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4362 Metcalf DrCITY OF EAGAN 3795 Pilot Knob Road Eagon, Minnesoto 55124 Phone: 454-8100 Dote: WATER SOFTE?VER PERMIT '51 No. ?,- Receipt No.: ' Single I Residential Multi Res., Comm./Ind. I Septersber 13, 1977 Site Address: ?1362 h''atCalf nr. Lot ? Block Sub/Sec. Name ' '`ancis C. Campbei : Address 6Z F3etGalf Ilz'. ; ? O City -,-'ran Phone: ` Nanw c'ommers Soft Water Uo. A Address'8,-j1 Califarnia 5t. N.R. Ci? ''t)? s. 'i ^ 421. Phone; This Permit is issued on the express condition that all work shall be Minnesota 5tatutes and City of Eagan Ordinonces. 3Zte1'ation New/Alter./Repair. Cost of Installotion 5: • r?C? Permit Fee Surcfwrge . ?>Q Toto I done in accordnnce with all applicable Stote of Building Official CITY OF EAGAN Remarks Addition R'ivar Hi l l S nY' Lot 16 Blk 1 Parcel 10 6 i2400 160 01 Owner .i +. street 4362 Metcalf Dri.we state Eagan,MN 5,5122 Improvement Date Amount Annual Years Payment Receipt Oate STREET SURF. STREET RESTOR. GRADING SAN SEW TRUNK 3£,SEWER LATERAL Paid WATERMAIN WATER LATERAL WATER AREA STORM 5EW TRK pniA STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT 1 WATER CONN. 205.00 13UILDING PER. SAC PARK Rec'd in Street MUNICIPAL . MINNEGASCO PERMIT N0. MpfS,O SERVICE INSTALLATION ORDER N0. •'?'?? Sub. E-N0. )3? Map No. '- Old? New? Bldg. Class 6 Customer's Name ?E'`?L? ?•` " Tel. Installatian Address Legal Description: Lot No. Block No. Addition Contr's Name Contr's Address Owner's Nome Owner's Address - pate Ordered ' -?' Max. Demand CF/Hr. Main Auth. No. Service Location: Add'I Info. -?i£ ` TA-43?3 5errr L',' • -li Date Completed Foreman's Name To the (City Engineer.._.,,: , {City Council (Village Council (Town Bqard The Minnesota Gas Company hereby requests permission to perform the work indicated above. MINNE50TA GAS COMPANY (Chlsf Design Enpineer) To the Minnesota Gas Company Permission is hereby granted the Minnesota Gas Company to perform the work indicated above. of Date gy (Authorized Signaturs) Tel. Tel Taken By Right 0 Left [:] Front ? FORM 52-9R 6/ 69 i/ CITY of EAGAN BUILDING PERMIT . DEV. CORPT Owne: ........... WIND%IR. ...... ......... ....... ................. ................................"---..... Addrese (preseat) .............. 141? .......4362..Metcalf . .. . .. . ............... auuae: ........... WIN I7.WR..AU..... .r.QRF ...............................:............ Addseu .... kfi60...W.,....7.7..th..S.t.,...Edina., ...Mina ................... w; ;+ N° 4164 3795 Pilo! Knob Road Eagan, Minneeola 55122 454-6100 aa:• ..... Dec...-30,...1'lZb........... Siories To Be Used For Fron! Deplh Heigh! Eet. Cosf Permi! Fsa Asmarks Sing. Fam Dwlg. S Gar ? 48 . 46 399500. 11????? Sing. Fam Dwlg. d Garg. S/c or 4362 Metcaif Dr. LOCATION 16 1 1 1 River Hills 9th This permit does not sufhorise the use of sireels, zoeda, alleys ox cidewalks aor doea it give !he oanes or his agen! the rfgh! !o ereale anp siluation which is a nuisence or whieh p:esenls a hazard !o the healfh, satelp, eonvealsncro aad general welfare !o anpane ia the eommunily. THIS PERMIT MUST BE KEPT ON THE PAEMISE WHILE THE WORK IS IN PROGRESS. This is !o cerfiip. Ihal.... Idindsur--D,ey. ..°-°°----------------------haspermlasion !o ereei a..._S7.1J$...Fam..... Dwlg..,,6_C,ar?x:_ayon the above descr'bed mise subjeet !o the provisions of atl applieable Ox es for the Cifq'lof Eagan • ? . / < -...... ..- -.-° 20r'=--....°.-.............. .---°-....... Per ..... ..._..... .. . . ...Ci.>..°..?.'................ ?Mayor SulldinQ Impeelos IF, void 18 months from Date of this Request?,19 n'? P 114 3 3 Which is occupied by a?-?C?Y I, asLicensed Elec 'cal ntractor OOwner, do hereby request inspection of the above electri- cal nng installed at: Street Add ess or R9ute No dX,L.I?!1 Cit Section / wn? ? Range County Is a roughin inspection required on this job? No ? YesZr- Ready Now ? Will CallJd Power Supplier Address Electrical Contractor" l??-u/t ?.?t? Contractor's License No!? 3, ^ (COmpany Name) A ? .? I Mailing Address '1141- "-A ( triwi con i Authorized Signature • I C a< or O ne MaM (? C%?m'Si?? BUD VIol7 Y 6 36 -`?? ? Minnesota State Board of Electricity niversity Ave., St. Paul, Minn. 55104-Phone 645-7703 REQUEST POR ELECTRICAL INSPECTION CHECK BELOW WORK COVERED BY THIS REQUEST p 11433 Type of Buiiding New Add. Rep. Check Appliances W3red Foi Check Fquipment Wtted For Home . ? ? Range El Temporazy W'uing ? ? Duplex ? ? ? Water Heater ? Lighting Fixtwes ? I Apt. Bldg. ? ? ? Dryei K Electric Heating ? i Commercial Bldg. ? ? ? Fumace ? Silo UNoader 0 Industrial Bldg. ? ? ? A'v Conditionei ? Butk Milk Tank ? Fazm ? ? ? List List Other ? ? ? p Herers? ) OehersI R COMPUTE INSPECTION FEE BELOW Service Entrance Size: # Fce Eceders&Subfeeders: # C'vcuita: # Fce 0 to 100 Am s. 0 to 30 Am res 0 to 30 Am eres 00 101 to 200 Amps. 31 to 100 Ampe ?1 C ! 31 to 100 Am eres Above 200 Amps. Above 1 A" Above 100 Amps. Trsnsformeis Remote n 1 r. Partialorothecfee ? D Signs Special ln-`tio ` Minimum fee $5.00 Remazks TOTAL FEE , 50 I, the Electrical Inspectoi, hereby certify that the above inspection has been made. }"• co (Rough-in)_ f Date (Final) Date This request void 18 months from MAR. -06' 06(MON) 13:51 LINDSTROM L?NDSTROM CLFANIMG 6 CONSiRUCnaN, lNC. ? 7 Z ?-f SS i?'? March 6, 2006 City ofEagan Building Inspecrions Department Re: Nicholas Aalerud 4362 Metcalf Drive Eagan MN 55122 '9Vater Damage RepAir! To Whom It May Concern: TEL 7635448166 P.OD1 inAui uiNrn:n01,111 Pf.l'Alrll1lll rtIN i;1a1 ,lNiS ? ?z% [vz MAR I 3 2006 ? Lindstrom Cleaning & Consuuction, ync. completed water damage repairs at the above referenced job site. lnsulation, though small amoun[s, was replaced. Drywall was supplied 1'k installed, taped, sanded and painting completed. There were also interiar doors and a smait amount of base finished & installed. Everything at the above job site was completed per code and in a professionsl manner. Thank you, Lin Clea ng & Construction,Inc. Gary Hennen VP of Operations GH/ml M1NN, LICENSE #0001087 1?l?o?iq 2004 RESIDENTIAL MECHANICAL PERNIIT APPLICATION 30 S16 City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 TelepLone # 651-675-5675 Please complete for: single family dwellings & townhomes/condos when permits are required for each unit Date o,'t_V / vy Site Address qJLO? M1f,+0(y2" ?J? • Unit # Property Owner 88 QQJ c?1J? Telephone #(LC)S I)?SS' I 6? 9 d Contractoe Street Address ?« Heating & A/C Li c City Q,?,,,,,,_ e s and Ave.2 So. State ""'Q!!°. MN 55378-1 ? Zip ? Telephone # Bond #:? ? t=?...????a' o? Expires: O( O W The Applicant is _ Owner ?S Contractor _ Other ? Add-on or alteration to existing dwelling unit ?? v $ 30.00 furnace _Additional Replacement A20044 AUG 3 air exchanger ? airconditioner _New ?Replacement By other State Surcharge $ .50 Total ? W?so I hereby apply for a Residential Mechanical Pemut and acknowledge that the inforntarion is complete and accurate; that the work will be in conformance with the ordinauces and codes oF the City of Eagan and with the Mechanical Codes; t6at I understand tlus 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 wMch requires a review and approval of pla%. ^ ?fyl, ? CvLob Q(ZeJ2 ApplicanPs Printed Name Applicant's Signature 2004 COMMERCIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 II Telephone # 651-675-5675 Please complete for: commercial/industria] 6uildings multi-family buildings when separate pemiits are not required for each dwelling unit Date Site Street Address Unit # Tenant Name (if applica6te) Previous Tenant Nam Property Owner Telephone # ( I ) Contractor Street Address City I I State Zip Telephone # ( I 'i ) Bond #: Eapires: The Applicant is _ Owner _ Contractor _ Other I ? n Work Type I I? New Construction _ - Underground Tank _ Install _Re I ove **see below Interior Improvement _ Install Piping _ Processed Gas ? Nature of Work: I "When installing/removing underground tank, call ior inspection by Fire Marshal andll I !Plumbing"lnspector ' Pe1'[Ilit Fees: $70.50 Underground tank installationhemoval „ $50.50 Mincneun (includes State Surcharge) or Contract Value $ x 1% _ $ I I Permit Fee • If nermi[ fee is $1,000 or less, add $.50 77> $ I II State Surcharge If ermit fee is over $1,000, add $.50 for every $1,000 permit fee $ Total Fee I hereby apply for a Commexcial Mechanical Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I understand this is not a pexmit, but only an application for a pernut, 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. II ApplicanYs Printed Name Signahue Approved By: , Inspector Date: MASTER CARD LOCATION 4362 Metcalf L 16 Blk 1 River Hills 9th OWNER SiRUCTURE AND LAND USED AS Permit No. Issued I Issued To Contracfor Owner eUILDING 4164 12/30/76 Windeor Dev Cn rn PLUMBING CESSPOOL - SEPTIC TANK ? / -42-7? r . Ca. WELL ELECTRICAL HEATING ??I7 ??r ? GAS INSTALLING SANITARY SEWER OTHER OTHER Items Approved (Initial) Date Remarks Distance From Well FGOTING SEPTIC FOUNDATION CE55POOL FRAMING TILE PIELD FT. FINAL ELECTRICAL HEATING 7' DEPTH OF WELL GAS INSTALLATION SEPTIC TANK CESSPOOL DRAINFIELD PLUM8ING ? . WELL SANITARY SEWER Violations Noted on Back COMMENTS: COMPLIANCE INSPECTION REPORTS TO BE USED ONLY IN EVENT OF OBSERVED VIOtATIONS PERMIT NO. CONDITIONS OF CONSTRUCTION AT THIS INSPECTION ? NO EVIDENCE OF NON-COMPLIANCE OBSERVED. DATE OF INSPECTION ? ACCEPTABLE SU&STITUTIONS. OR DEVIATIONS. ? NON-COMPLIANCE. BUILDER WILL COMPLY WITHOUT DELAY. NON-COMPLIANCE. BUILDER DOES NOT INTEND TO COMPLY. ? COMPLETION OF CERTAIN IMPROVEMENTS WILL BE DELAYED BY CONDITIONS BEYOND CONTROL. ITEMIZED AND DESCRIBED AS FOLLOWS: O REINSPECTION REQl11RED DATE OF REINSPECTION REINSPECTION REVEALED CERTI FICATION -1 cenify 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 o6served 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 IMPROVEMENTS ACCEPTABLY COMPLETED BIJILOING INSPECTOR DATE / CITY USE ONLY 1 sUBO.-R??sq- RECEIPT#: l jd RECEIPT DATE: 7- 3Q o-rq ? PERMIT# ?)lO?o 1999 PLUM$INC PERNIFT (RESID?'18TIAW C?o crnY oF fae?v sgso PaoT ?oa Rn ?sAv, Mr, ssi QQ (651) 6$1-4675 Please complete for: 9 single famity dwellings ? townhomes and condos when permits are required for each unit ? backflow preventer for underground sprinkler system FIXTURES EACH # TUTA:l, Bath tub $ 3.00 x = $ ! Floor drain 3.00 x = $ ' Ga5 i in oUtlet ' minimum - 1 3.00 X = $ ' Hot tub/s a 3.00 x = $ I Kitchen sink 3.00 x = $ I Laundr tra 3.00 x = $ ' Lavato 3.00 x = $ Minimum fee alterations to existin dwellin 30.00 x = $ Private Dis osal S stem new/refurbished " re uires MPC iic. 75.00 x = $ Private Dis osal S stem abandonment 30.00 x = $ RPZ new installation/re air 30.00 x = $ Rou h o enin 1.50 x = $ Shower 3.00 x = $ Under round s rinkler if dwellin is under construction 3.00 x = $ Under round s rinkler if existin dwellin 30.00 x = $ Water closet 3.00 x = $ Water heater 3.00 x = $ r Water softener if dwelling under construction 5.00 x = $ Water softener if existin dwellin 30.00 x = $ Water turnaround 30.00 x $ State Surchar e 50 --> ----> ----> $ 50 Total --> --> ----> ----> $ o ? Reminder. Call for inspections of alterations, i.e. water heaters, water softeners, etc. -----------------------------------------------------------------------?------------------------------------•--------- I hereGy adcnowledge that I have read this appliration, sfate that the information is corred, and agrea b comply with all applica6le Ciry of Eagan ordinances. It is the applicanCS responsibility to notify the property owner that the City of Eagan assumes no lia6ility for any damages caused by the Ciry tluring its normal operational and maintenance activities to the facilities constructed under this permit within City property/right-of•way/easement. SITE ADDRESS: 73 ?a Z. 1W7`621-1- &Q_ OWNERNAME:: dTELEPHONE#: ?3 (AREA CbDE) INSTALLER NAME: RG=?/ "x'w TELEPHONE #: CO/L n? STREE7 ADDRESS: ? D !7L '2XVU (AREA CODE) ? CITY. STATE: ZIP: `----- SIGNATURE ERMITTEE L /(P BL ?- CITY USE DNLY RECEIPT#: / 7?Jl- 5? SUBD. [,a?, RECEIPT DATE: 1997 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (672) 6814675 Please complete for; . single famiiy dwellings . townhomes and condos when permits-are required for each unit . backflow preventer for underground sprinkler system FIXTURES EACH ?Q TOTAL Shower 3.00 x = W:.:3r t'.I`SSe: 3.00 X = Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink. 3.00 x = Laundry Tray 3:00 x = Hot TublSpa 3.00 x = Water Heater 3.00 x Floor Drain 3.00 x - Gas Piping Outlet ' minimum -1 3.00 x = Rough Openings 1.50 x = Water Softener `fordwellings under construction 5.00 X = Water Softener " far existing dwelling 20:00 X = U.G. Sprinkler ' for dwelling under const. 3.00 = U.G. Sprinkler `forexistingdwelling 20:00 = Alterations ' to exisun9 resiaence 20:00 = Water Turn Around 20:00 = Private Disposal System ' Dak IXy lic. 75.00 = (new and refur6ished systems) . Private Disposal Systems' Abandonment 20:00 = STATE SURCHARGE .50 TOTAL 4;V1 --f?- I hereby adcnowledga that I have raad this:application, sfate that the information is cortect, and agree to wmplywith all applicable.City . W Eagan ordfnances. It is the appliwM's responeroility tonotify theproperty owner that the City M Eagan assumes no I4bility?for any damages wused by the CKy during fts nortnal operational arM mairrtenance aGivities.ro thetedlitie5mnshuUedunderthis permA witHin City property/right of-way/easement. "w-eel'q GF SITEAQDRESS: 6'6f //VE f /72 ?/Vmd6 1 - OWNER NAME: INSTALLER NAME: 141Z eCOV,?rW- 6-- TELE PHONE#: STREET ADDRESS: ?y00 L.V7,W7 CITY: STATE: ZIP; ` --?. SIGNATURE OF P MITTEE ?.: nwt ?: /? ??76 __- ?3*J.'.T.:77:iG P3ItPST c;.?PlaTG1T2Q?d R70CY. - ? . . .. ADDI'xSOrS--?---???Z'1'?`K-• `? '--'-'- Y & SE^'1'ZO?d .iIIi:L'W: -F ;i?:Q,i??`u',?, ?:;Oi:'i•'?._..?__/ , UCCi7F'i?1?CY r _.? f??.?A??ila:.v?????L. COP$T i:;C7'(.7R o50 !9/h t:ot? Tr.c1»d,? ?; s-.e ;.lan, bui3.J.ing pl ar.s, anfl energy calcula.:: on?o ::i. t1= ti:hzs aPpii.rci;ioit Signed ___. _- pP'FICE UuE ? eU 5AC H?a.tM co.,NRc?z013 'WiT,^-.li ?;:GSEi2 PII:iyD][i:;G FP'1.YIM.` P=;Z Suii:.^,Fm£.GE F_;F, I'I;e1'ti P"11s•. PAf21L b OT[:i:R EDiC:ATIa:3 I'h'E `O`S'I+i1k fL?':?RQJALS. ? .'?SSFSS?'' CLEF BUTLDING DEP7 '.=R & :'LwZR. DFP'i`. FI3L nL'FT._ '7;rv D - U -'?-T L5-. BA,x2IC DEPT r 3 1ep s? s ? /oo s? ? s? . r ? D b ,. ? r ? '. I ' ? 3S /90 le-V ? ?.t o d o c) ? ??- ?D / °3 ? ? d 5 ?! g 5? a ? 1 ? _ ?1.26 ? A ?b D b 5 yI 'D 0 iLWINDSOR December 14, 1976 City of Eagan 3795 Pi1ot Knob Road Eagan, MN 55123 Attention: Mr. Dale Peterson Dear Mr. Peterson: Enclosed find a check in the amount of $1,005.50 for building permit fees, surcharge, SAC, sewertrunk, water connection and meter on: Lot 16 B1ock 1 River Hi11s 9th Addition 4362 Metcalf Drive • This home wi11 be a Mode1 76-13 Elevation A and will include a standard fireplace and a deck off the dining room. This hovse is the same size as a 75-11. Allocation of funds is on the check stub. Proposed plot plan is enclosed. Thank you for your cooperation in this matter. SincereLy yours, WINDSOR DEVELOPMENT CORPORATION ?v aww q Warren R. Anderson Vice President WRA:jb Enclosure • SUITE 192, 4660 WEST 77TH STREET, EDINA, MINNESOTA 55435 • PHONE (612) 831-0717 2006 RESIDENTIAL BUILDING rERnzrT arrLicaTioN ? City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 t Telephone # 651-675-5675 FAX # 651-675-5694 New Conshuction Reouirements 3 registered site surveys showing sq. ft. ot lot, sq. ft, oi house; and all roofed areas (20% maximum lot coverage allowed) 2 copies of plan showing beam 8 window s¢es; poured found design, etc. 1 sel of Energy Calculations 3 copies of Tree P2servation Plan'rf lot platted aBer 711193 Rim Joisl Detal Oplions selection sheet (buildirgs with 3 or less units) Minnegasco mechanical ventilation form RemodellReoair Reauirements 2 copies of plan showing footings, beams, joists 1 set of Energy Calculations forheated addiCrons 1 sile survey for addAions & decks AddNion - indicate ifon-sde septic system ?crl3)A ORce Use Onlv CeROfSurveyRecd _Y _N Tree Pres Plan Rerd _ Y_ N, Tree P2s Requi2d _ Y_ N On-sileSepticSyslem _Y _N rir,a,iA ala4-,1\? Date v l Zl I Z2 k Construction Cast 0!;?, 3 32- S 2 Site Address 4 x e; z- Unit/Ste # Description of Work %T Multi-Family Bldg _ Y -?'N Fireplace(s) ? 0 _ 1 _ 2 Property Owner Telephone # Q?;Cl ) ?9?? - ?Sr? Contractor $'? Jf_ Address City ?- State Zip r? " Telephone t# I'1 '-I ??? '!?? I ., r lil r,??1 ? i•r I_; I ? FEI3 u COMPLETE THIS AREA ONLY Energy Code Category - Minnesota Rules 7670 Categorv 1 • Residential Ventilation Category i Worksheet (Jsubmissiontype) Submitted . Energy Envelope Calculations Submitted A NEW BUILDING Minnesota Rules 7672 • New Energy Code Worksheet Submitted In the lasf 12 months, has ihe City of Eagan issued a permit for a similar plan based on a master plan? _ Y _ N If yes, date and address of master plan: Licensed Plumber Mechanical Contractor Sewer/Water Contractor Telephone # ( Telephone # ( Telephone # ( I hereby apply for a Residential Building Permit and acknowledge that the information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN Statutes; I understand this is not a permit, but only an application for/m permit, and work is not to start without a permit; that the work will b in accordance with the approved pl approv lans. Applicant's Printed Name tXpp icant's case of worlS,which requires a review and DO NOT WRITE BELOW THIS LINE Sub Tvpes ? Ot Foundation ? 07 OS-plex ? 13 18-plex ? 20 Pool x 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 03 01 of_plex ? 09 07-plex ? 17 Garege ? 22 Porch/Addn. (4-sea.) O 04 02-pfex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo) ? OS 03-plex O 11 10-plex O 79 Lower Level ? 24 Storm Damage ? 06 04-plex ? 12 12-piex ? 25 Misqellaneous Work Tvpes ? 31 New O 35 Int Improvement ? 38 Demalish Interior 0. 44 ? 32 AddRion ? 36 Move Building ? 42 Demolish FoundaGon ? 45 ? 33 Alteration ? 37 Demolish Building' ? 43 Reroof ? 46 ? 34 ReplBCement 'Demolition (Entire Bldg) - Give PCA handout to applicant ..- BSC?IpflOfl: WaterDamage? Yes ` Valuation ?a [? Occupancy MCES System _ Plan Review 100% or 25% Census Code e? Zoning City Water _ SAC Units Stories Booster Pump _ # of Units Sq. Ft. PRV _ # of Bldgs Length Fire Sprinklered _ Type of Const VAZ_ Width ' _ Footings (new bldg) _ Footings(deck) _ Footings (addition) Foundation Drain Tile Roof _ Ice & Water _ Final Framing _ Fireplace _ R.I. _ Air Test _ Final --;K Insulation REQUIRED INSPECTIONS ? 30 Accessory Bldg ? 31 E#. Alt - Multi ? 33 Ext. Alt - SF ? 36 Multi Misc. Siding Fire Repair wndows/Doors _ Sheehock FinaVC.O. FinaVNo C.O. HVAC Other Pool Ftgs Air/Gas Tesu Final _ Siding _ Stucco Lath _ Stone I.ath _Brick Windows _ Retaining Wall Approved By: :M _ , Building Inspector Base Fee Surcharge Plan Review MC/ES SAC City SAC Utility Connection Charge S&W Permit & Surcharge Treatment Piant License Search Copies Other Totat ?I ?1&f/lr,? rl. Pftmoilc. /tl YwYwj Jr?L.c9tMi. ? ??1 ? ?2 CITY OR EAGAN WATER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.: Eagan, MN 55122 DATE: Zoning: _ No. of Units: Owner: — — Address: — Site Address: Plumber: _ Meter No.: _— Connection Charge: 05: Size: — _ Account Deposit: Reader No.• Permit Fee: agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: — i Total: By • = e Paid: Date of Insp.: — 1 -� — �� l nsp.: CITY OF' EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Road PERMIT NO.• Eagan, MN 55122 DATE: Zoning: No. of Units: Owner: — - - Address: — - — — — Site Address: — — — - — Plumber: -- — �o agree to comply with the City of Eagan Connection Charge: - - - -- Ordinances. Account Deposit: — Permit Fee: Surcarge: By —_ -- Misc. Charges: - Date of Insp.• Total: Insp.: ( aw � A 7 - Date Paid: — DEC -9-2013 11:55A FROM: 401/` City of hp 3830 Pilot Knob Road Eagan MN 56122 Phone: (661) 675-5675 Fax: (651) 675-5694 TO:6516755694 P.1 Use BLUE or BLACK Ink For Office Use Permit 8: Permit Fee: Date Received: Staff: 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: /Q/ 9// Site Address: /713k0 m.eroa LC OR Unit 8: J Resident/ Owner Name: -171D n R j/ j a i al Phone: 6, /o2 — / 7cid'�-7p a Address I City / Zip: /3[oe? 'eT7•aJ 2r e Applicant is: _ Owner Contractor Type of Work Description of work lJeu.l r 0o+ Construction Cost: O GD • 00 Multi -Family Building: (Yes _ / No _) Contractor:: Company: Rel a 1 nT•er ior f -J,. f i n c Contact: D4 ✓if -7" a6Oer—S Address: / 31/ il 077ztgoo- C T City: SQ UOq p State: /' ') rt Zip: -S—_57.3 7, Phone: iS-Z d/ �rP1 7 License S; A ( SA 7 / f Lead Certificate ii: _ j.�a T / 4y3s- — / If the project is exempt from lead certification, please explain why: (see Page 3 for additional information) - F)Ce ,,,pr — r0o1►i:� In the last 12 months, Yes _No If Licensed Plumber: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING has the City of Eagan Issued a penult for a similar plan based on a master plan? yes, date and address of master plan: Phone: Mechanical Contractor: Sewer & Water Contractor: Phone: Phone: NOTE: Plans and supporting documents that you submit are considered to be public information. Portions of the information may be classified as non - public if you provide specific reasons that would permit the City to conclude that the are trade secrets. CALL BEFORE YOU DIG. Call Gopher State One Call al (661) 464-0002 for protection against underground utility damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www.aooherstateonecall.orq I hereby acknowledge that this information is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Eagan; That I understand this is not a permit, but only an application for a permit, and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Exterior work authorized by a building permit Issued In accordance with the Minnesota State Building Code must be completed within 180 days of permit Issuance. x DAv t 0 i' rio Lerrf Applicant's Printed Name x U0^'f'J�-'�- Applicant's S gnatt' ure Page 1 of 3 PERMIT City of Eagan Permit Type:Plumbing Permit Number:EA156477 Date Issued:07/02/2019 Permit Category:ePermit Site Address: 4362 Metcalf Dr Lot:16 Block: 1 Addition: River Hills 9th PID:10-64400-01-160 Use: Description: Sub Type:Residential Work Type:Replace Description:Water Heater Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection. Allow an 18" minimum radius clearance to the water meter from all appliances (i.e. furnace, water heater, water softener). Fee Summary:PL - Permit Fee (WS &/or WH)$59.00 0801.4087 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 - Vieng Vongnalath 4362 Metcalf Dr Eagan MN 55122--191 (612) 876-6514 Champion Plumbing 3670 Dodd Rd., #100 Eagan MN 55123 (651) 365-1340 Applicant/Permitee: Signature Issued By: Signature