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1603 Clemson Dr BX90 City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Phone: (651) 675-5675 Fax: (651) 675-5694 Use BLUE or BLACK Ink 2010 RESIDENTIAL BUILDING PERMIT APPLICATION (�� C II r^ 5 6/- 1 � /Site address:I � 0 e�i� � �� �' Date:(((,, Suite #: Tenant RESIDENT / OWNER Name: 'ba+d TYPE OF WORK Address / City / Zip: Applicant is: Owner Contractor Van 5+&en JL4f Phone: '6 / CO 77 160 3 G ehl-. Dr 5-50Q CCNTRACTOR Description of work: r /act -3 (Jul hdQW S 1 h -eX1S4 n 1 � Construction Cost: © 3 Multi -Family Building: (Yes I No ?S) Name: 'J'\INc:Vc.) v1.e. e.,r, Address: 990 Lone Oak Rd)4 1r4`i City: EGL F1'1 Phone: License #:) G L-19:?.) State: ,AA Zip E I ` 1 Contact: f\)000,- CA -1 6 61 90 cp Irk Email: COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING In the ast 12 months, has the City of Eagan issued a permit for a similar plan based on a master plan? Yas No If yes, date and address of master plan Licensed Plumber: Mechanical Contractor: Phone: Phone: Sewer & Water Contractor: Phone: CALL BEFORE YOU DIG. Call Gopher State One Cali 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. gooherstateonecall.oro 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 accorda ice with the approved plan in the case of work which requires a review and approval of plans. 1 / k j1 C 56.11es- , / Applicant's Printed Name x. Applicant's Si City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Site Address: 1603 Clemson Dr B Lot: 64 Block: 2 Addition: Thomas Lake Heights 2nd PID:10- 75951- 640 -02 Use: Description: Sub Type: e - Fumace Work Type: Replacement Description: Furnace Comments: Quesetions regarding electrical permit requirements should be directed to Ma rk Anderson, State Electrical Inspector, 952- 445- 2840Ashley Orman 410 W Lak e St Minneapolis, MN 55408 612 - 824 -2656 ashley @standardheating.com Fee Summary: Contractor: Standard Heating & Air Conditioning 130 Plymouth Ave. N Minneapolis MN 55411 (612) 824 -2656 Surcharge -Fixed ME - Permit Fee (Replacements) Total: Applicant/Permitee: Signature PERMIT City of Eaan - Applicant - $0.50 $50.00 $50.50 Owner: Margaret A Mcglinn 1603 Clemson Dr B Eagan MN 55122 Permit Type: Permit Number: Date Issued: Permit Category: 9001 0801 Issued By: Signature Mechanical EA076825 02/27/2007 ePermit I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State City of Eagan 3830 Pilot Knob Rd Eagan, MN 55122 (651) 675 -5675 www.ci.eagan.mn.us Description: Sub Type: e - Furnace & Air Conditioner Work Type: New Description: Fumace & Air Conditioner Comments: Questions regarding electrical perm 952- 445 -2840. Fee Summary: Contractor: Sedgwick Heating & Air 8910 Wentworth Ave S Minneapolis MN 55420 (952) 881 -7739 ME - Permit Fee (Replacements) Surcharge -Fixed Total: Applicant/Permitee: Signature PERMIT City of Eaan Site Address: 1603 Clemson Dr B Lot: 64 Block: 02 Addition: Thomas Lake Heights 2nd PID:10- 75951- 640 -02 Use: - Applicant - Permit Type: Permit Number: Date Issued: Permit Category: equirements should be directed to Mark Anderson, State Electrical Inspector, Owner: David R Vansteenburg 1603 Clemson Dr Unit B Eagan MN 55122 -1868 $50.00 0801.4088 $0.50 9001.2195 $50.50 I hereby acknowledge that I have read this application and state that the informa of Minnesota Statutes and City of Eagan Ordinances. on is correct and agree to comply h all applicable State Issued By: Signature Mechanical EA082602 04/16/2008 ePermit City of Eagan 3830 Pilot Knob Road Eagan MN 55122 Ph e: (651) 675 -5675 Fax: 51) 675 -5694 i Use Permit j0�'7 Permit Fee: 90, Date Received: 0 2 Staff: 2009 RESIDENTIAL BUILDING PERMIT APPLICATION Date: q 2 J S Site Address: b 0 c t er» S a Dr. Tenant: korti) 2 d' MAr vcA. cnsfi rcl RESIDENT OWNER TYPE OF WORK CONTRACTOR Name: 1)a f 4 av1S tent- Address City Zip: 1b o3 k C( e.MSoi D(- Applicant is: Owner L Contractor Phone: 6S 407 Lit Description of work: liK C c e e N.1 e'-1 +1\1 ci GAF 1 Construction Cost: S 0 6 Multi- Family Building: (Yes No Name: 44 F o p o o rrP I a License t e t c i Address: 60 It `If 4Je s7 /000 City: a s ri-y> 1; State: Al t Zip: ,$'S3 Phone: 7 6 S 1 5 a C Contact Person: P f 4 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 subrnit are considered to be public information. Portions of t he information may be classified as nor public, if you provide specific reasons that t could p e::rn it the Ci to conclude that they 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 will be in accordance with the approved plan in the case of work which requires a review and approval of plans. Applicants Printed Name 'J OAe5 x Applicants Signature Use BLUE or BLACK Ink Suite Page 1 of 3 CITY OF EAGAN WATER SERVICE PERMIT 3£30 Pilot Knob Road PERMIT NO.: P. O. Box 21199 Eagan, I`: 55121 DATE: Zoning: No. of Units: Owner: X." Address: Site Address: Plumber: Meter No.:. Connection Charge: Size: Account Deposit: Reader No.: Permit Fee: 1 agree to comply with the City of Eagan Surcharge: Ordinances. Misc. Charges: Total: By Dote Paid: Date of Insp.: 7/7 e tZ Insp.: CITY OF EAGAN SEWER SERVICE PERMIT 3e30 Pilot Knob Road P. O. Box 21199 PERMIT NO.: Eagan, ftiN 55121 DATE: i Zoning: No. of Units: Owner: Address: Site Address: Plumber: 1 agree to comply with the City of Eagan Connection Charge: Ordinances. Account Deposit: Permit Fee: Surcharge: By Misc. Charges: Date of Insp.: Total: Insp.: Date Paid: ( 03 ....a.. J - /4/ • • • Use BLUE or BLACK Ink I For Office Use I Permit a - 'n__ i My of Eagn I c~i I Permit Fee. 45~ • S I 3830 Pilot Knob Road 1 2 Eagan MN 55122 I Date Received: 3 I Phone: (651) 675-5675 1 ~2 1 Fax: (651) 675-5694 1 Staff: cf lb I 2013 RESIDENTIAL BUILDING PERMIT APPLICATION 9 Date: Site Address: j ba i_ )1w b3S N& 'Vri g - _ Un td'i~:. 16 _ Name: Y4r21 L'n Phone: 1. 721- 7-M d N- Residettt Owntr Address I City I Zip: _ Applicant is: Owner Contractor Type of Vllork Description of work: Aei c~F - Construction Cost: _7 S 0 Multi-Family Building: (Yes No 7 25 Company: -PJ~UC7/C------ Contact: Jtt. Contractor Address:Q eL~al a-~__ City: 1~!C)1?e~LGJIr'S State: "-Zip: syd Phone:! License 0 ( 2-- Lead Certificate 2~ 1 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: __--_e- 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. CALL BEFORE YOU DIG. Call Gopher State One Call at (651) 4540002 for protection against underground utility damage. Cab 48 hours before you intend to dig to receive locates of underground utilities. www.oooherstateonecall.orp 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!l~r"'T ~harCl? x r Applicant's Printed Names Appiica s Signature Page 1 of 3