4333 Medary AveCITY OF EAGAN Remarks
Addition Lot $ Blk 3 Parcel 10 64400 M? 0-4
Owner Screet 4333 MPdar= AnP State Edgsn,= 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTQR,
GRADING
SAN SEW TRUNK
* SEWER LATERAL
70-
WATERMAIN
* WATER LATERAL
WATER AREA
STORM SEW TRK
* STORM SEW LAT 1976 3
CURB & GUTTER
SIDEWALK
STREET LIGHT ; 1980 67.80 13.56 $
WATER CONN.
BUILDING PER.
SAC
PARK
CITY OF EAGAN
, 3830 Pilot Ktab Road, P.O. Box 21•199, Eagan, MN 55121
? PHONE:454-8100
BIjJILDING PERMIT Receipt Te 6e wrd W DFLCX 13COEF Est. Value a6n 0(w Dote k2a:TT, a4, 19 ?u5
SiteAddress 13333 ''"?DAFZY AV' Erect 0' . Ocapency
3
Lot Blxk Sec/Su6 --Ij/,,F"y t*'y.j,J?r?..t.. e Remadel ? Zoning
. Repair ? Type of Const.
Parcel No.
Enlarge ?
No. Stories
" If d SC•j121D`d' Move
?
Length
? Name
?u
= ,?,,
SAI Demolish ? Depth
Address Grade ? Sq. Ft.
U City Phone -' Install ?
c S['Irtil': ApPeovals Faes
o Name
u
llsxsunent
Pertnit
?
Address U i
City Phone
Woter a $ew.
$urchorge
P I' PI Revie
?W
?uW
Name
x? Addrese
?W City Phone
o ?ce
FIro
Erq.
Planner
Council N
an w
SAC
Water Conn.
Water Meter
Rood Unit
1 hereby acknowiedge that I have read this opplicotion und stote tFwt gldg. Off. -4/2405 Perks
tha inlormation is correct and ogree to wmply with all cpplicable APC I Total
StaM of Minnewto Stotutes cnd City of Enflan Ordincnces. •
-' , ?- Var. Date
Siynotum af Permittee
il 114 6nAdtI4T
A 8uilding Pertnit Is issued M: _ on Me express conditlon 1hal
oll work shall De done in ocmrdan[s with oll opplimble State of Minneaoro_Statutea and Ciry of Eapan Ordirances.
Buildinq Officiol
' _kl
Permit No. Pertnit Holder Dete Tele hone #
Plumbing
H.VA.G
Electric
Softeaer
Inspedion Date Insp. Other
Footings yS o, `?
Foundation
Framing
Rooiing
Rou? Plbg. .
Rough HVAC
Inwlation
Finsl Plbp.
Final HVAC
Final
Cert/Oce.
Wahr Deseribe Loeation: .
YVell
Sewer
Pr. Disp.
CITY of EAGAN
? BUILDING PERMIT
Ownes .Kl,(/_
?•-.......
. . r .....................................•••-•
Add:esa (preaen!) ..................... --....
_---
..................
Huflder ..?J
,e?°'?,-..-••-• - -2?tJ._ ....................................
Address .Y.?2.?B..?I...?.?,P.st,?'...? ?I. ?'?'z.?4"/•?c?0-'.,/??'wi-r?'??5??35
&'y
r/
u,iw
N° 3844
3795 Pi1ot Knob Road
Eagan, Minnesofa 55122
454-BI00
aa:a :?.:?..'.7?
" LOCATION
Stree2, Road or ofher DescripYion of Location I Lot B1ock Addoa o: Trac!
lf 333 vA!Z' I 3 I _ Z?.
This permit does aot suih iae ihe use of slzeets, roads, alleys or sidewalks aor does i ive e owaar oz his agenf
the right fo ereate any situaiion which is a nuisance or which presents a hazard !o the health, safety, convenienee aad
general welfare !o anpone in ihe communify.
THIS PERMIT MUST BE KEPT ON 'I'HE "EMISE WHILE THE WORK IS IN PROGRE-SS?n.
This is !o eer3ity, thai..??-•---,???................ baspe:musion !o erect a.
2--
ihe above described premise subject So fhe provisions of all applicable Ordinances for f e City of Eag ?---k "'""ypon
..?.,..................................................... • Per , --?-•? -an ?'`
"-?'`""?•.F--?-'"?-!??..-•- •
Mayor • •••••••-•_• ............. ... ..•••••••....
Suilding Inspectos ??
CIlf.OF aAr,hT1
3?95 ?':i.?:o± ILiob Ro:z,d
Ea?,:n, i-I=rne::o-ta 55122
iz- /-/- 9
'rZ.?,',vII'T' ATO, e 807
T7e City of i;a.gan hereby grants
oi 4637 Chica,
a HEATING Pe=it for: ((7wner)_
atu _ 4333 Medant Ave. pursuant to
Fee Pa1d; $20•00 dated this 29 day
.50 s/c
to Ray N. Weltez Heating_& A/C
oAVe._ So. , 55407 .???.
__ WindsorDev. QorP•
application dated 3/22/76 _
of March
Builc',ing Inspector
P?ec:::anicaJ. Perrni+s:
Bid Totaie
, .
CITY . Cr' LP.C,ljrl
3i:?5 Pil.oi; I;.^cb 'i;oad
p?:r?= NO.:. 675
. . -- - ; . -
4
T:,e C_ty of Ea.gan herer.y g: ants to ThomPson Plumbinq do.
-?
Of 12201 Minnetonka Blvd. ?
?Ads0! L?8- V. ZbYp.v i
a PLUMBING Pe?a?it for: (Owner) Warren Andereon, & Ne?+ Horiaon Hamee
7flrd
4
"? -----.---? _? uan t to aj?plzcation dated 5/5/76 ,
billed
Fe? ftkk;: _ 160.00 ? dated this Stibay oi MaY ? 19 76 .
4.00sTc
Statement #865 •
L'aiidin.- Inspector '
L_1 rio-,.i?'7.!-.
?
CiTY OF EAGAN N 0- 101 4 2
3830 Pilot Knob Road, P.O. Box 21-198, Eagan, MN 55121
' PHONE: 454-8100
BUILDING PERMIT ttece+pt #
t
Te 6e ard ier DECK ROOF Est. Volue $4 r000 pote APRIL 24 lq 85
Site Address
4333 MEDARY
AVE erect
CK
Oca,pancy
5
Lot Bloek 3 ?/Sub RIVER HILLS 9 Remodel ? Zoning
. Repair ? Type of Const.
Parcel No.
Enlarge ? No. Staries
Name JIM SCHMIDT Move
h
D
li ?
? Length
h
Z
? Addreas S?E emo
s
Grade ? Dept
Sq. Ft.
city PAOne 894-5621 instan ?
? Name SP'ME
ou
Addreas
ul
? City Phone
?W
Name
?? Address
tw City Phone
1 hereby ocknowladge fhot 1 have read this applicction and stote that
the intormotion is correct and ogree to comply with oll applicoble
Stata of Minnesoto Statutes nd iry of Eoyan rdinanus. ,
Sipnoturo of Permittea
w Building Permie Is iuued to: JIM SCFiMIDT
all work shall be dons in accordcnee with all coolicalsk State of ir
Fees
Asussment Permit +"_'_ • ?jv
Water d Sew. Surchorge 2.00
Police Plan Review
fira SAC
Enq. Water Conn.
Plonner Water AAeter
Councfl Rood Unit
BIdg.Off.
1
1Z 241285 Parks
-
APC
I Total --5T6--3-U--
Var. Date
on ths expreas condition that
and City of Eoqon Ordinances.
Buildirp Official
VILLpCE OF EAGAN WATER SERVICE PERMIT
3795 Pilor Knob Rood PERMIT NO.: 1970_
Eogon, MN 55122 pp7'E; 515/76
Zoning: RI No. of Units: 1
Owner: WindsOr Dev. Oprp.
Address:
Site Address: 4333 Medary Aqe./ IS B3 RH 9
Plumber: V?MvPgOri P11IDlbiIlg CD.
Meter/? o.: ?803919 Connection ChazPs•? ?
Size?/ 5/8 RoCk Account Deposi[:
Reader No : 751170 Permit Fee: 10.00 billed 865
I a9r6ee }c eomOly with the Villoge of Eagan SurcharRe: • 50 billed 865
Ordinonces, Misa Chazges: 60.00 pCl
Total:
BY Date Paid:
Date of InsR.: Insp.:
*aLAcEIOF EAOAN SEWER SERVICE PERMIT
3795 Pilot Knob Road PERMIT NO.: 272$
Eagan, MN 55122 DATE: 5/5/76
RT
Z
i of Units:
No 1
on
ng: .
Uwner: Wi*+dsOt' DeV CorP
Address:
Site Address:4333 MedarTt
Plumber. ThomPson Pltm?bina Co
100.00 pd
with the Villoga o4 Eogan Connection Chaz
l
I
ne to com g?.50.00 pd
.
r
ag
p
osir
nt De
A
Ordinaeces. .
p
ccou 10. 00 billed 86
Permit Fee: .50 billed 865
Surchazge:
Chazges:
Misc
gy. .
f I Total:
7ate o
nsp.:
;
ngp Date Paid:
,
CITY U5E ONLY
PERMIT #: 4.?`? l I?v RECEIPT DATE:
EOOQ ftESIDEPTIAL MECRANICAI. PERMIT APPLICATIOA
crrY og EAsAN
ssso Pn.oT KNos Rn
EAEMM1v 551 Ss
651-6$1-4675
Please complefe for: ? single family dwellings
townhomes and condos when permits are required for each unit
Date: °1- 36 -0 Z-
SITE ADDRESS: " 3'5 ?j MC= O/-f R--' ?'"s"j C_
OWNER NAME: L , ^ C.N N ?v-y' L-_.?
INSTALLER NAME:
STREET ADDRESS:
CITY:
Place a check maric next to the permit work type
?
ZIP:
??F_r????TTN
_ Add-on, modification or alteration to existinp dwelling unit L OCT 0 4 2002 $ 30.00
• fumace replacement
• air exchanger
gi,
• air conditioner -= -- °- -
• other
Nature of work:
Zwo c )C,P1Gs?>1C,-A?rvC- _lDiooo g0`1e>
State Surchar e $ .50
Total $ 30. i ;
SIG ATURE 014 PERMITTEE
RESIDEWTIA. FIEA79NG ?'e Allk„ 1W'C,
1815 E.ast 41st Street, Suit? ;?%.
N?Inneapoi6s, MN 55407-3425
°51 e' 7"4-189c?
STATE:
TELEPHONE #: 6 r'J k
TELEPHONE #: b I 'Z- 72- 4 - I g c1 !
1/02
CITY USE ONLY
PERMIT #:
APPROVED BY:
INSPECTOR
RECEIPT DATE:
2002 COMbIEftCLfEL MEC}IANICi4I. PERM1T APPLICAT10ft
CITY 0F EAfi4R
3$80 PILOT KNO$ RD
EMM. MN 55Y 82
651-6$1-4675
Please complete for: all commerciallindustrial buildings
multi-family buiidings when separate permits are not required for each dwelling unit
DATE:
SITE ADDRESS:
OWNERNAME: PHONE#: -
TENANT NAME (IMPROVEMENTS ONLY):
WAS THERE A PREVIOU5 TENANT IN THIS SPACE? Y N. NAME:
INSTALLER:
STREET ADDRESS:
CITY:
TELEPHONE #:
STATE:
ZIP:
WORK TYPE: New construction Install U.G. Tank
_ Interior Improvement Remove U.G. Tank
_ Processed Piping
SpecifyNature of Work:
When installing/removing underground tank, call 651-681-4675 for inspection by Fire Marshal and
Plumbing inspector.
Fees: 1% of contract price OR $50.00 minimum fee, whichever is geater.
Underground tank removaUinstallation = minimlun fee
Contract price: $ x 1 %
State surchazge
TOTAL $
(Base Fee)
calculate at $.50 for each $1,000 Base Fee
SIGNATURE OF PERMITTEE
Updated 1/02
.:
L 5
SUBD.
? CITY USE ONLY
BL
12; ver l-h m G4-b,
RECEIPT #:
RECEIPT DATE: I V^2J-Oo
PERMIT# L33 % o
2000 PLUI-MING PERMIT (RESIDENTIAL)
CITY OF EAGAN
3830 PILOT KNOB RD
EAGAN, MN 55122
651-661-4675
Please complete for: ? single family dwellings
? townhomes and condos when permits are required for each unit
? backflow preventer for underground sprinkler system
CIYT11DFt
EACH #
TOTAL
Alterations to existing dwelling - minimum fee
Describe: $ 30.00
Bath tub $ 3.00 x = $
Floor drain 3.00 x = $
Gas pipin outlet ' minimum -1 3.00 = $
Hot tub/spa 3.00 = $
Kitchen sink 3.00 r = $
Laundry tray 3.00 = $
Lavatory 3.00 = $
Septic System new/refurbished " requires MPC lic. 75.00 x = $
Septic System abandonment 30.00 x = $
RpZ new installatioalrepairlrebuiid 30A0 x = $
Rough opening 1.50 x = $
Shower 3.00 x
Underground sprinkler if dwelling is under consVuction 3.00 x = $
Underground sprinkler if existing dwelling
Water closet 30.00
3.00 x
x =
= $
$
Water heater 3.00 x l = $
Water softener if dwelling under construction 5.00 x = $
Water softener if existing dwelling 30.00 x = $
Water turnaround 30.00 x $
State Surchar e .50 --> ----> --> $ .50
TOtal _> $
Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc.
---------------------------------------------------------------------------------------------------------------------------------------------
1 hereby acknowledge that I have read this applicatlon, state that the infarmation is coned, and agree to comply wRh all applicable City of Eagan ordinances.
It is the applicanYs responsibility to notify the property owner that the City of Eagan assumes no liability for any damages caused by the Ciry during its
normal operational and maintenance activities to the facilities constructed under this pertnit within City propertylright-of-way/easement.
SITE ADDRESS: ? ?3 m EDA94
OWNER NAME: TELEPHONE #: CPR,--L
(AREA CODE)
INSTALLER NAME: Nie, ga=l,? TELEPHONE #a?S-l -0SS-5
(AREA CODE)
STREET ADDRESS: r?'C A? ?/n1?5 t'?
CITY? ST TE:
0 T
SIGNATURE OF PERMITT'EE B?r_
i
4 IZ) /q 2,
1985 BUILDING PERNIT APPLICATION - CITY OF EAGAN
MOTE: ALL CONTRACTORS !{UST BE LICENSED WITH THE CITY OF EAGAN
INCLUDE 2 SETS OF PLANS
3 CERTIFICATES OF SURVEY
1 SET OF ENERGY CALCULATIONS
To Be Used For: Valuation: 4?(D66- 04' Date: q- Z4
Site Address :Y3 33 ?2cQCa.? -7 Al [1 C . OFFICE USE ONLY
-r-
Lot: s Block \.J Sect/Sub Erect ?
Remodel
Parcel # Repair
Enlarge
Owner j'c ? Fn ?4"I- Move
p Demolish
Address Y 3 33 hZ`v?c-?r ??-* Grade _
City/Zip Code
Phone y $?(- rC ?L (
Contractor
Address
City/Zip Code
Phone
Arch./Engr.
Address
City/Zip Code
Phone li
APPROVALS
Occupancy
Zoning
Type of Const
1l of Stories
Length
Depth
Sq Ft
Assessments Permit 44
_
Water/Sewer Surcharge 2.=°
Police Plan Review
Fire SAC
Engr Water Conn
Planner Water Meter
Council Road Unit
Bldg Off? Parks
APC ? Treatment P1
Variance
TOTAL
V6- S U
I ?" # js yo
DA'1.T :
BUILDIi`dG PEM,i'C'r APr T,TC,A..T''OY CHECK
LotBlock Addition
Parcel and section number
Street
---??-----
Owner Address T:='- L t:
Developer 7i Address-??,-,?
Zone-Ordinance #52
/6 7'?.ti / P?• a
Lot Size 7?, CP X3 O c?"?'xfc Total area Ju 90? ?..
b
Platted ? Unplatted
Building Size le?R ?L6 'y'• Total area /?JTq?A
Occupancy 5 1= /-,?.?,.,oD?p_????n
Type of construction /d?_??".?,., Q _
Setbacks: 5treet sides 39 Rear
' Sides
o,ca;. 2° Nac?ae
Parldnga
Total area
Parlang area setbacks:
Street side Rear Sides
Landscape apprrnral
Special Assessmentse
ShC charge
Water areas
Tota1 spaces
Bond required
@ $450.00 = 4D . rr0
/ 'r L-` • OP /24ln Sca
Assessed Unassessed
If assessed: Connection charge
If unassessed: Connection charge
Lot division:
Additional assessments needed
Laterals:
Assessed ?
laaiver of hearing a
Needed
Assessrnent clk Qs
Water & Sewer Dept
Not needed ?
Not assessed
Not needed ;i
}3uilding Dept
?
Police Dept _ Fire Dept (Comm & Ind only)
MASTER CARD
LOCATION ? A133
OWNER
. c ..
STRUCTURE AND ?
LAND USED AS
Permit ?
No.
Issued Issued To
Contractor Owner
BUILDING
PLUMBING
V
V ? 7G
CESSPOOL - SEPTIC TANK
WELl
ELECTRICAL
HEATING
GAS INSTALLING Q t?j 7
-u----F- -- 3? a ••?
'
SANITARY SEWER I
OTHER I
OTHER l
I
Items APProved
(Initial)
Date
Remarks
Distance From Well
FOOTING SEPTIC
FOl)NDATION ? I CESSPOOL
FRAMING TILE FIELD FT.
FINAL
ELECTR{CAL ?
HEATING DE PTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING -aq?7
WELL
SANITARY SEWER
- ?
Violations Noted
on Back
COMMENTS:
COMPLIANCE INSPECTION REPORTS
TO BE USED ONLY IN EVENT OF OBSERVED VIOLATIONS
PERMIT NO. DATE OF INSPECTION
CONDITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLfANCE
OBSERVED.
? ACCEPTABLE SUBSTITUTIONS OR
DEVIA710NS.
n NON-COMPLlANCE. BUILDER WILL COMPLY
??J WITHOUT DELAY.
ITEMIZED AND DESCRIBED AS FOLLOWS:
NON-COMPLIANCE. BUILDER DOES N07
INTEND TO COMPIY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL BE DELAYED 8Y CONDITIONS BEYOND
CONTROL.
? REIhSPECTION REQUIRED
REINSPECTION REVEALED
DATE Of REINSPECTIOtJ
CERTI FICATION - I certify that I 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 be at variance with ordinances of the Town of Eagan, approved plans and specifications, and any specific require-
ments for off-site improvements relating to the property inspected.
? ALL IMPROVEMENiS ACCEP7ABCY COMPCE7ED
BUILOING INSPECTOR
COMMENTS:
OATE
23
DEVELOPMEIVT CORPORAT[O(V
February 26, 1976
Mr. Da1e Petersons:
City of Eagan
3795 Pilot Knob Rd
Eagan, MN 55122
Dear Mr. Peterson:
Enclosed please find a check in the amount of $1,027.50 for
building permit fees, surcharges, SAC, water connections and
water meters on:
Lot 5 Block 3
River Hi11s 9th
4333 Medary Ave
This home will be a Model 76-52, Elev B, and wi11 include:
Walk up bsmt to garage Brick front under cantilever
Living room fireplace Patio door dining- no deck
Applia.nces Colored bath fixtures
Enclosed also please find a set of Master Plans for Mode1 76-52
for your files, and a proposed plot plan for Lot 5 Block 3.
A1location of funds is on the check stub.
Thank you for your cooperation.
5incerely,
WINDSOR DEVELOPMENT CORPORATION
Warren R. Anderson
Vice President
WR,A/ks
Enclosures
cA \ 1! J1; J I)
27, fgls
s'
?$
SUITE 192. 4660 WEST 77TH STREET, EDIIYA, MINNESOTA 55435 • PHONE (612) 831-0717
Cities Diaital Qualitv Control
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Use BLUE or BLACK Ink
r
I For Office Use
I
of Eakan 1 Permit a I
V
°.05 I
I Permit Fee: 105
3830 Pilot Knob Road
Eagan MN 55122 j
I Date Received: 0 13 I
Phone: (651) 675-5675
Fax: (651) 675-5694 Staff: I
L----------------J
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: ~d 7 D/ Site Address: Unit op or I Name: r /t Phone:
Od
Resident/ i
i Owner Address / City ! Zip: Jy.
/
Applicant is: Owner contractor
Type of Work Description of work:
a Construction Cost:
Multi-Family Building:
Yes /No
~ s ff
Company: ll~ 1jXA41OrS Contact:
Address: _33o f,. Agk y k ov City: ~h
Contractor 1 L'
State: ~L Zip: 41t179 Phone:
License Lead Certificate A07-1 Wl~
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 thelt 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.aooherstateonecall.ora
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 Building Code must be completed within 180
days of permit issuance.
x 4dade owq~ x -
Applicant's Printed Name l'41 nt's S' natur
Page 1 of 3
Use BLUE or BLACK Ink
� �-----------------i
+�;�� � For Office Use �
., � !o?�3a 7 �
ClU O1 1J� 1111 ��,"�� I Pennit#: �
Y � r�� � ��. �� �
� Permit Fee: �
3830 Pilot Kn'ob Road � / ,/�
Eagan MN 55122 �UN 2 6 ���1� I Date Received; '�(o '��`'�
Phone: (651)675-5675 � � �
Fax: (651)675-5694 BY; • � Staff: �
..�����������������J
2014 RESIDENTIAL PLUMBING PERMIT APP ICATION
Date: �' `�' Site�ddress: ....1� /'"V
Tenant: Suite#:
��: �„,�,���v ,��'ji� �,.f
ut; �j, ,
sy.ly 3�� '� '3 �8`�k �r'T! �`1t. Z .
�� „ �> �����*��; s ,� Name: '� . � ..-
Resi en�lOwner h Phone:
'� r ��� �.��� ���
k ����,���,��'�;�' �,.�,�` �': Address+�City/ZiP: `L.. ��
s � .: ,
�� �
�� � ���y� Milbert Company Inc dba Cul ` n Water
�":''.�� � �.��� ,
��_���;� ,��� `����: . , Name: ���nse#: WC643176
��d���w �'��� �� � ' � 180150t Street East
������� � .�� � Aaaress: c;t Inver Grove Hgts.
����Conxractor Y�
��z�t���������,������ �� M N z� 651-451-2241
<� „5 � r �r� � � State.:, p; 55�77 Phone:
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'��������� °�' ��r Nlew Replacement _Repair _Rebuild _Modify Space Woric in R.O.W.
��Typ"�e of Wor — —
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��r �,��� ����� � Des'cription o work:
�x;��.��, f�� ��� RESIDENTIAL
, �� „�� n
�`�'� �� `�'�d�� Water Heater
�`�k c � s;�� �� �,
4'x�x ��;. �' �Water Softener
, �,��� "�� ,F� Lawn Irrigation(_RPZ/_PVB)
��� Permit'T
� �+ �. � � yp•� ' Add Plumbing Fixtures�Main/_Lower Level)
� �������,.��� �,�=�r Se�ticSystem
��,�,����� ������
t '�;��,�_ ���� �.N�w Water Turnaround
�,�r'��,�}�,;<��'�� �
. �3h��„t$�,i+,.�✓ti w'�.' 'e �� �
`�� Abandonment
RESIDENTIAL f�EES: -
$&O.OD Water Heater;Water Softener, or Water Heater and Softener{includes$5.00 State Surcharge) �
$60.00 Cawn`Irrigation(includes$5.00 minimum State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Tumaround*(includes$5.00 State Surcharge)
, 'Water Turnaround(add$200.00 if a 5/8"meter is required)
�115.00:Septic Svstem New($10.00 per as built)(includes County fee and$5.00 State Surcharge) G�
TOTAL FEES S �
' CALL BEFORE YOU DIG. Call Gopher State One Call at(651j 454-0002 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive'locates of underground utilities. www.gopherstateonecall.or4
I hereby acknowledge fhat this informa_ion is complete and accurate;that the work will be in conformance with the ordinances and codes of the City oi
Eagan; thaY I understand this is not a permit but ony an appiication for a permit, and work is not to start without a permit; that the work wlll be In
acwrdance with:the approved plan in the case of wo►k which requires a review and approval of plans.
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Applicant's'.Printed Name Applicant's Slgn ure
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q 351 8'9
410/` City of Ba
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Date: I. J Li f
loQ
OC[062016
Use BLUE or BLACK Ink
For Office Use
Permit #: /369 S 8
Permit Fee:
Date Received: /0 - w "( 17
Staff:
2016 MECHANICAL PERMIT APPLICATION
0 Please submit LI (2) sets of plans with all commercial applications.
Site Address: LI 3 3 /`A1 d o- / e •
Tenant:
Suite #:
Name:Oti i I bU r tcdikhg
/
Address: I" I O y VCCUr i I I) oll
J '1
State: M N Zip: 7 3
Contact:
and h r License ##::> Le,` 1 .KJ
Hash i ash ns
Phone: 1151-113- -'IIT 7
Email:
4r41 f I O I t • it V i _` ► OSLO
New X Replacement
Additional Alteration Demolition
Description of work:
RESIDENTIAL
Fumace
NX Air Conditioner
Air Exchanger
_ Heat Pump
Other
New Construction
Install Piping
Gas
COMMERCIAL
Interior Improvement
Processed
Exterior HVAC Unit
Under/Above ground Tank ( Install / _ Remove)
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge
=$ Lv
TOTAL FEE
COMMERCIAL FEES
$60.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
Surcharge = Contract Value x $0.0005
If the project valuation is over $1 million, please call for Surcharge
Contract Value $ x .01
_ $ Permit Fee
= $ Surcharge
TOTAL FEE
=$
I hereby ackpowledge 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 Ka sseui Mo YS hrki
Applicant's Printed Name
x
Applicant's Sign
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