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4680 Nicols Rd Use BLUE or BLACK Ink I For Office Use I Permit I City of Eagan I Permit Fee: 3830 Pilot Knob Road Eagan MN 55122 I Date Received: Phone: (651) 675-5675 I I I Staff: I Fax: (651) 675-5694 L -----------------I 2010 Y, L jRESIDENTIAL PLUMPING PERMIT APPLICATION Date: " (Site Address: N C S CA Tenant: Suite RESIDENT / OWNER Name: Cut& Q-ZA Phone: Address / City ! Zip: 7- CONTRACTOR Name: ell, License Address: City: (2 State: (Y) Zip:` Phone: Contact: Email: TYPE OF WORK New _ ReplacementA~_ Repair Rebuild _ Modify Space _ Work in R.O. Description of work: Pt ✓ yl PERMIT TYPE RESIDENTIAL Water Softener Water Heater Lawn Irrigation RPZ PVB) Add Plumbing Fixtures Main Lower Level) Septic System Water Turnaround _ New Abandonment RESIDENTIAL FEES: $55.00 Minimum Water Heater, Water Softener, or Water Heater and Softener (includes $5.00 State Surcharge) $35.00 Lawn Irrigation (includes $5.00 State Surcharge) $55.00 Add Plumbing Fixtures, Septic System Abandonment, Water Turnaround* (includes $5.00 State Surcharge) *Water Turnaround (add $166.00 if a 5/8" meter is required) $105.00 Septic System New ($10.00 per as built) (includes County fee and $5.00 State Surcharge) $95.00 Fire Repair (replace burned out appliances, ductwork, etc.) (includes $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.aopherstateonecall.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 vvio a permit; that the work will be in accordance with the approved pan th in the case of work which requires a review and approval of plans. x7l!~Aclv' Applicant's Printed Name Applicant's Signature FOR OFFICE USE Reviewed By: Date: Required Inspections: Under Ground Rough-In Air Test Gas Test Final INSPECTION RECORD CITY OF EAGAN PERIIAIT TYPE: 3830 Pilot Knob Road Permit Number: Eagan, Minnesota 55122-1897 Date Issued: (612) 681-4675 SITEADDRESS: ,0 0 , 1 APPLICANT: r? r ?. i?? •; RIl . .??:? , , , . ???? , ? I c)?Ir. 1??N?tld 1 1', f ( t> 1.' ) tl•+l 1340 PERMIT SUBTYPE: ?, I . ??+,? i i??ra?:, I ti ! I TYPE OF 1NORK: ? .? .. ? PormR No. PermR Nolder Date TNphone s ELECTRIC PLUMBING HVAC Inspection Qate Insp. Camments FOOTINGS FOUND FRAMING ROOFING ROUGH PLUMBING PLBG AIR TEST ROUGH HEATINO GAS SVC TEST INSUL GYPBOARD FIREPLACE FIREPLACE AIR TEST FINAL PLBG FINAL HTG ORSAT TEST BLDG FINAL 149 BSMT R.I. BSMT FlNAL DECK FfG DECK FINAL CITY OF EAGAN Remarks fi hX Addition TOUSIGNANT' S lst ADDITION Lot 1 Blk 1 Parcel 10 7 7000 010 01 , i; Owner- T /, ^ ,, .; 4680 Street Cedar Ave Eagan, MN State 55122 , Y Improvement Date Amount Annual Years Payment Receipt Date STREET SURF. STREET RESTOR. GRADING * 5AN SEW TRUNK p 1973 285.00 19.00 15 paid ** SEWERLATERAL 1973 1,779.45 118.63 15 P81d WATERMAIN ** WATER LATERAL & 3t.Llb 1973 15 * WATER AREA 1973 15 STORM SEW TRK STORM SEW LAT CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN. 540.00 15729 8/29/79 BUILDING PER. SAC PARK CITY OF EAGAN 3795 Pilof ICnob Rocd C6gon, MN 55122 Zoning: Owner: _ { . .: Address: WATER SERVICE PERMIT PERMIT Na.: DATE: - No. of Units: Site Address: Plumber: Meter No.: _ Size: Reader No.: I agreo to eomplr wil6 !he CiFy of Eagon Ordinances. By Date of Insp.: Connection Charge: Account Deposit: Permit Fee: Surcharge: Misc. Charges: Total: Dote Poid: I n5p.: _ ? _ __ CITI' CF EAGAN SEWER SERVICE PERMIT 3795 Pilot Knob Rood PERMIT NO.: _ Eagon, MN 55122 DATE: Zoning: No. of Units: Owner: ' Address: Site Address: Plumber. 1 ogree to compFy with N+e City of Eagoo Connection Chorge: Ordinances. Account Deposit: Permit Fee: Surchorge: By -- Misc Chor es: . g Dote of Insp.: _ Total: Pldt ?,1 e EAGAN TOWNJHIP PEiaM IT N0. 273 Eagan Township Address ...... DESCRIPTION Town Hal] Dale.!°'?/f ....... -- -....._...... 5taries To -Be Used For _ Froni Depih Heighf I Esf. Cost l Permi! Fee - Remarks si'na?"s I s7?" '44d? Sfreei, Road or LOCATION This permii does noi aulhorise the use oi sixeels, r ds, alleys r sidewalks the righ! Yo creaie any siiualion which is a nuisance or whiah presenis a hazard general welfare 1o anyone in the community. - THIS PEAMIT MUST KEPT ON 7;E-PAEMISE ILE THE WORK IS IN This is !o cerfify. Shai.. Q!?CrSa?'???--------- _? s permission fo erec !he above desc ' ed p i the rovisions of fhe Building Ord'snanc 1955. ' „"__.-......... ..._._....------ __.__.. ' - __......._.. Per ...... ___..__.__... Chairman of To erd or nor/?es i3 give the owner ar his agen! !o `ie heal4h, safeiy, convenience and PROGRL`$S. ? i a /?/ ------- ----------._-------upon e for Eagan To ship edopled April 11. 8uilding Inspecior Pk'r f,j a l? EAGAN TOWNSHIP BUILDING PERMIT N° 1530 ? ? ?L•_?? ? ? :?--v.X? :'. Ownex --.....-----._ xr ..::.... ........?•--?---i--I---?---??---.-_-..J_....... Ea9an Township ? i - Address (Preseni) ...:-.^. .5??.I -.._..,fC:^?:i:r-=3: :?-'---_....,_-.--.G???.c.a Town Hall i/ - Builder .........?.x-?`?-t-'°--°--°-------°-----.....-----?---?------_.------- Date .......... Address ................................ ............__..................-'---'-"------......._... ?-- . DESCRIPTION ???5?9h4htS ?at lpdd 5fories To Se Used For Froni DepYh Heighf Esi. Cosi Pesmii Fae Remarks s'2E c?? L? /in ?EG I "'`t , i/ I LOCATION or I?..T .-1 / ??Cifi4?i ?IL?Yr•_.. -,.? 1'his permit does noY sufhoriae !he use ot sfreels, soada, alleps or sidewalks /or does if give !he owner or his agen! !he righ! !o ereate anp siluafion whieh is a nuisanae os which presenffi a haaard !o !he healih, safely, convenience and geaeral welfare !o anpone in !he communily. THIS PEAMIT MUST BE KEPT ON THE PAEMISE WHILE THE WORK IS IN PROGR SS. . . ... . .. . ......... .. . . . ? • - --...-' -'- °°°---: This is !o eeriifp. !ha!_.--. pe:mission !o erect a-.- -- ::• .'?Q<"'..` ?''?t ??? ... --' ?°--.-_upon ffie above described pre se subjec! !o e provisions of !he Building Ordinanee for Eagan Tow nship apfed April 11, 1955. ??l_.-._J ?Fi'`' .. .................. .l . . - - 'i`"--"'-.... ..... .....--'...."'-_........ °-°----.......-'--......---- ' •' - ""----.... Per -----.__'---.............-r Cheirman of Tnwn Boaxd Suilding InspeefiY o. ' rs. EAGAN TOiIVN S H I P BUILDING PERMIT ? . oWne: .L.a-t-........ l'?......- . /f' - ?? --?------.. . /. ... Addxess (P sen!) _/O.LO-?-' ........ F.L? ' -- ? .....-_'--"_ Suilder .......... -------- _ ............................................. ...... ............................. '--------.. _..... DESCRIPTION N° 92'7 Eagan Township Town Hall Daie ?-------'-......