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2091 Pin Oak DrPERMIT City of Eagan Permit Type:Building Permit Number:EA127481 Date Issued:10/02/2014 Permit Category:ePermit Site Address: 2091 Pin Oak Dr Lot:7 Block: 1 Addition: Vienna Woods PID:10-81950-01-070 Use: Description: Sub Type:Windows/Doors Work Type:Replace Description:One Window/Door Census Code:434 - Zoning: Square Feet:0 Occupancy: Construction Type: Comments:Improvements to the home require smoke detectors in all bedrooms. If altering window openings or installing Bay or Bow windows, call for framing inspection. Call for final inspection after installation. Carbon monoxide detectors are required by law in ALL single family homes . Valuation: 500.00 Fee Summary:BL - Base Fee $500 $40.00 0801.4085 Surcharge - Based on Valuation $500 $0.50 9001.2195 $40.50 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 - Igor Y Pavlenko 2091 Pin Oak Dr Eagan MN 55122 Applicant/Permitee: Signature Issued By: Signature j CITY OF EAGAN • , ' + j 3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 PHON E: 454-8100 BUILDING PERMIT Receipt To be used for Est. Value t Date ,19 " SiteAddress )41 P1N UAK D[t Lot Block Sec/Sub. Parcel No. Y 1 r.NNA W(wl?S a Neme 1 CT1ON W = Address Phone `" ` - = 144 0 City °C Name_ ,o ? ` Address ? City _ ?y W Name _ F W ? ? Address I W City Phone I hereby acknowledge that I have read this application and state I that the information is corcect and agree to comply with all applicable State of Minnesota Statutes and City of Eagan Ordinances. Signature of Permittee iI LLi,FS C:UNsTRL'CTION OFFICE USE ONLY On Site Sewage T OCCUpancy ' MWCC System _ Zoning On Site Well _ Type of Const City}Nater _ {Actuaq {Alloweble} ' of Stories Length Depth S.F. Total Footprint S.F. APPROVALS FEES Aasessments _ Permit Water/Sewer Police _ Surcharge _ Plan Review ? Fire _ SAC, City Engr. _ SAC. MWCC Planner WaterConn. • 'u Council _ _ Wafer Meter ' • ut Bldg. Off. _ Road Unit APC Treatment Pt Variance _ Parks COpies TOTAL A Building Permit is issued to: on the express condition that all work shall be done in accordance with all applicable State of Minnesota Statutes and City of Eagan Ordinancea Bullding Official Permit No. Permit Holder Dats ToIophono x Plumbing H.V.AC. ± ? i ,, ? i ?!? 7 Electric Softener Inspactlon Date Insp. Comments Footings I Footings u Y7 itb-f rc ? 9• Foundation Framing Rootin9 •vof ??4 7-3 ? p7 Rough Plbg. Ro ugh Htg. V Isul. -17 ?_ ,Q. Fireplace Final Htg. /.,f7 a ,r1, Final Plbg. F 81dg. Final cert occ. Temp. LP Deck Ftg. Deck Frmg. Well Pr. Disp. PERMIT # PLUM8ING PERMIT CiTY OF EAGAN RECEIPT # ??? ti,1 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: 46A? CONTRACT PRICE Site Address Lot -Block ? Name ? Address H c Ciry 1__ , P Name _ 3 Address O CitY ? FEES COMM/IND FEE - 1ai6 OF CONTRACT FEE APT. BLDGS - COMM RATE APPLIES TOWNHOUSE 8 CONDO - RES. FiATE APPLIES MINIMUM - RESIDENTIAL FEE - $12.00 MINIMUM - COMM/IND FEE - $20.00 STATE SURCHARGE PER PERMIT - .50 (ADD $.50 S/C IF PERMIT PRICE GOES BEYONO $1,000.00) SIGNATURE OF BLDG. TYPE WORK DESCRIPTION Res. New Mult. Add-on Comm. Repair Other RES. PLBG. ONLY - COMPLETE THE FOLLOWING: ND. FIXTURES TOTAL Water Closet - $3.00 : ? ? Bath Tubs - $3.00 ?Lavatory - $3.00 ? ___?__Shower - $3.00 _LKitchen Sink - $3.00 Urinal/Bidet - 53.00 Laundry Tray - $3.00 1 Floor Drains - $1.50 ` Water Heater - $1.50 Whirlpool - S3.00 Gas Piping Outlets - $1.50 (MINIMUM - 1 PER PERMIn Softener - $5.00 Weil - $10.00 Private Disp. - $10.00 _V_VRough Openings - $1.50 FEE: STATE S/C: FOR: CITY OF EAGAN GRAND TOTAL: ?- 1_1 It, MECHANICAL PERMIT RECEIPT # CITY OF EAGAN 3830 PILOT KNOB ROAD, EAGAN, MN 55122 DATE: - Site Address - '• ' ? ?_ ' 1y ' BLDG. TYPE WORK DESCRIPTION Lot ^' - Block ? Sec/Sub ' - ? ? 1 Res. New Mult Add-on m Name Comm. Repair Address ? ; r Other City_ Phon?' J u Name , FEES RES HVAC 0-100 M BTU -$24 00 ? c Addregs . ADDITIONAL 50 M BTU . - 6.00 p City ' Phone ? (RES. HVAC INCLUDES A/C ON NEW CONSTRUCTION) GAS OUTLETS (MINIMUM - 1 PER PEkilAlT) 50 EA - 1 TYPE OF WORK COMM/IND FEE - 1% OF CONTRACT FEE . . Forced Air M BTU APT. BLDGS. - COMM. RATE APPUES TOWNHOUSE & CONDOS - RES. RATE APPLIES Boiler M BTU MINIMUM RESIDENTIAL FEE - ALL ADD-ON 8 Unit Heater M 8TU REMODELS - 12.00 Air Cond M BTU g MINIMUM COMMERCIAL FEE - 20.00 . STATE SURCHARGE PER PERMIT - .50 Vent CFM $ (ADD $.50 S/C IF PERMIT PRICE GOES Gas Piping Outlets # ' BEYOND $1,000) Other $ FEE: . ------ - - S/C: ' SIGNATURE OF PERMITTEE , TOTAL• FOR: CITY OF EAGAN ,? ? 16. • (Ltr#i#ira#t uf (IDrrupttnry Citp of eagan Ervartnmt o# WWIdmg JWpdinn This Cernfrcate issued pursuant to 1he requrrements of Section 306 of the Uiriform Building Code certifying that at the tince of issuance this structure ww in cornpliance with the Harioas ordinances of 1he City regulating burldeng construcriarc or use. For the fallowing: u.o clus;6wtioo `T ''-MGMM B1dg. Rrmrc rb. 138 IG Oocup-y,rype R3 ZooirK Disuia cq ? l,ype Caoet. ? Owxr aF Buildius jIUAS CMELpdd?ess Xf)?b AV=A11- r*avn_Z aLla;? nea? •'91 P??f ? tih.k '.'?,T' ?;ty L7, B 1. VL?3wsA T?t7l? Budd'mg OlGcid POST IN A CONSPICUOUS PLACE CITY OF EAGAN Remarks Addition vzENNA Wnnn s Lot 7 Blk 1 Parcel 10 8 1950 070 01 Owner PlII 03}C Dr1.Ve State Eactan, Street ?Q.g.i MN 55122 - Improvement Date Amount Annual Years Payment Receipt Date STREETSURF. IIIlPY 1981 .2a34.4 283,45 10 STREET RESTOR. GRADING 1981 ??3 58.7 ;58 77 10 , . SAN SEW TRUNK 1973 129.78 8.65 I5 * SEWER LATERAL • services WATERMAIN * WATEfi LATERAL * WATER AREA * STORM SEW TRK 1981 * STORM SEW LAT 1981 CURB & GUTTER SIDEWALK STREET LIGHT WATER CONN, BUILDING PER. SAC PARK CASH RECEtPT ;-? ? CITY 4F EAGAN 3830 PILOT KNOB ROAD EAGAN, MINNESOTA 55122 ? ,k r , DATE ?L 19 - ? RiCLIVED ?` .. _..._ ' FROM AMOUNT $ I ? & DOLLAR6 ?oo ? CASH ? CHECK BY ' YVhite-Payers Copy Yellow-Posting Copy Pink-File Copy Ok: Thank You BLDG,. PERMIT N0. • , j,t-'-l ?ii? ,-r -? 01-3210 Kdg. Permi 01-3422 Plan Check 0I-3445 Surch./Adm. 01-3446 5AC/Adm. 01-2155 Surcharge 17-3860 Road Unit 20-2275 SAC 20-3$65 Water Conn. 20-3868 Water Trmt. 20-3716 Water Meter 20-2252 Acct. Dep. 20-3713 Water Permi 20-3743 Sewer Permi 79-3866 Sewer Conn. 11-3855 Park Ded. TOTAL CASH RECEIPT ?•? CITY OF EAGAN 3830 PILOT KNOB ROAD .EAGAN, MINNESOTA 55122 ' DATE ? 19 _ . AMOUNT $ ? CASH CHECK -a rOR \ ? FUND CODE AMOUNT ? • i_ (_, L4' 1 1 Thank You BY ,,lj i_ / 4 1 . ?? . . White-Peyers Copy Yellow-Posting Copy Pink-File Copy crrv oF F-AGaN 3830 P11W K?? Road P aQ X21199 iagan, MN 55121 Zoning: _ rj SEVVER SERVICE P pERMIT ERMrT NO,: 1 ?0?7 DATE: No. of Unit 6-? ? ?g, s; ? 2 ? -,? - ? a9ree fo C ' `-• -?s I 71 : Ordinance'omp'y wlth the CItY oi Eagan Connecyon Charge; r ? pd Account Deposit: ?By Permit Fee: ? Date of Insp,: Surcharga; ? MfBC. Char a ?>? Insp.: 9es: rotal: Date Paid; CITY pF EqGAN Permit No: s? ?= ? 3830 PtlopXn?-.R?d P O: Box 21199 Meter No: Dat? 6-30-87 ? Eagan, MN 55121 Reader No: Size: Date: Owner. Till Site Addrp.Q.• 2 no l,. ? ?. Conn. Chg: 525 ?? . Qti ?-1 Acct. Dep: d Permit Fee: 10.00 ? Surcharge; Tr. Plant 18 Aeter. By-------? WATER SERVICE pERMIT Conn. Chg: Acct pep;_ Permit Fee; , Surcharge: . Tr. Plant Penriit No: Meter No: ' ? S- Reader No: Date: -30_g7 Size: Qate: - ? _ Meter. ?.? Misc.: Zoning: _ No. of Units: I a9ree to comply with tha Cfty of Eagan Ordinancea. CITYOFEAGAN nJ° 13810 3830 Pilot Knob Road, P.O. Box 21-799, Eagan, MN 55121 BUILDING PERMIT PH ONE: 454-8100 Receipt n i`? c/ ? ?? ? , Tobeusedfor SF DWG/GAR Est.Value $113,000 Date JliNE 24 19 87 SiteAddress 2091 PIN OAK DR Lot 7 Block 1 Sec/Sub. VIENNA WOODS Parcel No. : Name TILLGES CONSTRUCTION = Address 20936 HOLYOKE o City LAKEVILLE phone 469-2144 ¢ Name_ .o ?? Address ? City_ ¢ Ww Name_ z? Address u ,a, i w City_ I hereby acknowledge that I have read thia aDPlicatfon and atate that the information is conect end agree to comply with ali applicable State of Minnesota Statutes and City oT Eagan Ordinances. Signature of Permittee A Building Permlt is isaued to: 1?1LLGES C NSTRUCTION all work shall be done in accordance with all ap ' e, tate of M Building Official OFFICE USE ONLY On Sile Sewage Occupancy R3 MWCC System X Zoning Prl On Site W ell Type of Const v_ Cily Water .]- (ACtual) (Alloweble) V # of Stories Length 69 Depth 56 S.F. Total Footprint S.F. APPROVALS FEES Assessments _ Permit $ 542.50 Water/Sewer _ Swcherge 56.50 Police _ PlenReview 271-75 Fire _ SAQCiry 100.00 Engr. _ SAC,MWCC 59S_00 Planner _ WaterConn. 595_fl0 Council _ WaterMeter _ 'aZ.,O( BIdg.Off, _ RoadUnit 305_(]0 APC _ 7reatment P7 180.00 Variance _ Parks covies TOTAL 5 ? on the express condition that rsotaSJ?atutes and City of Eagan Ordlnances. GOLD COPY-PERPffT RELEASE FORM PERMiT ll If-o S 2- ADDRESS , PICKED UP BY ? ThiS requesl void (??/8r/y ? ?9F266 ht?/. 7 13 1?171519v 0??5? 4,0 _._ ..? ..?. ..?.... ... .... ._?..?.. ? Required7 DPeadv NowF(] WiII Notify Insper ?NO lor When qeatly ? Licensed Elecvical Contractor 1 herebr repuesl ins0aetion of above Ownet eleclrical work instelleA et: Sir¢et Atldress, Box o Route No. fl P C & . ?o0-ai. a0q ? ecuon o. Township Name or No. Range o. Coun[y ?c.•cn r,? n_ yt r.Ja_ Occupantl?RINT1 , a Phone No, v-o ' T Power $?y\pOlier N/? r CN?.L• Atldress kil Contractor IC mpan Namel Elect Cuntracm?'s License No. r Mailing ACreas (COnuac[or or Owner Ma ing Instailation) as ?` , Authoriz SiBnawre (C ntrecmr Owner KWking Insta11a1ion) Phona Number ? THIS INSPECTION flEQUEST WILL NOi MINNESOTA STATE BOARD OF E CTNICITV Grip9s-Midwey BICB• - Aoom N•1 1 BE ACGEPTED BY THE STATE BOAXD UNLESS PROVEN INSPECTION FEE IS 1821 Universitv Ave.. 8t. Psul, MN 65104 ENCLOSED. VhnnolRl]1669-OROO "X" Below Work Covered by This Request AAd NeD. Type ol BuilEinp Appliantea WiraE Equiument Wired Home Range Temporary Service Duplex Water Heater Lightin, Fixtures Apt. Building Dryer Electric HeaUn Commerciai Bidg. Fumace Silo Unloader Industrial BIAg. Air Conditioner Bulk Milk 7ank F2fT Nxr pe.cI y iher (Sner,ity) ? .? uec?ty t er Othi,r Compute lnspection Fee Below M Fae ServiceEntranca5ize p Fee Feada,s/Subfeeders 4 Fee Circutts $ U to 200 qm 5 0 to 30 Am s .Op 0 to 30 Am Ak>ov e 200 qmp 31 t o 700 Amps 31 to 1U0 A s nvnin Pool Above 700-Am s Above 700_Am s ; siormers Irngation Booms 0 Pdrtial.b tbar-Fee s Specialinspection S TO emarks . - St1 T FE f ? XouOh.in ,.? ---'-' IecVi ?specto , weby tit th t th b Fina? cer e e a ove Y spection han Eeen de. REQUEST FOR ELECTRICAL INSPECTION /eya/-o,.ooapi-as 0 Sae instruetions br eompletine this form an back of yellow copY. //d n-/19 TMS repueat volO 18 montM trom V CITY OF EAGAN APPLICATION FOR PERMIT SEWER AND/OR WATER CONNECTION *IOT?': PAYMEnTC OF FEE AT TIIM pg arriscAzorr noFS Mr oorSrrn? APPROVAL oF PERMrr. iNsrECriorr oF sEVM AND/OR WATEa 7Nu^'LA77.AT'fQNS wrr.r• fA7,` $F $(,HED- UI,ID ONPIL PII2MIT HAS BM APPROVID. P ease Print 1) PROPERTY ADDRESS: P, ninn, ra LEGAL DESCRIPTION: (Lot'/Block/Subdivision or Tax Parcel ID IF EXISTING STRL'=]E2E, DATE pF pgIGINAL BQILDING PERN1iT ISSL'ANCE: . PRFSEIJf ZONING/PROPOSID CSE: Mbn ear q coMMEaciat,/tErFUL/oFFice Q IDIDL'S7RIAL ? INSTIZL'TIONAL/GOVERIZIENT 2) ? ?. R-1 SINGLE FAMILY Q R-2 DC!PLEK (24,o L?nits) ? R-3 TOWNIOUSE (Three + Units) ( Cfiits) ? R-4 APARTNg2IT/COPIDOMINIL?M ( Units) tvAME:_ ADDRESS: - CITY. STATE. ZIP: A PHONE: 4 Ln \ ` 2 ( ? ? 3) • ?:?• D7AME: ADDRFSS: ? • CITY, STATE, 2IP: R ?Z?2 PHONE:qrd-'-1-O1 ? LICENSE# Plumbers License: Active Expired Not recorded Steff-Initial 4) •• ? i?+• NAN1E: ADDRESS: CITY. STATE, ZIP: ' PHONE: 5? 'J Y' •JI• :3 ? 7?! . .__. . . nCONNE(.TION T0 CITY SEWER ? CONNECTION 4+0 CITY WATER ? OT,'HER '. . 6) E3 ?? g''`' ? ? ? c PLEASE HOLD APPROVID PERMIT FC)R PICK-UP BY ONE OF ABOVE PLEASE MAIL APPROVfa PIItMIT TO 1, 2. 3, 4, AHOVE n ? „ /'? (Circle one) .-FOR CITY USE ONLY PERMIT # ISSUED Pd w/Bldg. Permit $ $ $ ?- 7, e-r $ ? .._. -,. FEES: S-7 SEWER PERMIT ( INCLLDE SURCHARGE) S I6'S? WATER PERMIT (INCLUDE SURCHARGE) $ WATER METER/COPPERHORN/OLTSIDE READER $ WATER TAP (INCLUDE CORPORATION STOP) $ $ SEWER TAP S S ?5 C'Z) ACCOUNT DEPOSIT - SEWER $ ACCOONT DEPOSIT - WATER $ ? ?- S - G+'L $ WAC $ ?n Z S - U 6 $ SAC $ $ TRLNK WATER ASSESSMENT $ $ TRUNK SEWER ASSESSMENT $ $ LATERAL BENEFIT/TRUNK SEWER $ $ LATERAL BENEFIT/TRUNK WATER $ $ WATER TREATMENT PLANT SURCHARGE $ $ OTHER: $ $ ?I(J Z) TOTAL . . .?. - ? 7,r)_65 3 RECEIPT RECEIPT < ' DOES UTILITY CONNECTION REQLIRE EXCAVATION IN PUBLIC RIGHT OF WAY? F__j YES IF YES, THEN A"PERMIT FOR WORK WITHIN PLBLIC Q ROADWAY" MUST BE ISSUED BY THE ENGINEERING NO DIVISION. LIST AS A CONDITION. SUBJECT TO THE FOLLOWING CONDITIONS: APPROVED BY: TITLE: DATE : (p 13 6 ? -f7 ? 1987 BOILDING PERMIT APPLIC$TION - CITY OF SAGAN SINGLE FAMILY DWELLINGS INCLUDE 2 SETS OF PLANS, 3 CfiRTIFICATES OF SORVEY, 1 SST OF ENERGY CALCOLATIONS NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOANER MOST DESIGHATE AHICH ADDRESS IS DFSIRED. NO CHANGfiS WILL BS ALLOWED ONCE BDILDING PERMIT IS ISSQED. MU[.TIPLE DWELLINGS - RESIDENTIAL RENTAL U?iITS FOR SALE IINITS INCLUDE 2 SETS OF PLANS' CERTIFIC9TE OF SIIRYEY - CHECK WITfl BLDG. DEPT., 1 SET OF ENERGY CALCULATIONS C0MPIERCIAL INCLUDE 2 SETS OF ARCHITECTURAL & STRUCTURAL PLANS, 1 SET DF SPECIFICATIONS AND t SET OF ENERGY CALCULATIONS, $2,000 LANDSCAPE BOND To Be Used For:? Cfxri( Valuation: Date: 4--?q -e7 ? -r- ?? Site Address aOq ? p(i OFFICE USE ONLY Lot ? Block On Site Sewage_ Occupancy ,? ' Parcel/Sub {?'le??{?L{ VV??GI MWCC System ? On Site Well Zoning Type of Const City Water ? (Aetual) .? Owner??f?/ (Allowable) S? ?p, CIf?G qf?LS # of Stories Address ?j(p Length 6?9 City/Zip Code ?!'-??/??I??/yy?/?,s??' Depth S.F. Total Sln Footprint S.F. Phone - APPROVALS FEFS - .e, '?'°/ • y? Contractor Assessments Permit Water/Sewer Sureharge Address Police Plan Review 2'1 I.?s ? Fire SAC, City I ep _ City/Zip Code Engr SAC, MWCC 52? Planner Water Conn 5-2S Phone Council Water Meter &7. Bldg Off Road Unit 3OS Arch./Engr. APC Treatment P1 130. Variance Parks Address Copies TOTAL Z, S12, City/Zip Code Phone # Due to the high existing elevation on the lot I am requesting approval for a 12% grade for driveway from street to qarage floor. 2? ? 3 5gt. = 5 #? (?. 6 21- ?9- 25 ix, 32- ?3& x(2Y cp x 14- -- ?? ?- xSc6 ? ob32 4 b72 . Il?ooo I __--- ------- --- - __ _ __ + --- ? ?--- ? ? ? t ? Uj I • ?:-- ? -- . ` I I ; ? y I ? I ?- ?h N ? •?,'??3 ?? ? N I ? ? ??`(AINtNI.+ ! .F.uR? ?a 1?3 ?`. ??; Iv3?G ? ? ? - I Y J ; ? ?? - - -?- `+R -- ? - - -? -? ? ? I y I ? ' q I - - ? 91 II pI N oP.K ? ?l v rz _ PLoT f L A ?4 ?or ?, 5I.40%:',?k i, VtiJNA Waa? EX7ERIOR ENVELOPE AVERAGE "U" COnPUTA7I0N 061NER STTE ADDRESS 20q I 'F?tM (DASG- `UlnV'l° CONTIZ4CTOR MSDA7E (o ''I PHONE 4(A^- Determine working square footage of each. 1. Total exposed wall area ..... ?(00j sq. ft. x,,., _ ? 1! 2. Total roof/ceiling area ..... ? DS sq. ft. x-"n?ti Total exposed wall area above f7oor =_94 QR a. Total wa11 window area ........................... (9b b. Total door area ................................. x x c. Total sliding glass door area.............. , td. Total fireplace wall area ....... ... ......... . . e. Total wa11 framing area (average 10%)...'........ f. Total net wall area above floor ................ g. Total rim joist area ............................ Y 0 7otal ekposed foundation area = Iq ?;- h. Total foundation window area .............. :: ? i. Toal net foundation area above grade .......... Determine "U" value of each wa11 segment. a. ?00 X ????i -;,f, b. ss?s4' xliuii , 7- = 7??? c: 3?-"$A x lluit .53 = I ???'3 a. x :lull _ e.I Sfs, sa X„u„ , ?';6. f. 10(a +qb X ?lull l0 = ('0 g. 1QZ" nD g "u?? ,pL,. h. X "U" i. l9z x ,.ull 3 .....................................Tota1 If item #3 is the same as, or less than item #1, you have met the intent of 58C 6006(c)2. r r Total er.posed roof/ceilina area = 1R>6S j. Total skylight ar2a ............................. k. To.tal roo4/ceiling `raming area (averzqe 100?) 1-470 1. Tota1 net insulated roof/ceiling area.... VaAY`cfS,00 " Ftt+ l 1 a9, so Determine "U" value for each roof/ceiling s:g-Ment. j _ X ?pUll k I o,;SO X"U'l .- ?z,3g • t .??? a „u„ .4.Q?- ,. ................................ Tocat a.. If iotal of W 1s Lhe sars as, or 1°ss than r2, you have met the intent of SBC 6006(c)1. Alternate Buildin9 Envelope Design 7o utilize the total envelope system method, the values established by tne sum o` items n3 and `'4 s.ha11 not be greater than the sum o` items #l and 02. * 2. s. 249 , Q8__ ? a.. ?? , ob = Z53 , o Use BLUE or BLACK Ink r For Office Use I 11°~ (fig City Ol Eapn i Permit a s I Permit Fee: 1 0 15° 3830 Pilot Knob Road I I Eagan MN 55122 Date Received: 3 Phone: (651) 675-5675 I I Fax: (651) 675-5694 I Staff: I I I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION Date: Site Address: Unit Name: % to 1 i U 1 /a f;( ri tt Phone: 40C~ ( g Resident/ 1 Owner j Address/City/Zip: 2_Dg ( Pi \A QALk' aP n F`lV Applicant is: Owner t~ Contractor I Type of Work Description of work: ILO 0 Construction Cost: 12, ID © O Multi-Family Building: (Yes / No ~ E Company: Contact: 5~t?Y 15~~ bf1Ku(©✓ L2 Address: l -F r[ *_L't) A,.)e City: 3 Contractor & Stater zip: S a t( Phone: 6 12 3 6 8 2 i License Q_ t- 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 classified as non-public if you provide specific reasons that would permit the City to conclude that 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.gopherstateonecall.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 ~Q 1Z~P~ ocZj✓i v2 vt' D✓ x Applicant's Printed Name App!' s Signature Page 1 of 3 Date: City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Tenant: Use BLUE or BLACK Ink For Office Use Permit #: Permit Fee: Date Received: Staff: 2014 RESIDENTIAL PLUMBING PERMIT APPLICATION ¢ f i I Site Address: a 7( f t el ©gibc 4t'.. Eck la, Resident/Owner Contractor Name: Address / City / Zip: _41-0 q f Suite #: J Phone: (p1) d` 6 p— ld' ) r Name: --r %`^ � t License #: OiP��� pl14 Address: /6 l J'tc_.k .:197 4 /L& City: C,0-e/j State: cl .3 Type of Work Zip: 47191/ Phone: /)-. " . $ '/ -'/c!' Contact: •1/41/447 r Email: 4- /t. New replacement _ Repair _ Rebuild _ Modify Space _ Work in R.O.W. Description of work: RESIDENTIAL Water Heater Lawn Irrigation ( RPZ / _ PVB) Septic System New Abandonment Water Softener Add Plumbing Fixtures ( Main / Lower Level) Water Turnaround 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 System 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) (includes 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.gopherstateonecall.orq 1 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. x f "-A � eA `tN**1- Applicant's Printed Name ! Applicant's S FOR OFFICE USE Required Inspections: Meter Related Items: Reviewed By: Date: Under Ground Rough -In Air Test Gas Test Final Meter Size Radio Read Staff: