1768 Serpentine DrCity of Eagan
PERMIT
City of Eaan
Permit Type: Building
Permit Number: EA127358
Date Issued: 09/30/2014
Permit Category: ePermit
Site Address: 1768 Serpentine Dr
Lot: 051 Block: 6 Addition: Cedar Grove 6th
PID: 10-16705-06-051
Use:
Description:
Sub Type: Windows/Doors
Work Type: Replace
Description: Two or More Windows/Doors
Census Code: 434 -
Zoning:
Square Feet: 0
Construction Type:
Occupancy:
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.
Fee Summary:
Valuation: 4,000.00
BL - Base Fee $4K
$103.25
Surcharge - Based on Valuation $4K $2.00
0801.4085
9001.2195
Total: $105.25
Contractor:
Minnesota Exteriors
8600 Jefferson Hwy
Osseo MN 55369
(763) 391-5514
- Applicant -
Owner:
Stephen C Melin Tste
1768 Serpentine Dr
Eagan MN 55122
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.
Applicant/Permitee: Signature
Issued By: Signature
Date:
CityofEaaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
Permit #: ► .g 5
Permit Fee:
Date Received:
Staff:
INFLOW .a INFILTRATION PERMIT APPLICATION
J\ Plumbing / Sewer &Water
ZL` Site Address:
J
/ 7 G S :/c , t kJ 4 1P ,/Z E (A-6
Tenant: Suite #:
RESIDENT / OWNER
Name: 5X.,..7, 4 6-A-) ! 6 (( 'L Phone: 6S7 S
O gEf 2
vv C �/
Address / City / Zip: / / l 76 e ^ J �Pr� !%tJ`� fotX` iZ 0
G—is4 L--)
CONTRACTOR
Name: License #:
Address: City:
State: Zip: Phone:
Contact: Email:
TYPE OF WORK
PLUMBING (Within the building envelope) SEWER & WATER(Outside the building
t -t "- 4 Pi(' L 1� i S (/, A a 6 E If A.' 4- 1.---/t. r/ r^+ : / LA
v Sump Pump Repair Repair
envelope)
p
(. Other: 40 %/Z / /PO -C='-ti L'=2 Other:
2- . s"-- 'pi./.. -4 c/c-
DESCRIPTION
Description of work: %> A/o I t".--4.1 ry �c: w c-'&- ,1•5"J CC/t)
%
' %'7` -II-
CI /4/ g_A 06,e,tU� (Air /o /IAt-VCc,e/o,-„
FEES
$55.00 / Each (includes
$5.00 State Surcharge) TOTAL FEE $
*
*Permit fees will NOT be reimbursed by the City of Eagan. If you plan to submit I/1 repair costs for
reimbursement, two quotes from qualified contractors must accompany this application. A list of contractors
can be found by visiting www.citvofeagan.com/inflow, or City Hall at 3830 Pilot Knob Rd.
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.gor herstateonecall.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. th- he w k will be in accordance with the approved plan in the case of work whichrequires a review and approval of plans.
A2,A6.:-7A-1/
Applicant's Signature
pplicant' Printed Name
FOR OFFICE USE
Required Inspections:
FFr,. _ CITY OF EAGAN .,?,. •--- „_ ,?..,.y 4 ._ .. „
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121 t
' i S74 3
PHONE: 454-8100
BUILDING PERMIT Receipt #
To be used for
Site Address 1708 39RPitiMLIM
Lot 031 Block 6 Sec/Sub. _
Parcel No.
W Name STEPIILN & MRGHAX
3 Address 1768 SERPZ T1'INZ
City EAGAN
,o Name
Z ?.
g4 Address
City Phone
W W Name
Xu Address
C w City Phone
I hereby acknowlege 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.
Signature of Permitee t ` t
A Building Permit is issued to: STEPHEN OR MZG11A11 NZLIN
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official . j
ow
Occupancy
Zoning
(Actual) Const
(Allowable)
* of 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
FEES
_na Bldg. Permit 111,iil0
S
?
Surcharge
•
Plan Review
-?' SAC, City
?Z6 SAC, MCWCC
- Water Conn
- Water Meter
Acct. Deposit
S/W Permit
- S/W Surcharge
Treatment PI
Road Unit
Park Ded.
_ Copies
TOTAL 122.00
Permit No. Permit Holder Date Telephone #
WATER
SEWER
PLUMBING
H.V.A.C.
ELECTRIC
Inspection Date Insp. Comments
Footings 1
Foundation ?p
Framing I p
Roofing
Rough Plbg.
Rough Htg.
Isul.
Fireplace
Final Htg.
Orstat Test
Final Pibg. Plbg. Inspector - Notify Plumber
Const. Meter
Engr./Plan
Bldg. Final
Deck Fig.
Deck Final
Well
Pr. Disp.
MINNESOTA FEDERAL SAVINGS
SAINT PAUL • MINNEAPOLIS ROSEVILLE HOPKINS •
WHITE BEAR LAKE • SHAKOPEE HASTINGS KNOLLWOOD
PAY TO THE
ORDER OF
fii
No. 12 369941
33-1T
T13
0, a it
Q1
t MINNESOTA FEDERAL SAVINGS AND LOAN
f
{ Federal Home Loaa Bank of Des Moines NON NEGOTIABLE
Des Moines, Iowa 50309
MINNESOTA FEDERAL SAVINGS AND LOAN ASSOCIATION
THE ATTACHED CHECK IS IN FULL SETTLEMENT OF THE ACCOUNT AS STATED HEREON. NO RECEIPT REQUIRED.
PARTICULARS
Cedar groMe , I G ?
1768 Serpmt1w Or. i
REQUESTED BY APPROVED BY
LOAN/CONT. NO.
ACCOUNT NO. INS. PREMIUM ?
CHECK REGISTER BY
?
?
LOAN ON SAVINGS ACCT. TRANSFER OF FUNDS J
LOAN CLOSING CARD BY BOND REDEMPTION ? OTHER
OF EAGAN
Cedar Grove #6
Sew & wtr permits 11-14-68
Street 1
10
Improvement Date Amount Annual Years Payment Rec ' Date
STREET SURF.
STREET RESTOR.
GRADING
SAN SEW TRUNK
# SEWER LATERAL 1970 00 20 Paid
WATERMAIN
# WATER LATERAL 1970 29
WATER AREA
# STORM SEW TRK 1970
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN 20000 1072 11-20-68
EUILDIN ER.
SAC 200.00 1072 N,0-66
KR
CITY OF EAGAN Remarks
Addition UnAR CROVE0#6 Lot Blk Parcel 10-16705-051-06
•
Street State LAUM14 MI JJ1LL
Owner !S ]• A/.J ,
Improvement Date Amount Annual Years Payment Receipt Date
STREET SURF.
STREET RESTOR.
GRADING
* SAN SEW TRUNK 1970 Paid and original p arcel
SEWER LATERAL
WATERMAIN
* WATER LATERAL 1970
WATER AREA
* STORM SEW TRK 1970
STORM SEW LAT
CURB & GUTTER
SIDEWALK
STREET LIGHT
WATER CONN.
BUILDING PER.
SAC
PARK
E X
BUILDING PERMIT
To be used for GARAGE
CITY OF EAGAN N4 18743
3830 Pilot Knob Road, P.O. Box 21-199, Eagan, MN 55121
PHONE: 454-8100
Receipt # ' lz?=
Est. Value $10,000 Date SEP 26 ig 91
Site Address 1768 SERPENTINE DR
Lot 051 Block 6 Sec/Sub. CEDAR GROVE 6TI
Parcel No.
w Name STEPHEN & MEGRAN MELIN
o Address 1768 SERPENTINE DR
City EAGAN 454-0482
o Name
?a Address
¢ City Phone
?Q
?
Name
Address
¢ W
a City Phone
I hereby acknowlege 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 pt Eaga Ordinagee A Yp
Signature of Permitee r w??
A Building Permit is issued to: S ° PHEN OR MEGHAN MELI1
on the express condition that all work shall be done in accordance with all
applicable State of Minnesota Statutes and City of Eagan Ordinances.
Building Official
Occupancy
Zoning
(Actual) Const
(Allowable)
# of 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
M--1
R-1
V-N Bldg. Permit
V-N
_1 Surcharge
24 Plan Review
-6r SAC, City
16,24
FEES
117.00
5.00
X24 SAC, MCWCC
Water Conn
Water Meter
Acct. Deposit
S/W Permit
SMy Surcharge
Treatment PI
Road Unit
Park Ded.
Copies
TOTAL
122.00
EAGAN TOWNSHIP
BUILDING PERMIT
Owner ._. ...... ........ .. .... ?ia-1. SSF^?.._n....................__
Address (Present) ...... :._.. ....((k_---- !< t-a--.
Builder
Address ................
N° 1872
Eagan Township
Town Hall
Date .... /..a3/? -----------'-
51o:ies To Be Used For Front Depth Height Est. Cost permit reel Remarks
Qf ( _
V
Street, Road or other Uescrlpiion or Location IJ LOX 151OCa Addition or Tract
Iu7..S =.4L CUf
This permit does not authorise the use of streets, roads, alleys or sidewalks nor does it give the owner or his agent
the right to create any situation which is a nuisance or which presents a hazard to the health, safety, convenience and
general welfare to anyone in the community.
.
THIS PERMIT MUST BE KEPT/ ON THE PREMISES WHILE THE WORK IS IN PROGRESS
This is to certify, that ..... C_-_,.?/.-.......?rt.¢'FS-<- 7.._.?a. .....has permission to erect a------ d..__ .. ...... .... _. upon
the above described premise subject to the provisions of the Building Ordinance for Eagan To nship ad pted April 11.
1 ?)
1955.
_ .............'-- "- L.... ........-........ Per ........._._......... /fl u _----
Chat an of Tnwn?Board / -Building Ins ector
a.
MEMO
TO: DIANE DOWNS, UTILITY BILLING CLERK
FROM: ED KIRSCHT, SR. ENGINEERING TECH
DATE: AUGUST 25, 1993
SUBJECT: STREETLIGHT ENERGY COSTS
CEDAR GROVE NO. 6 (141 LOTS)
This memo is to inform your department to begin to invoice the energy costs at the single
family rate effective August 1, 1993 to the property owners in Cedar Grove No. 6 Addition
as listed below:
Block 1, Lots 1 1
Block 2, Lots 1-8 8
Block 3, Lots 1-18 18
Block 4, Lots 1-11 11
Block 5, Lots 1-9 9
Block 6, Lots 1-53 53
(Lots 54 through 61, Block 6, should not
be billed at this time)
Block 7, Lots 1-12 12
Block 8, Lots 1-18 18
Block 9, Lots 1-11 11
TOTAL 141
The City is currently being billed by Dakota Electric for streetlighting in the above listed
subdivision.
Ed Kirscht
Sr. Engineering Tech
cc: Mike Foertsch, Asst. City Eng.
EK/je
1991 BIIILD??Fq RMIT APP 43ATION
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 - & STRUCTURAL 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.
A- ACA49a:)
/?
To Be Used For: igxnc? /c Va\lua
Site Address ?6 y ?CIP/£iLJT/NE U,2
Lot ? Block
ee
tion:
Date: 7-12-1(
/O/ eoa OFFICE USE ONLY
FEES
Occupancy M-? Bldg. Permit (r1•oo
Zoning -1 Surcharge co
Actual Const V-N Plan Review
Allowable V-N SAC, City
# of stories I SAC, MWCC
Length Z4' Water Conn.
Depth Water Meter
S.F. Total i//Acct. Deposit
Footprint S.F. d S/w Permit
S/W Surcharge
On site sewage_ Treatment Pl.
On site well Road Unit
MWCC System Park Ded.
City water Trail Ded.
PRV Copies
Booster Pump _
Parcel/Sub CC-011
j?/S (SW4)I/C
Owner "?1/?c"6r 14AJ G ?/N
Address 17AY- S6/{pl7 /11067jJ?1-/NE DR.
City/Zip Code&?j?(/ Rd SS(Z 2i
Phone ??7 Q T ?j Zi
Contractor 01861 (WI-pe)OZ30
Address
City/Zip Code
Phone
Arch./Engr. _
Address
City/Zip Code
Phone #
Sewer/Water Licensed Contr.
APPROVALS
Planner _
Council
Bldg. Off. DS 9.259/
Variance
SUBTOTAL
Penalty
Lot Change
TOTAL
agrees that all work shall be done in accordance with
(Signature of Contractor)
all applicable State of Minnesota Statutes and City of Eagan Ordinances.
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EAGlfi TOWNSKIP
3795 Pilot Knob P.cad
St. Paul, Minnesota 55111
Telephone 454-5242
PERMIT FOR SEWER SERVICE CONNECTION
DATE: NIMER 264
OWNEP.: Address 'a.
PLUMBER2?e i/2?i TYPE OF PIPE
DESCRIPTION of BUILDING
Industrial) Commercial[ Residential 4 Multiple Dwelling No. of units
Location of Connections:
Connection Charge oz?- o "? 7?-'P
Permit Fee 7.50
Street Repairs
Total
Inspected by:
Date
Remarks:
sy
Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do the proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota
Please notify when ready for inspection and connection and before any portion
of the work is covered.
4. '>
EAGAN TOWNSHIP
3795 Pilot Knob Road
St. Paul, Minnesota 55111
Telephone 454-5242
PEP14IT FOR WATER SERVICE CONNECTION
Date: {lIL`eA, Number: 147
Billing Name: Site AddressY?A-d -6 ?.Cf2
Owner: Billing Address
p?,2
Plumber:
tion Meter Size Connection Chg.a,?,° d?
Meter No. Permit Pee 7.50
Meter Reading Meter Dep.
Meter Sealed: Yes Add'l Chg.
No Total Chg.
Inspected by
Date
Building is a: + Remarks:
Residence-1_
Multiple No. Units
Commercial
Industrial By:
Other Chief Inspector
In consideration of the issue and delivery to me of the above permit, I
hereby agree to do tte proposed work in accordance with the rules and
regulations of Eagan Township, Dakota County, Minnesota.
By: ,CIA!?! edgl
Please notify the above office when ready for inspection and connection.
"COUNTY OF RAMSEY
OFFICE OF
STATE OF MINNESOTA
JAY P. O'CONNOR
ABSTRACT CLERK
City or Village:
% Clerk
County of:
Subject: Pending Assessments
WARREN H. SCHMITT
CHIEF DEPUTY
Request is hereby made as of this date r: 1969
to determind whether or not there are any pending assessments
not certified to the office of the County Auditor pertaining to
the following described property:
Assessed in the name of:
The following improvements are contemplated or pending after
having been approved, and are now in process, planning, or
completion.
Nature
Date
Sewer & Water Lateral & Storm Sewer completed
to
$1472.00
Whereas the information shown above is intended to be reliable
the Ram&E4:t°ocn t clerk assumes no liability for its
accuracy.
g A3astiaac-t Clerk
Ga-c-q-wi i u??'.
Please return one copy
SAINT PAUL
MINNESOTA 55102
8/ a4
2007 RESIDENTIAL BUILDING PERMIT APPLICATION
City Of Eagan
3830 Pilot Knob Road, Eagan NIN 55122
Telephone # 651-675-5675 FAX 4 651-675-5694
New Construction Reouirements
3 registered site surveys stowing sq. ft of lot, sq. ft. of house; and all rooted areas
(20% maximum lot coverage allowed)
I Soils Report if proposed building is to be placed on disturbed soil
2 copies of plan showing beam & window sizes; poured found design, etc.
7 set of Energy calculations
3 copies of Tree Preservation Plan d lot platted after 711/93
Rim Joist Detail Options selection sheet (buildings with 3 or less units)
Minnegasco mechanical ventilation form
RemedellReoair Reouirements
2 copies of plan showing footings, beams, joists
1 set of Energy Calculations for heated additions
1 site survey for additions & decks
Addition - rndlcafe if orr-site septic SAfem
Office Use Only
cerlof Survey Reod Y -N
Soils Report Y _N
Tree Pres Plan Recd Y '.N,
Tree Pres Required' Y 9N
On-sde Septic System Y 'N
Plane am rnneirlprorl nnhlir- infnrmatinn tlnlPas you state they are trade secret and the reason.
Date 6 77
Site Address 7? tf f?f/J esJ ?'-e 2'eQB'U0
Construction Cost /
r Unit/Ste #
Description of Work /c4.?-D_ Qe? yUT
Multi-Family Bldg - Y 2(N Fireplace(s) - 0 1 - 2
Property Owner ye {yIG??
?--
Telephone # ?"o
Contractor <-/1p t/il Z q4 H
97.M1 -L-,n n/rff ?Gi',q Cy17T
Address 3
State ! k-) {
e*2A City L?'?/6 GAn9c?9
Zip -7 Telephone # #,R) C? P 5- 76 7
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
- Minnesota Rules 7670 Category I _ Minnesota Rules 7672
Energy Code Category . Residential ventilation Category 1 Worksheet New Energy Code Worksheet
(J submission type) Submitted Submitted
. Energy Envelope Calculations Submitted
Licensed Plumber
Mechanical Contractor
Sewer/Water Contractor
apply for a Residential Building Permit and
information is complete and accural
e;
that the work will be in conformance with the ordinances and codes of the City of Eagan ana the Mate or tviN
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.
Applicant's Printed Name Applicant' na sire
Telephone #(
Telephone #(
Telephone #(
DO NOT WRITE BELOW THIS LINE
Sub Types
? 01 Foundation ? 07 05-plex ? 13 16-plex ? 20 Pool ? 30 Accessory Bldg
? 02 SF Dwelling ? 08 06-plex ? 16 Fireplace ? 21 Porch (3-sea.) ? 31 Ext. Alt- Multi
? 03 01 of_ plex ? 09 07-plex ? 17 Garage ? 22 Porch/Addn. (4-sea.) ? 33 Ext. Alt - SF
? 04 02-plex ? 10 08-plex ? 18 Deck ? 23 Porch (screen/gazebo/pergola) ? 36 Multi Misc.
? 05 03-plex ? 11 10-plex ? 19 Lower Level ? 24 Storm Damage
? 06 04-plex ? 12 12-plex ? 25 Miscellaneous
Work Types
? 31 New ? 35 Int Improvement ? 38 Demolish Interior ? 44 Siding
? 32 Addition ? 36 Move Building ? 42 Demolish Foundation ? 45 Fire Repair
? 33 Alteration ? 37 Demolish Building" ? 43 Reroof ? 46 Windows/Doors
? 34 Replacement -Demolition (Entire Bldg) - Give PCA handout to applicant
Description: Water Damage _ Yes
Valuation Occupancy MCES System
Plan Review 100% or 25%
Census Code Zoning City Water
SAC Units Stories Booster Pump
# of Units Sq. Ft. PRV
# of Bldgs Length Fire Sprinklered
Type of Const Width
- Footings (new bldg)
- Footings (deck).
- Footings (addition)
_ Foundation
_ Drain Tile
Roof _ Ice & Water _ Final
Framing
Fireplace _ R.I. _ Air Test a Final
Insulation
REQUIRED INSPECTIONS
Sheetrock
Final/C.O.
Final/No C.O.
