex O 11 Apt./Lodging
? 02 SF Dwg. ? 07 4-Plex ? 12 Multi. Misc.
? 03 SF Addition O 08 8-Plex ? 13 Garage/Accessory
? 04 SF Porch O 09 12-Plex ? 14 Fireplace
? 05 SF Misc. ? 10 Multi. Add'1. ? 15 Deck
?
WORK TYPE
? 31 New ? 33 Alterations ? 35 Tenant Finish
? 32 Addition ? 34 Repair ? 36 Move
GENERAL INFORMATION
Const. (actual)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Depth _
APPROVALS
Planning
Engineering
REGIUIRED INSPECTIONS
? Site
? Wallboard
Basement sq. ft.
lst F1. sq. ft.
2nd F1. sq. ft.
Sq. Ft. total
Footprint Sq. ft.
On-site well
On-site sewage
Building
Variance
? Footing
? Final
?
.,. ? ? ."??
.. ? •,.ti . :? ? ? „r•r"4.
? 16 Basement Finish
El 17 Swim Pool
? 18 Camm./Ind.
? 19 Comm./Ind. Misc.
? 20 Public Facility
? 21 Miscellaneous
? 37 Demolish
MWCC System
City Water
PRV Required
Booster Pump
Fire 5prinkler
Census Code
SAC Code
Census Bldg
Census Unit
Assessments
0 Framing
O Draintile
? Insulation
0 Fireplace
Permit Fee
Surcharge
Plan Review
License
MWCC SAC
City SAC
Water Conn.
Water Meter
Acct. Deposit
S/W Permit
5/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trails Ded.
Copies
Other
Total:
vetuat;«?: g
SAC %
SAC Units
c U
1987 BDILDING PERMIT 9PPLICATION - CITY OF EAG9N
SINGLE FAMILY DWELLINGS
INCLIIDE 2 SETS OF PLANS, 3 CERTIFICATES OF SQfiVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOTiiNEE MUST DESIGAATE WHICH ADDRESS
IS DESIRED. NO CHANGES WILL BE ALLOWED ONCE BIIILDING PERMIT IS ISSQED.
MULTIPLE DWELLINGS - RFSIDENTI9L RENTAL ONITS X FOR SALE [JBiITS
INCLUDE 2 SETS OF FLANS, CERTYFICATE OF SIJRVEY - CHECK WITH BLDG. DEPT.p
1 SET OF ENERGY CALCULATIONS
COLNMRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
. ENERGY CALCULATIONS,
« $29000 LANDSCAPE BOND
To Be Used For: Multifamily Valuation: Date:
Site Address 4 1 00 L?. 4%,(F_ OFF
Lot ? Block ? On Site Sewage
MWCC System ?
ParcellSub Lexington Hills First Addition On Site Well
Owner H & Z Partners City Water
Address PO BOX 2997
City/Zip Code La Crosse Wi 54602
Phone 608 784 5910
Contraetor H & Z Partners
Address p0 BOX 2997
City/Zip Code La Crosse Wi 54602
Phone 608 784 5910
Areh./Engr. Saterbak Architects
Address N751 Bloamer Mill Rd
City/Zip Code La Crosse Wi 54601
Phone Ik 608 788 2764
areaovALs
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
Oecupancy
Zoning
Type of Const
(Actual)
(Allowable)
?k of Stories
Length
Depth
S.F. Total
Footprint S.F.
FEEs
Permit
Surcharge
Plan Review
SACt City
SAC, MWCC
Water Conn
Water Meter
Road Unit
-Treatment P1
Parks
Copies
TOTAL
c U
1987 BQILDING PERMIT APPLICA?ION - CITY OF EAGAN
SINGLE FAMILY DWELLINGS
INCLIIDE 2 SFsTS OF PLANS, 3 CERTIFICA?ES OF SURVEY, 1 SET OF ENERGY CALCQLATIOHS
AiOTE: ADDRESSES FOR COBNER LOTS - CON?RACTOR/HOMEO'iiNER MIIST DESIGAASE WHICH 9DDRESS
IS DESIRID. NO CHANGES WILL BE ALLOWED ONCE BQILDING PERMIT IS ISSQED.
MOLTIPLE DWELLINGS - RESIDENTIAL RENTAL QAITS X FOR SALE IIBIITS
INCLliDE 2 SETS OF PLANS, CERTIFICATE OF SIIEVEY - CHECK IiITH BLDG. DEPT.,
l SET OF ENERGY CALCULATIONS -
CO'I?MRCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIFICATIONS AND 1 SET OF
, ENERGY CALCULATIONS,
y $29000 LANDSCAPE BOND
To Be Used For: Multifamily Valuation: Date:
Site Address 4 1 OO LEC. &Ie-
` Lot ? Block ?
Pareel/Sub Lexington Hills First Addition
Owner H & Z Partners
Address PO BOX 2997
City/Zip Code La Crosse Wi 54602
Phone 608 784 5910
Contraetor H & Z Partners
Address pp BOX 2997
City/Zip Code La Crosse Wi 54602
Phone 608 784 5910
Areh./Engr. Saterbak Architects
Address N751 Bloamer Mill Rd
City/Zip Code La Crosse Wi 54601
On Site Sewage_
MWCC System ?
On Site Well
City Water ?
6PPROYALS
Assessments
Water/Sewer
Police
Fire
Engr
Planner
Council
Bldg Off
APC
Variance
Oecupaney
Zoning
Type of Const
(Actual)
(Allowable) '
? of Stories
Length
Depth I
S.F. Total
Footprint S.F.
FEFS
Permit
Surcharge
Plan Review
SAC, City
SAC, MWCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAI.
Phone # 608 788 2764
C:CT`! Q!= [::r'1[:,AN
Ci1S1..I. ''i.l-.,?,; `:i if:l:MINt'il... Nt'3a 764
n•}- r..• ? ? r +,. _° i? ?`i'..::';rr
ii,-i L.C f1..??7.?t/:3:.) ?r.L,tL-
?W
;T1;;
MnMF : i s_;P t:,t.lN :i: Fdr,
;:'c':I.C? 9001 KDO I._f:_?( ialJE 03,25
c..`..'i5 9::101 /+:Lflfl L_L•:X Fl'.,l!: i „Lii}
i
To'i:al CiS7t:_£•. i ?-.p'f ? ( i!. _ r?d(i' 1?1tC 07.2?!
C; : I, C; s; };:; :.=, 4.
I..MG:.R ILI,°, A.ifyi\f[,"Y
_? k . ?jnY(i.,:•,..,.1FY?Ci,.:-..d.n>,..,,$.:?.Er.M.r.p.:?...,,,r;th:?tr.5,....?r....rR)'r
1999 BUILDING PERMIT APPLICATION
?Q? CITY OF EAGAN
? v (651) 681-4675
Submit followina to obtain ner.ecsanv nprn,if
Name:---L.f?? ?? Phone #:
Last First
Foundation Onl New Construction Interior Im rovement
structural plans (2 sets)
civil plans
2 architectural plans
(2 sets)
architectural plans
(2 sets)
(
sets)
code analysis (1) •' svuctural plans
civil plans (2 sets)
(2 sets) code analysis
ro
ect s
ecs (t) ••
1
project specs (1)
landscaping plans
(2 sets) p
j
p
Key Plan (
set)
Special Inspections 8 Testing Schedule " cotle analysis (1) " energy calculations (1) not aMays "
SAC determination letter from MC/ES - soils report
SAC determinaGOn letter from MC/ES - (1) Electric Power & Lighting Form
SAC detertnination lerier from MC/ES - (1)notalways °
call 602-1000 cail 602-1000 qil 602-1000
Special Inspections & Testing Schedule (1) •'
project specs (1)
energy plculations (1) ••
Electric Power & Li htin Fortn 1 '•
'v, omnpic
Food & Beverage or Lodging facilities: Plan must be submitted to Minnesota Department of Health. Call 215-0700 for details.
DATE:_ _ 6 / q (? WORK TYPE: X NEV/ _ RFMODEI
DESCRIPTION OF WORK:
CONSTRUCTION COST: O.?ITENANT NAME: ??n?rCf 1 pM eII nl1P.Y)
SITE ADDRESS: ?y ?-??" y? ?- ??? ?
SUITE #:
LOT I BLOCK ( SUBD. P.I.D. #
PROPERTY
OWNER
CONTR4CTOR
ARCHITECT/
ENIGINEER
Screet Address::1 Itz? (?'a(jfm / 0
City V W!I LU' I State:
?
(COMMERCIAL) ?• ??
?
nl A.). Zip: 5sIa3
#: ??- 3VIo-A?kz
Sneet Address: f U7t"'S( Q ??)r1??(1&, 01,1a,
: ;ty State: 1 f l L Zip: SS `( 3-?-
Company:
Stree
MAY 11 199?
city
. `.-----
Sewer 8 water iicensed plumber (only if installing sewer &
Phone #:
Registration #:
State: Zip:
I hereby acknowledge that I have read this application, state that the information is co?ct, and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances. V 1
Signature of Applicant:
ei ;5!A
BUILDING PERMIT TYPE
? 01 Foundation
? 18 Comm./Ind.
WORK TYPE
? 31 New
? 32 Addition
GENERAL INFORMATION
Const, (ac+uai)
(Allowable)
UBC Occupancy
Zoning
# of Stories
Length
Width
APPROVALS
OFFICE USE ONLY
? 19 Comm./lnd. Misc.
? 20 Public Facility
O 33 Alterations
13 34 Repair
? 21 Miscellaneous
? 35 Tenant Finish
O 37 Demolition
Rqcempnt sa. ft. ? Census Code
First Floor sq. ft. SAC Code
sq. ft. Census Unit
sq. ft. Census Bldg.
sq. ft. ' • MC/ES System
sq. ft. ' City Water
Footprint sq. ft. Fire Sprinklered
Planning Building Engineering Variance
. .. ?
VALUATION:
? 53 • a?
Permit Fee
Surchar
e
g
Plan Review
%nG/ES S4C % SAC
City SAC SAC Units
Water Supply & Storage Meter Size
S/W Permit
S!W Surcharge
Treatment Plant
Park Dedication
Trails Dedication
Water Quality
Other '
Yr
Copies .
"
•
,i
2
t. ' r
Total
$
I
CLAIM VOUCHER - REFUND REQUEST
CITY OF EAGAN
MAKE CHECK PAYABLE TO: Top Gun, Inc.
ADDRESS: 10736 lYormandale Blvd.
Bloomington, MN 55437
LOCATION: 4100 Lexington Ave P.I.D./LEGAL: Lot 1 Block i Lexington Hills
RECEIPT #/DATE: 108854/5-14-99 VALUATION: $8,000.00
REASON FOR REF[JND: Valuation was incorrect PERMIT #: 35768
TYPE OF REFUND:
Electrical Permit 3211-9001 $
Plumbing Permit 3212-9001 $
Mechanical Permit 3213-9001 $
Building Permit Fee 3210-9001 $ 56.00
Plan Review Fee 3422-9001 $
SAC (MC/WS) 2275-9220 $
SAC (City) 3866-9379 $
SAC (Admin) 3446-9001 $
Water Connection 3865-9220 $
Sewer Permit 3743-9220 $
Water Permit 3713-9220 $
Account Deposit 2252-9220 $
Water Meter 3716-9220 $
Water Treatment 3868-9220 $
Surcharge 2155-9001 $
Utility Acct Overpayment 2250.9220 $
Curb Box Deposit Refund 2253-9220 $
Construction Meter Dep Refund 2254-9220 $
Water Usage Charge 3711-9220 $
Other $
TOTAL $ 56.00
I declare under the penalties of law that this account, claim, or demand is just and that no part of it has been paid.
SIGNATURE7/?/Q q ?
?
?
C?
DATE
North Office
5014 Parrish Ave. N.E.
Rogers, MN 55374-9009
(612) 428-4559
Faac (612) 428-8826
July 2, 1999
City of Eagan
Building Inspections
3830 Pilot Knob Rd.
Eagan, MN 55122
To Whom It May Concem:
License # 20155030
South Office
10736 Normandale Blvd.
Bloomington, MN 55437
(612) 346-8000
Fax (612) 346-8005
RECEIvED
JUL a 8 1999
BY:
This letter is in regards to a phone conversation I had with a woman in the Building Inspections
division. On Apri127, 1999 we applied for a residing permit for the following address.
Lexington Hills Apts.
4114 Lexington Ave.
Eagan, MN 55123
When I filled out the permit application, I did not realize that the job consisted of two separate
buildings. Therefore, I entered the job value of the $8,000.00. When it was brought to my
attention that the project consisted of residing two buildings and not just one like I applied for. I
sent a check in the amount of $157.25, which is for the value of $8,000.00. It was someone from
your inspections deparhnent who brought it to my attention that I was going to need another
permit for the job. So, I mailed another check for $157.25 for the second permit not thinking
that I should've only paid for the total job value of $4,000.00 for each permit. I guess what I am
trying to say is that for permit number EA035400 (address: 4110 Lexington Ave.), the job value
is $4,000.00 and I should've paid $99.25 and not job value $8,000.00 for $157.25. The very
same situation goes for permit number EA035768 (address 4100 Lexington Ave.). We would
very much appreciate the change in your system and refund us the difference of $116.00. If you
have any questions at all please call me at 612-346-8000. I wouici be happy to explain this more
clearly to you. Enclosed, please find a copy of the permits for your reference. I am very sorry
for any inconveniences this might have caused
Sincerely,
,
Kellie Busker
Top Gun, Inc.
South Office
&Ijltlo
Tu"TN, ?NC.
cvNrRacroRs
- --U vou in advance.
P-
,--?? ????90
, . . .
North Office
5014 Parrish Ave. N.E.
Rogers, MN 55374-9009
(612) 428-4559
Fax (612) 428-8826
TT ???? ?NC.
?
C???RACTQRS
License # 20155030
July 2, 1999
City of Eagan
Building Inspections
3830 Pilot Knob Rd.
Eagan, MN 55122
To Whom It May Concern:
South Office
10736 Normandale Blvd.
Bloomington, MN 55437
(612) 346-8000
Fax (612) 346-8005
RECEIVED
JUL 0 8 1999
BY:
This letter is in regards to a phone conversation I had with a woman in the Building Inspections
division. On Apri127, 1999 we applied for a residing permit for the following address.
Lexington Hills Apts.
4114 Lexington Ave.
Eagan, MN 55123
When I filled out the permit application, I did not realize that the job consisted of two separate
buildings. Therefore, I entered the job value of the $8,000.00. When it was brought to my
attention that the project consisted of residing two buildings and not just one like I applied for. I
sent a check in the amount of $157.25, which is for the value of $8,000.00. It was someone from
your inspections department who brought it to my attention that I was going to need ariother
permit for the job. So, I mailed another check for $157.25 far the second permit not thinking
that I should've only paid for the total job value of $4,000.00 for each permit. I guess what I am
trying to say is that for permit number EA035400 (address: 4110 Lexington Ave.), the job value
is $4,000.00 and I should've paid $99.25 and not job value $8,000.00 for $157.25. The very
same situation goes for permit number EA035768 (address 4100 Lexington Ave.). We would
very much appreciate the change in your system and refund us the difference of $116.00. If you
have any questions at ail please caiI me at 612-346-8000. i wouid be happy to expiain this more
clearly to you. Enclosed, please find a copy of the permits for your reference. I am very sorry
for any inconveniences this might have caused you. Thank you in advance.
Sincerely,
Kellie Busker
Top Gun, Inc.
South Office
&?w
??0 P
?
CITY OF EAGAN
APPLICATION FOR PERMIT
SEWER AND/OR WATER CONNECTION
xx]f%C]«]tJY]t]«JCxKxx F'?]CxLF ?F Ri[;i[]CiClC?]C'F ?R
. ?
^ATS: PAYMFNT OF M AT TIME OF *
ArPUcAMoN ooFS tUr oorSTIMM *
APPRovAZ oF pEFdUT. *
*
INSPF]CTION OF SEiWQt ANID/C2 WA1II2 *
I T.TA`['3ONS WILL BX)T BE SCHM-
t
UI,M t)DTrIL PER14LT HAS BEQI *
?
APPRWM.
*
?
*
*
- - - - - - - - - - - - - - - - - ---- - - - - - - - - - - - - - - - -
P ease Print
1) PROPERTY ADDRESS:
LEGAL bESCRIPTI013:
?/I?e 1- 5 Xi/L.? c.ra,? "4 Ll'&(
, kar , ????K _/
sion or Tax Parce
IF EXISTING STRL'CMIRE, DATE OF ORIGINAL BLILDING pERMiT ISSL'ANCE: "
Nbn Year)
PRESIIVT ZONING/PROPOSID L'SE:
q corMERcIAL/RErAtr./oFF2cE
Q 2NID(!STRIAL
n INSTI7.i]TIONAL/GOVERI?mENT
? R-1 SINGLE FAMILY
? R-2 DL'PLEX (Zt,o Lnits)
? R-3 TOWNHOUSE (Three + Units) ( Units)
? R-4 APARTMENT/coDIDOMINIUNl ( a-`r Units )
2) ?? .
N11(E: H44 2?-
ADDxESS: 9 7 ?.. '
CITY, STATE. ZIP:
PHONE: 6°? p
3) • i: a?• For City Use
NAME: ?.Pk
Plumbers License:
ADDRESS : ?o, 8° 2 9? 7 Active
EScpired
CITY. STATEt ZIP: 1, r,. ('r PS S? (,.9 /jC • S?j/6 ?/ Not recorded
PxorE: `° ? : y y _3?-y i ? rAsTm iscErrsE#
Staff Initial
4) •• •
NAME:=?.
_ P.DDRESS: p, o 24 'q 7 ' .
CITY. STATE, ZIP: f-a. Q?P rf e L-i1J.
PHONE: ?f f
'5)
oCONIVECTION 7O CITY SEWgt
Q COIVDIDCTZON ZO CITY WATER
6) 10 • i- CTPLEASE HOLD APPROVID PERNCLT FY)R PICK-C?P BY ONE OF ABOVE ..--
Q PLF.ASE MAIL APPROVID PEE2NLiT TO 1. 21 3, 4, ABOVE
`f _ (Circle one)
SIC?lA4[IRE-'•
1 /0-13 -IF7
aonm ,
FOR :CITY USE ONLY
PERMIT # ISSUED ,
? j -5--a -j .
Pd w/Bldg. Permit FEES:
$ $ /G -? SEWER PERMIT (INCLUDE S[JRCHARGE)
$ $ & WATER PERMIT (INCLUDE SURCHARGE)
$ $ WATER METER/COPPERHORN/OUTSIDE READER
$ $ WATER TAP (INCLLDE CORPORATION STOP)
$ $ SEWER TAP
$ $ ACCOUNT DEP05IT - SEWER
$ $ ACCOLNT DEPOSIT - WATER
g??? ?6 6) i? b - o- ? $ wAC
S SAC
$ $ TRUNK WATER ASSESSMENT
$ $ TRUNK SEWER ASSESSMENT
$ $ LATERAL SENEFIT/TRLNK SEWER
$ $ LATERAL BENEFIT/TRLNK WATER
S A
R R
A
W
TE T
EATMENT PLANT SLRCH
RGE
$ $ OTHER:
$ LrZTOTAL
--- _? c3 -f ? ? , ,• . ?lJ ? ? ?-RECEIPT ' RE EIPT -DOES UTILITY CONNECTION REQLIRE EXCAVATION IN POBLIC RIGHT OF WAY?
