1619 Johnny Cake Ridge LaBURNSVILLE
Heating & Air Conditioning, L.L.C.
12481 Rhode lsland Ave S, Savage, MN 55378 • 952-894-0005
Orstdt Test Report for Jobt `18.3 3
/IddfeSSI& Ia fa?NNY CAKE 61m[ /^/ CIly EAGAn1
Occupant 141 TGfI t LL
Daleoflnstall ?-/5-03
Type of HT. F/A_)-(- HW Space HT Unit HT
Otlha
Malae I-c'rVPv x
Model 69(90-75- (p
Serial SSOaL- ZOr-) 5-0
Input 75, voo g77,4 N
Pilot Type HOT SURFACE IGNITOR
Pressure 3•S ?wK- C02 b. S
InputCFH "75- 02 X•?
StackTemp 98 CO .&-
Date Tested 3- Z % - o
Company BURNSVlLLE HEATlNG & AlR CONDITIONING
Technician
PLUMBING (RESIDENTIAL)
Permit Application
g? City Of Eagan \
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5674
Please complete for: Single Family Dwellings
Townhomes and Condos when permits are required for each unit
Date 2V
SiteAddress Unit#
Property Owner Telephone k(((!
Contractor
Add
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?
ress
I/fo (
ty
Y?
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State ,OA /I . Zip 11(-- Telephone #
The Applicant is Owner Contractor _ Other
Septic System New _ Refurbished Submit 2 sets of plans and MPC license $ 100.00
Includes County fee. Additional consultant fees may apply.
Alterations To Existing Dwelling Unit, Including $ 50.00
_ Adding fixtures to lower levels or room additions, excluding water softener and water heater
_ Abandonment of septic system
_ Water tumaround (+ 5/8" meter if needed -$121.00)
Other:
_ RPZ _ new installation _ repair _ rebuild $ 30.00
_ Lawn irrigation system
1 Water softener _ Water heater $ 15
00
\ .
_ replacement . additional
S
S
h .50
tate
urc
arge
V? ??
? ? S?
Total $
-
I hereby apply for a Residenrial Plumbing Pemilt and acknowledge that the information is c In_aud.accaratr--th: work will
be in conFormance with the ordinances and codes of the City of Eagan and with the Plumbi o es; that I understand this is not a
pemvt, but only an application for a permit, and work is not to start without a pemvt that the work will he in accordance with the
approved plan in the case of work which requires a review and approval of plans.
?b.-c z,?e--
Applicant's Printed Name ApplicanYs Signature
Site address: ??\ J-ot\rN jct? 3t; ?_Lot ?L7 Block s( Subd. D?r Ic=1e3?a?'?-
On April 15, 2000 the Minnesota Energy Code, Category I Building Requirements for insulation protection, air
tightness, and ventilation, was adopted. As a result, the City of Eagan is requiring that the following information be
submitted prior to issuance of a Certificate of Occupancy.
This structure: Is constructed to meet minimum requirements of the Mn Energy Code, Chapter 7670
OR
This structure: will be constructed to meet more restrictive requirements of Chapters 7672 or 7674
APPLIANCE GAS ELEC MANUFACTURER MODEL BTU'S VENTINGTYPE
Water Heater
Furnace 23 --dI fL- .S/oloa "re.tf
Dryer
EXHAUST SYSTEM
LOCATIDN
TYPE
MODEL
CFM's VENTED
YES No
Kitchen kitchen C-c-
Bathroom 1 41A 16AM FV -6 5 Va Sp </
Bathroom 2 1 ( ?' -P V._OS- v/0 -C t7 cl
Baihroom 3
? ?'
/ata •-- ? ?
- ?
Balhroom 4 Y? 1 ' 5-6 ?
Other
FIREPLACE S
LOCATION
GAS
WOOD
MANUFACTURER
MODEL
BTU'S VENTING
DIRECT ATMOS
? ,.?? ?a.v ? NGf . 2 3
I hereby acknowledge that the above information is correct and agree to comply with the Minnesota Energy Code and City of Eagan
requirements.
Signa ure ?
J tic
Compa y Name
?/ :
Date
This form is the responsibility of the General Contractor.
? Qjt' a-7 6eo c.k I fIj'p- 5'-l l 5 a a-
n RESIDENTIAL fy? 0 - , -1 t r,3 ,-i? C?6
. BUILDINC PERMIT APPLICATION -,-?\
• CITY OF EAGAN Q S) 90'v
3830 PILOT KNOB RD, EACAN MN 55122
651-681•4675 S(A) S7-aSq -
4 '--I c) o ?.3a-
NewConstructianRaouiraments RemodellReuairReauirements ?
• 3 registerea site surveys showing sq. ft. o( lot sq. fl. of house; and all roo(ed areas . 2 copies of plan
(20%maximum lot coverage allowed) . 1 set of Energy Calcula[ions for heated atlditions
. ? copies of plan showing beam 3 window sizes; poured found design, etc.) . 1 site survey tor ex[enor additions 8 decks U?
• 1 set o( Eneryy Cakulations . Indicate if home served by septic syslem for additions
• 3 copies of Tree Preservation Plan if lot platted after 711193
• Rim Joist Detail Option5 selection sheet (61dgs wiN 3 orless units) 5a C1
?
DATE (IVALUATION
SITEADDRESS MULTI-FAMILYBLDG _Y ?N
TYPE OF WORKJVG? FIREPLACE(5) _ 0X1_ 2
APPLICANT e6)& lleii
SiREET ADDRESS S S TG???? CITY_4?!? STATE fvlN ZIP 5751121
TELEPHONE # 65/-fQ$'--057,/CELL PHONE # ?3(01 a 60 ? PAX #(0Si "91Y ""68*>7
PROPERTY OWNER TELEPHONE #
--------^----------------------------------------------------------° -----
COMPLETE THIS SECTION fOR "NEW" RESIDENTIAL BUILDINGS ONLY
gy CadeC tec? n? i_ MINNF.SO'C:\ R[A.ES 7670 G\"CI:GORY t MQV VfiS01'A RC1,1S 7672
s?bm?si? 1?pgy?n, ' ? • Residential Ventilafion Category 7 Worksheet Submitted ?• New Energy Code Worksheet Submittetl
? f ? • Energy Envelope CalculaGonS Submitted
PI
Plumbing system
_ Wa£er Softener
_ Water Heater
No. of Baths
Phone #
L.awn Spnnkler
No. of R.I. Baths
Mechanical Contractor: lirji?1SV/6/C /TPo?7l+?J?
Mccli>uiical systcm includes: Air Candilionie,
_ Heal Rccovcry Systcin
Sewer/Water Conhactor.
?
qt?;t-*Z - v01
----P'ee $90.00
P h o n e # -d 1el~&Ws-
Fcc: S70.00
Phone # ?f??'. `1/°2 Q-a"9?°
------ --------°-----°-----.....--------------°---------°--°-° °-°-----....---------------°°-------------------°-
I hereby acknowledge that I have read this appiication, state thai the information is correct, and agree to comply
with all applicable State of Minnesota Statutes and City of Eagan Ordinances.
Signature of Applicanf ?
OFFICE USE ONLY
Certificates of Survey Received ?p Tree Preservation Ptan Received - Not Required _57?) Updated 4102
OFFICE USE aNLY
? 01 Foundation ? 07 OS-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
?? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 27 Porch (3-sea.) ? 31 Ext. Alt - Multi
? 03 Ot of _ plez ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (d-sea.) ? 33 Eut. Alt - SF
? 04 02-plex ? 10 08-plex ?18 Deck ? 23 Porch (screened) ? 36 Multi
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex Plbg_Y or_ N ? 25 Miscellaneous
11 31 New ? 35 Int Improvement ? 38 Demolish (Interior) ? 44 Siding
? 32 Addition ? 36 Move 81dg. ? 42 Demolish (Foundation) ? 45 Fire Repair
? 33 Alteration ? 37 Demolish (Bldg)• ? 43 Reroof ? 46 Windows/Doors
? 34 Repiacement 'Demolition (Entire Bldg only) - Give PCA handout to applicant
Valuation LLL-0 0 V Occupancy g,j -y MC/ES System
Census Code Ito J Zoning Yt'i
City Water
SAC Units Stories ? Booster Pump
Nbr. of Units Sq. Ft. (o PRV _7-
Nbr. of Bldgs Length Fire Sprinklered
Type of Const W idth
REQUIRED INSPECTIONS
? Footings (new bldg) }( FinaliC.O.
? Footings (deck) T FinaVtio C.O.
Footings (addition) _ Plumbing
Foundadon _ I-IVAC
Drain Tile Other
Roof Ice & Water Fi nal Pool Ftgs Air.?Gas Tests Final
Framing Siding Stucco Stone
4 Fireplace _?, R.I. )?Au Test V
, Final _ Windows(new-replacemeny
Insulation t y
7" Retaining Wall
Approved By J?-L , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
ciry sac
Water Supply & Storage
S&W Permit & Surcharge
Treatment Plant
Plumbing Permit
Mechanical Permit
License Search
Copies
Other
Total
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MNr: li 1• coMPLIANCE RBP()RT
Mir,,,, i ? FJn9x.'gY Code
MN''?`?? 3.0
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2£35
2f . i° r-r i-nr Thatt Code
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t^?AI i. , .t,,:,d rr.am? , lh° O. C'.
14° 0. C.
?'S?C.Iy'I b•rl•'?. 9.C)l hL/8.3` iJg/9.01.
.
F?SP^'I': ? „uc7. 3.5' ht/3.1' bg/3.5'
GT?7,;'. ,? :. 61 i 11 r3 nvt^. oY Dc?nr'? , Ah?ivr
Prr ,;: ' •
Permit #'
Cher-,kec? by/Date
Ar.ea or Cavity Cont. Glazi.na/Doar
PeL-imeter R-Va].ue R-Value U-Value
----------
__ ---134?.--- 44.0 0.0 l
1986 19.0 2.10
169 10.0 2.0
i.nsul 11.2 11.0 010
insul 20 10.0 0.0 0.350
?
rad? 7.94
38 0.350
}?+;]i,%' ' n1PMPsNTi FurTSaC'?. 92.0 ArUE ----°-`----
CO"r; "r SIAPEMET7'I': `I'lie proposcd bvi].ding design described here ir:
"co11;1 r-Tlt with the bui.ld.ing plans, specifiaations; and oGher calculatione
requirements t of n Che T Minnesota e ?n?rc,?r dCodehas been
ksf;,i?;?>?3 d t.n1mk eet 11 the permit
dP
IIui 1 a„r/nesi_gner
Date
LOT SURVEY CHECKLIST FOR RESIDENTIAL
' BUILDING PERMIT APPLICATION
' PROPERTY LEGAL: L 6 T ?2r7
DATE OF SURVEY:
LATEST REVISION:
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DOCUMENTSTANDARDS
• Registered Land Surveyor signature and company
• Building Permit Applicant
• Legal description
• Address
. North arrow and scale
• House lype (rambler, walkout, split w/o, split entry, lookout, etc.)
• Directional drainage arrows with slope/gradient %
• Proposed/existing sewer and water services R invert elevation
• Street name
. Driveway
• Lot Square Footage
• Lot Coverage
ELEVATIONS
B" Ll ?
V? ?
V?/ ?
? Yd"/ 0
? Y/ ?
? ?9 ?
Existina
• Sewer service (or Proposed)
• Property corners
• Top of curb at the driveway and property line e#ensions
. Elevations of any existing adjacent homes
• Adequate footing depth of structures due to adjacent utility Venches
• Watenvays (pond, stream, etc.)
Prooosed
? ? n • Garage floor
[3'? ? • Basement floor
G1/? ? ? • Lowest exposed elevation (walkout/window)
? ? . Property corners
11 ? • Front and rear of home at the foundation
PONDING AREA fif aoolicablel
? L?/' ? • Easement line
?
? H/ ?
? / ? . NWL
. HWl
? ff/ ? . Pond # designation
? ? . Emergency Overflow Elevation
? d ? . PondlWetland buffer delineation
DIMENSIONS
?p ? . Lot Iines/Bearings 8 dimensions
? • Right•of-way and street width (to back of curb)
[A' C] ? . Proposed home dimensions including any proposed decks, overhangs greater than 2', porches, etc.
(i.e. all structures requiring pertnanent footings)
[ZO ? . Show all easements of record and any City utilities within those easements
? . Setbacks of proposed structure and sideyard setback of adjacent exi ng structures
? n? . Retaining wall requirements, if any
Reviewed: ..+? ?
Name ateJ
G:/FORMS/BUilding Permit Application
- •. s
_ Surveyor's Certificate
SURVEY FOR :PULTE HOMES Itlvv 2 ? KLC u
DESCRIBED AS :Lot 27, Block 1, OAKBROOKE 6TH ADDITION, City of Eagan, Minnesota and reserving
easements of record.
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ai
VaCOn2
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4
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7
3 7000
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. 91
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rv
50.3
921.3 " o ?
t? o
S75°4]'
o8.,e
7o'O?
Vacant
9:1 maxximum Slopes
ot Ra4aining VNall WiII
8e Raquired
S/? l
,•"' -
?
>6>9
9SO.e JOHNNY C'AKE
RIDGE LANE
LOT SQ. FOOTAGE = 3,080
HSE. SQ. FOOTAGE = 1,686
LOT COVERAGE = 54%
'17
?
# 17934
PROPbSED ELEVATIONS
Top of Foundotion = 932.5
Garage Fioor = 931.4
Basement Floor = 923.5
Aprox. Sewer Service = 920.5
Proposed Elev. _ ?
Existing Elev.
Drainage Directions =-
Denotes Offset Stake = •
SCALE: 1 inch a 30 feet
HEDLUND I HEREBY CERTIFY 7HAT 1HI5 IS A
OF iHE BOUNDARIES OF 7HE ABO?
BY ME OR UNDER MY DIRECT SUPI
PLANNlNG BNGJNBFRINC SUXV6YING SHOW IMPROVEMENTS OR ENCROAC
2005 Pln Oak Drive
Eagan, MN 55122 DATE -1-1-ILCII
Phone: (651) 405-6600
Fax: (651) 405-6606 f/-'/? -0(? ?
BENCHMARK,
CP # 9012 TNH
EL= 931.19
MIN. SETBACK REQUIREMENTS
Front - House Side -
Rear - Gorage Side-
N0:
02R-748
TO
SURVEYOR Oakbrooke 5
t ua76
DEC-13--2002 13:0: LLTEIu MPLS
7e35711168 P.ffi
alid=i.
DESIGN ANlI DETAILING pF NCIUSE REAR FnUNDATIQF! VALL. CONSTRUC7ICEN [S Tt] EE mC1N£
IN ACCORBANCE '.J1TH TWESE DRAWYNGS AND STAWDARD ZNDUSTRY PRACT3CE.
NCRE7E: 3000 pSI C 28 DAYS
mm le 7HF3 DOCUMENT APPLIES Ta STRi1C7URAL ONIY. COH&TERIAU
REFER TO ARCH%TEC7URAL DRAWINGS FOR MC1RE €+GGREGATE! ?F ?L? 1??*? MMRX
INFI?RMATION.
Z. PRIOR TO BACKFILLING, F13tfNDAT?I7N WALLS REINFORCINGi ASTM A615 GRADE 60
MUS7 $E LA7ERALl.Y SUPPORTED BY ADEQUAiE BACK SpNDY CLAY - GRI7UP YI
TEMP[]RARY BRACING. PLACE BACKFII.I. IN TWO FILL: ER?I? AL4?T?cFUID PRES5URE
F'a0T Ai.TERNATING LiFTS,
3. DRAYN 7ILE, INSULA7ION, & DAh1P-PROCIFTNG,
AS WELL RS THEIR TNSTALLATICIN, ARE TQ BE
IN ACC13RDANCE WIfH THE CODE.
#4 x S'-0" HC1L3K5
@ 48" 0•C,
CENTER IN SLAB
?
2'
1JOL7D PRAMING
BY aTHERS
1/2"0 0 x B" ANCHtIR BOL75
OR SIMPSCSN MAB15 ANCFICIRS
I7R APPROVED EQUAl.. @ 12" S7.C.
2x6 TREATED WOOD
PLATE w/ MIM, 0F
(2) ANCHi]RS w/ UNE
WI?HIN 12°' OF EAC6i 6ND ,
? SLOPE GRADE--- . L3 i!2 " ? SLA& ON
f WAY FRUM 1 ° GRAIJE
F6Uh1DA7$QN
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t5? °t4 HpRIZ. BARS d
EVENLY SPACED 2?
b e° TH CK C.,P,
(???l??y L?Fi?y?1 ?-?``Z c?n?J4vE?rs?L . ..
@ 4$" O,C, CENTEREA .??a
IN WALL ?
?-#4 x 2"-Q'° DO`dELS g
t H,?REBY LERi9i1' THAT 7kiiS PUN, $f'£CIFICAT'•ON, 47R @ 5P11 CIIC,
RE?OR? Wh5 PREPhitEO BY ME OR UP!DER MY oIRf.CT e Y?
SuPERvis*n aNa ttsnT I aM aDuLr ucENSEO 16" VIDE x 8" THSCK ?
DRCNE55ICNAL FNGINEER l1NDER lHE lAWS CF THE STRIP FOOTYNG
STArE OP MINNESr]TA ?
Dsrc 12/ !02 REC N . _ 26817
DANIEL SAR ANT WALL-aE.' +ON
WALr AT LQW GRADE
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RESIDENCE UNDER C13hIS7RUCT217N p2=?gp0 UL a Gj
1619 JOHNNY CAKE RSDGE LANE crw,? er E?IG?IN ERS INCo S- 1
EAGAlJ, F4N TA p?°p us vPN 9S4e1SUite
for TwIN CI7IES CONCRETE SYSTEMS, iNG ?_ phone 763-s7s-2500 rox 76 - 71-1 69 12/93102
ro?aL F.oz
PERMIT
Permit Type: Building
City of Eagan
Permit Number: EA105980
Date Issued: 08/06/2012
Permit Category: ePermit
Site Address: 1619 Johnny Cake Ridge La
Lot: 27 Block: 1 Addition: Oakbrooke 6th
PID: 10-53765-01-270
Use:
Description:
Sub Type: e-Reroof
Construction Type:
Work Type: Replace
Description: House & Garage
Census Code: 434 -
Occupancy:
Zoning:
Square Feet: 0
If there is no ice protection inspection prior to final, the contractor must meet the inspector w/ a ladder and flat bar. Pictures are
Comments:
not acceptable in lieu of inspections.
Carbon monoxide detectors are required by law in ALL single family homes.
BL - Base Fee $4K $103.25 0801.4085
Fee Summary:
Surcharge - Based on Valuation $4K $2.00 9001.2195
Valuation: 4,000.00
Total:
$105.25
Contractor: Owner:
- Applicant -
Krech Exteriors Inc Elizabeth O Mitchell
5866 Blackshire Path 1619 Johnny Cake Ridge La
Inver Grove Heights MN 55076 Eagan MN 55122
(651) 688-6368
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State of
Minnesota Statutes and City of Eagan Ordinances.
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA127686
Date Issued:10/10/2014
Permit Category:ePermit
Site Address: 1619 Johnny Cake Ridge La
Lot:27 Block: 1 Addition: Oakbrooke 6th
PID:10-53765-01-270
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth O Mitchell
1619 Johnny Cake Ridge La
Eagan MN 55122
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA128127
Date Issued:10/27/2014
Permit Category:ePermit
Site Address: 1619 Johnny Cake Ridge La
Lot:27 Block: 1 Addition: Oakbrooke 6th
PID:10-53765-01-270
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Lisa Nyberg
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth O Mitchell
1619 Johnny Cake Ridge La
Eagan MN 55122
Property Claim Solutions Llc
2005 Pin Oak Dr
Eagan MN 55122
(651) 994-2028
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Mechanical
Permit Number:EA149118
Date Issued:05/08/2018
Permit Category:ePermit
Site Address: 1619 Johnny Cake Ridge La
Lot:27 Block: 1 Addition: Oakbrooke 6th
PID:10-53765-01-270
Use:
Description:
Sub Type:Residential
Work Type:Replace
Description:Air Conditioner
Comments:Questions regarding electrical permit requirements should be directed to State Electrical Inspector, Mark Anderson at (952)
445-2840.
Carbon monoxide detectors are required within 10 feet of all sleeping room openings in residential homes (Minnesota State
Fee Summary:ME - Permit Fee (Replacements)$59.00 0801.4088
Surcharge-Fixed $1.00 9001.2195
$60.00 Total:
I hereby acknowledge that I have read this application and state that the information is correct and agree to comply with all applicable State
of Minnesota Statutes and City of Eagan Ordinances.
Contractor:Owner:- Applicant -
Elizabeth O Mitchell
1619 Johnny Cake Ridge La
Eagan MN 55122
Haley Comfort Systems
4320 Hwy 52 N
West Frontage Rd
Rochester MN 55901
(507) 281-0138
Applicant/Permitee: Signature Issued By: Signature
i •
I
For Office.Use �
L{ ( �3 r
�/
Y� 1f1
Permit#: 1 1
+,.REAGAN.
Permit Fee: D'
Date Received: (l 4—t
3830 PILOT KNOB ROAD I EAGAN,MN 55122-18.10
(651)675-5675 I TDD:(651)454-8535 I FAX:(651)675-5694 JUN O 4 c '1ia
buildInginspectionsAcityofeagan.com Staff:
L
2018 RESIDENTIAL PLU BING PERMIT APPLICA ION
(5,_?_3
Date: Site Address: �1A lit)it
Tenant: `1 1A[ ub 1%
i t v, -.v4 E �1Suit�el#: a1
�{n vu �°^'`� Name: . i I \ ��i!' `�J Q'D
e. cie Phone:
}
wiz) is � r: Address/City/Zip: + • �Aiv AL � _
,,,,,1„,.,0` ."1 ,4 Name:" MILBERT COMPANY dba CULLIGAN WATER
S "° f License#: WC641376
;4 , t.01. it' h4,. Address: 1801 50TH STREET EAST
1 yg iii �:f City: INVER GROVE HEIGHTS
`. r 'a . State: MN zip; 55077
• Phone: 651-451-2241
*AA
? n v' �tContact: BILL MILBERT
Email: gforia.abas@culligan4water.com
:?,...V ,TE �I �Et f A
`j , t ___,New —Replacement Repair
1 t f 0 ta, P Rebuild Modify Space Work in R.O.W.
tt`�ir f it.: .,e.,,i,„: j�t�..%,:,,, Description of work:
al; Vr ' RESIDENTIAL
�o 4 trNf(t)'. :%fist
4 to t.. 5- * ____Water Heater
;ftfk>`f @ X Water Softener
kiN 7 r " t,< ��..- Lawn Irrigation( RPZ/ PVB)
.0- Perm(tsT,ypg )
{1�+,;� �V� dy �,f _Septic System Add Plumbing Fixtures( Main./ Lower Level)
• �t t t ' St !(' +�f( New Water Turnaround
tl f!1;+tea z.v. fit t
>,r',: ,s s-A ,{fK•owrg'�_ Abandonment
RESIDENTIAL FEES: - --- - — __�___�
$60.00 Water Heater,Water Softener, or Water Heater and Softener(Includes State=Surcharge)
$60.00 Lawn Irrigation (includes State Surcharge)
$60.00 Add Plumbing Fixtures, Septic System Abandonment,Water Turnaround*(includes State Surcharge)
'Water Turnaround(add$280.00 if a 3/4"meter is required)
$115.00 Septic System New(Includes County fee and State Surcharge) TOTAL FEES $ 60.00
CALL BEFORE YOU 016, Call Gopher State One Call et(651)454.0002 for protection against underground utility damage. Call 48 hours before you
Intend to dig to receive locates of underground utilities. www.gopherstateonecall.orq
You may subscribe to receive an electronic notification from the City of proposed ordinances by signing up for an email update on the City's
website at www.cltvofeagan,eom/subscribe.
I hereby acknowledge that this Information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of
Eagan; that I uI\
nderstand this is not a perm , but only n application for a permit, and work Is not to start without a permit; that the work will be In
a or nce witthe approve n1 cas f work w ch requires a review and approval of p1
Cern
Applicant(� x . 1/(4/(1-6(
Printed Name Applicant's Signature
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