2904 Lone Oak Pkwy??r' I?. 2005 COMMERCIAL PLUMBING PERMIT APPLICATION
J'7 CITY OF EAGAN
3830 PILOT KNOB ROAD, EAGAN MN 55122
651-675-5675
Dateta_ /
SiteAddress ?N!?N Unit#
Tenant Name Former Tenant Name
Property Owner Telephone # ( )
Contractor Tfn?C.x\ tTcch
Address `leabi C(eLys'( Ncvxc- L' c City (6,?fN??
State Zip,SW,`j'? Telephone # F.?, aP ( - _15AC
License # ,?',1"? r'?y'r? Expires: 11- ak4?
The Applicant is _ Owner _ Contractor _ Other
Work Type New Bldg _ Modify Tenant Space RPZ PVB New Repair/Rebuild _ Replace
_ Irrigation system Work within public right of-way/easement _ Yes _ No
Rain sensors are re uired on irriation s stems.
Description of Work ?? *AJ CA
To inquve if Ressure educing alve is required on new serncq ca11 6 5 1-6 7 5-5 646
Meters - f:all 651-675-5300 to venfy that hydrostatic, conductiviry, and bacteria tests passed prior to oiclune un meter.
Imgation Size & Type Avg GPM 2" turbo req'd unless smaller size allowed by Public Works
Fire Size & Price 3/4" disolacement $161.00
DomestiC Size & Type Avg GPM Includes high demand devices? _ Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No
Permit Fee $50.50 minimum (includes State Surcharge)
Contract Value $ x 1% _$ PermitFee
$ Meter(s)
Requ'ved on all new buildings & boulevazd irrisation svstems $ RBdio Meter Read
ff pemtit fee is $1,000 or less, sorcharge is $.50 $ Sta[e Surcharge
I£perm([ fee te over $1,000, aurcharge fe $.50 per $1,000 of the Permit Fee
--------------
Following fees apply only when installing new irrigaNon sys[em ? $ W3ter Pemut
CaR Jerry Wobschall at 651-675-5024 for required fee amounts
$ Treatment Plant
$ Water Supply & Sroragc
$ State Surctiarge
------------------ ----------------------- ------- ------- ------- --------------- ------ $ ---- \L----?------ ------------- ---------------- ------°
Total Fee
I hereby apply for a Commercial Plumbing Pemu[ and acknowledge that the mtb[mation is complete and accurate;Jtnat me wor??wip' oe?:
confoanance with the ordinances and codes of the City of Eagan and with the Plumbing Codes; that I understand th?s ,is not a pemrit, burbnly=
application for a pemiit, and work is no[ to start without a peanit; that the work will be in ac ce with the apprbved pl"lvt gie3asoof?.v+c
which requires a review and approval of plans.
,?ou A ??? K
Applic ted Nazne Appli t's i ure
PLUMBING (COMMERCIAL)
Permit Application
City OfEagan
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX # 651-675-5694
_5 K?D .Cfb
.._. . w ? __j
Date /o ! J I (az
SiteAddress 2)oy L,:M4t' P?-`?L L?Ct- Unit#
Tenant Name /sc WGcL +'u3 k Former Tenant Name
Property Owner Telephone # ( /44
Contractor
Address ? cv?Y`?` City \J?a°
State Zip-s ?? 3 9 Telephone #(??
The Applicant is _ Owner Conlxactor _ Other
Work Type _ New Bldg _ Add-on Repair _ RPZ PVB _ Irrigation system
' Jer Wobschall [o calculate fees. Re uired meter size is 2^ [urbo unlus smaller size ermitted bv Public Works
Description of Work 9,2bvAA kP Z
To mquire iFRessure Reducing Valve is required on new service, call 651-675-5646
Meters - Call 651-675-5300 to verify that hydrostatiq conductivity, and bacteria tests passed prior to pickine uo me[er
Irrigation Size & Type Avg GPM
Fire Size & Price 3/4" disolacement $156.00
Domestic Size & Type Avg GPM Includes high demand devices? _ Yes _ No
Flushometers _ Yes _ No PRV Required _ Yes _ No
Permit Fee $50.50 minimum (includes State Surcharge)
Connact Value $ x 1% _ $ Base Fee
$ Meter(s)
Required on all new buildings & boulevard irri¢ation svstems $ Radio Meter Read
If base fee is $1,000 or less, surcharge is $.50 $ $t8[0 SuiChaigO
If base fee is over $1,000, surcharge is $SO per $1,000 of the Base Fee
Following fees apply oNy when installing new irrigation system Water Permit
Conpct Jerry Wobschall at 651675-5024 for required fee artrounts
$ --- - -Tyatrnent Plant
?r
g r,-i c', I ? •• ? I ?Vater Supply & Storage
" $ ?Sfate Surcharge
-------------------------------------------=------------------------------- ? -------------------------------
""""___"'___""__"""""""""'___""" $ a._
•S?__i9ltal Fee
'-'? -
I here6y apply for a Commercial Plumbing Permrt and acknowledge that the information is complete and accurate; [hat the work will 6e in
conformance with the ordinances and codes of the City of Eagan and with [he Plumbing Codes; that I understand ihis is not a permit, but only an
applica[ion for a permit, and work is not ro start without a pemut; that the wor ill be in accor ance the approved plan in the case of work
which requires a review and approval of plans.
ppphcanPs Printed Name ApplicanPs Signature
PLLiMBING (COMIIJERCIAL)
Permit Application
City Of Eagan 2:E?o .5 ?
3830 Pilot Knob Road, Eagan Mn 55122
Telephone # 651-675-5675 FAX #t 651-675-5674
Date o? / _i-a / _?
Site Address OnN LuDe WL Unit #
Tenant Name j n A PQYI Former Tenant Name
Property Owner Telephone # ( )
Contractor }?wli fZ
1Y1C'
?
Address Ci[y ?r
? ?j +S Telephone # (-ff?Z ) 4 0
State ?N Zip L*
The Applicant is _ Owner ? Contractor _ Other
Work Type _ New Bldg _ Add-on _ Repau ? RPZ PVB Irrigation system *
•.Snrrv Wobschall to cnimilate fees. R uired meter size is 2" torbo un]ess xmaller sizr ennit[ed bv PuhGeR'orks
Description of Vi'ork fpz ie5? 0vC"`Y%0
To inquire if Pressure ReAucmg Valve is required on new service, cail 651675-5646
Meters - Call 65I-675-5300 to verify that hydrostatiq conducfiviry, and bac[eria tests passed prior to oickine uo meter
Irrigation Size & Type Avg GPM
Fire Size & Price 3/4" disolacemen[ $156.00
Domeatic Size & Type Avg GPM Includes liigh demand devices7 _ Yes _ No
Flushometers _ Yes _ No PRV Req uired _ Yes _ No
Permit Fee $50.50 minimum (includes State Surcharge)
Contract Value $ x.Ol°/a =$ Base Fee ??•
?
$ m
Lat?
? CI '? '?
1
r
?
Required on all new buildings & boulevard inigation svstems $ um Meter Read '
, 4 7003 ?
? [?
If base fee is $1,000 or less, surcharge is $.50 ?_?
$ S t??'S?"
If base fee is over $1,000, surcharge is $.SO per $1,000 of the Base Fee
??
Following fees apply ouly when instatling new irrigation system Wa Pennit _?
? $
Y
Contact Jerty Wo6schall at 651-675-5024 for requued fee amounts
$ Treatrnent Plant
$ Water Supply & Storage
$ State Surcharge
------------------
------------------- ---------------------------------------------------- ------- ------------- - ---------------------------------------------- -
$ C-513150 Total Fee
I hereby apply for a Commercial Plumbing Permit and aclmowledge that the mformanon is complete and accurate; that the work will be m
confoimance with the ordinances and codes of the Ciry of Eagan and with [he Plumbing Codes; that I understand this is not a permit, but only an
application for a pemilt, and work is not to start without a pemvt, that the work will be in accordance with the approved pian m the case of work
which requires a review and approval of plans.
ApplicanPs Prnted Name ApplicanYs SigpliNre
y
s
PERMIT #:
RECEIPT DATE:
HOOE COMM£RCIAL PL1JbI$INH PEiiMIT RPPLICi4TION
CTfYOF Ek6kF
S$SO PILOT KFOH RD
EA&AH, MA 851 EE
631-881-4875
1NCOMPLETE APPLlCATlONS WlLL NOT BE PROCESSED
Date: % ? ! " d -2-
WORK TYPE New Bldg Add-0n Repair RPZ _ PVB Irrigation system
• Jerry Wobschall to calculace fees. Required meter size is 2" turbo unl s Iler size permitted by Public Works
DESCRIPTION OF WORK ??S'f h L () ???
To inquire if Pressure Reducing Vslve is required on new service, ca11 65 1-681-4646
METERS - Call 651-681-4300 to verify that hydrostatic, conductiviry, and bacteria tesu passed prior to oickin¢ un meter
Irrigation 5ize & Type
Fire Size & Price 3/4" disolacement $152.00
Domestic Size & Type
Does this inciude high demand devices i
FLUSHOMETERS
Site Address:
Tenant Name:
_ Yes _ No
_ Yes _ No
(Area code)
Was there a previous tenant in this space? _ Y_ N. If Yes, Name:
Instalier Natne: T4 e i /?'
Telephone #: /-S°Z " ? V Lq - S 3 v'-I
_ (nrea Code)
Installer Address: 17- v 6 l.? o`?> J a
City: Cko., I?Yb. I rj'L State:
FEES Contrect price $ 32?,? x 1% ($50.00 min)
Requ'ved on all new buildings & boulevard irrigation systems
Surcharge: $.50 Minimum. If base fee exceeds $ 1,000, calculate at
50 cents per $1,000 base.
Supplementary fees for new irrigation system:
Contact Jerry Wobschall at (651) 6814624 regarding fees
Plbg Permit
Meter(s)
Radio Meter Read
Stste Surc6arge
Sub ToteUTotal
Zip Code SS ? V ?
$
$
$
S
?Q ?-
'
$
Water Permit $ Su.Ov"
Treahnent Plant $ 640.00
Water Supply & Storage $
State Surcharge $
a
Total $
I hereby acknowledge tha[ I have read this applicarion, sta[e that the informarion is coaect, and agree to comply with all applicable Ciry of Eagan
ordinances.Itistheapplicant'sresponsibilitytonotifythepropertyowner CiryofEagan assumesnoh i foranydamagescausedbytheCiry
during its nortnal operational and maintenance activiees to the faciliries co eted er this it ' hin r), right-of-way/easement.
SI ATURE F PE EE
Yes No
CITY USE ONLY
Avg GPM
Avg GPM
PRV REQUIRED