? YES IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC
ROADWAY" MLST $E ISSUED BY THE ELVGINEERING
El NO DIVISION. LIST AS A CONDITION.
SUBJECT TO THE FOLLOWING CONDITIONS:
APPROVED BY:
?
TITLE:
DATE :
zl,{ e
CASH RECEIPT
CITY OF EAGAN
? 3830 PILOT KNOB ROAD ,
EAGAN, MINNESOTA 55122
;. \ DATE zI -7 tg '
) I i
Q lp ? 1 t
NECEi?vE?o yl '1 ? J ?I I ..r?n. ..
1 A
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? A
a ooLLAas
? V ?
? CASH IETtHECK
? ? wn ''J ? -? ,c,j '_7 0 ? y ' ? L n,.{ l ' 1,.0 •,
?
i
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Plt??c?t*
4//ov
`? / _s ? ?¢ I I ca
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FUND O&IEC-V - AMOUNT
?? .
clFr "? 1 'E?P? IS -
a
,
,
hadn oy.?? ?? \
??? ?I(??n/1 eY ;0
asP 9?0? ? -- ;l??c ?. vy O??
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Y ?+' , R ? . . Yellow-Poetug Copy . /' .,
. Pink-FfleCo(iY
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I`QCid?°?'
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I e r-l' m. 3?6 1?-.
3 ?V(/ 91 ?2,
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ORF) 9q632,
p&P 99UCoG
Os' P 99OCo']
DAKOTA COUNTY NAME / DESCRIPTION AND DELINQUENT TAX RECORD
?
l
w
N
V DESC fi IPTIQ
PROPERT
.
J
PARCELIOENTIFICATION D?STRICT? _. ' ? T
??? ?l?r Schoa
iCt
Di
1 SECIOi 70W?
a
CK RANGE F
OIST PLAT LOT BLK 5
? S io
? i? 0[v q., u?64 :_Sc u L_Xi:Vi;7?:;+ NILL? =
.t T a
_ ?
TRANSFER DATE CRV. NO. IAST GRANTEE
?1 ,;IVIS1..'rJ
JIV :.?XIPv7L:i? ,?'s'..;UTH iNL
d7 Y..? L`?%I!??T?:J ??.:+t7H INC
?U H L Z PTN!t5
4 17 87 H& Z Paztners WD
13 T
D' S
T,l
u.
?f
.,? 5 Al N7 S
(5-11?)
?-??-
f?_,?
/ ? - ig
?
v - -. tJ
HAUGE, EIDE & KELLER, P.A.
J'Lttn.neys at d.ow
TOWN CENTRE PROFESSIONAL BLDG., SUITE 200
? 1260 YANKEE DOODLE ROAD
EAGAN, MINNESOTA 5512-3
(612) 456-9000
June 17, 1987
TO: Tom Hedges
Tom Colbert
X Gene VanOverbeke
Dale Runkle
FROM: Paul Hauge
Kevin Eide
X Dave Keller
Lori Bellin
Debra Schmidt
i%ij 7 7
PAUL H. MAUGE
KEVIN W. EIOE
DAYID G. KELLER
IORI M. BEILIN
DEBFA E. SCNMIDT
?. Lots 1,4,7,8 and 11,_Block l,?Lexington Hills First Addition
project rto.i` 478 - Lexinqton South, Inc. to the City of Eagan
Enclosed please find:
Development Contract
PUD Agreement
1 Easement Trai1 Easementi
Deed `
Other
Action requested: Please place this recorded document in your permanent
file.
cc: Bruce Allen
?
TRAIL EASEMENT
r ..?.Yw.q q w
THIS INDENTURE made and entered into this /,S"11A_ day of ,-4 ?-I "",?jzz- ,
1986, by and between LERINGTON SOUTH, INC., as Grantor, and the CITY OF EAGAN,
Dakota County, Minnesota, as Grantee. ?
WITNESSETH WHEREAS, said Grantor is the owner of the tracts of land in the
City of Eagan, Dakota County, Minnesota, legally described as follows:
Lots 1, 4, 7, 8 and 11, Block i, Lexington Hills First Addition.
NOW THEREFORE, the said Grantor in consideration of One ($1.00) Dollar and
other good and valuable consideration to it paid by Grantee, receipt whereof
is hereby acknowledged, hereby conveys, warrants and dedicates to said
Grantee, its heirs and assigns, for trail purposes, together with the
unrestricted right to improve the same, free and clear of all encumbrances,
the following described tracts of land:
A 10.00 foot wide perpetual easement
and across that part of Lots 1, 4,
First Addition, according to the
Minnesota, the Westerly line of sa
southwesterly lines of said lots and
right-of-way of County Road No. 43.
for street and trailway purposes over
7, 8 and 11, Block 1, Lexington Hills
recorded plat thereof, Dakota County,
id easement being the westerly or
being parallel with and adjoining the
The Grantor, for itself, its hzirs, executors, administrators and assigns,
does covenant never to cut, damage, destroy or remove any tree or shrub or _
other natural, growth upon the hereinbefore described premises for the -
continuance of this easement, and does hereby grant and convey to the said
City of Eagan all grasses, shrubs, trees and natural growth now existing on
said lands or that may be hereafter planted or grown thereon.
The Grantor, for itself, its heirs, executors, administrators and assigns
does hereby release the said City of Eagan, its successors and assigns, from
all claims for any and all damages resulting to the lands through and across
which the parcel of land hereby conveyed is located by reason of the location,
grading, construction, maintenance, and use of a public trail wer and upon
the premises hereby conveyed and from the uses incident thereto, and the said
City of Eagan shall have the right to use and remove all earth and other
materials lying within the parcel of land hereby conveyed and the right to
construct and maintain, upon the lands adjoining the parcel hereby conveyed,
such portable snow:fences during such months as weather conditions ,make
necessary.
All s,tumps and other debris resulting from the clearing of the right-of-
way will be disposed of by Grantee by burning or otherwise, according to law,
The Grantee shall have the right to post such signs and posters along said
trail as are deemed necessary and suitable to define the above lands and
locate them for public use.
,-
.. `
LEX/NGTOIV HILLS FIRST ADDIT/ON
?
? I . .
I ?? `\ YMM ?j1Y 1/ III? f1 111 I/ ft K 01I 11 SKIIM _23
y.?\ rA ? ""S89'0139'E 123926--• - ' ? --- -
"
wa
'uM 7
I \Si S
3
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\ ` 1? ?, `? ??/l 4???a \'Y
I \ •? ``` • ` ` ???/Y•`\? / \ fr'I ? '
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4
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`L. N1 I
t \?? `';?4 .r"° i•? ? a?? nwr?eoti ? i e m wo a
,I ,? ,? ?w? ` .•'. a m ? 1 L-?+1?.? _
? ?_, q?`\•? •y; uav . mao ? ? us m 6 0 8 ? 0
{?, J .? ' ?` t[4[
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?rw. ...?.. ....... .. ;
.,
-
Street and Trailway Easement \I %` ?-"??4-`-- ?
EXHIBIT \Z " 1 - Hgg•49'00'W 620'54-- , ..( .
,,O 1 u i
I J' I _
Z
A 10.00 foot wide Perpetual Eaeemant.`for 5treet and Trailway
purposes over and across that part of Lots 1,4,7,8 and 11,
Bloek 1, LEXINGTON HILLS FIRST ADDITION, according to the
recorded plat thereof, Dakota County, Minnesota, the i9esterly
line of said easement being the westerly or Southwesterly
lines of said Lots and being parallel with and adjoining .
. the right-of-way of County Road No. 43. -
?
?
.r ? ?-
IN WITNESS WHEREOF, said Grantor has hereunto set its hand avtDc.vexi the
day and year first above written.
LEXINGTON SOUTH, INC.
sy: ,
zts • el??
By:
irs:
STATE OF MLNNESOTA)
) ss.
COUNTY OF ?//{ 1__ )
On this i50 day of c, 19?'G, before me a Notary Public
within and for said County personally appeared 77?j j?• C?ui22
and ?- to me personaliy nown, who..y, being each y me
duly sworn that they are respectively the ?and
°--' of the Corporation named in the foregoing instrument,
and that the seal affixed to said instrument is the corporate seal of said
corporation, and that said instrument was signed and sealed in behalf of said
corporation by authority of its Board of Directors and said ,i.4 „C/,7,k 1„ L
and -? acknowledged said instrument to be the ree act and
deed of the corporation.
(S E A L)
THIS DOCUMENT DRAFTED BY:
Hauge, Eide fi Keller, P.A. ?
1200 Yankee Doodle'Road '
Water View Office Tower, Suite 303
Eagan, MN 55123
(612) 456-9000
a
.+u U
< ,•o, eiaa?•M
PiOTA4Y FU3GC MINNESOTA '
? DAKOTA COUN7Y
`•?? y Commiasion Expires Sapt. B,1S 90
A?
EXEMPT FROM STATE DEED TAX STAMPS
Exempt from Dakota County Deed Tax
hhYY)l?n
Oekota
County Treasurer
COVNTV CONSERVATIO??h?F
klbtL= Unma?
DAKOTA COUNTY TAFASURErI jlb-?
2004 COMMERCIAL PLUMBING PERMIT APpLICATION
. ? CITY OF EAGAN
/ 3830 PILOT KN08 ROAD, EAGAN MN 55122
651-675-5675
Date 3
Site Address
? Unit #
Tenant Name t a Y?_:_ u?}r A_ e
_ Former Tenant Name
Property Owner
Telephone # ( )
-% ? :f ?,
Contractor Address
State Zip r) 1 Telephone #
The Applicant is pWRCT
Work Type _ New Bldg
.,
__,K'Contractor
RPZ
meter si" is
PVB Irrigation system *
ess smaller size permitted by Public Works
Description oF Work rZ C!2 p?
To mquire if Pressure Reducine ValvP;?
new service,
Meters - Call 651-675-5300 to verify that hydrostatiq conductivity, and bacteria tests passed prior to nickin2 un meter
Irrigarion Size & Type Avg GPM
Fire Size & Price 3/4" dis lacement 155.00
Domesfic Srze & Type Av GPM
g Iacludes high demand devices? Yes No
Flushometers , Yes _ No PRV Required _ yes No
Permit Fee $50.50 minimum (includes State Surcharge)
Contract Value $
x 1% _ $
Base Fee
Required on all new buildings & boulevard irrisationsystems $
$ Meter(s)
If base fee is $1,000 ur less, surcharge is $
50 Radio Meter Read
.
If base fee is over $1,000, surcharge is $.50 per $1,000 of the Dase Fee
------^---- $
State SutChal'ge
-????______-------------
Following fees apply only when installing new irrigation system
C
ontact Jeny Wobschall at 651-675-5024 for required fee amounts WatCr Peirilit
$
? , - ? -? -
? Treatment Plant
, Water Supply Bc Storage
-----------
?
l $I
I
State Surcharge
-------------
k
--------------
,
?_;
?----------------
------ ?
- ------------------------
---------------------------
---------
;r"y $ ? 5? • ? Total Fee
I hereby apply for a Commercial Plumbing Permit and aclrnowledge that the information is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Ea
an
d
i
h
h
g
an
w
t
application for a permit, and work is not to start without a permit; that the
which requires a review and approval of plans. t
e Plumbing Codes; that I understand this is not a pernvt, but only an
work will be in accordance with the approved plan in the case of work
P&,, I L2 a-sQ-V?e.?- 2
Z-
f ¢'
ApplicanYs Pnnted Name 1
-
-
- --
Apphcant', Signature
'
REQUIRED INSPECTIONS:
PLANS SUBMITTED
CITY USE ONLY
_ U.G. _ Air Test _ Gas Test
_ APPROVED BY:
_ Rough In _ Final
, BUILDING INSPECTOR
General Information
• Radio Meter Read (required on all new buildings & boulevard irrigation systems- $141.00
• RPZ's must be rebuilt every five yeazs. A miniroum fee permit per address is required for RPZ rebuilding or repairing.
• Water meters include copper horn/sirainer, remote wire, and touch-pad meter
GPM METERS USE PRICE GPM METERS USE PRICE
1-20 7/8" residential $121.00 4-120 1-1/2" ltng3tlOri Syst $ 788•00
displacement sm commercial turbine**
must receive
maximum
appCOVaI
continuous
10 from Public
Works
2-30 3/4" lawn irrigation $155.00 4-160 2" turbine Ig irrigation syst $ 992.00
maximum displacement residential &
continuous sm commercial production lines
15
3-50 1" displacement very lg res $200.00 1/4 to 160 2" wmpound bldgs over $ 1,880.00
bldg to 24 units 65 units
maximurn sm commercial &
continuous & lg comm bldgs
ZS irri ation systems
5-100 1-1/2" bldgs 25-64 units $488.00
maximum displacement &
continuous most comm bldgs
50
METERS REOiJIRING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbine very lg irrigation $1,338.00 6-500 4" compound +300 unit bldgs & $3,749.00
syst & production very lg comm bldgs
lines
1/2-320 3" compound +200 unit bldgs $2,407.00 10-1000 6" compound +400 unit bldgs S6,124.00
very Ig comm bldgs very lg comm bldgs
15-1000 4" turbine very lg irrigation 52,384.00
syst
& production lines
?,ammencs
• To schedule inspection of the inside water line and backflow preventer, ca11651-675-5675.
• To arrange for water turn-on, ca11651-675-5300.
cc: Maintenance Division Clerical Technician
Updated 8103
,
22405 EAGAN CENTER 1ST 41600 KENSINGTON PLACE
••22407 EAGAN CENTER 3RD 45025 LEXINGTON HILLS 1ST
22602 EAGAN RSC TWO 45097 LEXINGTON POINTE 13TH
24100 EPISCOPAL CHURCH
LEXINGTON AVENUE PAGE 4 OF 4
4045 10 02200 015 75 sF
4065 10 02200 020 75 sF
4085 10 02200 012 76 sF
,f+?'C)U 10 45025 010 01 LexingtonHills24-UnitApt
1 Q 10 45025 030 01 Lexington Hills 24-Unit Apt
4116 ' 10 45025 04001 Lexington Hills Community Center
q
10 4502$ 050 01
Lexington Hills 24-UniY Apt
e?
412$ 10 45025 060 01 Maintenance/Office For Apts
_4j--Ie 10 4$02$ 070 01 Lexington Hills 24-Unit Apt
41 0 4$02$ 080 01 Lexington Hills 24-Unit Apt
4 10 45025 090 01 Lexington Hills 24-Unit Apt
4155 10 70500 040 01 Knowledge Beginnings Daycare
4160 10 45025 110 01 1.exington xills 24-Unit Apt
4165/ 10 02300 031 54 City Booster Pump
4175 10 22602 010 01 Qwest Addition - 2001
4180 10 24100 010 01 Episcopal Church
4201 10 Lexington/Diffley Athletic Facility
4220 10 45097 010 01 Walgreens
4225 10 02700 012 01
4250 10 22405 010 01 Lexington Ctr Mall-Dr Jacqueline Burns 2/99
4260 OUTLOT D
4300 10 22407 010 01 New Horizon Child Care
4301 10 02700 014 01 Lexington Diffley Service Bldg
4325 1002700 Lexington Diffley Park Pavillion
4391 10 02600 015 31 Goat Hill Park
10 41600 010 00
11
2004 COMIVVIERCIAL PLUMBING PERNIIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
-A 5 0•Z??
Date
Site Address Unit #
Tenant Name ? Former Tenant Name
Property Owner Telephone # ( )
Contractor
Address *jQt- City
'?(
[C(C?_r/\
State ?VkNf Zip Telephone # (Lj
The Applicant is _ Owner ? Contractor _ pther
Work Type _ New Bldg _ Add-on _ Repair RPZ PVB Irrigation system *
* Jer Wobschall to catculste fees. Re uired meter size is 2" turbo unless smaller size ermitted bv Public Works
DesCription of Work r-Q mCy.,e_ + CC+.Q 1 mCIC:??? h,,`?
To mquire if Pressure Reducmg V'alve is require?on new service, ca11651-G75-5646
Meters - Call 651-675-5300 to verify that hydrostatiq conductivity, and hacteria tests passed orior to nickine un meter
Irrigation Size & Type Avg GPM
Fire Size & Price 3/4" disnlacement $155.00
Domestic Size & Type Avg GPM Includes high demand devices? _ Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No
Permit Fee $50.50 mrnimum (includes State Surcharge)
Contract Value $ x 1% _ $, Base Fee
$ Meter(s)
Required on all new buildings & boulevard uri tion systems $ Radio Meter Read
If base fee is $1,000 or less, surcharge is $.50 $ StatC SAich3rge
If base fee is over $1,000, surcharge is $.50 per SI,000 of the Base Fee
-"
-----------'---°--------'-°-------------------'--'°--'---
FoUowing fees apply only when installing new irrigation system $ ----------- ------'---??
Water Pernut
Conffict Jerry Wobschall at 651-675-5024 for required fee amounts
Treatment Plant
$ Water Supply & Starage
$
i State Surcharge
-----------------------------------------
--------------------------------°--rr------- --- ----------=-------,---------
t??._. -----------------------------------
? Total Fee
, L___ti..
-° ??, 'rrr . w,noIng rermu ana acimowieage tnat tne mtormanon is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a permit, but only an
application for a permit, and work is not to start without a pemvt; that the work will be in accordance with the approved plan in the case of work
which reqmres a review and approval of plans.
PcL ?... I? Cz SCke r- ?? ????
Applicant's Printed Name Applican 's Signature ?-
CITY USE ONLY
REQUIRED INSPECTIONS: U.G. Air Test Gas Test
PLANS SUBMITTED APPROVED BY:
Rough In _ Final
BUILDING INSPECTOR
General Information
• Radio Meter Read (required on all new buildings & boulevard irrigation systems- $141.00
• RPZ's must be rebuilt every five years. A minimum fee pernut per address is required for RPZ rebuilding or repairing.
• Water meters include copper horn/strainer, remote wire, and touch-pad meter
GPM METERS USE PRICE GPM METERS USE PRICE
? 1-20 5/8" residential $121.00 4-120 1-1/2" irrigation syst $ 788•00
displacement sm commercial turbine** must receive
tnatimum
approval
continuous
10 from Public
Works
2-30 3/4° lawn urigation $155.00 4-160 2" turbine lg irrigarion syst $ 992.00
maximum displacement residential &
continuons sm commercial producrion lines
15
3-50 1" displacement very Ig res $200.00 1/4 to 160 2" compound bldgs over $ 1,880.00
bldg to 24 units 65 units
maximum sm commercial &
continuous & lg comm bldgs
25 irri ation s stems
5-100 1-1/2" bldgs 25-64 units $488.00
mzximum displacement &
continuous most comm bldgs
50
METERS REOUIRING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
F METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbine very lg irrigation $1,338.00 6-500 4" compound +300 unit bldgs & $3,749.00
syst & production very lg comm bldgs
lines
1/2-320 3" compound +200 unit bldgs $2,407.00 10-1000 6" campound +400 unit bldgs $6,124.00
very lg comm bldgs very Ig comm bldgs
15-1000 4" turbine very ig irrigation $2,384.00
svst
& production lines
?.VIIIIIIGllLS
• To schedule inspection of the inside water line and backflow preventer, ca11651-675-5675.
• To arrange for water turn-on, call 651-675-5300.
cc: Main[enance Division Clerical 'fechnician
Updated 8/03
?
2005 COMMERCIAL PLUMBING PERMIT APPLICATION
CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
,-? 5D .E?D
Date 3 / iq_ / Q(,
Site Address I ?? e-5 Unit #
Tenant Name L{' I fp f-? t?t,6 Former Tenant Name
Property Owner ?e- Telephone #( 451) 45.1"-6313
Contractor I2F7 2 ??V-0 Ce5
Address ? Lfqp ? 153 ? e- VS .Fi Cit? ??4-(LE
State rn t'? Zi ? Telephone #(t/j
License #=3?2PM Expires: 1.`) - 3
The Applicant is _ Owner Contractor _ Other
Work Type New Bldg _ Modify Tenant Space RPZ PVB _ New Repair/Rebuild /V, Replace
_ Irrigation system Work within public right of-way/easement _ Yes _ No
Rain seosors are re uired on irri ation s stems
erv vc- 2 veL c- i a- D
Description of Work (0 n'6n?[
4r- JA)l ?AeJ1G . ?V'i%7,+? Iw) 3:'i -LF?.? •-`r?s??- ?G//I?
.
fioi?juire tf ressure Reducing Valve is require on new service, call 51-bi 75-5646
Meters - Ca11 65 1-675-5 300 to verify that hydrostatic, conductivity, and bacteria tests passed prior to nickine uu meter.
Irrigation Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works
Fire Size & Price 3/4" displacement $161.00
Domesric Size & Type Avg GPM Iacludes high demand devices? Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No O
0
Permit Fee $50.50 mdnimum (includes State Surcharge) ?O
?
?
?
Contract Value $ x 1% _ $ ? • ? Permi
?
e
?
$ Meter(s) Z?6?6' ?
Required on all new buildings & boulevard irripation svstems $ Radio Meter Read
If pemvt fee is $1,000 or less, surcharge is $.50 $ SY3te SUICh3ige
If permit fee is over $1,000, surcharge is $.50 per $1,000 ot the Permit Fee
Following fees apply only when installing new irrigation system $ Water Permit
Call Jerry Wobschall at 651-675-5024 for required fee amounts
$ Treahnent Plant
$ Water Supply & Storage
$ State Surcharge
-- ---- ---------------------------------------------------------------------- ??
---------------------------
$ ?? ? J V
----------------------------------------
Total Fee
1 hereby apply tor a Commercial Plumbing Permit and acknowledge that the information is complete and accurate; that the work wiD be in
conformance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand this is not a pemut, but only an
application for a permit, and work is not to start without a pernut; that the work wi11 he in accordance with the approved plan in the case of work
which requires a review and approval of plans. ?
?
Wi p.ha e I lkks?ma..n
ApplicanYs Printed Name Ap icant's Signature
j ?
CITY USE ONLY
REQUIRED INSPECTIONS: _ U.G. A'v Test, . Gas Test Rough In _ Final
,
;,.
PLANS SUBMITTED ,4PPROVED,BY BUILDING INSPECTOR
. . . . .n _ . .. i ?....,.?,?i.
General Information
•.
• Radio Meter Read (required on:all new liuiiduigs & boulevard irrigaUOtt systems- $141,00
• RPZ's must be tested everyyeaz and rebuilt;every five years. Test results should be mailed to Paul Heuer at the City of Eagan.
• A minimum fee permit per address is required for the following RPZ's: new, rebuild re air , remove.
_?
• Water meters include copper horn/strainer, remote wire, and touch-pad meter.
METERS REOUIRING 4-HOUR ADVANCE NOTICE PRIOR TO PICK UP
METERS USE ,;. , . PRICE, ..,GPM METERS USE PRICE
residential $125.00 4-120 1-1/2" . "imgatlon Syst $ 735.00
[ displacement sm commercial turbine** public Works
ra
must approve
meter size
3/4" lawn irrigation $161.00 4-160 2" turbine Ig irrigationsyst $- 931.00
maxunum displacement residential &
conhnuous
....
. _
..
sm commercial _ .. ,-..
production . lmes _.....,..,.
15 ,
,,
. .
„
?,- •_ _- ...
i
•
, ._ `?
?..
77
_
3-50 1" displacement very lg res $296.00, ._1/4 to 160 2" compqund b]dgs,ovez f ?$ I;$49.00
bldg to 24'-umts " - - ?` 65 units
•
maxunuxn
° . : _ _ . .
. _ sm commercial _, ._,. .. , .
&.,-- .._. ... .,
continuous & ..
m , ; ,
± lg comm bldgs
25 irrigation s stems
5-100 1-1/2" bldgs 25-64 units , $429.00 •. - ;
maxunum displacement & -
continuous most comm bldgs
50
METERS REOUIRING 30-DAY ADVANCE NOTICE PRIOR TO PICK UP
GPM METERS USE PRICE GPM METERS USE PRICE
5-350 3" turbine very lg irrigation $1,182.00 6-500 4" compound +300 unit bldgs & $3,563.00
syst & production very lg comm bldgs
lines
1/2-320 3" compound +200 unit bldgs $2,282.00 1 1 10-1000 6" compound +400 unit bldgs $6,076.00
very Ig comm bldgs very lg comm bldgs
15-1000 4" turbine very7g irrigation $2,226.00
, syst
.
'
,
,
._
,
...
& production
Bnes
... . .:...: .. :
,
;
, ._
,.,,
. . _
:
iV11LL11111W
• To schedule inspection of the inside water line and backflow preventer, ca11651-675-5675.
• To arrange for water turn-on, ca11651-675-5300.
cc: Maintenance Division Clerical7'echnician January 2005
i- - -----------,
? Far OH.ice?Use ?
I Permit #: 85034 I
I
j Parmit Fee:
I I
? Date Received: ?
? Staff:
J
- - - - - - - - - - - - -
2008 COMMERCIAL BUILDING PERMIT APPLICATION
Date: 72 O$ Site Ad?es s:`EXI NG7?.r .IQv? 5,
TenantName: /ExlAJb'}nj T'tf"5 (Tenantis: New/ k- Existing) Suite#:
PROPERTY OWNER Name: ??4 Co2 ? c- Phone: °y97
Address / City / Zip: 6q0 9 fITT 40t3T/h* 4--- t d2-
Applicant is: _ Owner ?C Contractor
TYPE OF WORK Description of work: r1
Construction Cost: 091'5tu?,' ?I
CONTRACTOR Name: WALICxyL 4'-'F (N(y License #:
Address: Z27 C/vaP 4
City: S"s `'A?.[- Siate: A/"4-) Zip: SS?/Y
Phone: & 5-('ZSI"0910 ContactPerson: C-/L( C- 4
ARCHITECT / Name: Registration #:
ENGINEER
Address:
City: State: Zip:
Phone: Contact Person:
Licensed plumber installing new sewer/water service: Phone #:
NOTE: Plans and suppartfng documents fhat you submit are consfdered to be publlc information. Portlons of
the information may be ctassified as non-public if you provlde speclfic reasons that wouid permlt the City to
conclude that the are irade secrets.
I hereby acknowledge that lhis information Is complete and accurale; Ihat the work will be in conformance with the ordinances and codes of the Ciry of
Eagan; thal I understand this is not a permit, but only an application for a permit, and work Is not to start without ermit; that the work will be in
acwrdance with the approved plan in the case of work which requires a review and approval ot plans. "V
X grcc-
ApplicanYs Printed Name
Page 1 of 3
Use BLUE or BLACK Ink
I For Office Use
I
Permit
City of Ea
Permit Fee:
3830 Pilot Knob Road I L I
Eagan MN 55122 Date Received: f 1
Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I Staff:
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: U e 17 Gvj S Unit
Name: CL Cli X2 Phone: -763 " 3 ~3
Resident/ v 1 _
Owner Address / City / Zip: inA Si 3
Applicant is: Owner _ Contractor
Type of Work Description of work: Z5-
Construction Cost: Multi-Family Building: (Yes / No
Company: I'`)~~~~ > z~rs n~ Contact: EJ/ kR c
r
Contractor Address: J LGL4. -k- Sh%; -e- City: '-LAy-er- (so-
,e-State: /YIZip: ~ X71- Phone: 31- ~ V-666 t1'
License 9 e g$'3-7,']l{ Lead Certificate A/A-r 7L/s3 S-/
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 they 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. www.oopherstateonecall.ora
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 Building Code must be completed within 180
days of permit issuance.
x tAk///A.yt K2C/e-k x
Applicant's Printed Name Applicant's Signatur
Page 1 of 3
Use BLUE or BLACK Ink
. r_________________
I For Office Use �
� Permit#: �� � �� �
Clty of �a�a� , ,
3830 Pilot Knob Road I Permit Fee: U I
Eagan MN 55122 � �
Phone: (651) 675-5675 � Date Received: �
Fax: (651) 675-5694 � �
I Staff: I
�-----------------f
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications.
Date: �� �1' l� SiteAddress: '�� � �-�X���'����`" �U� �"�.� ���rV
Tenant: Suite#:
Name: ��1�-� -- - --- - � ..�...� �. N �.9..w._.._.__,
Resident/Owner "'� ��^'�0j F m�w Phone: �J63��{�� 3//�
Address/City/Zip: �{� C� W�sT r ��cvt� ci'Fw l�Af��� ��.3��
Name: f� � � (,��yS �f1 f��'�S License#: ��Yl C'S� G a�
Contractor Address:_��S � GDL�f,� L-(� J.�- City: �112��, � f �ivfS
(� Udv.��� State:��'-�Zip: 5���� Phone: ���' 36�' �a��
���^
(�O U G Contact: (�S J` o�I� - Q��y Email:
New _�Replacement Additional Alteration Demolition
� Type of Work Description of work:
NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
RES/DENTIAL COMMERCIAL
_Furnace _New Construction _Interior Improvement
� Permit Type —A��co�a�t�o�e� Install Piping _Processed
� _Air Exchanger �Gas PtP�M1'G _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) �`'�
$100.00 Residential New(includes $5.00 State Surcharge) _ $�Q�� TOTAL FEE
� COMMERCIAL FEES � �� Contract Value $ x.01 �
$55.00 Permit Fee Minimum �
$70.00 Underground tank installationlremoval =$ 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
""I� f 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 t� rV � X ,
Applican 's rinted Name ApplicanY S'gnature
FOR OFFICE USE
__ Required Inspections: Reviewed By: Date:� � � ��
,, _ - �/'�����
Underground Rough In Air Test \ Gas Service Test In-floor Heat -�inal � HVAC Screening
Use BLUE or BLACK Ink
�-----------------�
� For OfPlce Use �
f 3 I
' � Permit#: /� G( ����/ �
�1�� �f ���a� � � �D. �� �
� Permit Fee: � �
3830 Pilot Knob Road � �
Eagan MN 55122 4 ,� • � Date Received: �
Phone: (651) 675-5675 � ��� �� � star�: � � i
Fax: (651)675-5694 �________________�
2015 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: �� � Site Ad ress: � V�- � � �
Tenant• � L t� � Suite#•
���������` Name: �v� I �l� ��`� Phone: l(J✓l '� �1 J� T D 3� 3
�°� Address/City/Zip: �� �'� ��� `� `-�-� ��
` pc�� a�
� `;� . Name: icense#: D
1 ri: �Q,� �
��+M�?�`��f"' ` , .
Address: �-' � Ci
' Phone:�'�-'' '- ��`°l
State: Zip: �
f ��: �"� \ !��
Contact: Email:
_�
` ' New Replacement !Repair Rebuild _Modify Space Work in R.O.W.
������� — — ��� � (,��-� a.- 33
y„ ' Desc�iption of work:�=�L e �
� ���
RESIDENTIAL
�
Water Heater
Lawn Irrigation(_RP21_PVB} Water Softener
���'�� Add Plumbing Fixtures�Main!_Lower Level)
Septic System
� �� t .��� New Water Turnaround
� Abandonment
RESIDENTIAL FEES:
$60.00 Water Heater,Water Softener, or Water Heater and Softener(includes$5.00 State Surcharge}
$60.00 Lawn Irrigation (includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic SYStem Abandonment,Water Turnaround*(includes$5.00 State Surcharge)
*Water Turnaround(add$200.00 if a 518"meter is required)
$115.00 Septic SVStem New($10.00 per as built)(includes County fee and$5.00 State Surcharge)
TOTAL FEES$
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 unde�ground utilities. www.cl,opherstateonecall.org
I hereby acknowledge that this infamiation is complete and accurate;that the work will be in conformance with the ordinances and codes of the City of
Eagan; that 1 understand this is not a permit, but onty an application for a permit, and rk is not to start with t a perm+t; that the work rnriH be in
accordance with the approved plan in the case of work which requires a review and approv f plans.
.�-�
X � �� �f l� t.�¢- x 'I �
ApplicanYs Printed Name App cant s Signature
, � , � �
� , ; �
�����"����� ; �z x�_ a x` _ •�������'r r � .-:��i.u.w ����- .
���� � �.��Y��:��� $ s�' z����� �,_����� �,��� h t,y`
1
+' � t
1��!I��`���+����`c ��'�����k�!� �� ����+f�t� y Z'1�3 � �" �� � ,
;
_:, <
c � k.`
. a...a� ... ..,...� ,.✓ �, h.,,..w. . , �rt.. ,x.n � , . .. ,. a.�. �
v:
.�.� . ... .., .. .. �=
� x