4313 Rahn RdCITY OF EAGAN Remarks Cedar Grove Acquisition
Addition Cedar Grove #2 Lot 30 eik 1 Parcel 10 16701 300 01
Owner °I" / ;'t -: 'i `??ct! 1_L Street 4313 Ra.hri Rd. State Eagan,, MN 55122
Improvement Date Amount Annual Years Payment Receipt Date
STREETSURF. 1270 330-00 3.00 10 Paid
STREET RESTOR.
GRADING '
SAN SEW TRUNK
* SEWER LATERAL 1ka 1972 130•QQ 52.16 2
WATERMAIN
# WATER LATERAL 1972
WATER AREA
STORM SEW TRK
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT -
WATER CONN.
BUILDING PER.
SAC ?
PARK
?„ . .?.._^-.. ?r _. ?,..._, . ,. _. .
CITY OF EAGAN
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
BUILDING PERMIT PHONE: 454-8100
Receipt # To be used for j)$C(( Est. Value Date AUG 22 , 19_91
Site Address 4313 W?RIt gn
Lot 30 Block I Sec/Sub. _C£nAR GROVE 21iD
Parcel No.
W Name CARQLYI?LS .1L?nAlA
3 Address 631,1 gAHM An
0
City F4=eH Phone 651-3645
, o Name $AME
Ov
U¢ Address
1- City Phone
W W Name
-? ; Address
<? City Phone
W
I hereby acknowlege that I have read this application and state that the
information is correct and agrpe to comply with all applicable State of
Minnesota Statutes and of EagIT?n Ordinances.
,
Signature of Permitee ? ? - L--?
A Buiiding Permit is issued to: cAR6L? s.1 RDAK
on the express condition that all work shall be done in accordance with all
applicable State ot Minnesota Statutes and City of Eagan Ordinances.
Building Official ,
Occupancy
Zoning
(Actuaq Const
(Allowable)
# or stories
Length
Depth
S.F. Total
S.F. Footprints
On Site Sewage
On Site Well
MWCC System
City Water
PRV Required
Booster Pump
APPROVALS
Planner
Council
Bldg. Off.
Variance
OFFICE USE ONLY
2210
12114
Bldg. Permit
Surcharge
Plan Review
SAC, City
SAC, MCWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
S/W Surcharge
Treatment PI
Road Unit
Park Ded.
Copies
TOTAL
FEES
zs•so
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Comments
Footings I
Foundation -
Framing
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orstat Test
Final Plbg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
Dedc Ft9•
Dedc Final
Well
Pr. Disp.
CITY.OF EAC!,N
3795 I'iJ_ot Knob Road
Ea;&,ny 'Minne::ota 55122
F i n;?HITT N:) .: 787
The City of Ea.,r?,an he.re'_y grants to Fredrickson Heating & A/C
c e-f 4030 Beau d' Rue Prive
a v?•,mTA,?_ Pe.rmit fors (Gwner)C. Jordan
_.--_*_..._..
at 12 Rohn RoAd , pu2 suant to apr,lication dated 1/14/76 ?
7--?0 _-
Fee Paide s5.oo _ dated this 21 da.y el Jan. ' 19 76 .50 s/c
Duild:i_r, Izispector
MechanicaJ_ Permits:
Bid Toi,al :
CITY OF EAGAN yo 19592
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
B ? t rr 0 ? ?
J
UILDING PERMIT Receipt #
To be used for DECK Est. Value Date AUG 22 , 1 g 91
Site Address 4313 RAHN RD
Lot 30 Block 1 Sec/Sub. CEDAR GROVE 2ND OFFICE USE ONLY
Parcel No. occupancy _ FEEs
Zoning -
W Name CAROLYN S JORDAN (Actual) Const Bldg. Permit 25.00
AddreSS 4313 RAHN RD (Allowable) _
- 50
o Surcharge .
City EAGAN Phone 454-3645 # of Stories -
22
W Plan Review
Length 2
o Name SAME Depth 12XL4 SAC
Cit
Q
0
Address
S.F. Total ,
y
-
0 SAC, MCWCC
? City Phone S.F. Foolprints _
r Co
Wal
On Site Sewage e
nn
_
r-
? W
N8m@
On Site Well
W
t
M
=
?-
AddrG'SS
MWCC System -
a
er
eter
?
y
<W CltY Phone City Water _ Acct. Deposit
PRV Required _ S/W Permit
I hereby acknowlege that I have read this application and state that the Booster Pump - S/W Surcharge
information is correct and agr e to comply with all applicable State of
Minnesota Statutes and o Eag dinance . Treatment PI
Signature of Permitee APPROVALS Road Unit
A Building Permit is issu to: C OLYN S ORDAN Planner - park Ded.
on the express conditio that all work shall be done in accordance with all Council
applicable State of Minnesota Statutes and City of Eagan Ordinances. Bldg. Off. _ Copies
Building Official ?(???? Variance - TOTAL '15. 50
? This request void
78 months from 1 /9 «?
?' p E?
?
E 3 2 3 6./ 0/c2 -?
Request Da.te ' Fire No. Rough-in InsVertion
Required? ,?(
PR-a'y NuwJr(1 Will Notify, Inspec-
8?L ? ?Yes No / tor When Ready
Licensed Electrical Contractor I hereby request inspection of above
Owner electrical work installed at:
Street Address, Box or Route No. n
R City
tl31
3 r34-
JC
oc 0
,
k-
?1 4- 0
ection o. Township Name or No. Range No. County
oTi?
Occupant (PRINT) Phone No.
&L, 0-a.,., A r
Power Su plier Address
-YA ? p
Electrical CIontractor (Company Name)
e.? Contractor's License No.
?b gS2? -
Mailing Address (Contractor or Owner Making Instailation)
.? '? /S 02J.( 'te o/
Auth 'zed Signature (Contract / ner Making Installation) Phone Number
1
MINNESOTA STATE BOARD OF ELECTRICITV THIS INSPECTION REQUEST WILL NOT
Griggs-Midway Bidg. - Room N-191 BE ACCEPTED BY THE STATE BOARD
1821 Universitv Ave.. St. Paul, MN 55104 UNLESS PROPER INSPECTION FEE IS
Phone (612) 642-0800 ENCLOSED.
E 3 2=3.6
REQUEST FOR ELECTRICAL INSPECTION .c-« Ee-ooooi-os
, See instructions for completing this form on back of yellow copy.
"X" Below Work Covered by 7his Request
Add Rep.
. Type of Building Appliances Wired Equipment Wired
Home Range Temporary Service
Duplex Water Heater Lightiny Fixtures
E Apt. Builcling Dryer Electrie Heatni
Commercial Bldy. Furnace
4 Silo Unloader
Industrial Bldg. Air Conditioner Bulk Milk Tank
Farm
Other Speci Y
(?ther (Specify)
ther SVecify Other Other
Compute lnspection Fee Below
tl Fee Service Entrance Size tt Fee. Feeders/Subfeeders # Fee Circuits
0to200Am s ? 0to30Am s 0 to30Am s
Above 200 qmps 31 to 100 Arnps 31 to 100 Am s
Swimming Pool Above 100_Amps Above 100_Amps
Transformers Irrigation Booms Partial- Other Fee
Signs Special Inspection ?p?
$?
r'
T A
FE
Remarks
?.. , ?t1 i r??''f
?"'
?
?
A
v,p
Rough-in Date
I, lectrical ;
, Inspector, hereby '
94 ify that the above
Final ection has been
made.
rnca --t void 1R months irom
EAGAN TOWNSHIP o
, N. 1252
= BUId-DING PERMIT . ?
Owner ... :?c,'t-!
hi
°- ---•••• . ............'---------•••---••-- ------°..-------- Eagan ns ?
Address (Preseni) -?--=-••-?---•?----`'"?''?-?:...?i.`'---?..,-`--- Town Ha1
Builder .--:...... ?.-...... ----------------
--------------------- ----------
---
Dafe
•---? --------l-.`-:_?•- ---------•----------
Address ---•- ---------•-------•--••••---•••.---..--=--•--••-:••---••--•---------•--•---?------ _
. • , .. DESCRIPTION' ?
5iories To Be .Used For Froni -Dep2h Heighi. Est. Cost Permii Fee Remarks
"f
LOCATION'
Sireet, Hoad or oiher Descripfion of Location Lo! Black ? Addilion or Trac2
? I{ JZLX 'T, ? a2.s- Y- ?;2 G, 13t e.
J)
This permii does not suthorize ihe use of s2reets, roads, alleys br sidewalks nor does ii give the owner or his agent
!he righf io create any situation which is.a .nuisance or which presents a hazazd to the heal2h, safety, convenience and
general welfare '3o anyone in the community. ?
THdS PERMIT MUST BE KEPT ON THE•PFEEMISE WHILE THE WORK IS IN PROGRESS. -
This is to cer3ify, ihai--- (f? ;------------- __ ???::.?z'.__has permission to erec2 a_.._:??-_?__ :_. :. •?•-`--- •<<?` ? ? ? <<< , .upon
•----••-----------=f .....
' !he above described premise subject io the provisions of the Building Ordinance for Eag3n T wnship adopted' Aprii 11,
1955.
..--°----•---•----•--r?^'= -Chan o Tnwn Boar ?, ? t , J ?.? ,.
--.-- -=t--=--.-'?-= -- ......... .,?--..? --------_-.---=. - . ----
•---••------. Per ......... - -F---?-?`---4--<<--•_-•-•-........ .
d Building Inspeclor
' ? ? ?
?
.,
/dfl)
S?
?
?-- ?%
?op 7 ,
?
I
/el?o r
?
.
,
272-4zk l
y313
Ci ci`? I te 2005 RESIDENTIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please oomplete for: single family dwellings & townhomes/condos when permits are required for each unit
.1*%! ?
A 30 ,Sa
Date v ?
Site Address Unit #
Property Owner Telephone # (651 ) q,5 4/ - 3?y J'r
Contractor C,a,?
Street Address _3CD ?'j Q ?e.`(N Y?c- tr, City
State G___
?- J YY1 IV Zip Telephone #(?k"j
Bonil Expires:
The Applicant is Owner ? Contractor Other
Add-on or alteration to existing dwelling unit $ 30.00
furnace _Additional _ Replacement
air exchanger
7z air conditioner _New ?Repiacement
other
State Surcharge $ .50
Total $ ?Q
I hereby apply for a Residential Mechanical 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 with the Mechanical Codes; that I understand this is not a
permit, but only an apptication for a permit, and work is not to start without ermi t at the work will in accordance with t
ap =UT in the case ork whi ! requires a review and approval f pl s
?-? r1 ?5t7
Applicant's P inted Name Applicant's '' atu nn ?
i''JUN 1 5) 2005
?
?..? .
1-
?,
2005 COMMERCIAL MECHANICAL PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675
Please complete for: commerciaUindustrial buildings
multi-family buildings when separate permits are not required for each dwelling unit
Date : / /
Site Street Address Unit #
Tenant Name (if applicable) Previous Tenant Name
Property Owner Telephone # ( )
Contractor
Street Address City
State Zip Telephone # ( )
Bond #: Expires:
The Applicant is Owner Contractor Other
Work Type
New Construction _ Underground Tank _ Install _Remove **see below
Interior Improvement _ Install Piping _ Processed _Gas
Nature of Work:
**When installing/removing underground tank, call for inspection by Fire Marshal and Plumbing Inspector
Permit Fees: $70.50 Underground tank installation/removal
$50.50 Minimum (includes State Surcharge)
or
Contract Value $ x 1% _ $ Permit Fee
• If e? fee is $1,000 or less, add $.50 =1 $ State Surcharge
If ep rmit fee is over $1,000, add $.50 for
every $1,000 permit fee $ Total Fee
I hereby apply for a Commercial Mechanical 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 with the Mechanical Codes; 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.
Applicant's Printed Name
Applicant's Signature
Approved By: , Inspector
1991 BUILD I P ICATION
CITY OF EAGAN
SINGLE FAMILY DWELLINGS
MULTIPLE DWELLINGS
COMMERCIAL
2 SETS OF PLANS 2 SETS OF PLANS 2 SETS OF ARCHITECTURAL
3 REGISTERED SITE SURVEYS REGISTERED SITE SURVEYS - & STRUGTURAL PLANS
1 SET OF ENERGY CALCULATIONS (CHECK WITH BLDG. DEPT.) 1 SET OF SPECIFICATIONS
1 SET OF ENERGY CALCULATIONS 1 SET OF ENERGY CALCS
# OF RENTAL UNITS # OF FOR SALE UNITS
PENALTY APPLIES WHEN: TYPING OF PERMIT IS REQUESTED, BUT NOT PICKED UP BY LAST WORKING DAY
OF MONTH IN WHICH REQUEST IS MADE.
LOT CHANGE IS REQUESTED ONCE PERMIT IS ISSUED.
NOTE: ADDRESSES FOR CORNER LOTS - CONTRACTOR/HOMEOWNER MUST DESIGNATE WHICH ADDRESS IS
DESIRED. NO CHANGES WILL BE ALLOWED ONCE BUILDING PERMIT IS ISSUED.
PROCESSING TIME FOR SEWER & WATER PERMITS IS TWO DAYS ONCE A PERMIT HAS BEEN COMPLETED.
PERMIT MUST SHOW A LICENSED PLUMBER.
To Be Used For: Z1197S6aF7- Valuation: ?- Date:
Site Address ?.?13 go4-/¢3tJ ,QP
Lot ? Block ._ 41- 6e4^f- GF-e"V`ty
.
Parcel/Sub
Owner Gf1-20(,yn1 S.
Address 41?13 447q?./ City/Zip Code
Phone
Contractor
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
Sewer,Wator Licensed Contr.
ignature/fa(f Contr
OFFICE USE ONLY
Occupancy
Zoning
Actual Const
Allowable
# of stories
Length 22 xl s..
Depth
S.F. Total
Footprint S.F.
On site sewage_
On site well
MWCC System _
City water _
PRV _
Booster Pump _
APPROVALS _
Planner
Council
Bldg. Off.
Variance
FEES
B1dg. Permit 2 S'40ro
Surcharge ?Sa
Plan Review
SAC, City
SAC, MWCC
Water Conn,
Water Meter
Acct. Deposit
S/w Permit
S/W Surcharge
Treatment P1.
Road Unit
Park Ded.
Trai1 Ded.
Copies
SIIBTOTAL
Penalty
Lot Change
TOTAL So
agrees that all work shall be done in accordance with
all"applicable State of Minnesota Statutes and City of Eagan Ordinances.
,.. ._ .: .. ? ? ? ?
November 11, 1969
Dakota County Auditor
H$ttings, Minnesota
Dear Sir:
we have reoeived paymer,t in our office for special aseesements
on the f.'cll.owi.ng li Ft of' legal descriptfonst ..
Lct 1, _--?'Lcck 1, Cedur Crove #2, Street Aaseasment
Lot 1;, Blocl: /, Country HomE ;'eiehte, Storm :ewer
- Pareel 3216-F, Section 16, Kenneth nound, Trunk
Assessment
,ot 3f-, .1131oCk I. y Cedar Grove ,,=', Street Assesement.
- ?
Please a.djust your records accourdingly.
' Thank-you.
Sincerely,
_ ro
(Mrs.) Alyce Bolke
Clerk, Eggan Township
AB:ag
?
?
?q8l3
2004 RESIDENTIAL BUII,DING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan MN 55122
Telephone # 651-675-5675 FAX # 651-675-5694
$770,0 6
New Construction Reauirements RemodeVRepair Reauirements
3 registered site surveys showing sq. ft of lot, sq. ft. of house; and all roofed areas 2 copies of plan
(20% maximum lot coverage allowed) 1 set of Energy Calculations for heated additions
2 copies of plan showing beam & window sizes; poured found design, etc. 1 site survey for additions & decks
1 set of Energy Caiculations Addition - indicate if on-site sepfic system {?? °. ?; ??,? ?t
3 copies of Tree Preservation Plan 'rf lot platted after 711/93
Rim Joist Detail Options selection sheet (bldgs with 3 or less units
Date / a 7 Construction Cost
Site Address YL? l? Wa /'J Unit/Ste #
Description of Work 1?o,Q--)0 / C&/' o F C earJ!c
Multi-Family Bldg _ Y_XN Fireplace(s) _ 0 _ 1 _ 2
Property Owner ? Telephone #( ) QJy•J? 7`S
Contractor K
Address City
State AM-/ Zip Telephone #(gs? [J yL -34 39
COMPLETE THIS AREA ONLV IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Categorv 1 Minnesota Rules 7672
Energy Code Category . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
0 submission type) Submitted Submitted
• Energy Envelope Calculations Submitted
Have you previously constructed a building in Eagan with a similar plan? _ Y _ N If so, 25% plan review
fee applies.
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
Telephone # (
Telephone # (
Telephone # (
N 1 5 2004
I hereby apply for a Residential Building Permit and acknowledge that the information4?p7and accurate;
that the work will be in conformance with the ordinances and codes of the City of Eagan and the State of MN
Statutes; 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. , /f
4a-tzj*r1 1
Applicant,s Pnnted Name Apphcant,s Signature
OFFICE USE ONLY
Sub Types
? 01 Foundation
? 02 SF Dwelling
0 03 01 of _ plex
? 04 02-piex
? 05 03-plex
? 06 04-plex
Work Types
? 31 New
? 32 Addition
? 33 Alteration
? 34 Replacement
Valuation
Census Code
SAC Units
# of Units
# of Bldgs
Type of Const
_ Footings (new bldg)
_ Footings (deck)
_ Footings (addition)
Foundation
Drain Tile
Roof Ice & Water Final
_ Framing
_ Fireplace _ R.I. _ Air Test _ Final
_ Insulation
Occupancy
Zoning
Stories
Sq. Ft.
Length
Width
MCES System
City Water
Booster Pump
PRV
Fire Sprinklered
REQUIRED INSPECTIONS
_ Final/C.O.
Final/No C.O.
_ Plumbing .
HVAC
Other
_ Pool Ftgs _ Air/Gas Tests Final
_ Siding _ Stucco _ Stone _ Brick
_ Windows
_ Retaining Wall
Approved By: , Building Inspector
Base Fee
Surcharge
Plan Review
MC/ES SAC
City SAC
Utility Connection Charge
S&W Permit & Surcharge
Treatment Plant
License Search
Copies
Other
Total
? 07 05-plex ? 13 16-plex ? 20 Pool
? 08 06-plex O 16 Fireplace ? 21 Porch (3-sea.)
? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.)
? 10 08-piex ? 18 Deck ? 23 Porch (screen/gazebo)
? 11 10-plex O 19 Lower Level ? 24 Storm Damage
? 12 12-plex Plbg_Y or _ N ? 25 Miscellaneous
? 30 Accessory Bldg
O 31 Ext. Alt - Multi
? 33 Ext. Alt - SF
? 36 Multi Misc.
? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
O 37 Demolish Building'` 0 43 Reroof ? 46 Windows/Doors
*Demolition (Entire Bldg) - Give PCA handout to applicant
2008 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: /V ' 1,57- 0? Site Address: 7 313 I, aAA / 1CI
Tenant
Suite #:
RESIDENT / OWNER I Name:
Phone:6 9` yd Y 36 /57
Address / City / Zip: /-/ (, / l Gf'Ih ?U l/?' R Up?
Applicant is: Owner ,,e_ Contractor
TYPE OF WORK Description of work: TrGv' ,CJ`1'4 /7C,'rJ 0 T
Construction Cost: o1C1 _ Multi-Family Building: (Yes / No
CONTRACTOR I Name: A&ACJ License #: 1179
Address:
City: 0J/"/0!- 4-1 /<? ' State Zip:
Phone: (012- 5 WM s Contact Person: //y(/t cJ0v.SCbt 6-12-20T-577 ,?
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateaorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category submined 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:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
Phone:
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. /J
x ?'/w-d lIC/SIh x 40;
ApplicanYs Printed Name ApplicanYs Signat e
Page 1 of 3
?
?
?- - -----------
? For pfhce<'M.Use ? ' ?
j Permit #:
? Permit Fee:
? Date Received: j
I ?
I Staff: I
I I
?--___--____-____J
Date:
2008 RESIDENTIAL BUILDING PERMIT
?9? Sitp oddrPCC- / 313 Ak kV
Tenant:
Suite #:
RESIDENT / OWNER Name: t Phone:
Address / Ciry / Zip: al,
Applicant is: Owner Contractor
TYPE OF WORK ?
Description of work: tS
Construction Cost: l4/ 1000 Multi-Family Building: (Yes / NG?Kj
CONTRACTOR Name: G`1 i:n. D vZ5 `/ License #: r????
Address: 4.F4;? ? z-Zob
City: State: ee Zip: 5?5 1'?a2_5
Phone: Contact Person:
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
_ Minnesota Rules 7670 Cateaory 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:
NOTEPlans and supporting documents thaf you submit are considered to. he publlc Information. Portions of
-:#he,inforrriation may:be classifiedas non public if you"provide speafic 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 without a permit; that the work wiil be in
accordance with the approved plan in the case of work which requires a review and approv I of plans.
•
x g ( G.' VJ /- "'o a, Awo?l
?
Applicant's Printed Name ApplicanYs Signature
Page 1 of 3
PLICATION
Use BLUE or BLACK Ink
I
For Office Use
~ EaEno nn Vl O Permit# i b
41 F I
I
I Permit Fee: (Lt.
I
3830 Pilot Knob Road t 1
Eagan MN 55122 1 Date Received:
I
Phone: 651 675-5675 t
Staff:
Fax: (651) 675-5694 L - - - - -
2013 RESIDENTIAL PLUMBING PERMIT APPLICATION
Date: 6 Site Address: T , ~ d) C/ ~l yi / ~
Tenant: Suite
Resident/Owner Name: 0 d z -114 o r a-I Phone: 5 6~
Address/ City / Zip: ,C a
Name: " 61 4 License T l D 5 ~C') J°~
Contractor Address: LqbZ, 't/ e,- e: lie, City:
State: / Zip: U Phone:
Contact: f lWa~tZ Email:
Type of Work XNew _Replacement -Repair _Rebuild - Modify Space - Work in R.O.W.
Description of work:
RESIDENTIAL
Water Heater
Lawn Irrigation RPZ / PVB) Water Softener
Permit Type
Septic System Add Plumbing Fixtures Main Lower Level)
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 System Abandonment, Water Turnaround* (includes $5.00 State Surcharge)
*Water Turnaround (add $200.00 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)
TOTAL FEES $
CALL BEFORE YOU DIG. Call Gopher State One Cali at (651) 4544=2 for protection against underground utility damage.
Call 48 hours before you intend to dig to receive locates of underground utilities. www._qopherstateonecall.org
t 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 1 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 why requires a review and approval of ans.
x sue! C! ~ C x
Applicant's Printed Name Applicant's Signature
FOR OFFICE USE Reviewed By: Date:
Required Inspections: Under Ground -Rough-In Air Test -Gas Test -Final