4550 Scott Tr WATER SERVICE PERMIT
• . ."Y OF EAGAN
5795 Pilot Knob Road PERMIT NO.:
Eagan, MN 55122 DATE:
Zo~ing: No. of Units:
Owner:
Address: , _ . . -
5ite Address:
Plumber: Connection Chorge:
Meter No.:
AccounY Deposit:
S1Ze~ Permit Fee:
Reoder No.:
I agree to eomVh with the City of Eogan Surcharge:
0?dinaneet. Mix. Chorges:
Total:
Date Poid:
By
p.:
Dote of Ins
SEWER SERYICE PERMIT
Cr . Y OF EAGAN
~795 Pllot Knob Road PERMIT NO.:
Eogon, MN 5S1Z'l DATE:
Zoning: No. of Units:
Owner. `
Address: . . . - . '
Site Address:
Plumber. ~
1 agroe ta oen~Ph~ wi~' ~O ~h' °f Eo9°n Connection Charge:
~~~n~ Account Deposit:
Permit Fee:
Surcharge:
BY ~y{isc, Charges:
Date of Insp.: Total:
Date Paid:
I nsp.:
cirr oF ~?cAN
=7!S Pilof Keob Rood EOy011~ MN SS122
' ' PHONE: 454-61 p0
BU1tDING PERMIT Receipt #
To b~ uted fa Est, Volue Date _ 19
Site Address ~ Erect ~ Occupanry
Lot Block Sec/Sub. Nlter Zoning
parcg~ # Repoir Q Fire Zone
Enlar~s ? Type of Const.
oWc Name Move ~ Stories
; /lddress Demolish ? Length
b
Ci phone Grade p Depth Sq, Ft.
~ Name Approvals Foes
Address Assessment Permit e
~ Cit p~ne Water b Sew. Surchorge
~ Police Plan check
~
FZ Nome Fire SAC
Addrtss Eny. Woter Conn.
~W Ci p~~ Picnner Water Meter
Councif Road Unit
I hereby ocknowledge that 1 huve reod this opplicotion ond stote that Bldp. Off.
the informotion is correct ond ogree to comply with oll appiicoble
Stote of Minnesoto Statutes and City of Eogan Ordinances. APC Totol
Siynoturc of Permittee
A Building Permit is issued M: - on fha express condition thn~
oll work shall be done in occordonce with olt oppliooble Stqte of Minnesota $tatutes ond City of Eapan OrEinonces.
8uildinp Official
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• 3795 Pilot Knob Rood Eogoe, MN 55122 N° 6 5 41
~ ' PHONE: 454-8100
BUILDING PERMIT Rece~Pt #
Te ra wed for Est. Volue Date , 19
Site Address - _ Erett : p Occuponcy
Lot Block Sec/Sub. l' Alter ? Zoning
Pa?cal # . Repair ? Fire Zone
Enlorge ? Type of Const.
W Name Move ? Stories
3 Address Demolish ~ Front ft.
b Grode ? Depth ft.
Ci Phone
°C Nome ApProvols Fees
o ,
u~ Assessment Permit
Ci Phone Woter & Sew. Surcharge
Police Plan check
~°C Nan+e Firo SAC
WW
FW
Address Eng. Water Conn.
tW C~ p}p~e Planner Water Meter
Council Rood Unit
I hereby ockr?owledge thot I have reod this applicotion and state that gldg. Off.
the informotion is correct cnd ogree to comply with oll npplicnble AP~ Totol
Stote of Minnesofa Statutes and Ciry of Eagan Ordinonces.
Slgncture of Permittee
A Building Permit is issued to: on the express condition that
oll work shall be done in accordance with all opplicoble State of Minnesoto 5tatutes and City of Eagan Ordinances.
Building Officiol
Pen~k # Dab Mn~d P~m~MM~
Plumbing ,l,j(o 5~ /
Mechanical a ~3.7 - / Q
; -L%-~~ ' JZ C " ~ ~
INSPECTIONS DATE INSP. I Rough-In Finol
FOOtingS ~ Date Insp. Date Insp.
Foundotion Plumbing 1
Fro 3 7 Mechanical ~ 3-
Final ~~I
Remarks: '
Receipt PLUMBING PERMIT Permit No.
CITY OF EAGAN
Fee
Fi/l in number~ed spaces S/C
Type or Print legib/y Tot.
1. Date 2. Installation Cost
3. Job Address ~ r' Lot Blk. l Tract'
4. Owner - ; . ~ f_ . `e ,
5. Contractor ' , ' , ~ : ~ Phone
6. Address 2. L 7 Oa~n;_
c.~•~•
7. City 1~, State Zip .
8. Building Type: Residential Commercial ? Institutional D
9. Work Description: New Add ? Alter ? Repair O
10. Oescri be
11. No. Fixtures No. Fixtures
Water Closet Cesspool/Drainfield
Bath tubs Septic Tank
Lavatory Softner
Shower Well
Kitchen Sink
Urinal/Bidet Other
Laundry Tray
Floor Drains ~
Drinking Ftn.
Stop Sink
Gas Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this tYpe of work.
Signed :
for
' Rough Final
Inspections: Date Insp. Date Insp.
This is your permit when numbered and approved.
Approved CITY OF EAGAN 464-8100
Receipt MECHANICAL PERMIT Permit No.
CITY OF EAGAN
Fea
Fi/! in numbered spaces S/C
Type or Print legibly Tot.
1. Date 2. Installation Cost
3. Job Address ~ - Lot BIk. Tract
4. Owner "aclvnr~r~ ~
5. Cont~actor ~ Phone `
6. Address , ~
7. City ' State Zip r' '`r'
8. Building Type: Residential Q' Commercial 0 Institutional ?
9. Work Description: New C~ Add ? Alter ? Repair ?
10. Describe Fuel Type
11. No. ~puinment 8TU - M. Ea. No. EQUiament CFM
Forced Air Air Handling:
Mfg.
Boilers Mech. Exhaust
Mfg.
Unit Heater
Mfg. Other
Air Cond.
Mfg.
Gas, Piping Outlets
12. I hereby certify that the above information is true and correct, and I agree to
comply with all ordinances and codes governing this type of work.
Signed : for
, ~ Rough Ffnal
Inspections: Date Insp. Date Insp.
Thia is your permit when numbered and approved.
' Approved CITY OF EAGAN 454-8100
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tCQtL Y3J1lLC~ ~11lrauuru ta the rcquirement.r o f Section 306 o f tl~e Uni f orm Building
Code certif
ring that at the time o
f iisuana thir structu?e was in com plrancc with the various
~~;J ordinances o f the City regulatrng btrilding tmtitruttion ar ust. For thc folloudng:
4?~: ~ z;~ I,,. -
~ ux cr~,n~ S~81e Fami 1y Avellin~ &d& p,,,~, No. 6541 ~
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~P~Y'1~YP° ~~'P~ Comuuction__~~ Firo ZonA ~d Zoning District .~1 ;
7760 l[itehell Rd. Eden Prs;~~~ ~
~ ovo.~ore~ua~oa Z8e2]ID~9II HOIIte9 ,?nares ~
4550 Scott ZYsil L~,,;ty Lot 9,Bloek 1,Cedar Cliff 3~~~' ~
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CASH RECEIPT
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CITY OF EAGAN
3795 PILOT KNOB ROAD
EAGAN, MINNESOTA 55122
DATE 19
wecttv~o ~
FROM
AMOUNT $ I
~ DOLLARS
+oo
? CASH ? CHECK
. j ~
FOR j ~
FUND COOE AMOUNT
~
Thank You ~
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~ VYhite-PaYers CoPY
Yeltow-Posting Copy
Pink-File Copy
CITY OF EAGAN Remarks
Addition ~~dar C~iff Third Addn i ot Q sik Parcel
Owner ~r~ ` , ~ st~~t 4550 5cott Trail state agan, i~V 55122
Impro~ement Date Amount A~nual Years Payment Receipt Date
STREETSURF. 19HZ 1496.30 299.26 S 1 96.30 C0072 S
STREET RESTOR.
GRADING Z . . . - -
SAN SEW TRUNK 105_ 4Q.1 AOlO4 8 B-lO-Sl
SEWERLATERAL j~ CQ~]225 9-IO- 1
WATERMAIN
otc WATER LATERAL i9SZ S
WATER AREA 9 O. S AOZO~ 8 S-ZO-BZ
* Service 5tubs 1982 5
STORM SEW TRK S ~Z~'. ]q Qr . c i 3~~.2~1 AOZO~ B 8-~.0-~~.
* STORM SEW LAT 19$2 S
CURB & GUTTER
SIDEWALK
STREET LIGHT
Road Unit 185.00 23812 3-20-81
WATERCONN. 335.0~ 23812 3-2~-81
9UILDING PER. 6541
sa,c 525.00 23812 3-20-81
PARK
, . . , ~ _ . _ . ~ _ .
CITY OF EAGAN Nq 6910
, , ~795 Pilof KeoF~ Raod Figan, MN SS14f _
~ PHONE: 431-8100
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BUILDING PERMIT Receipf # ~
Te ee waa ~o. GARAGE en. voi~ $5~~~ oore October 1_. ~y 81 ~
Site Addreu R~3
Eiecf ~ Otcuponcy
i.o~ 9 ei«k 1 sK/s~n. Cedar Cliff 3rd A~~ef ~ Zo~i~9 R-1
pa~~ # lO 16602 09O Ol Revolr ? Fire Zone ~
~ N,,,,, 5teve Weinberger E"i°'°° ? Type of Const. 0
W Mo~. o # s~a.~e5
= Address ~550 SCOtt TTflil Demolish ? Leng[h ~
~ C~ FsEan 55122 phone 452-5174 Grode ? Depth~Sq. Ft.-
p Name ~YPR2T Apvrorals Fea~
o~ Addrezs Assessment Permit •
Ph~ Woter & Sew. Surcharge 2•5~
G Polite Plun check
~ Nome
~Z Fire SAC
Address Enp. Woter Conn.
<W Cf Phone Planner Woter Meter
~ Council Rood Unit
I hereby acknowledge thot I hove read this applicotion and state that g~dg. Off.
fhe info~mation Ia correcf and agree to comply with all opplicoble APC Totol $53.~
Stote of Minnesoto Smtut nd City of Eap Ordirances.
~
Sipnoturc of Permiflee ~
~
A Building Permil is issued to: on tha ezpress corditlon ~hnr
oll work sholl be done in occordonce with a pplicable t innewro Stututes ond City of Eoqan Ordinonces.
Buildirp Offidol
^ +L ~ C{ ~ aTy pF EAGAN Include 2 sets of plans.
~K 1 site plan w/elevations &
~ • _ BUILDING PERNffT APPLICATIOD] 1 set of energy calculations.
~ Date g~~5 -8/
~ib Be Used For ~ARAC~ti Valuation S,f/f/I
Site Address Lh~50 ~'~C:o"~l fYwl- ~,~p z OFFICE USE ODII,Y
Iot~~( _~alocx ~~sec./sub.t~_(%~Y"~~ Occupancy -3
Parcel` /0 /l~~o O~ C~ 9~ Alter Zoning
Repair Fire Zone
osmer: `~7'~'U~ (.)E~n~~C2GC-'~.'_ ~~4e 'i~'Pe of const.
Acklress: P'b`R # Stories .
"~J~C~ ~ c o~~' Af L._ De~nlish Front ~5~ ft.
City/Zip Code: t.i~a~lv , "~'J5i Z~- - Grade Depth ,x'y ft.
v •
Phone 4~i2. " 'rJ( 7~{ _ APP1mVAL5 ~S
Contractor: ~T~UC 1~~I1.aC5:`721'~'~ ~~Sg~~ P~ut 50
?Vater/Se.rer Surcharge-~-
Address: ~r poli~ Plan Check
City/Zip Code: Fire ~
glq, Water Conn.
Phor~ Plaru~er Water Meter
Council It~ad Unit
~~./~J.: Bldg. Off.
Address: ~
City/2ip Cacle:
Phone # : 'ICYrAL d'S3 ~
, +,tt~ ~~P.~e ir~Q.t'
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CITY OF EAGAN
' 3795 Pllot Knob Raad Eagan, MN 55142 N~ 65~ ~
PHONE; 454-8100 ~3~(~_
BUILDING PERMIT APPLICATION Receipt #
To be u~ed for SF DWG Esf. Volue 35,0~~ Dote , 19.SL
Site Address 4550 SOOtt TY Erect Occupancy ~
Lot 9 Block 1 s~o/s~b. ~ Cliff 3 Alter ? Zoning
10 16602 090 Ol Repair ? Fire zone ~
Pnrcel # V
Enlarge ? Type of Const.
W Name ac~hman H a Tn . Move ? Stories -
Addreu 7760 MitChell R~1. Demolish ? Front 36 ft.
q Eden Prai.rie ~„e 937-9520 Gmde ? o~oth 24 K.
o Name ApProrala Feee
o~ Address Assess~fit 3-11-$1 permit ~-~3. ~0
z
u~ Cit Phone Water&Sew. Surchar9e ~7-50
F Polite Plan check 51 , 5~
ww Name Fire SAC 525.00
~
Address Eng. Water Conn.335.00
iw Q Phone Planner WaterMeter~_Q.,~_ .
- Council Road Unit 1R5_00
I hereby ockrawledge tFwt I have read this application and state thot Bldg. Off.
the information is rnrrect and agree to wmply with oll~applicable AP~ T~a~ ~ a~~_nn
State of Minnewta Statutes ond City of Eogan Ordinances.
Slgnature of Permittee
A Building Permit Is issued to: ZdCYlli12T1 HOICLS IriC. on the exprea condition thot
all work sholl ~be done in accordanc 'th ol/ appli le Stgte of Minne~a Stotutes and Ciry of Eagan Ordinonces.
Building Official ~ ~
,
~ ~I
I,, ~ ~ CPTY or EAC'vltd Include 2 sets of plans,
1 site plan w/elevations 3
BUIIDING PFtNIIT APPLICATION 1 set of ei~,gy calculations.
Zb Be Used For valuation 3S;Q~ nate ~/6
site Ac3dress: ~.6-~1' !/71~ oFFIC~ USE Ot~Y - _
Lot ~,Block Sec./Sub. ~3PC~~._~_ ~~-Y K
Parr.el ~l~~f/°l,~~/~// Dl Alter Zonu~g /
Re~ i r Fize zone q/,¢
Enlarge _ 'Iype of Const.
' " ~R~' NDVe II Stories
Pddress: = ~7-]~ ~~~{,~yJ ~ D~rulish F1vnt ft.
City/Zip Code: ~'j~,(~ Grade Depth ft.
Phone 9: 7 J 7-! S~ APP%T7AIS FE~S
I!/ Permit
ContractDr: ' Pssessrents J p 3=°
Address: • Wat~s/Se~.er Surrharge / ~
Police Plan C~~e~c- `y / ~
City/Zip Code: Fire SAC ~
as
g~q_ 4:ater Conn. 33s ~
~
Pho:~e Planner Water Metes
Arch./F7~g_: Council Rnad Unit r Sf~
Bldg. Off.
Address: APC
Qty/Zip Gode:
Phone ~ro2 ~ ~I d 0
~/I. . . s.
~ 'CALVIN H. HEDLUND 96os a~~a~a n~.~~. so~fn
{ 8loomingfon, Minn~+oto 55431
' ~and Surv~yor Clvil Eoqinser P~on~:968-2080
~ surver~or~s G'ert~,f
"~cate
JOB N0. ~ 69
SURVQY FOR~ Zachman Homea
OESGRIBED AS~ I,ot 9, Block 1, CED~AR CLIFF 3RD ADDZTION~ City of Esgan,
Dakota County, Minnesota, and reaerving eaeementa of record.
900.1 901.0
- - - 75.00 = - - 'v
r- - - - - --i i-°~'r
I ~ c3o,y
~ I
~ i
~ ~ Top of Founda+ion • 903.4
~ ~ Basemen* Flaor = 900.2
~ 6erayG Floor = 903.0
I I ,
i
OI ~p Proposed Elevdl'IonS ~
~ ~Q Exiatin9 EI¢vations -
NI ~nNi pe~aFes Drgina9e
I oL. 02• Denotes Lo+ Co~ne~ O
~ 36 20 -1
ID~Os+aWe~ ~ woooHUe\sT.~, Fu+. ~p'~ s+akes
l~~ sp~r1 4~oyer Gar~ ~
~ ~ ~ I r ~
~7 ' sJ ~ ~ ~ - ;
~ driVB ~I
~ ~ - J
8R9.4 75 0 900.8
51~6
O
M s. s. e ~e r. 8~~ S
$99_6, SGOTT TRA?L 9on.5
~ERTIFICATE OF SURVEY
I hare~y cerfify fhot on 2-2p-SI 2 surveyad ihe properfy described obove ond that
tAe obove platia o correct representation of sald survey.
~~LU~--~ ~ s~-D~d~.
Calvin H. Hedlund, Minn. Req. No. 5542
au
T'`1~ti.ie~.~uest void ~ 9 f{ G'•C'. ~ '
18 months from ~ ~ r~
Date of this Request 4-2-81 Fire No. o"~
I, as ? Licensed Electrical Contractor OOwner, do hereby request inspection of the above electri-
cal wiring installed at:
Street Address or Route No. 4550 Scott Trail City Eagan
Section Township Range County
Which is occupied by Zachman Homes
(Name of Oc<uoant)
Is a roughin inspection required on this job? No ? Yes f{7 Ready Now ? Will Call ?
Power Supplier Hakota Electric Address
Electrical Contractor Gu*++-~ seELectxia, Tnc . Contractor's License No39778
(GOmpany Name)
Mailing Address
ectrlca Contla<toI of wn Making Thls Installatlon)
Authorized Signature Keith R Heali Phone No. 566-8600
(Elettrical Contractor o~ Owner Makin9 This Installation)
~D This inspection request will not 6e accepted by ffie ~
g*;~ ~ ~1~~ State Baard unless proper inspection fee is enclosed.
.
.esow aca~e uoam or necviciry .
Griggs Midway 81dg. - Room N191 . EB•00001-02
.~..r1 i university Ave., St. Paul, Minn. 55104 - Phpne ?97-2111
~ R~QUEST FOR ELECTRICAL INSPECTION . •7 p
CHECK BELOW WORK COVERED BY THIS RbQUEST ~ 2 J O H 7
Type of Buildi~ New Add. Rep. ~¢~k Appliances W'ved For Check Equipment W'ved For
Home [~r ? ? Range ? Tempoxary Wiring ?
Duplex Watei Heater ? Lighting Fixtures ?
Apt. Bldg. Dryer ? Electtic Heating ?
Commercial B(dg. Furnace ? Sito Unloader ?
Industrial Bldg. Au Conditioner ? Bulk Milk Tank ~
Farm ? ? ? pLis[ List ~
Othei ? ? ? Heieis~ . ~ereecs~
COMPUTE INSPECTION FEE BELOW
Service Entiance Size: x Fee Feeders&Subfeeders: tt Fee ~ ~ C'vcuita: n Fee
0 to 100 Am s. 0 to 30 Am res 0 to 30 Am eres
101 ta 200 Amps. 31 to ]00 Am res 31 to 100 Am tes
Above 200 Amps. Above (00 Amps. Above ]00 Amps.
Transformer ~ RemoteControlC'vc. Partialorothectee
Signs ' ciai )ns ction Minimum fee
Remarks
TOTAL F~E d 2, 00
I, the Electrical Inspector, e eertify e a e ~ctio as been /
(Rou8h-in) ~ ~ate • ~ /7 (
(Final) ~ ate ~
This request void
IS months from
~----------------i
i ~4rorrceu~
Cit~ of Ea~a~ j Pertnit# ;
~ ~
I Pertnit Fee:
3830 Pilot Knob Road ~ I
Eagan MN 55722 ~ Date Received: j
Phone: (651) 675-5675 j scafr: ~ i
Fax:(651)675-5694 ~ ~ i
2009 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: I"l,~n" O~ SiteAddress: ~JrS~ SCot"-~ ~}-r I 'e~~0./V h7~ ~5~~,a-•
Tenant: Suite
RESIDENT/OWNER Name: ~~~7^~~5 ~CE'~fln/Vf Phone: CDS (-~Ol$''~p~,~Y
Address/CitylZip:-`S7a 5ce~z-F-~~~1 ~-~,ti'~',LN Y`l~/ ~SS%~~
Applicant is: _ Owner ~Contractor
T'YPE OF WORK Description ofwork: Piu~ ~ ~ t-~1+~'+~~. ~ S
Construction Cost: ~ ° Multi-Family Building: (Yes _ / No ~
CONTRACTOR Name: h•' r~E'~f~i7~/'~ License#: ,~C °Jr(3~ 3~~~~
Address: 3$~l0 ~J~ 5'r ffw l~
City: ~u.~Jl SU, /~f
State: Zip: SS 3 3 7
Phone: C1S `6Qy` 3~00 Contact Person: Q~~
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
Minnesota Rules 7670 Cateqorv 1 Minnesota Rules 7672
Energy Code . Residential Ventilation Category 1 Worksheet • New Energy Code Worksheet
Category Submitted Submitted
5ubmission type) • Energy Envelope Calculations Submitted
In the last 72 months, has the City of Eagan issued a pertnit 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 fhat you submit are considered to be public information. Portions of
the i~fonriation may be classified as non-public if you provide specific reasons that would perniit the City to
conclude thaf the are trade secrets.
I hereby acknowledge that this information is complete and accurate; that the work will be in confortnance with the ordinances and codes of the Cdy 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 CoaY SK,II~~Jnn/ ~ _
Applicanfs Printed Name ignature
Page 1 of 3
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA124042
Date Issued:06/19/2014
Permit Category:ePermit
Site Address: 4550 Scott Tr
Lot:9 Block: 1 Addition: Cedar Cliff 3rd
PID:10-16602-01-090
Use:
Description:
Sub Type:Reroof
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please print pictures of ice and water protection and leave on site.
Carbon monoxide detectors are required by law in ALL single family homes .
Greg Stein
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
James A Lebrun
4550 Scott Tr
Eagan MN 55122
Polar Builders Inc
1103 West Burnsville Parkway
Suite 110
Burnsville MN 55337
(612) 432-1597
Applicant/Permitee: Signature Issued By: Signature
PERMIT
City of Eagan Permit Type:Building
Permit Number:EA130871
Date Issued:05/19/2015
Permit Category:ePermit
Site Address: 4550 Scott Tr
Lot:9 Block: 1 Addition: Cedar Cliff 3rd
PID:10-16602-01-090
Use:
Description:
Sub Type:Siding
Work Type:Replace
Description:
Census Code:434 -
Zoning:
Square Feet:0
Occupancy:
Construction Type:
Comments:Please leave printed pictures of house wrap on site for the final inspection.
When installing ventilated soffit material, remove existing material (i.e. debris that could block vents) and take steps to
ensure maximum ventilation to attic. Call for final inspection after installation.
Valuation: 4,000.00
Fee Summary:BL - Base Fee $4K $103.25 0801.4085
Surcharge - Based on Valuation $4K $2.00 9001.2195
$105.25 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 -
James A Lebrun
4550 Scott Tr
Eagan MN 55122
Polar Builders Inc
1103 West Burnsville Parkway
Suite 110
Burnsville MN 55337
(763) 370-0074
Applicant/Permitee: Signature Issued By: Signature
Use BLUE or BLACK Ink
City
Office Use
City o1 Eaa n Permit#: /114 Y5 7
3830 Pilot Knob Road Permit Fee:
Eagan MN 55122
Phone: (651)675-5675 MAY 1 2016 Date Recei �°�ved: � a-1
Fax: (651)675-5694
• Staff:
2017 MECHANICAL PERMIT APPLICATION
E Please submit two (2) sets of plans with all commercial applications.
Date: "/ 1 Site Address: 4/5' D 2 ,
Tenant: Suite#:
Name: CJ 1 V'
- e �1 A Phone: � " "dg`-f�S
‘S-1— Com`
gaztinti _,a : Address/City/Zip: f)
/Kw-A
Name: Ray N Welter Heating Company License#:
77,7
Address: 4637 Chicago Ave City: Minneapolis
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t
State: MN Zip: 55407 Phone: 612-825-6867
. ' Gerri
Contact: Email: ricicw@welterheating.com
„� ,_ New lrReplacement Additional Alteration Demolition
® Description of work:
fte ® e ®� a��rOt7� a echanical��U1�77 s req it to bea Greened Cit
•!91,-7174 ease o ta echa V ntspectti of n fcr at on .e itt eenin hods
I , - RESIDENTIAL COMMERCIAL
4mace� New Construction Interior Improvement
Air Conditioner
Install Piping • Processed
um. Air Air Exchan er
g _Gas Exterior HVAC Unit
—Heat Pump Under/Above ground Tank ( Install/_Remove)
Other
RESIDENTIAL FEES
$60.00 Minimum Add or alteration to an existing unit, includes State Surcharge
$100.00 Residential New, includes State Surcharge =$ TOTAL FEE
•
COMMERCIAL FEES Contract Value$ x.01
$60.00 Permit Fee Minimum
$75.00 Underground tank installation/removal, includes State Surcharge =$ Permit Fee
Surcharge=Contract Value x$0.0005
_$ Surcharge
If the project valuation is over$1 million, please call for Surcharge =$ TOTAL FEE
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 isnot to start without a,permit;that the work wi be in accordance
with the approved plan inWJ
the case of work which requires a review and approval of plans. G
x ` �� N, *kit) c312 x e/ d
Applicants Printed Name Appl' - s Signature
j��^��'tea � `r �.,1 Ea►,1 eco- a$�' �a',,��-p�'��r-,��; .�" ._a DatE �'' �^-
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rgro Ir eS x `e �71 aoor'V ea �� 74d G enrn
PERMIT
City of Eagan Permit Type:Plumbing
Permit Number:EA172248
Date Issued:09/22/2021
Permit Category:ePermit
Site Address: 4550 Scott Tr
Lot:9 Block: 1 Addition: Cedar Cliff 3rd
PID:10-16602-01-090
Use:
Description:
Sub Type:Residential
Work Type:Alteration
Description:Fixtures
Meter Size Meter Type Manufacturer Serial Number Remote Number Line Size
Comments:Please call Building Inspections at (651) 675-5675 to schedule a final inspection.
All tiled shower bases require a water test.
Fee Summary:PL - Permit Fee (miscellaneous)$59.00 0801.4087
Surcharge-Fixed $1.00 9001.2195
$60.00 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 -
James A & Barbara Lebrun
4550 Scott Trl
Saint Paul MN 55122--235
Sowada And Barna Plumbing
PO Box 188
Cedar MN 55011
(763) 444-0292
Applicant/Permitee: Signature Issued By: Signature