4230 Moonstone DrCITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21 -199, Eagan, MN 55121
PHON E: 454-8 100
BUILDING PERMIT Receipt #
To be used for Est. Value ' Date
Site Address • ' ? ` ` '•? OFFICE USE ONLY
Lot BloCk Sec/Sub. ? ?-??'• `' ? ` ` 'v ' ? ? : : On 5ite 5ewage Occupancy
Parcel No. MWCC System Zoning
On Site Well (Actual) Const
a Name A' ; Clty Water (Allowabls)
W
z
Address PRV Required # of Stories
0 City Phone ?•--`+ ??% `` 1- 7? 7?? Booster Pump Length
Depth
°Co
. Name S.F. Tatal
? i Address Footprint S.F.
¢ City Phone APPROVALS FEES
U ¢
Ly W
Name Engr./Assess. Permit
_ z Address Planner Surcharge
L) W City PhOne Council Plan Review
Bldg
Off Ciry
SAC
.
. ,
I hereby acknowledge that I have read this applicetion and state that the Variance SAC, MWCC
information is corcect and agree to comply with all applicable State of Water Conn.
Minnesota Statutes and Ciry of Eagan Ordinances.
Water Meter
Signatu?e of Permittee Road Unit
A Building Permit is issued to:_ L ' Treatment P1
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances. Parks
TOTAL
Permit No. Permit Holder Date Telephone #
Plumbing
H.VAC.
Electric
Softener
Inspection Oate Innp. Comm2nt5
Footings I
Footings II
Foundation
Framing
Roofing
Rough Plbg. 1 1
Rough Htg.
Isul,
Fireplace
Final Htg.
Final Plbg.
Bldg. Final
Cert Occ.
Temp. LP
Deck Ftg. 6f? L,) 8
Deck Final ,y
Well
Pr. Disp.
CITY OF EAGAN Remarks Cedar Grove Acqi,7isition
Addition Cedar Grove #2 Lot 26 Bik 2 Partel l0 16701 260 02
Owner street 4230 Moonstone Dr. state Eagan,MN 55722
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. uAC 1985 1266.95 84.46 15
STREET RESTOR.
GRADING
SAN SEW TRUNK
SEWER LATEflAL 1/-, 1972 1304.00 L.1 2
WATEFMAIN
?E WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET IIGHT
WATER CONN. 00
BUILDING PER.
SAC
PARK
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE:454-8700 p
BUILDIIVG PERMIT
To be used for DECK
Est.Value $1,000 Date
Receipt #.
JUtiE 15
N_ 15199
73 8
19 8$
Site Address 4230 MOONSTONE DR
Lat 26 Block Z Sec/Sub. CEDAR GROVE 2ND
Parcel No,
a Name AUSTIN C& CECILE M McINERNY
3 Address 4230 MOONSTONE DR
0 City EAGAN Phone 454-4727 681-7474
¢ Name SAME I
0
oa Address
: City Phone
r?
ww Name
i z., Addre
aW City_
I hereby acknowledge that I have read this application and state that the
information is correct and agree to comply wilh all applicable State of
Minnesota Statutes and City of Eagan ?OJrdi?na,,n?ce?s,/./J
Signatureof Permittee_G?C?c<JL?_/?/ ?.[/
A Building Permit is issued to: HUJ111v Vi( GL'G1LE C1C[IVC;lt
on the express contlition that all work shall be done in accordance with all
applicable State ofM?????_in??.???ne??-sota Statutes and^ City of Eagan Ordinances.
Building Official?((( (???l.
? ?
OFFICE USE ONLY
On Site Sewage _ Occupancy
MWCC System _ Zoning
On Site Well _ (ACtual) Const
City Wa[er _ (Allowable)
PRV Required _ 4 of Stories
Booster Pump _ Length
Depth
S.F. Total
Footprint S.F.
APPROVALS
EngrJASSess.-
Planner _
Council _
BIdg.Off. _
Variance -
FEES
Permit
SurCharge
Plan Review
SAQ City
SAC, M WCC
WaterConn.
Watef Meter
Roatl lJnit
Treatment P1
Parks
TOTAL
24.00
.50
24.50
0
CITY OF EAGAN ND 8908
3630 Pilot Kno6 Road, P.O. Box 21•199, Eagan, MN 55121 •
PHONE: 454-8700
BUILDING PERMIT Receipt
Te bs wed !er ALUM SID. Est. Value $ 9800. Date MARCH 22 , i9$4
SiteAddress 4230 MOONSTONE DR. Eect ? Occupanq R3
Lot 26 slock Z Sec/Sub. CED. GRV. 2 qtter j[] ZoNnB
Parcel No. 1 0-1 6701 -160-02 Repoir ? Firo Zone
Eniarge ? Type of Const.
at Name AUSTIN MCINERNY Move O # Stories
Z qddress 4230 MOONSTONE DR. Demolish ? Length_
? City EAGAN Phone Grade ? Depth Sq. Ft.-
? SAME Apv,orals Feaa
O Name
OG Address
A55essment
?Permit 0•50
u? City Phone Warer & Sew. Surcharge 5.00
P.R. EXTERIORS
?w Police Plon check
Name
U Address 1390 FOX ST. Ea. waerConn.
?W City WAYZATA phone 473-3378 Planner WaterMeter
Council Road Unit
I hereby ackrwwledge that I have read this op0licotion ond stofe that Bldg. Off.
the informofion is wrrect and ogree to comply with nll applicable APC RS _ SQ
Totol $
Stafe of Minnesoto Stotutes ond City o4 Engan Ordinances. ,
Signature of Pertnittee
A Building Permit is issueA ro- on t he express Conditlon thnt
oll work sholl be done in accordonce with I oppli ble State gf-A4jnne wta Sfatu and City o4 Eogan Ordirwntes.
Building Official
BUILDING PERMIT
NOO 8908
ReceipT $ S'
To M umd For ALUhl SID. Est. Value $ 9800, pafe PiARCH 22 , 1q84•
SiteAddress 4730 PSOONSTONE DR. Erect ? Occuponcy R3
Lot 26 Block 2 Sec/Sub. CL''D. GRt/. 2 Alter [j . Zoning
rarcel nlo. 10-16701-260-02 Repair ? Fire Zone
Name AUSTIN MCINRRPIY
Address 4230 T•IOONSTONF, DR.
City EACAN phone '
p( Jlll"Il+
o Name
?? Address
1- City Phone
LW Neme r.n. nniric?.vico
F
.?T.
Z ddre?s
` C 4?JAYZATA
_337E
Y P o Q
Enlarge ?
Move ?
Demolish ?
Type of Consr.
# Stories _
Length_
Grode ? Depth Sq. Ft._
Avvrovols Fees
Assessment _
Woter 8 Sew.
Police -
Fire
Eng.
Planner _
Council _
Permit y
Surthorge 5.00
Plon check
SAC -
Water Conn.
Woter Meter
Road Unit _
I hereby acknowledge that I hove reod this oODlicotion ond stafe that Bldg. Off.
fhe informafion is correct and agree to wmply with nll opplicoble $ II5.50
Sfate of Minnewto Statutes and City of Eognn Ordinances. APC Total
r
SiOnaturc of PermiMee ?-lK? ? ? ? •
A Building Permif Is issued to: an the express condition thm
oll work shall be done in uccordonce with oll? oppliCab`le State af Minnewto Statutes or itC y of Eogon Ordinanccs.
Buildirg Officlal ?- f J C..(
?> v
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MP155721
PHONE: 454-8100
Permit No. Pe.mit Holder Miac. Permit No. Holder
Plumbing
H.V.A.C.
n
Electric
Inspection Dete Insp. Other
Footings
Poundetion
Freming
RouBh Plbp.
Rough HVAC
Inwlatfon
Final Plbg
Final HVAC
Final
Weter Dewi6e Location:
Well
Sawer
Pr. Disp.
CITY OF EAGAN Include 2 sets of plans,
V 1 Certificate.of Survey &
BUILDING PEf2MIT APPLICATION 1 set o` enerrjv cal.culations.
'Ib Be Used For ,SZDY/Z(6 Valuation Date
Site Address: ? OFFICE USE ONLY
Lot ?Coslock Z /SubCki :L. Erect Occupancy
Parcel #: J U- I 67 D/- e36 0=(7 ?? Alter ? zoninq
Repair Fire Zone
p?aner: Enlarge _ Type of Const.
Move # Stories
Address: Deimlish _ Front ft.
City/Zip Code: Grade Depth ft.
Phone #
Contractor:
Address:
City/Zip Code:
Phone #:
Arch./Eng.:
City/Zip Code: ?,>-Jq-751-
Paone #: ?173 ? 3 ? 7 ?
APPi?OUAL.S FEES
?
Assessmznts
Water/Sewer
Police
Fire
Eng.
Planner
Council lc?
Bldg. Off. , %E r
APC
Perntit p ?
Surcharge
Plan Check
SAC
Water Conn.
Water Mzter
Road Unit
TaraL -e,?
EAGAN TOWNSHIP
? BUILDI G PEFZIv01T
Addiess (PreseW,Z?-
Address /...?Zl.1`??tjt7lyP4.l?lG.Yi?lX?l9Y/"?Z
Builder .......... '._...... ----- .------------------- ----------------------------------------
? DESCAIPTION
N° 6'78
Eagan Township
Town HIall
na:??.-?'?.'_?'S__.
..- - - - -- - - " -
5lories To BeUsedFor FrontDep1h Heighi Esf. CosSPermi! Fee Aemacks' ??- ---- ---
__
L
or
LOCATION
or
This permii does noi aufhorize the use of slxeeSs, roads,.alleys or sidewalks nor does it give the owner or his, aqeni
ihe righiio caeaie any situafion which is a nuisance or which presenis a hazard !o ihe health, safety, convenience and
general welfare io anyoae in ihe communily.. -
T
PERMI MU5T PT TH E SF.?/?HILE THE WORK IS IN P
ROGAE$%? This is So cerlify, kh???
THIS ???G?t-has permissian So ereci upon
2he a6ove descxibed premise subjeci io ihe pxovisions of ihe SuiJding rdinance for pied April 11.
1955.
__...... __.._... ....._ ............. P r
. _____. .? . ' ...._ _._._...._ ... .
Chairman of Town Board - • Build'i nsnecior
EAGAN TOWNSHIP
? BUILDING PERMIT
Owne: _'-(i?c°?`.Y.',::/"'.._?'-"-' ......._...-_-.... ----'
Address (Preseni) ....T...._ y?? ^+z?y? '--'-"'-_"_
........"-----'. ..
? 0 ?..-°-° ........................_f?2a ,
Builder
Address
DESCAIPTION
N° 3010
Eagan Towaship
Town Hall
Dele ...'•S._!_7-73
"--........."' ...............
Sfosies To Be Used For Fzoni Deplh Heigh! Esl. Cos} Permit Fee Ramarka
?zr ??--?
???
??
???
a s'?° ia-?
`' s ?
s,?
" LOCATION /3 ? .S?
or
?.6 ? 2_
C9cr.t-.?i t?t ?
This permii does ao! aulhoxise ihe use of sireets, zoads, alleys or sidewalks aor does St giva the ownar or his agenY
!he zigh!!o creale any siluetion whieh ia a nuisance or which presenls a heaard !o !he heallh, safely, eonvealanee and
genesal welfare !o anyone in the eommuni2p.
THIS PERMIT MUST BE KEPT ON E PREMISE WHILE THE WORK IS IN PAOGAESS. ?
This ia to cerlify. lhai...._? :...r..'?'.._...?.'..^..°.:i'.`.`.:'"? ..............hes permissian !o eree! a...a:?..yc?,?..,.?........ p?...c.? `. ?:._`.?....?.'...._upon
!he above desoribed premise subjee! !o !he psov?siom of !he Buildiag Ordinance for Eaga T3C owaship adopled Aptil 11.
1955. ?1
...........-' .................l-ef.-:.....---?...... ? . ??X-c??e ?,/-?'?,j.r?--
--'............?"J Per ---......_...-------_.........' .............."""'-"._._......._..__.........."'_'_"""'-
Chairman of nwn Board ? Buitding Iaspeelor 1S
f ?nst. Co. 130-56
F. C. JACKSON
_ u,t+o suRVerore
RtGIfT[PED UMD[R LAWf MSTAT! OF MINN[iOTA
LIGiN/[D t1' ORGINANC[ O' CIiY Or MINM[11rOL1S ?
?
8616 EAST 467H STREET PA. 4-4681 '
\
Oburbcpoc'g 4Ltrtfficaft , I
.1
•? :?.
-- -t„
? i ;. -
I?
C
f141 t
. ,
^
1
1 1
? - - - yy,-
?. ,Q
N ?
I HER!!Y CCRTIFY TNAT TM[ ABOV[ 19 A TqU[ AND ODRR[GT PI.AT DP A SURV[Y Or
Lot 26 Blook 2, Cedar Grove No. 2
EagaA Townahip, Dakota County, Minn,
As euRVEVeo er ME TMIS-15t.h oAv „ June ¦,o. 1_091
F. C.
/.
?oo
?
?
MASTER CARD
LOCATION
- .C - GOM AA~ Z--
OWNER
STRUCTURE AND
LAND USED AS
Permit
No.
Issued Issued To
Coniractor I Owner
BUILDING
PIUMBING OID ? I'? 7 ?
CESSPOOL - SEPTIC TANK
WELL
ELECTRICAI
HEATING
GAS INSTAILING
SANITARY SEWER I
OTHER I
OTHER I
I}ems Approved
(Initial)
Dafe
Remarks
Distance From Well
FOOTING -
77
SEPTIC
FOUNDATION CESSPOOL
FRAMING
FINAL
ELECTRICAL
? TILE FlECD PT.
I
HEATING DEPTH
OF WELL
GAS INSTALLATION
SEPTIC TANK
CESSPOOL
DRAINFIELD
PLUMBING I
WELL I
SANITARY SEWER
?
Violations Noted
on Back
COMMENTS: I
I
COMPLIANCE INSPECTION REPORTS
70 BE USED ONIY IN 6VENT OF OBSERVED VIOLATIONS
PERMIT NO.
CONOITIONS OF CONSTRUCTION AT THIS INSPECTION
? NO EVIDENCE OF NON-COMPLIANCE
OBSERVED.
a ACCEPTABLE SUBSTITUTIONS OR
DEVIATIONS.
DATE OF INSPECTION
? NON-COMPLIANCE. BUILDER WILL COMPLY
WITHOUT DELAY.
NON-COMPLIANCE. BUILDER DOES NOT
INTEND TO COMPLY.
? COMPLETION OF CERTAIN IMPROVEMENTS
WILL 8E DELAYED BY CONDITIONS BEYOND
CONTROL.
ITEMIZED AND DESCRIBED AS FOLLOWS:
? REINSPECTION REQUIRED
REINSPECTION REVEALED
DATE OF REINSPECTION
CERTI FICATION -1 certify that I have carefully inspected the abwe in which I have no interest present or prospective, and that I have reported herein
all significant conditions obwrved to be at variance with ordinances of the Town ot Eagan, approved plans and specifications, and any speciHc,reOuire-
ments for off-site improvements relating to the propercy inspected.
? ALL IMPROVEMENTS ACCEPTABIY COMPLETED
BUILDING INSPECTOR OATE
- - 1988 HUILDING PERMIT APPLICATION - CITY OF E$GAN
.? ?
? 1 l
SINGLE FAMILY DWELLINGS 16
INCLUDE 2 SETS OF PLANS, 3 CERTIFICATES OE SURVEY, 1 SET OF ENERGY CALCULATIONS
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS
IS DESIRED. NO CHANGE3 WILL HE ALLOWED ONCE BIIILDING PERMIT I3 ISSUED.
MULTIPLE DWELLINGS RENTAL QNITS FOR SALE UNITS # OF UNIT3
INCLUDE 2 SETS OF PLANS, CEHTIFICATE OF SURVEY - CHECR WITH HLDG. DEPT.,
7 SET OF ENERGY CALCULATIONS
COMMERCIAL
INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS,
1 SET OF SPECIrICATIGr1S AIdD i SGT, Oc ENERGY CALCULATIONS „
To Be Used For: pE"cK' Valuation:
Site Address
?
Lot 2/ gy ' Block 0.2-
_ i
, <.
4
Parcel/Sub
Owner
Address `?3a %onnisro.?C
IM JuN
ODC9- Date: _
On site sewage
MWCC system ,
On site well _
City water _
PRV required ,
Booster Pump _
City/Zip Code )5A1-1A-h!, /{1A(. -52L 2z
;?:;,r •,.?ti k'
Phone APPROVALS
d
Contractor A/F O?F L,er£aioS Engr/Assess
Planner
Address VJCi
Cicy/Zip Gotie
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
Council
Bldg. Off.
4ai'i.aiiGe
Occupancy
Zoning
Aetual Const
Allowable
# of stories
Length
Depth
S.F. Total
Footprint S.F.
FEES
Permit
Sureharge
Plan Review
?(o?ASAC O City
3nCp i1flCC
Water Conn
Water Meter
Road Unit
Treatment P1
Parks
Copies
TOTAL
Zy
, SD
1
Use BLUE or BLACK Ink
For Office Use 1
j Permit v
City of Ea V}~Il ~ I
I Permit Fee: I I ~ l
3830 Pilot Knob Road F-i i
Eagan MN 55122 j Date Received: 7-1-
Phone: (651) 675-5675 I 1
Fax: (651) 675-5694 1 Staff: I
2012 RESIDENTIAL BUILDING PERMIT APPLICATION C' A
Date: Site Address:
Unit
Name: ~14 Phone
t -17
RESIDENT /
OWNER Address / City /Zip.'/ ell - ItIlAl
Applicant is: Owner Contractor
TYPE OF WORK Description of work: 5
Construction Cost: Multi-Family Building: (Yes / No
Company: flj/s-e. 6r Contact:
CONTRACTOR Address: City:
State: Zip: Phone:
License Lead Certificate
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 m nths, 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 the 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 ooi)herstateonecall org
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.
XX
Applicant's Printed Name I
pp • ant's Signature
Page 1 of 3
D 0-16~- ; r ~r q
DO NOT WRITE BELOW THIS LINE ~v~3 l3
SUB TYPES
- Foundation _ Fireplace _ Porch (3-Season) _ Storm Damage
Single Family _ Garage _ Porch (4-Season) _ Exterior Alteration (Single Family)
Multi _ Deck _ Porch (Screen/Gazebo/Pergola) _ Exterior Alteration (Multi)
01 of _ Plex _ Lower Level _ Pool _ Miscellaneous
Accessory Building
WORK TYPES
_ New _ Interior Improvement _ Siding _ Demolish Building*
Addition _ Move Building _ Reroof _ Demolish Interior
Alteration _ Fire Repair _ Windows _ Demolish Foundation
Replace _ Repair _ Egress Window _ Water Damage
Retaining Wall *Demolition of entire building - give PCA handout to applicant
DESCRIPTION WK Valuation Occupancy MCES System
Plan Review Code Edition SAC Units
(25%_ 100%7yj Zoning City Water
Census Code Stories Booster Pump
# of Units Square Feet PRV
# of Buildings Length Fire Sprinklers
Type of Construction -4~6- Width
REQUIRED INSPECTIONS
Footings (New Building) Meter Size:
Footings (Deck) Final / C.O. Required
Footings (Addition) Final / No C.O. Required
Foundation HVAC _ Gas Service Test Gas Line Air Test
Drain Tile Other:
Roof: -Ice & Water -Final Pool: Footings Air/Gas Tests -Final
Framing Siding: -Stucco Lath -Stone Lath -Brick
Fireplace: -Rough in Air Test -Final Windows
Insulation Retaining Wall: _ Footings _ Backfill _ Final
Sheathing Radon Control
Sheetrock Erosion Control
Reviewed By: Building Inspector
RESIDENTIAL FEES
Base Fee
Surcharge
Plan Review
MCES SAC 14
City SAC
Utility Connection Charge L
S&W Permit & Surcharge
Treatment Plant
Copies
TOTAL
'P 2of3
F. C. JACKSON X73
1
LAND SURVEYOR
R9616TERED UNDER LAWS OF STATE OF MINNESOTA
LICENRRD MY ORDINANCE OF CITY OF MINNEAPOLIS /r
8616 EAST 55TH STREET PA. 4-4681
Opurbepa't Certificate
v~ 5 ✓ v~ c f J
•in 13
3
4 s,
I'D
r<vr1
i
i
°A `
rl 1
` Jj- w
1
I HERESY CERTIFY THAT THR ABOVE 19 A TRUE AND CORRECT PLAT OF A SURVEY OF
Lot 26 Blook 2, Cedar Grove No. 2
Eagalq Township, Dakota County, M inn .
15t TT AS SURVEYED BY ME THIS 'h -DAY OF yu--P A.D. ~ I
SIGNED F. C. JACKSON, MINNESOTA EGISTRATION. No. 800
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA124857
Date Issued:07/14/2014
Permit Category:ePermit
Site Address: 4230 Moonstone Dr
Lot:26 Block: 2 Addition: Cedar Grove 2nd
PID:10-16701-02-260
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 .
Dave White
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 -
John Mcinery
4230 Moonstone Dr
Eagan MN 55122
Prowork Builders Llc
7850 163rd Lane NW
Ramsey MN 55303
(612) 232-2743
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
. . . . � r---�-------------�
I For Office Use I
� � Permit#:� ���T_ I
Clty of ����� ; . . �� ;
Permit Fee. ��
3830 Pilot Knob Road /
I
Eagan MN 55122 � Date Received: 1 � I � �
Phone: (651)675-5675 I I
Fax: (651)675-5694 I Staff: � �
I I
2014 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: Site Address: Unit#:
Name._ ---JG�`7i,r� d�i� �_:��2��rs�f Phone: UJ� ���.� �7l��
Resident/ ��� �/`������ �
, Owner Address/City/Zip:
Applicant is: V Owner Contractor
� � ,-/ >
' Description of work: c=:� �`� ���
Type of Work
Construction Cost: 1' ��Z, Multi-Family Buiiding: (Yes !No�
- Company: Contact:
C011traCtOt' `' Address: City:
State: Zip: Phone: Email:
! License#: Lead Certificate#:
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 c/assified as non-public if you provide specific reasons that would permit the City to
conclude fhat 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.qopherstateonecall.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 _ ii���'
ApplicanYs Printed Name Ap canYs Signature
Page 1 of 3
Use BLUE or BLACK Ink
r-----------------
I For Office Use (
.qa �� i '
. �
� Permit#: / , � I
Clty of �� a� � �� ;
� � Permit Fee: �-
3830 Pilot Knob Road I 2 I
Eagan MN 55122 � Date Received: � �J� � j
Phone: (651) 675-5675 I �
Fax: (651) 675-5694 I Staff: I
�------- ---------I
2014 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: `� � Site Address: 'Y'o��C� /�✓�Ul�y/v�" ,
Tenant: Suite#:
'� Name: i������'r Phone:
Resident/Owner =���-�� ��-- f��O�����—�.-�
Address/City/Zip: I°�� `G�%U���l,rYCe �j ,
` Name: License#:
-Contcacfor, . Address: City:
- State: Zip: Phone:
Contact: EmaiL
Type Of WOt'k —New _Replacement _Repair _Rebuild _Modify Space _Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
ater Softener
Lawn Irrigation�RPZ/_PVB)
' Perrriit Type Add Plumbing Fixtures �Main/_Lower Level)
Septic System
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 Svstem Abandonment, Water Turnaround*(includes$5.00 State Surcharge)
'`Water Turnaround(add$200.00 if a 5/8"meter is required)
$115.00 SeptiC System New($10.00 per as built) (inciudes 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 underground utilities. www.qopherstateonecall.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 lans.
X ��>� n �C��rn�s i���
ApplicanYs Printed Name � A canYs Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground Rough-In Air Test Gas Test Final
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