-' 3tories To Be Used For Fron! Depih Heigh! Esi. Cos2 Permi! Fee Aemarks °""°PL- /J ,iJ"" i'`A 1'f LOCATION Sireel, Road oz oi es Deseripfion of I.ocaYion Lo! Bloak AddiSion ox Traei - }? q L Thie permii does nof aufhorize the use of siseiffs, roads, all s or sidewalks aor does it give the owner or his ageni the righ! So create any situation which is a nuisance or whieh presenls a hazard !o the healSh, safeiy, eonvenience and genexal welfare io anqone in the communilp. THIS PERMIT MUST 8F? KE? ON THE PREMISE WHILE THE WORK IS IN PROGRE S. This is !o cer?ifp, Yhai.._?"_f .l?C?4??.r------- has permissioa !o erec! a..______..."' ...._/ ?___.."_'._..........'_...'._upon ffie above desaribed pre?A?se subjecY the provisions of the Building Ordinance for Eag Township adopled April 11, 1955. 12 -'...'_........---- ...............•--'_-..(!..'.'S*v'.`.-'........'-------.. Per ---...._...- -°'----?--"'--?.?^.fJ?'?-`?-- ??-''"1 ' ? ?----..-"'---... Chairman of ? wg Sosrd Building Inspeeior ?5• I 1II IIII02 0 2M-61 I I7III*III REDUE5T FOR ELECTRICAL INSPECTION Minnesota State Board of ElecVicity 1821 (612) 842-0800 m. S-1 a, t Paul. MN?s 1oa * t ? P ??9f' f //5 Home Duplez Apt. Bldg. Olher: New Addn Commercial Induskial farm Remod Re air Air Cond. Hfg. Equip. Wa}er Htc Load Mgmt Ofher: D er Ran e Elec. Hea} Tem . Service "X" above the work cov red 6 fbi requesG Enkr remarks in spoce and on the bock of the white copy only, i?t;?. ,? ( ?? Calculafe Inspection Fee - This Inspecfion Requesf will not be accepted wifhout rhe correct fee: OIher Fee # $ervice Enhonce Sim Fee # Circuifs/Feeders Fee Mobile Homa Park Sfall 0 to 200 Amps 0 to 10 Amps Sheet Ltg./Troffic Sig. Above 200 Amps bova.l0 Amps Transformer/Generator INSPECTOP'SUSEONLY TOTAL/?i1r1 (J Sign/Oufline Lfg. X(mr. ? l/ Alarm/Remote CoNrol ?_o'. . , D $wimming Pool I hereb ?nem Ihal I ins Med Ma eleNncal inalallafion deacnbed herein on fie da fpd/ O Irtigation Boom Rough-In Oma Special Inspedion Inves}igative Fee F??al Dax /?r J Y THIS INSTALLATION MAY 8E ORDERED DISCONNECTED IF NOT C MPLETED WITHIN 18 MONTNS. L U L- 617 [T OF/F.IC5E U/SyE O(N7LY ThiQe rfqoest.oid 18 monlhs Gom validarAan d/oM? p?n/ntqed in ' .6(o'x. PLEASE PRINT OR TYPE Reqo 1 / es , ( /?L Pwogh-in in:pection reqWred2 Yes ? N. Inspedion Other Than Rou9h-In: ? Reody Now WIII Call ?' / ?4? ? ? (You musimll 1he inspenar when reody) te Ready: I, ' li<ensed con}ractor ? owner hereby request inspecfion of }he a6ove elecfr' I wor OQ No.? ? Job - 8ox,61e ?e IV n YI A Ciry ?fL?wtJ ( Seclion No. Township Nome or No. Ronge No. Fire No. Coony ? Om nl . _ y? ITI/ (JL (. Phane . PowerSupplier Address Elenn ntfp r Company Nam Conirad« License No. Masrcr lic No. (Planl Elect Only) / ? 7Ci Mai) in (Comrador er Performing Inst Ilafionl -1 ,...?? lwihon C ador or er dn ' a Ilation) P JIq7 ?/ t>J- ?? EB-006MIC106/95 / / STpTEBOARUCOPY-SEEINSTNUCfION80NBACKOFYELLOWCOPY 2007 RESIDENTIAL PLUMBING PeRnniT aPPUCanoN CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings Date Site Street Address ??Q?? ? ?? ?' ?C?? ? Unit # (? Property Owner Telephone # ( ) Telephone# ..? - Contractor 1 State kL?L ZiP? Cit y _ Address The Applicant is: _ Owner 8 Occupant ? Licensed Plumbing Contractor New _ Refurbished Submd 2 sets of plans and MPC license Septic System InGudes County fee _ $ 100.00 Per as-built $ 10.00 Fire Repair (replace burned out fi#ures, etc.) $ 90.00 This fee a lies when extensive lumbin re irs are made to a buildi . Alterations to existing dwelling $ 50.00 _ Add plumbing fixtures to main level lower level. This fee includes instailation of a water softener and/or water heater at the same time. lf you are installing on/v a water softener and/or water heater, do not complete this section; move to the next section and place a checkmark next to the appliance(s) you are fnstalling. _Septic System Abandonment _Water Turnaround (add $136.00 if a 5!8" meter is required) Other: Water Softener XWater Heater $ 15.00 _ new ? replacement Lawn Irrigation _RPZ _PVB _new _repair _rebuild $ 30.00 State Surcharge $ 50 MAl' l 5?001 gb rotai 1 hereby apply for a Residential Plumbing 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 plumbing codes; that I understand this is not a permtt, but only an application for a permit, work is not to staR without a permit and work will be in a M wit lpi approved plan in the event a plan is requir to b eviewed and approved. ?(A?7? ll-4 - ApplicanYs Printed Name Applican's ture ? 7?Z9 2007 RESIDENTIAL PLUMBING PERnntraPPUCarIorv CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN MN 55122 651-675-5675 Please complete for modifications to existing residential dwellings. Date 1_9_ Or) Site Street Address 'lUE)b AltC' liO/s L26v'(d Unit # r lP r Property Owner Telephone # ( ) Tele hone# (?J"1) s?& p i p l Contractor , I ..! t l ? M[S) Zip ? " ??¢ ?>1 City 1_yj ri'ti'll l &C State ? Address 7L ?L _ _ y . The Applicant is: _ Owner 1>4ontractor _Other Septic System _ New _ Refurbished Submit 2 sets of plans and MPC license Includes County fee $ 100.00 Per as-buiit $ 10.00 Fire Repair (replace burned out fixtures, etc.) $ 90.00 Afterations to existing dwelling $ 50.00 Add plumbing fixtures. This fee incfudes instaliation of a wafer softener andlor water heater at the same time. If you are insta!ling onI a water sofrener and/or wafer . heater, do not complete this section; move to the next section and check the appiiance(s) you are installing. _Septic System Abandonmenf Water Turnaround (add $136.00 if a 5/8" meter is required) Other: -4 Water Heater Water Softener X $ 15.00 _ new ? repiacement ? I Lawn Irrigation _RPZ _PVB _new _repair _rebuifd $ 30.00 State Surcharge $ 50 y $ ? ".? Total I hereby apply for a Residential Plumbing Permit and acknowieage tnat tne inrormanon is corripieLe enu aU?U[ aLo, Ll Io< 11 1. work will be in conformance with the ordinances and codes of the City of Eagan and the plumbing codes; that I understand this is not a permit, but only an application for a permit, work is not to start wiihout a permit and work will be in accordance with th approved plan in the event a plan is required to be reviewed and approved. h A .,. .r^: / .D I ?1'? r /Y/?,,. / (iLlfa n % A plicant's Printed Name Applicant's Signore 77?a 7 2007 RESIDENTIAL MECHANICAL PERmi'r ApPLtcaTTON City Of Eagan 3830 Pilot Kno6 Road, Eagan MN 55122 Telephone # 651-675-5675 Plcase cnmplete for: single fxmily dwallings &, tuwnhomes/condos when pertni[s are requGred for each uni[ Date?_/_ -7 SiteAddress41Q??i??? IInit# 1AW_ Property Owner Telephoee # ( ) p? ? ?/? ? ( C? ? ??? Contractor C(A. 1 1 • Street Address ?one_?,? Cit3' S[ate A,I N) Zip Telephoue# ( G? ??I ) T??O`Lj? Bond#: Espires: ?(9 -o ? The Applicant is _ Chvner -xContractor _ CNher Fire repair (replace bumed out appliances, ductwork, etc.) $ 90.00 This fee applies when extensive mechanical repairs are mad e to a building. AdAon or atteratiaa to existing dwelling unit $ 50.00 furnace _Additionai X Replacement _ New air exchanger air conditioner heat pump ? other S[ate Surcharge $ .50 T c i ?VAY 1 5 2007 LU) s f5c'50 o a _ I hereby apply for a Residential Mechanical Petmit and acknowledge that the infomiation is complete and accura[e; that the work will be in conformance with the ordinances and codes of the Cily of L'agan and with the Mechanical Codes; that I undt`rstand this is not a petmit, but only an application for a permiL and work is not to start wilhout a permit, Yhat the work will be in accordance with the a proced plan in lhc case of work which requires a review and approval of plans. /] 1'i! 4'ep't?* -7 %sw ' ApplicanYs Pnnted jVame Applicant's SigrLdture 2? 2007 RESIDENTIAL MECHANICAL PERMIT APPLICATION City Of Eagan 3830 Pilot Knob Road, Eagan MN 55122 Telephone # 651-675-5675 'Pfease Cov`7'plete Yof smgle famdy dweElmgs R. lovmhomes/condos when petmiLS are required for each unit S'o . s6 Date Site Address Unit #? Properh• Owner Telep6one # ( ) Contractor ? a- Pi rl I Sn C- StreetAddress ?uaJ wes? CirY / y ?a?rn??Ub? e# ( J?? Tele ho &61 State p n Zip ? ??? Q lJ I ires: Ex Bond#: p The Applicant is _ Owner ? Contractnr Other Fire repair (replace borned out appliances, ductwork, etc.) $ 90.00 This fee applies when extensive mechanical repairs are made to a building. Add-on ur alteration to eaisting dwelling unit $ 50.00 furnace _Adddional XReplacement _ New air exchanger air conditioner heat pu?m p ,1 ? other T )Dl 1 Ie,('- __ State 5urcharge ?aY ? ? 2007 T $ so $ ?1?5 Total I hereby apply for a Residential Mechanical Peimit and acknowledge that the infotmaUOn is complete and accurate; that ihe work will be in confonnance with the ordinances and codes of the City of Eagan and with the Mechanical Codes; that I undarstand this is not a pennit, but only an application for a permit, and work is nol to sGVt without a permit; Ihat the work will be in accoidance with the ap roved plan in the case of work which requires a review and approval of plans. IIn n/ 4-e?0A-7_ oi-I? I'S' Applican4s Printed 1?ame 'Applicant's Signffture 0 'o City af Eapn 3830 Pilot Knob Road Eagan MN 55122 Phone:(657)67b-6675 Fax:(651)675-5694 • ? -------- ? FoiOfficeUse j Permit#: S4 ? PermiiFee: l V ? ? Date Received: I ?? I I Staff: I i 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: ?-A L0 c 40 I V..1 CJJ Ls a-PC I Tenant: Suite i!: ? RESIDENT / OWNER Name: Phone: 1co ( ? Address / City / Zip: y ??? ? ;7 L:?,-? ?'(' ?? +irL' _ 3 f? L?'?C` ? ? Y' IN ?i C A li t i O pp can wner s: _ ontractor TYPE OF WORK Description of work TU? ' Construdion Cost: Multi-Family Building: (Yes _ I No ) CONTRACTOR Name:?1 ?'? l"ltitil??.?-License#: '?Jl? Addres City : ???'??1C: F_ ?, j(") iH_., State:N i? Zip: 5?i?2 Phone: (o10???7 ContactPerson: Q - COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672 Energy Code . Resitlential Venfilation Category 1 Worksheet • New Energy Code Worksheef Category Submitted Submiftetl (4 Suhmission type) • Energy Envelope Calculations Suhmitted In the last 12 months, has tbe City of Eagan issued a pennk for a similar plan based on a master plan9 _Yes _No If yes, date and address of master plan: Licensed Plumber: Phone: Mechanical Contractor: Phone: Sewer & Water Contractor: Phone: NOTE: Plans and supporting docaments that yousu6mit are consldered fo be pqb7/c lnlormafion. Portlons of . the informaflon may be classffied as non public !f you provJdespecltic reasons fhat woWd permJt the City to conclude ihat the are trade secrets. 1 hereby acknowledge thal this informalion is complete and accurate; that the work will 6e in conformance wifh the ortlinances antl cotles of the CiTy of Eagan; that I understand this is not a permit, but onty an application for a permit, antl work is not to start wrth that ihe work wiil be in accordance with the approved plan in the case of work which requires a review and approval of plans. ? X Applican Printed N e ApplicanCs 3 nature ? Page 1 of 3 \N%LL ?ic_e-, t?p 1-,4 -WP.pr:,) x +)O-A? ?C1TY OF EAGAN 3830 Pilot Knob Road Eagan, Minnesota 55122-1897 (612) 681-4675 PERMIT PERMIT TYPE: Permit Number: Date Issued: ck44ofl auILozNe @26535 ie/1z/9s SITE ADDRESS: P.I.N.: 10-77000-010-01 4680 NTCOLS F2D LOT: 1 BIOCK: 1 70USIGNANT 1ST DESCRIPTION: 6,d71kd3,2t?,Permit Type SF (MISC.) ?uild$qt? 4o?rk T.YPe REPAIR s 'nt" s 16% , eZ., W E 93 bg D ; ?19r REMARKS: SIDING/ROOFING/WINDOWS/DOORS FEE SUMMARY: VALUATION $30,000 Ciase Fec-, $394.75 Surcharge Total Fee $409.75 CONTRACTOR: - App7.icant - sT. Lzc. OWNER: MINNESOTA CONST 18911340 20007379 DAKpTA COUN7Y HRA 15205 GODSON DR 2496 145'(`M ST W LAKEVILLE MN 55044 ROSEMOUNT MN 55065 (612) 891-134e (612)423-8106 ., CITY OF EAGAN ?, 4? 3830 PILOT KNOB RD - 55122 1995 BUILDING PERMIT APPLICATION (RESIDENTIAL) 681-4675 ? s resistered site wneys ? s cooies of vlan ? 2 copiea of plana (uvdutla beam & window slzes; poured fid. design; etc.) ? 2 si[e surveys (exterior additrons 6 dedcs) ? t errergy ealeulations ? 1 energy celwlations for hasted addRions ? 3 copies ot tree preservation plan If lot platted after 7/1/83 required: _ Yes _ No - DATE: I0 I17- /q5 CONSTRUCTION COST: 30, 26-0•o DESCRIPTION OF WORK: S=13-?? , Roop=qb. , u?wlxls '? DaoZS STREETADDRESS: 14650 ?I.LLOL-SRc'?op LOT BLOCK SUBD./P.I.D. #•??a^?? ?-A PROPERTY Name: -DAKOTA, urrN Phone #: W23-Al0LD OWNER Street Address-2-"4% 141s-k? ST, LA?'=M City: (Zos?t?tout?t- State: Zip: M14 CONTRACTOR Company: MT?A1AOZ14 Ce--,t-isT. Phone #: ER L 13140 Street Address: tVAS G??sou? License #- Ciry: Lz.r-;Exa.Lt- State:?\W Zip.ss'o4L( ARCHITECTI Company: Phone #- ENGINEER Name: Registration #• Street Address- City: 5tate: Zip: Sewer 8 water licensed plumber. change are requested once permit is issued. Penalty applies when address change and lot I hereby acknowledge that i have read this appiication and state that the infomiation is correct and agree to comply with atl applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Applipnt: OFFICE USE ONLY Certificates of Survey Received _ Yes _ No Tree Preservation Pian Received Yes No _- w CITY USE ONLY L _L BL ? RECEIPT #: !k ? SUBD. DATE: ? 7 Q5 1995 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 P1L0T KNOB RD EAGAN, MN 55122 (672) 681-4675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH NO. TOTAL Shower 3.00 x = Water Closet 3.00 x Bath Tub 3.00 x Lavatory 3.00 x = Kitchen 5ink 3.40 x = Laundry Tray 3.06 x Hot Tub/Spa 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 5.00 x = Privete DispOSal * Dakota Cty. license 20.00 = U.G. Sprinkler * home under const. 3.00 = Alterations * to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL o?d. 6D k C_ SITE OWNER INSTALLER NAME: /-- / r STREET ADDRESS: ?!UL ' 3-506nh 2- N? CITY: ?L?-r.Lr.eJ STATE: ZIP: ?y PHONE #: ( ?/?;) ?I? CITY USE ONLY L BL RECEIPT #: SUBD. 12Gu?,? DATE: 1*7 95 1 .I 1995 PLUMBING PERMIT (RESIDENTIAL) CITY OF EAGAN 3830 PILOT KNOB RD EAGAN, MN 55122 (612) 681 at675 Please complete for: ? single family dwellings ? townhomes and condos when permits are required for each unit FIXTURES EACH NO. TOTAL Shower 3.00 x = Water Closet 3.00 x ^L = ?_ Bath Tub 3.00 x = Lavatory 3.00 x = Kitchen Sink 3.00 x = Laundry Tray 3.00 x = Hot Tub/Spa 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 5.00 x = Private Disposal * Dakota Cty. license 20.00 = U.G. Sprinkler ' home under const. 3.00 = Alterations ` to existing 20.00 = Water Turn Around 20.00 STATE SURCHARGE .50 TOTAL o5zO. S D SITE OWNER NAME: /?/? Go ls • ADDRESS: " i'? W ?"j• INSTALLER NAME: ?????? LtL?? STREET ADDRESS: g?-7?2 -sz " /vz- J?? ? CITY: lJlo'LL2 STATE:zL&I ZIP: PHONE #: ( rIS.?3-ze? ? 1\? p `?; ? Y '?? ? ? ,/ ./?? t? ? \, • ? . l?he/.?1 i:903P - - ----. .`__ L??: •? . ? O ? ? ?L "v m v ? f 'I , __...._.. .. _ ..,,.._ . , v c)? ; . `+ W ?IG . ?.. Wsc- 21 n f ? ? % Q Z l` ?? Sa I h ?^ , J v C?a ? I ? I b ? v U, \ I ? \.? . Cc? ? . ,v \? ? , . ._. _. .. _..:,_ ^' -... . _ ' _. .._ .. ... ...__...._. _...,_ ??; = ?,•j ^ ? 1 I ? , .' l ..^ • . I J ,,` . . , .?•, J C?? O ?'-'1 ; . ?. 7 ?:J ?:.?. ;51 ' ? ; I? .n t !l l l + Y, . I For Office Use I I City Of LI Permit* I I Permit Fee: 3830 Pilot Knob Road I I Eagan MN 55122 j Date Received: j Phone: (651) 675-5675 I J I Fax: (651) 675-5694 1 Staff: 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date Site Address: Tenant: Suite RESIDENT / OWNER Name: Phone: Address/ City /Zip: I~ 4~ Applicant is: Owner )~=L Contractor TYPE OF WORK Description of work: Construction Cost: Multi-Family Building: (Yes / Nolte) CONTRACTOR Name: ~-1 t 1(:1 C-. ,^A_ License Addre~K~'n. INVI j~~t City: State Zip: Phone: Contact Person: r- COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING _ Minnesota Rules 7670 Category 1 _ Minnesota Rules 7672 Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet Category Submitted Submitted submission type) • Energy Envelope Calculations Submitted 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 classified as non-public if you provide speck reasons that would permit the City to conclude that the are trade secrets. 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 withouL ) that the work will be in accordance with the approved plan in the case of work which requires a review and approval of plans. 0 XA ~ ( X Applicant'o Printed N e Applicant's S nature Page 1 of 3 PERMIT City of Eagan Permit Type: Plumbing Eagan. Permit Number: EA100806 Date Issued: 08/31/2011 OR Permit Category: ePermit 41~ it~ of E3 E Site Address: 4680 Nicols Rd Lot: I Block: I Addition: Tousignants 1st PID: 10-77000-01-010 Use: Description: Sub Type: e - Fixtures Work Type: New Description: Basement Fixtures Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size Comments: Tiffany Avery 99 5th Ave. NW, Ste. 200 New Brighton. MN 55112 651-638-9990 Fee Summary: PL - Permit Fee (miscellaneous) $50.00 0801.4087 Valuation: 1.500.00 Surcharge-Fixed $5.00 9001.2195 Total: $».00 Contractor: - Applicant - Owner: Roto Rooter Dakota County CDA 99 Fifth Ave NW, Suite 200 1228 Town Centre Dr New Brighton MN 55112 Eagan MN 55123 (61)638-999 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 Cite of Eagan Ordinances. ApplicantiPermitee: Signature Issued Bv: Signature