_ HVAC
Other
Pool _ Figs _ Air/Gas Tests _ Final
- Siding _ Stucco Lath - Stone Lath -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
City of Eagan
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
Use BLUE or BLACK Ink
r
For Office Use
Permit #:
Permit Fee:
I_�_��v
3S.D5
Date Received:
Staff:
2013 RESIDENTIAL BUILDING PERMIT APPLICATION
Date: '6-0 8' " 3 Site Address: Unit #:
Resident)
Owner
Name: 3 4 -eve_ 1", t V, Phone:6S{ — sq Q4/32
Address / City / Zip: /74' $ Je-✓'p'p- itw'e P'7 V' -e.
Applicant is: Owner Contractor
Type of Work
Description of work: "Re. ro o -C-
Construction Cost: //eel 0Multi Family Building: (Yes / No X )
Contractor
Company: k• tSOv\. e?( -j O R. S Contact: 4h.Cb--7
Address: 123Z nI 1
1',. 1-rV►c ivC City: f�,G�litt /C .e.,
c / ,^I�/i�
State: &I Zip: 55 0 L/ to Phone: f 2" S 7 g "'T d 2
License #: I3C43C 09' 3 Lead Certificate #:
If the project is exempt from lead certification, please explain why: (see Page 3 for additional information)
In the last 12 months,
_Yes No If
COMPLETE THIS AREA ONLY IF CONSTRUCTING A NEW BUILDING
has the City of Eagan issued a permit for a similar plan based on a master plan?
yes, date and address of master plan:
Licensed Plumber:
Mechanical Contractor:
Sewer & Water Contractor:
Phone:
Phone:
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 the 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 Avtc l"�C - r' ct
Applicant's Printed Name
fix -
App
App'' cant's S' : nature
Page 1 of 3
City of Eaall
3830 Pilot Knob Road
Eagan MN 55122
Phone: (651) 675-5675
Fax: (651) 675-5694
L
Use BLUE or BLACK Ink
For Office Use
Permit #:
Permit Fee:
Date Received:
Staff:
2014 MECHANICAL PERMIT APPLICATION
❑ Please submit two (2) sets of plans with all commercial applications._/
Date: / P _ CIG _ 2° (4— Site Address: /'7 G 9 ` S� �\ /9EN 1 /4/ C f .
Tenant:
Resident/Owner
Name: 51�/1`j�� e
Suite #:
Phone: GT / ¢ 8 2
Address / City / Zip: (7 6 "Qve,C/'f iAi
Contractor
Name:
Address: City:
License #:
State: Zip: Phone:
Contact:
Email:
New " Replacement Additional Alteration
Type of Work Description of work: R Cly! e cc= 1? F)/,q-c� ,e Ai' fi e--e=NOTE:
c=NOTE: Roof mounted and ground mounted mechanical equipment is required to be screened by City
Code. Please contact the Mechanical Inspector for information on permitted screening methods.
Demolition
Permit Type
RESIDENTIAL COMMERCIAL
Furnace New Construction Interior Improvement
Air Conditioner /d/ 5fol2 /At 6 -
Air Exchanger
Heat Pump
Other
RESIDENTIAL FEES
Install Piping Processed
Gas Exterior HVAC Unit
Under/Above ground Tank ( Install / _ Remove)
$60.00 Minimum Add or alteration to an existing unit (includes $5.00 State Surcharge)
$100.00 Residential New (includes $5.00 State Surcharge)
COMMERCIAL FEES
=$
TOTAL FEE
$55.00 Permit Fee Minimum
$70.00 Underground tank installation/removal
*If contract value is LESS than $10,010, Surcharge = $5.00
**If contract value is GREATER than $10,010, Surcharge = Contract Value x $0.0005
**"If the project valuation is over $1 million, please call for Surcharge
Contract Value $
=$
=$
=$
x .01
Permit Fee
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 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.
S(. ME -7//k/
Applicant's Printed Name
x
pplicant's S' • nature
FOR OFFICE USE
Required Inspections:
Underground Rough In Air Test Gas Service Test In -floor Heat --Final HVAC Screening
Reviewed By: Date: