1650 Oakbrooke Way
MAY-17-2010 08:34 PM s In 9528911800 P. 8
Use BLUE or BLACK Ink
6
I .Permit
City of Eajan
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I Permit Fae: I
3830 Pilot Knob Road i
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Eagan MN 55122 pate Received: -
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Phone: (651) 675-5675 I I
Fax: (651) 675-5694 I staff:
2010 COMMERCIAL
PLUMBING
,~,/PERMIT APPLICATION
Dates Oofo Site Address: 16!;7-0 ~K ~1(~IL.~e W&Z
Tenant;' ® J~AEO t•t~ ~ Suite#:
PROPERTY //►►,,-~~n~ S L~QGI
OWNER Name: Phone:
Name: I I License # '574~
CONTRACTOR
Address City: ff'h G Stets: ollZip: ~ I 1
Phone: 0 (CPDA A( Email:
TYPE OF _ New _ Replaoement _ Repair J&Rebulld _ Modify Space Work in R.O.W.
WORK' Description of work: 49R~6JL LQ p,'Z
COMMERCIAL
PERMIT TYPE _ Now Construction M04ify Space
Irrigation System L_ yes I _ no) RPZ 1 _ PVB)
Rain sensors required on irrigation systems
Avg. GPM (2' turbo required unless smaller size allowed by Public Works)
Motors Cali (651) 6755646 to verity that teats passed nr! r to ''joking up meter
Damea#tc: Size 3 Type Fire: 1
Avg. GPM High demand devices? Yea _No Flushometers Yes „_No
$50.50 MinIMUm (Intl . es State Surcharge) OR Contract Value $ X1%
■ $ Permit Fee
Required on ALL new buildings and boulevard Irrigation systems 4 - $ Radio Meter Read
If P.lt E.W I$ lose than $1,000, surcharge Is $.50 - $ Meter(s)
- If Permit f, Is a $1,000, surcharge Increases by $.50 for each $1,000
$1,000 Permit Fee (Le. a $1,001-$2,000 Permit Fee requires a $1.00 surcharge). $ State Surcharge
Following foes apply when installing a now lawn irrigation system. $ Water Permit
Call the Clty's Engineering Department (051) 076-5546, for required fee amounts.
$ Treatment Plant
- Water Supply & Storage
$ state Surcharge
TOTAL FEES $ i . _
GALL BEFORE YOU DIG. Cell Gopher State One Call at (651) 454.0002 for protedon against underground utility
damage. Call 48 hours before you intend to dig to receive locates of underground utilities. www. C herstateonecall.or
I hereby acknowledge that this Informatlon 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 withou a permit that the work will be in accordance with the approved
pl he case of work which ulres a review and approval of plans.
x Lt '-K ( ED Fy . x /YIN vP~/5
Applicant's Printed Name Applicant's Signature
EF* Apprat,irs
d t>s - pecost:IndeGra n$ Roug. ' ~h-1n.PRa ~ • . est in~l:, : q .:Y .
Page 1 of 3
ctTV OF FAr.,AN
Cli',;.li;cR: JS iI::RMTNAL ML': i'63
PAVr 09/0r/93 TTME: o8ac?9:48
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II)•a
NMEr. AQtlA CITY 7:h.?.T.GF?TTOt4
'c!:L2 '?t?Ui 1650 nRICDRC!OItC :30.00
3716 `,1220 :1.6E70 UAItRIiUOI:I:: 635 „00
3':1.3 9220 1650 D(-SI:Ttr.()pE;E 50,00
3965 7E?0 I.f,:it] UAI:LiI'iOQF;F_ 825.470
3868 3220 1600 OFit;RFf]QF;E 469.00
215; 3001. 1650 f1AKCfIiUO1iE. i,O()
7u+,a1 ftece.r.l_,i; Amoun+,;; 27000.00
Ch i 1630;:i
I.tSFR T.LIs .tAid
CITY USE ONLY
L B RECEIPT #:
SUBD. ?r )YCSYS-? 3 r? RECEIPT DATE Cl ?- -cil Qt
APPROVED BY: , INSPECTOR PLUMBING PERMIT # (4
1999 PLUM$IN& PERMIT (COMMEftC1i4L)
C11'Y OF E4fiAN
S$SO PILOT KNOS iiD
£Afii4N, MN 55122
(651) 681-4675
Please complete for: all commerciaVindustrial buildings
mul[i-family buildmgs when separate building pertnits are not reqwred for each dwelling umt
installation of backflow prevenrer in commercial areas or residential boulevards
Date: q-'1 •am Work Type: _ New Bldg. _ Add-on _ Repair }(_ U.G. Sprinkler _ RPZ
Description of Work: DoULEtlARA t1ZRItoN?101J
To iuquire if Pressure Reducing Valve is required on new service, ca11681-4646.
FEFS
o; cvn7ac_ p:;cz cr•?3C:OC ?'sz;7am Contract Price: $ x 1%
COMPI,ETE THIS AREA ONLY IF INSTALLING LINDERGROLIND SPRINKLEI2 SYSTEM
ao
Backllow Preventer Permit Fee - $ 30.00 'Pe $ 30
)+?z• -tuie-r?o W fn??4,? l0 3S '?
Water Meter: 2" Turbo - $ 889.00 unles p an approved for smaller s?ze
Service: _ existing (if coming off domestic line) OR v new .
If "neiv senrce". contact Jen1 Wobscha7l Finance Consultant to conf:rm atidirvg fves for:
Water Permit & Surcharge - $ 50.50 y.f (36 Rrvi $ S0
Water Supply & Storage - $ 825.00 ? w c-o fj4! $ S ZS"
Water Treatment Plant Charge - $ 468.00 W* kmT $ U 1,, 9'
Permit Fee $ o? b0w () ?
' State surcharge is calculated from Permit Fee at right -
'$.50 for each $ 1.000 with a minimum of $.50 due
SV'?C1lSK
State Surcharge $
Total Fee $
I hereby acknowledge that I have read this applicatioq state that the information is correct, and agree to comply with all applicable Ciry
of Eagan ordinances. It u t; e apphcanYs responsibility to notify the property owner that the Ciry of Eagan assumes no liability for any
damages caused by ihe City darung its normal operational and maintenance activities to the facilities conshucted under this permit withm
Ciry property/right-of-wayleasement.
SITE ADDRESS: N 65 O O Ak i3(taOti•F W(}L_?
TENANTNAME: `ui-"-S 40 MEs TELEPHONE#: (,i$ 45Z-5zoo
(AREA CODE)
INSTALLER NAME. EA M A.KIt Ptru.&t 13 1 n1 L? TELEPHONE #: ?, f T- ?; -" -1D _??
rnuFn rnnFi
STREE".
CITY:
CITY USE ONLY
DOMESTIC METER SIZE COMPOUND TURBO
PRV: Yes No
• Contact Utility Billing Division for price: 651- 681-4631.
IRRIGATION METER SIZE:
• 2" hubo unless approval for smaller merer granted by Public Works.
• Contact Utiliry Billing Division for price: 651-681-4631.
PRIOR TO SELLING A METER:
• Enter site address on Screen 301, Petinit Inquiry, to obtain sewer and water permit number.
• On PIMS Screen 320, enter sewer and water permit # to check that hydrostatic, conductiviry, and bacteria tests have been
approved. If not, do not issue meter.
Miscellaneous Information
• Meter larger than 5/8" - ask plumber to wait while you call Central Maintenance (ext. 300) and verify that one is in stock.
• To schedule inspection of the inside water line and backflow preventer, call 651-681-4675.
• "Io schedule water tum-on, call 651-681-4300.
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CD/Permit forms/plbg permit (comm) 1999