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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 Meter Related Items: Meter Size Radio Read Manomefer Staff: